Myriam Vervaet

The functional neuroanatomy of mental pain in depression

This study aimed at determining the functional neuroanatomy of mental pain, a hitherto neglected symptom in the study of depression, which according to DSM-IV is stronglylinked with suicide. Mental pain (measured with the Orbach & Mikulincer Mental Pain Scale), suicidal ideation (measured using the Hamilton Rating Scale for Depression), hopelessness (measured using Becks Hopelessness Scale), and regional cerebral blood flow as measured with single photon emission computed tomography were assessed in 39 depressed individuals. Levels of mental pain were significantly and positively associated with suicidal ideation and levels of hopelessness. When compared with patients with low levels of mental pain, those with high levels of mental pain showed relatively increased perfusion in the right dorsolateral prefrontal cortex, occipital cortex and inferior frontal gyrus and in the left inferior temporal gyrus, and relatively decreased perfusion at the medulla. The findings indicate that mental pain in depressed patients is associated with an increased risk of suicide and that high levels of mental pain are associated with changes in perfusion in brain areas that are involved in the regulation of emotions. Further study is warranted to understand whether this association reflects increased emotional processing or decreased cognitive control over mental pain in depressed individuals.

Punishment and Reward Sensitivity: Are Naturally Occurring Clusters in These Traits Related to Eating and Weight Problems in Adolescents?

Little is known about the role of sensitivity to punishment (SP) and reward (SR) in eating problems during adolescence. Therefore, the aim of the present study was to examine the naturally occurring clusters of high and low SP and SR among nonclinical adolescents and the between-cluster differences in various eating problems and weight. A total of 579 adolescents (14-19 years, 39.8% boys) completed the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Behavioural Inhibition System and Behavioural Activation System scales (BIS/BAS scales), the Dutch Eating Behaviour Questionnaire and the Child Eating Disorder Examination Questionnaire and were weighed and measured. On the basis of the SPSRQ, four clusters were established, interpreted as lowSP × lowSR, lowSP × highSR, highSP × highSR and highSP × lowSR. These were associated with eating problems but not with adjusted body mass index. It seemed that specifically the highSP × highSR cluster outscored the other clusters on eating problems. These results were partly replicated with the BIS/BAS scales, although less significant relations between the clusters and eating problems were found. The implications of the findings in terms of possible risk and protective clusters are discussed.

Is there a neuroanatomical basis of the vulnerability to suicidal behavior? A coordinate-based meta-analysis of structural and functional MRI studies

Objective: We conducted meta-analyses of functional and structural neuroimaging studies comparing adolescent and adult individuals with a history of suicidal behavior and a psychiatric disorder to psychiatric controls in order to objectify changes in brain structure and function in association with a vulnerability to suicidal behavior. Methods: Magnetic resonance imaging studies published up to July 2013 investigating structural or functional brain correlates of suicidal behavior were identified through computerized and manual literature searches. Activation foci from 12 studies encompassing 475 individuals, i.e., 213 suicide attempters and 262 psychiatric controls were subjected to meta-analytical study using anatomic or activation likelihood estimation (ALE). Result: Activation likelihood estimation revealed structural deficits and functional changes in association with a history of suicidal behavior. Structural findings included reduced volumes of the rectal gyrus, superior temporal gyrus and caudate nucleus. Functional differences between study groups included an increased reactivity of the anterior and posterior cingulate cortices. Discussion: A history of suicidal behavior appears to be associated with (probably interrelated) structural deficits and functional overactivation in brain areas, which contribute to a decision-making network. The findings suggest that a vulnerability to suicidal behavior can be defined in terms of a reduced motivational control over the intentional behavioral reaction to salient negative stimuli.

Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: A fast road to remission?

Although accelerated repetitive Transcranial Magnetic Stimulation (rTMS) paradigms and intermittent Theta-burst Stimulation (iTBS) may have the potency to result in superior clinical outcomes in Treatment Resistant Depression (TRD), accelerated iTBS treatment has not yet been studied. In this registered randomized double-blind sham-controlled crossover study, spread over four successive days, 50 TRD patients received 20 iTBS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). The accelerated iTBS treatment procedure was found to be safe and resulted in immediate statistically significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham). While only 28% of the patients showed a 50% reduction of their initial Hamilton Depression Rating Scale score at the end of the two-week procedure, this response rate increased to 38% when assessed two weeks after the end of the sham-controlled iTBS protocol, indicating delayed clinical effects. Importantly, 30% of the responders were considered in clinical remission. We found no demographic predictors for response. Our findings indicate that only four days of accelerated iTBS treatment applied to the left DLPFC in TRD may lead to meaningful clinical responses within two weeks post stimulation.

Do restrictive and bingeing/purging subtypes of anorexia nervosa differ on central coherence and set shifting?

OBJECTIVE Anorexia nervosa (AN) has been associated with weak central coherence (CC) and weak set shifting (SS). The main aim of this study was to examine possible differences between restrictive AN (AN-R) and bingeing/purging AN (AN-BP) on these features. METHODS A total of 31 patients with AN-R, 20 patients with AN-BP and 26 healthy controls (HC) completed five neuropsychological tests (Block Design, Object Assembly, an adapted task-switching paradigm, Wisconsin Card Sorting Test and Trail Making Test). RESULTS Using Block Design and Object Assembly, indicative for CC, AN-R patients performed significantly worse than AN-BP patients and HC, without any difference between AN-BP and HC. On SS measures, no group differences were observed. DISCUSSION The results suggest that cognitive profiles of AN-R and AN-BP patients differ significantly on CC and not on SS. Our current findings support the idea that the two subtypes of AN have a distinctive underlying nature and might need a different approach in cognitive remediation.

Temperamental differences between adolescents and young adults with or without an eating disorder.

OBJECTIVE There is an increasing interest into the role of temperament, and more specifically the traits Sensitivity to Punishment (SP) and Sensitivity to Reward (SR), in the occurrence of eating disorder (ED) symptoms. However, the results on this topic are inconsistent, different instruments are used to measure SP and SR and there is a lack of research on adolescents and young adults, although they form a group at risk to develop an ED. Therefore, the present objective was to study personality profiles co-occurring with specific EDs in adolescents and young adults. METHOD The present study examined the levels of SP and SR for different ED-diagnoses, namely Anorexia Nervosa of the Restricting type (AN-R; n=41), Anorexia Nervosa of the Binge/Purge type (AN-B/P; n=20) and Bulimia Nervosa (BN; n=30), and compared these with a Healthy Control group (HC; n=292). SP and SR were measured by three different temperament questionnaires in order to rule out instrument-specific findings. Only female participants between the age of 14 and 25 years were included. RESULTS SP was transdiagnostically increased compared to HCs, whereas SR was lower in AN-R patients compared to BN patients. These results were independent of the questionnaire being used. DISCUSSION Further research is necessary to explain how these traits may influence specific ED-symptoms.

Attempted suicide in patients with eating disorders

BACKGROUND Suicide is a major cause of mortality for patients with eating disorders (ED), especially for patients with anorexia nervosa. Attempted suicide is also relatively common in patients with anorexia or bulimia nervosa. AIMS This study aimed at examining associations between attempted suicide and trait- and state-dependent characteristics in a large clinical population of ED patients. METHOD The sample consisted of 1,436 in- and outpatients of the Centre for Eating Disorders of the Ghent University Hospital. Measures of ED symptoms, psychopathology, and personality traits were compared between ED patients with and ED patients without a history of attempted suicide. RESULTS A history of attempted suicide was found in 11.8% of the ED patients and lifetime suicidal ideation was reported by 43.3%. Multivariate analyses showed that a history of attempted suicide was associated with higher scores on depression, purging symptomatology, early-developed cognitive schemes (impaired autonomy and increased inhibition), and social insecurity. CONCLUSION These findings support the increased risk of suicidal behavior in ED. The presence of particular personality traits, of cognitive schemes, and of purging and depressive symptoms should increase vigilance for suicidal behavior.

Decreased resting state metabolic activity in frontopolar and parietal brain regions is associated with suicide plans in depressed individuals

Suicide plans are a major risk factor for suicide, which is a devastating outcome of depression. While structural and functional brain changes have been demonstrated in relation to suicidal thoughts and behaviour, brain mechanisms underlying suicide plans have not yet been studied. Here, we studied changes in regional cerebral metabolic activity in association with suicide plans in depressed individuals. Using 18FDG-PET, a comparative study of regional cerebral glucose metabolism (rCMRglu) was carried out in depressed individuals with suicidal thoughts and suicide plans, depressed individuals with only suicidal thoughts, depressed individuals without suicide thoughts and plans, and healthy controls. When compared to the other groups, depressed individuals with suicide plans showed relative hypometabolism in the right middle frontal gyrus and the right inferior parietal lobe (Brodmann areas 10 and 39). Suicide plans in depressed individuals appear to be associated with reduced activity in brain areas that are involved in decision-making and choice, more particularly in exploratory behaviour.

Are there differences in central coherence and set shifting across the subtypes of anorexia nervosa?: a systematic review

Abstract Anorexia nervosa (AN) has been associated with weaknesses in central coherence and set shifting. In this line, it has been proposed to directly address these neuropsychological features in treatment (e.g., cognitive remediation therapy). It is not clear, however, whether the 2 subtypes of AN, the restricting (AN-R) and bingeing/purging (AN-BP) type, have the same amount of problems in these domains. A systematic search of the literature was conducted, using the databases Web of Science and PubMed, looking for studies on the comparison of AN-R and AN-BP in performing central coherence/set-shifting tasks. Notably, very few authors describe the results of a direct comparison of the performance of patients with AN-R and AN-BP. In summary, the available indications for possible group differences are not strong enough to draw definitive conclusions.

Psychometric Properties of the BIS/BAS Scales and the SPSRQ in Flemish Adolescents

Objective: Gray’s Reinforcement Sensitivity Theory (RST) is a frequently used model of personality that is relevant to the period of adolescence. However, the psychometric properties of the most frequently used questionnaires to measure the RST-constructs, namely the Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS Scales) and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), are rarely examined in samples of adolescents. Therefore, the goal of the present study was to examine the two-factor structure, reliability and convergent validity of the BIS/BAS Scales and SPSRQ in a Flemish adolescent community sample. Method: A sample of 579 adolescents (39.5% boys; 14–19 years) was recruited. The proposed two-factor structure was assessed using Exploratory Structural Equation Modeling. Reliability was evaluated using internal consistency and construct validity was examined with the correlations between the two questionnaires and with the Temperament and Character Inventory–short form (TCI-SF). Results: After the removal of problematic items, and the addition of correlated errors, all indices indicated a good fit for the two-factor structure of the modified BIS/BAS Scales. For the modified SPSRQ, three fit indices indicated a good model fit, while a fourth fit index was slightly below the cut-off score of an adequate model fit. Internal consistency of both questionnaires was sufficient. In general, the associations with scales of the TCI-SF were as expected, with positive correlations between BIS-related scales, and between BAS-related scales of all three instruments. Discussion: In Flemish adolescents, the use of a two-factor model to analyze data gathered with the modified BIS/BAS Scales or modified SPSRQ seems appropriate.