From Peking University Sixth Hospital, Institute of Mental Health, Beijing, China (Wang, Kong, Li Xue-Ni, Chen, Qian, Li Ji-Tao, Su, Zhang, Si); the National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China (Wang, Kong, Li Xue-Ni, Chen, Qian, Li Ji-Tao, Su, Zhang, Si); the Department of Radiology, 306 Hospital of People's Liberation Army, Beijing, China (Li Ke, Zeng); the Shanxi Mental Health Center, Shanxi, China (Feng); the Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY (Correll); the Hofstra Northwell School of Medicine, Hempstead, NY (Correll); the Feinstein Institute for Medical Research, Manhasset, NY (Correll); the School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia (Mitchell); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China (Yan); the Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China (Yan); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing (Yan).
J Psychiatry Neurosci. 2017 Nov;42(6):414-423. doi: 10.1503/jpn.160183.
Bulimia nervosa is a severe psychiatric syndrome with uncertain pathogenesis. Neural systems involved in sensorimotor and visual processing, reward and impulsive control may contribute to the binge eating and purging behaviours characterizing bulimia nervosa. However, little is known about the alterations of functional organization of whole brain networks in individuals with this disorder.
We used resting-state functional MRI and graph theory to characterize functional brain networks of unmedicated women with bulimia nervosa and healthy women.
We included 44 unmedicated women with bulimia nervosa and 44 healthy women in our analyses. Women with bulimia nervosa showed increased clustering coefficient and path length compared with control women. The nodal strength in patients with the disorder was higher in the sensorimotor and visual regions as well as the precuneus, but lower in several subcortical regions, such as the hippocampus, parahippocampal gyrus and orbitofrontal cortex. Patients also showed hyperconnectivity primarily involving sensorimotor and unimodal visual association regions, but hypoconnectivity involving subcortical (striatum, thalamus), limbic (amygdala, hippocampus) and paralimbic (orbitofrontal cortex, parahippocampal gyrus) regions. The topological aberrations correlated significantly with scores of bulimia and drive for thinness and with body mass index.
We reruited patients with only acute bulimia nervosa, so it is unclear whether the topological abnormalities comprise vulnerability markers for the disorder developing or the changes associated with illness state.
Our findings show altered intrinsic functional brain architecture, specifically abnormal global and local efficiency, as well as nodal- and network-level connectivity across sensorimotor, visual, subcortical and limbic systems in women with bulimia nervosa, suggesting that it is a disorder of dysfunctional integration among large-scale distributed brain regions. These abnormalities contribute to more comprehensive understanding of the neural mechanism underlying pathological eating and body perception in women with bulimia nervosa.
神经性贪食症是一种严重的精神综合征，其发病机制尚不确定。涉及感觉运动和视觉处理、奖励和冲动控制的神经系统可能有助于贪食和催吐行为的特征。然而，目前尚不清楚这种疾病患者的整个大脑网络的功能组织改变。
我们使用静息态功能磁共振成像和图论来描述未经药物治疗的神经性贪食症女性和健康女性的大脑功能网络。
我们对 44 名未经药物治疗的神经性贪食症女性和 44 名健康女性进行了分析。与对照组女性相比，神经性贪食症女性的聚类系数和路径长度增加。该障碍患者的节点强度在感觉运动和视觉区域以及楔前叶较高，但在下丘脑、海马旁回和眶额皮层等几个皮质下区域较低。患者还表现出主要涉及感觉运动和单模态视觉联合区域的超连接性，但涉及皮质下（纹状体、丘脑）、边缘（杏仁核、海马）和旁边缘（眶额皮层、海马旁回）区域的连接性降低。拓扑异常与贪食、消瘦欲望和体重指数的评分显著相关。
我们招募了只有急性神经性贪食症的患者，因此尚不清楚拓扑异常是否包含疾病发展的脆弱性标志物，或者是否与疾病状态相关的变化。
我们的研究结果表明，神经性贪食症女性的大脑存在内在功能的结构改变，特别是整体和局部效率异常，以及感觉运动、视觉、皮质下和边缘系统的节点和网络连接异常，表明这是一种大尺度分布式脑区功能整合失调的疾病。这些异常有助于更全面地了解神经性贪食症女性病理性进食和身体感知的神经机制。
