神经性厌食症急性和恢复期女性患者的代谢状态和基于价值的决策。
Metabolic state and value-based decision-making in acute and recovered female patients with anorexia nervosa.
机构信息
From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Bernardoni, King, Geisler, Ritschel, Boehm, Seidel, Ehrlich); the Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Bernhardt, Pooseh, Smolka); the Freiburg Center for Data Analysis and Modeling, Albert-Ludwigs-Universität Freiburg, Germany (Pooseh); and the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Roessner, Ehrlich).
出版信息
J Psychiatry Neurosci. 2020 Jul 1;45(4):253-261. doi: 10.1503/jpn.190031.
BACKGROUND
Patients with anorexia nervosa forgo eating despite emaciation and severe health consequences. Such dysfunctional decision-making might be explained by an excessive level of self-control, alterations in homeostatic and hedonic regulation, or an interplay between these processes. We aimed to understand value-based decision-making in anorexia nervosa and its association with the gut hormone ghrelin. Besides its homeostatic function, ghrelin has been implicated in the hedonic regulation of appetite and reward via the modulation of phasic dopamine signalling.
METHODS
In a cross-sectional design, we studied acutely underweight (n = 94) and recovered (n = 37) patients with anorexia nervosa of the restrictive subtype, as well as healthy control participants (n = 119). We assessed plasma concentrations of desacyl ghrelin and parameters of delay discounting, probability discounting for gains and losses, and loss aversion.
RESULTS
Recovered patients displayed higher risk aversion for gains, but we observed no group differences for the remaining decision-making parameters. Desacyl ghrelin was higher in acutely underweight and recovered participants with anorexia nervosa relative to healthy controls. Moreover, we found a significant group × desacyl ghrelin interaction in delay discounting, indicating that in contrast to healthy controls, acutely underweight patients with anorexia nervosa who had high desacyl ghrelin concentrations preferably chose the delayed reward option.
LIMITATIONS
We probed decision-making using monetary rewards, but patients with anorexia nervosa may react differently to disorder-relevant stimuli. Furthermore, in contrast to acyl ghrelin, the functions of desacyl ghrelin are unclear. Therefore, the interpretation of the results is preliminary.
CONCLUSION
The propensity for risk aversion as found in recovered patients with anorexia nervosa could help them successfully complete therapy, or it could reflect sequelae of the disorder. Conversely, ghrelin findings might be related to a mechanism contributing to disease maintenance; that is, in acutely underweight anorexia nervosa, a hungry state may facilitate the ability to forgo an immediate reward to achieve a (dysfunctional) long-term goal.
背景
尽管厌食症患者已经消瘦且健康状况严重恶化，他们仍然会拒绝进食。这种功能失调的决策可能是由于过度的自我控制水平、体内平衡和愉悦调节的改变，或者这些过程之间的相互作用所导致的。我们旨在了解厌食症患者的基于价值的决策及其与饥饿激素 ghrelin 的关联。除了其体内平衡功能外，ghrelin 通过调节相位多巴胺信号，参与了对食欲和奖励的愉悦调节。
方法
在一项横断面设计中，我们研究了急性体重不足（n = 94）和恢复（n = 37）的厌食症限制性亚型患者，以及健康对照参与者（n = 119）。我们评估了去酰基 ghrelin 的血浆浓度，以及延迟折扣、收益和损失概率折扣以及损失厌恶的参数。
结果
恢复组患者对收益的风险回避程度较高，但我们没有观察到其余决策参数的组间差异。与健康对照组相比，急性体重不足和恢复的厌食症患者的去酰基 ghrelin 水平较高。此外，我们在延迟折扣中发现了一个显著的组 × 去酰基 ghrelin 相互作用，表明与健康对照组相比，急性体重不足的厌食症患者中，去酰基 ghrelin 浓度较高的患者更倾向于选择延迟的奖励选项。
局限性
我们使用金钱奖励来探测决策，但厌食症患者可能对与疾病相关的刺激有不同的反应。此外，与酰基 ghrelin 不同，去酰基 ghrelin 的功能尚不清楚。因此，结果的解释是初步的。
结论
在恢复的厌食症患者中发现的风险回避倾向可能有助于他们成功完成治疗，或者它可能反映了该疾病的后遗症。相反，ghrelin 的发现可能与导致疾病持续的机制有关；也就是说，在急性体重不足的厌食症中，饥饿状态可能会促进患者放弃即时奖励以实现（功能失调的）长期目标的能力。
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