Sternheim Lot Catharina, van Passel Boris, Dingemans Alexandra, Cath Danielle, Danner Unna Nora
Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.
Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pro Persona, Nijmegen, Netherlands.
Front Psychiatry. 2022 May 9;13:868921. doi: 10.3389/fpsyt.2022.868921. eCollection 2022.
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) share a neuropsychological profile characterized by cognitive inflexibility as evident in set-shifting problems, and by strong detail focus. Clinically, both patient groups display a strong rigidity which may be explained by these neurocognitive difficulties. Cognitive inflexibility may hinder treatment uptake and help explain suboptimal treatment outcomes in both AN and OCD. This is the first study to compare clinical AN and OCD groups andto examine similarities and differences in cognitive flexibility. Specifically, this study aims to investigate neuropsychological outcomes and self-reported difficulties in both clinical groups and a control group, and explore associations between the different flexibility outcomes and illness.
Two hundred participants (61 AN, 72 OCD and 67 HC) performed neuropsychological tasks on set-shifting abilities (Trail Making Task, Stroop color-word interference, Intradimensional-Extradimensional shift task), detail focus (Group Embedded Figures Test) and self-reported set-shifting abilities and attention to detail (DFlex).
Similarities between patient groups were found in terms of reduced set-shifting ability on the Trail Making Task and detail focus. Moreover, both patient groups self-reported more set-shifting problems but a less strong detail focus than HC, which in turn were not related to neuropsychological task outcomes in either of the groups. In both patient groups longer illness duration was associated to longer reaction times in the switching tasks and for both groups symptom severity was associated to higher experienced inflexibility and attention to detail.
Cognitive inflexibility processes are largely similar in patients with AN and OCD. Both patient groups report inflexibility, yet this is unrelated to neuropsychological outcomes. Illness duration seems to contribute to poorer set-shifting and higher illness severity is linked to more experienced inflexibility. Findings highlight the need for entangling different domains of cognitive flexibility and detail focus and examining self-report measures for a cohesive understanding of clinically relevant flexibility weaknesses in AN and OCD.
神经性厌食症（AN）和强迫症（OCD）具有共同的神经心理学特征，表现为认知灵活性降低，如在任务转换问题中明显可见，以及对细节的高度关注。临床上，这两组患者都表现出很强的僵化性，这可能由这些神经认知困难来解释。认知灵活性降低可能会阻碍治疗的接受，并有助于解释AN和OCD治疗效果欠佳的原因。这是第一项比较临床AN组和OCD组并研究认知灵活性异同的研究。具体而言，本研究旨在调查两个临床组和一个对照组的神经心理学结果及自我报告的困难，并探讨不同灵活性结果与疾病之间的关联。
200名参与者（61名AN患者、72名OCD患者和67名健康对照者）进行了关于任务转换能力（连线测验、斯特鲁普颜色-文字干扰任务、维度内-维度间转换任务）、细节关注（群组镶嵌图形测验）以及自我报告的任务转换能力和对细节的关注（DFlex）的神经心理学任务。
在连线测验中的任务转换能力降低和细节关注方面，发现两组患者存在相似之处。此外，两组患者自我报告的任务转换问题更多，但与健康对照者相比，对细节的关注程度较低，而这又与两组中的任何一组的神经心理学任务结果均无关。在两组患者中，病程较长与转换任务中的反应时间较长相关，并且对于两组而言，症状严重程度与更高的灵活性体验和对细节的关注相关。
AN患者和OCD患者的认知灵活性过程在很大程度上相似。两组患者均报告有灵活性降低的情况，但这与神经心理学结果无关。病程似乎导致任务转换能力较差，而疾病严重程度较高与更多的灵活性体验相关。研究结果强调需要区分认知灵活性和细节关注的不同领域，并检查自我报告测量方法，以便对AN和OCD临床上相关的灵活性弱点有一个连贯的理解。
