Clinique des Maladies Mentales et de l'Encéphale, Hopital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France.
Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France.
Eur Psychiatry. 2022 Oct 21;65(1):e68. doi: 10.1192/j.eurpsy.2022.2327.
Patients with anorexia nervosa (AN) show impaired decision-making ability, but it is still unclear if this is a trait marker (i.e., being associated with AN at any stage of the disease) or a state parameter of the disease (i.e., being present only in acutely ill patients), and if it has endophenotypic characteristics. The aim of this study was to determine the endophenotypic, and state- or trait-associated nature of decision-making impairment in AN.
Ninety-one patients with acute AN (A-AN), 90 unaffected relatives (UR), 23 patients remitted from AN (R-AN), and 204 healthy controls (HC) carried out the Iowa gambling task (IGT). Prospective valence learning (PVL) model was employed to distinguish the cognitive dimensions underlying the decision-making process, that is, learning, consistency, feedback sensitivity, and loss aversion. IGT performance and decision-making dimensions were compared among groups to assess whether they had endophenotypic (i.e., being present in A-AN, UR, and R-AN, but not in HC) and/or trait-associated features (i.e., present in A-AN and R-AN but not in HC).
Patients with A-AN had lower performance at the IGT ( < 0.01), while UR, R-AN, and HC had comparable results. PVL-feedback sensitivity was lower in patients with R-AN and A-AN than in HC ( < 0.01).
Alteration of decision-making ability did not show endophenotypic features. Impaired decision-making seems a state-associated characteristic of AN, resulting from the interplay between trait-associated low feedback sensitivity and state-associated features of the disease.
神经性厌食症（AN）患者表现出决策能力受损，但目前尚不清楚这是一种特质标志物（即在疾病的任何阶段都与 AN 相关）还是疾病的状态参数（即在急性发病期才出现），以及是否具有内表型特征。本研究旨在确定 AN 中决策障碍的内表型、状态或特质相关性质。
91 名急性 AN 患者（A-AN）、90 名未受影响的亲属（UR）、23 名从 AN 中缓解的患者（R-AN）和 204 名健康对照（HC）进行了爱荷华赌博任务（IGT）。采用前瞻性效价学习（PVL）模型来区分决策过程的认知维度，即学习、一致性、反馈敏感性和损失厌恶。比较各组的 IGT 表现和决策维度，以评估它们是否具有内表型（即在 A-AN、UR 和 R-AN 中存在，但在 HC 中不存在）和/或特质相关特征（即在 A-AN 和 R-AN 中存在，但在 HC 中不存在）。
A-AN 患者在 IGT 中的表现较低（<0.01），而 UR、R-AN 和 HC 的结果相当。与 HC 相比，R-AN 和 A-AN 患者的 PVL-反馈敏感性较低（<0.01）。
决策能力的改变没有表现出内表型特征。受损的决策似乎是 AN 的一种状态相关特征，是特质相关的低反馈敏感性和疾病的状态相关特征相互作用的结果。
