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Brain and Cognitive Development in Adolescents with Anorexia Nervosa: A Systematic Review of fMRI Studies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Uppsala Univ, Dept Neurosci Funct Pharmacol, S-75124 Uppsala, Sweden.ORCID iD: 0000-0002-7514-4493
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Univ Campus Biomed Roma, CIR, Area Diagnost Imaging, I-00128 Rome, Italy.ORCID iD: 0000-0001-7165-881x
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Sechenov First Moscow State Med Univ, Inst Translat Med & Biotechnol, Moscow 119146, Russia.ORCID iD: 0000-0001-7112-0921
2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 8, article id 1907Article, review/survey (Refereed) Published
Abstract [en]

Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.

Place, publisher, year, edition, pages
2019. Vol. 11, no 8, article id 1907
Keywords [en]
adolescents, adolescence, eating disorders, anorexia nervosa, fMRI, functional magnetic resonance imaging
National Category
Psychiatry Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-395635DOI: 10.3390/nu11081907ISI: 000484506000222PubMedID: 31443192OAI: oai:DiVA.org:uu-395635DiVA, id: diva2:1364976
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Swedish Research CouncilAvailable from: 2019-10-23 Created: 2019-10-23 Last updated: 2019-10-23Bibliographically approved

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