Elena Tenconi
Università degli Studi di Padova, Neuroscienze, Faculty Member
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Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was... more
Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was to longitudinally assess the impact of partial hospitalization on clinical and cognitive functioning in anorexia nervosa.Materials and Methods: 56 women with anorexia nervosa according to DSM-5 criteria and 58 healthy women were enrolled in the study. At baseline, all participants underwent clinical, diagnostic and neuropsychological assessment (T0). Patients were also assessed at the end of the treatment program (T1; n = 56).Results: BMI improved significantly throughout treatment. At baseline, patients showed significantly poorer executive abilities and less specific autobiographical memory. After the day-hospital program, decision-making abilities improved significantly. Response to treatment was predicted by BMI at admission and duration of illne...
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Purpose Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of... more
Purpose Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being. Methods The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool. Results T...
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Background Social cognition and temperamental and interpretative styles could play a role in the outcome of bariatric surgery. This study aims to assess preliminary evidence about how obesity surgery patients evaluate social inclusion and... more
Background Social cognition and temperamental and interpretative styles could play a role in the outcome of bariatric surgery. This study aims to assess preliminary evidence about how obesity surgery patients evaluate social inclusion and exclusion through a ball-tossing game called Cyberball, looking at the influence of early maladaptive schemas. Methods Thirty-four patients with a history of obesity surgery interventions and 44 controls were recruited for this study. A psychological evaluation was performed before and after the Cyberball task with self-report questionnaires. Results In the ostracism condition, significant differences were seen across all the patients’ fundamental psychological needs with less perceived ostracization (p = 0.001) even if they recognized less interaction via fewer ball tosses than controls. Moreover, the ostracism paradigm resulted in patients experiencing a higher urge to binge (p = 0.010) and a higher urge to restrain (p = 0.012) than controls. Loo...
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Purpose Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of... more
Purpose Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation. Methods A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects. Results Bisexual women and gay men reported significantly higher BWD than other groups (p < 0.001); ...
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Anorexia nervosa (AN) is a complex and serious eating disorder, occurring in ~1% of individuals. Despite having the highest mortality rate of any psychiatric disorder, little is known about the aetiology of AN, and few effective... more
Anorexia nervosa (AN) is a complex and serious eating disorder, occurring in ~1% of individuals. Despite having the highest mortality rate of any psychiatric disorder, little is known about the aetiology of AN, and few effective treatments exist.Global efforts to collect large sample sizes of individuals with AN have been highly successful, and a recent study consequently identified the first genome-wide significant locus involved in AN. This result, coupled with other recent studies and epidemiological evidence, suggest that previous characterizations of AN as a purely psychiatric disorder are over-simplified. Rather, both neurological and metabolic pathways may also be involved.In order to elucidate more of the system-specific aetiology of AN, we applied transcriptomic imputation methods to 3,495 cases and 10,982 controls, collected by the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED). Transcriptomic Imputation (TI) methods approaches use machine-l...
Research Interests: Biology and Transcriptome
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Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by... more
Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive s...
Research Interests: Psychology, Decision Making, Eating Disorders, Attention, Adolescent, and 15 moreMedicine, Anorexia Nervosa, Executive Function, Problem Solving, Clinical Decision Making, Humans, Gambling, Female, Male, Clinical Sciences, Adult, Iowa Gambling Task, Dysfunctional Family, Impulsive behavior, and Neuropsychological Tests
Network analysis is increasingly applied to psychiatric populations to understand relationships among symptoms. Network analysis was applied on 955 patients with anorexia nervosa (AN; 631 restricting-type [ANR] and 324 binge... more
Network analysis is increasingly applied to psychiatric populations to understand relationships among symptoms. Network analysis was applied on 955 patients with anorexia nervosa (AN; 631 restricting-type [ANR] and 324 binge eating-/purging-type [ANBP]), assessed with Symptom Check-List 90 (SCL-90), Eating Disorder Inventory (EDI), and Tridimensional Personality Questionnaire. Depression, anxiety, interpersonal sensitivity (SCL-90), and ineffectiveness (EDI) had the highest centrality (strength from 1.19 to 1.35 in ANBP, and from 1.15 to 1.51 in ANR). Body mass index (BMI) had low centrality (0.14 ANBP and 0.41 ANR). Drive for thinness showed the strongest correlation with central nodes in ANBP (correlation around 0.44) and ANR (correlation range 0.38-0.47), and drive for thinness had higher centrality in ANR (1.15) than in ANBP (0.81), whereas body dissatisfaction in ANBP (0.73) than in ANR (0.61). In addition to ED-core symptoms, psychiatric comorbid symptoms should be the focus o...
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IntroductionThe possibility of evaluating cortical morphological and structural features on the basis of their covariance patterns is becoming increasingly important in clinical neuroscience, because their organizational principles reveal... more
IntroductionThe possibility of evaluating cortical morphological and structural features on the basis of their covariance patterns is becoming increasingly important in clinical neuroscience, because their organizational principles reveal an inter-regional structural dependence which derive from a complex mixture of developmental, genetic and environmental factors.ObjectivesIn this study, we describe cortical network organization in anorexia nervosa using a MRI morpho-structural covariance analysis based on cortical thickness, gyrification and fractal dimension.AimAim of the research is to evaluate any alterations in structural network properties measured with graph theory from multi-modal imaging data in AN.MethodsThirty-eight patients with acute AN, 38 healthy controls and 20 patients in full remission from AN underwent MRI scanning. Surface extraction was completed using FreeSurfer package. Graph analysis was performed using graph analysis toolbox.ResultsIn acute patients, the co...
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IntroductionNeuropsychological impairments in anorexia nervosa (AN) have been considered both as putative risk factors and as a target for treatment. However, the role of neuropsychological variables as predictors of outcome is not... more
IntroductionNeuropsychological impairments in anorexia nervosa (AN) have been considered both as putative risk factors and as a target for treatment. However, the role of neuropsychological variables as predictors of outcome is not clear.AimsOur aim is to investigate the role of neuropsychological variables as predictors of response to treatment in a group of individuals affected by AN.MethodsThe study sample consisted of 144 patients diagnosed with acute AN, according to the DSM-5 criteria, referred to the Eating Unit of the Hospital of Padova, Italy. All participants were assessed by means of a neuropsychological and clinical test battery at intake and followed during outpatient treatment for an average of 531 days. Eighty-three percent of the patients underwent cognitive behavioral therapy, the families of 75% of the patients were included in the treatment and 48% of the patients took antidepressants (SSRI).ResultsBoth body mass index at assessment and illness duration appeared t...
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Self-reported 'personal recovery' and clinical recovery in schizophrenia (SRPR and CR, respectively) reflect different perspectives in schizophrenia outcome, not necessarily concordant with each other and usually representing the... more
Self-reported 'personal recovery' and clinical recovery in schizophrenia (SRPR and CR, respectively) reflect different perspectives in schizophrenia outcome, not necessarily concordant with each other and usually representing the consumer's or the therapist's point of view. By means of a cluster analysis on SRPR-related variables, we identified three clusters. The first and third cluster included subjects with the best and the poorest clinical outcome respectively. The second cluster was characterized by better insight, higher levels of depression and stigma, lowest self-esteem and personal strength, and highest emotional coping. The first cluster showed positive features of recovery, while the third cluster showed negative features. The second cluster, with the most positive insight, showed a more complex pattern, a somewhat 'paradoxical' mixture of positive and negative personal and clinical features of recovery. The present results suggest the need for a c...
Research Interests: Psychology, Clinical Psychology, Schizophrenia, Medicine, Biological Psychiatry, and 13 moreInsight, Humans, Female, Male, Cluster Analysis, Adult, Mental Health and Psychiatry Nursing, Self report, Cross Sectional Studies, Psychiatric Status Rating Scales, Recovery of Function, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Adolescent, Medicine, and 15 moreAntisocial Personality Disorder, Italy, Biological Psychiatry, Humans, Female, Male, Psychosocial, Clinical Sciences, Aged, Middle Aged, Adult, Neurosciences, Psychosocial Functioning, Age of Onset, and Psychiatric Status Rating Scales
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ABSTRACT Introduction: Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study... more
ABSTRACT Introduction: Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study was to provide data on DM functioning in AN using both veridical and adaptive paradigms. While in veridical DM tasks, the individual’s ability to predict a true/false response is measured, adaptive DM is the ability to consider both internal and external demands in order to make a good choice, in the absence of a single true “correct” answer. Method: The participants were 189 women, of whom 91 were eating-disordered patients with a lifetime diagnosis of anorexia nervosa, and 98 were healthy women. All the participants underwent clinical, neuropsychological, and genetic assessment. The cognitive evaluation included a set of neuropsychological tasks and two decision-making tests: The Iowa Gambling Task and the Cognitive Bias Task. Results: Anorexia nervosa patients showed significantly poorer performances on both decision-making tasks than healthy women. The Cognitive Bias Task revealed that anorexia nervosa patients employed significantly more context-independent decision-making strategies, which were independent from diagnostic subtype, handedness, education, and psychopathology. In the whole sample (patients and controls), Cognitive Bias Task performance was independently predicted by lifetime anorexia nervosa diagnosis, body mass index at assessment, and 5-HTTLPR genotype. Conclusions: Patients displayed poor decision-making functioning in both veridical and adaptive situations. The difficulties detected in anorexia nervosa individuals may affect not only the ability to consider the future outcomes of their actions (leading to “myopia for the future”), but also the capacity to update and review one’s own mindset according to new environmental stimuli.
Research Interests: Cognitive Science, Decision Making, Eating Disorders, Cognition, Adolescent, and 15 moreMedicine, Anorexia Nervosa, Italy, Humans, Female, Body Mass Index, Genotype, Adult, Iowa Gambling Task, Age Factors, Educational Status, Body Weight, Genetic variation, Cognition disorders, and Functional Laterality
The study aimed to assess the construct validity, internal consistency and factor structure of the Specific Levels of Functioning Scale (SLOF), a multidimensional instrument assessing real life functioning. The study was carried out in... more
The study aimed to assess the construct validity, internal consistency and factor structure of the Specific Levels of Functioning Scale (SLOF), a multidimensional instrument assessing real life functioning. The study was carried out in 895 Italian people with schizophrenia, all living in the community and attending the outpatient units of 26 university psychiatric clinics and/or community mental health departments. The construct validity of the SLOF was analyzed by means of the multitrait-multimethod approach, using the Personal and Social Performance (PSP) Scale as the gold standard. The factor structure of the SLOF was examined using both an exploratory principal component analysis and a confirmatory factor analysis. The six factors identified using exploratory principal component analysis explained 57.1% of the item variance. The examination of the multitrait-multimethod matrix revealed that the SLOF factors had high correlations with PSP factors measuring the same constructs and...
Research Interests: Psychology, Clinical Psychology, Personality, Schizophrenia, Medicine, and 15 moreActivities of Daily Living, Italy, Humans, Female, Confirmatory factor analysis, Construct Validity, Male, Exploratory Factor Analysis, Middle Aged, Adult, Reproducibility of Results, Social Behavior, Psychology and Cognitive Sciences, Medical and Health Sciences, and Residence Characteristics
Background— Blood pressure (BP) responses to dietary sodium and potassium intervention and cold pressor test vary considerably among individuals. We aimed to identify novel genetic variants influencing individuals’ BP responses to dietary... more
Background— Blood pressure (BP) responses to dietary sodium and potassium intervention and cold pressor test vary considerably among individuals. We aimed to identify novel genetic variants influencing individuals’ BP responses to dietary intervention and cold pressor test. Methods and Results— We conducted a genome-wide association study of BP responses in 1881 Han Chinese and de novo genotyped top findings in 698 Han Chinese. Diet-feeding study included a 7-day low-sodium (51.3 mmol/d), a 7-day high-sodium (307.8 mmol/d), and a 7-day high-sodium plus potassium supplementation (60 mmol/d). Nine BP measurements were obtained during baseline observation and each intervention period. The meta-analyses identified 8 novel loci for BP phenotypes, which physically mapped in or near PRMT6 ( P =7.29×10 –9 ), CDCA7 ( P =3.57×10 –8 ), PIBF1 ( P =1.78×10 –9 ), ARL4C ( P =1.86×10 –8 ), IRAK1BP1 ( P =1.44×10 −10 ), SALL1 ( P =7.01×10 –13 ), TRPM8 ( P =2.68×10 –8 ), and FBXL13 ( P =3.74×10 –9 ). ...
Research Interests: Genetics, Biology, China, Medicine, Humans, and 15 moreInternal Medicine, Hypertension, Blood Pressure, Female, Male, Middle Aged, Genotype, Adult, Asian Continental Ancestry Group, Genetic Association, Allele, Confidence Interval, alleles, Gene frequency, and Cardiovascular medicine and haematology
Research Interests: Psychology, Psychiatry, Adolescent, Medicine, Population, and 15 moreHumans, Female, Male, Substance Dependence, Cannabis, Prevalence, Alcohol dependence, Adult, Cannabis Dependence, Cross Sectional Studies, Substance-Related Disorders, Attention deficit disorder with hyperactivity, Symptom assessment, Attention deficit hyperactivity disorder, and Cocaine dependence
Research Interests: Psychology, Clinical Psychology, Borderline Personality Disorder, Multidisciplinary, Germany, and 15 moreHumans, Child, Aggression, Female, Phenotype, Clinical Sciences, Genotype, Adult, Hostility, Life Change Events, Gene Expression Regulation, Impulsive behavior, Personality Inventory, alleles, and Medical and Health Sciences
Fractal Dimension (FD) has shown to be a promising means to describe the morphology of cortical structures across different neurologic and psychiatric conditions, displaying a good sensitivity in capturing atrophy processes. In this... more
Fractal Dimension (FD) has shown to be a promising means to describe the morphology of cortical structures across different neurologic and psychiatric conditions, displaying a good sensitivity in capturing atrophy processes. In this study, we aimed at exploring the morphology of cortical areas by means of FD in 58 female patients with Anorexia Nervosa (AN) (38 currently underweight and 20 fully recovered) and 38 healthy controls (HC). All participants underwent high-resolution MRI. Surface extraction was completed using FreeSurfer, FD was computed using the calcFD toolbox. The whole cortex mean FD value was lower in acute AN patients compared to HC (p < 0.001). Recovered AN patients did not show differences in the global FD when compared to HC. However, some brain areas showed higher FD in patients than controls, while others showed the opposite pattern. Parietal regions showed lower FD in both AN groups. In acute AN patients, the FD correlated with age (p < 0.001), body mass ...
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Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa... more
Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge-eating, AN without binge-eating, and a BN factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder (MDD). Total sample sizes per phenotype rang...
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Introduction: Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study was to... more
Introduction: Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study was to provide data on DM functioning in AN using both veridical and adaptive paradigms. While in veridical DM tasks, the individual's ability to predict a true/false response is measured, adaptive DM is the ability to consider both internal and external demands in order to make a good choice, in the absence of a single true " correct " answer. Method: The participants were 189 women, of whom 91 were eating-disordered patients with a lifetime diagnosis of anorexia nervosa, and 98 were healthy women. All the participants underwent clinical, neuropsychological, and genetic assessment. The cognitive evaluation included a set of neuropsychological tasks and two decision-making tests: The Iowa Gambling Task and the Cognitive Bias Task. Results: Anorexia nervosa patients showed significantly poorer performances on both decision-making tasks than healthy women. The Cognitive Bias Task revealed that anorexia nervosa patients employed significantly more context-independent decision-making strategies, which were independent from diagnostic subtype, handedness, education, and psychopathology. In the whole sample (patients and controls), Cognitive Bias Task performance was independently predicted by lifetime anorexia nervosa diagnosis, body mass index at assessment, and 5-HTTLPR genotype. Conclusions: Patients displayed poor decision-making functioning in both veridical and adaptive situations. The difficulties detected in anorexia nervosa individuals may affect not only the ability to consider the future outcomes of their actions (leading to " myopia for the future "), but also the capacity to update and review one's own mindset according to new environmental stimuli.
The aim of the present study was to investigate executive functioning and visuospatial abilities in patients with bulimia nervosa (BN), with a particular interest in exploring the impact of a previous diagnosis of anorexia nervosa (AN).... more
The aim of the present study was to investigate executive functioning and visuospatial abilities in patients with bulimia nervosa (BN), with a particular interest in exploring the impact of a previous diagnosis of anorexia nervosa (AN). Several neuropsychological tasks were administered to 89 BN patients (52 with a previous history of AN and 37 without previous AN) and 160 healthy women. A poorer performance on set-shifting measures (Wisconsin Card Sorting Test) was found only in BN patients with a previous history of AN. Decision-making abilities (Iowa Gambling Task) were significantly impaired in the whole sample of BN patients, but difficulties were more pronounced in the subgroup with previous AN. Finally, we did not find any differences in response inhibition and visuospatial abilities between the two samples of BN patients and healthy women. Our findings support the idea that cognitive abilities in patients with BN are more impaired in the presence of a prior history of AN. The clinical and treatment implications of our findings should be explored in future studies. Copyright © 2015 John Wiley &amp; Sons, Ltd and Eating Disorders Association.
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Anorexia nervosa (AN) is a disorder characterized by high levels of cognitive control and behavioral perseveration. The present study aims at exploring inhibitory control abilities and their functional connectivity correlates in patients... more
Anorexia nervosa (AN) is a disorder characterized by high levels of cognitive control and behavioral perseveration. The present study aims at exploring inhibitory control abilities and their functional connectivity correlates in patients with AN. Inhibitory control - an executive function that allows the realization of adaptive behavior according to environmental contingencies - has been assessed by means of the Stop-Signal paradigm. The study involved 155 patients with lifetime AN and 102 healthy women. A subsample underwent resting-state functional magnetic resonance imaging and was genotyped for COMT and 5-HTTLPR polymorphisms. AN patients showed an impaired response inhibition and a disruption of the functional connectivity of the ventral attention circuit, a neural network implicated in behavioral response when a stimulus occurs unexpected. The 5-HTTLPR genotype appears to significantly interact with the functional connectivity of ventral attention network in explaining task performance in both patients and controls, suggesting a role of the serotoninergic system in mechanisms of response selection. The disruption of the ventral attention network in patients with AN suggests lower efficiency of bottom-up signal filtering, which might be involved in difficulties to adapt behavioral responses to environmental needs. Our findings deserve further research to confirm their scientific and therapeutic implications.
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Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding... more
Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors. Hum Brain Mapp 36:5113-5122, 2015. © 2015 Wiley Periodicals, Inc.
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Prenatal stress is hypothesized to have a disruptive impact on neurodevelopmental trajectories, but few human studies have been conducted on the long-term neural correlates of prenatal exposure to stress. The aim of this study was to... more
Prenatal stress is hypothesized to have a disruptive impact on neurodevelopmental trajectories, but few human studies have been conducted on the long-term neural correlates of prenatal exposure to stress. The aim of this study was to explore the relationship between prenatal stress exposure and gray-matter volume and resting-state functional connectivity in a sample of 35 healthy women aged 14-40 years. Voxel-based morphometry and functional connectivity analyses were performed on the whole brain and in specific regions of interest (hippocampus and amygdala). Data about prenatal/postnatal stress and obstetric complications were obtained by interviewing participants and their mothers, and reviewing obstetric records. Higher prenatal stress was associated with decreased gray-matter volume in the left medial temporal lobe (MTL) and both amygdalae, but not the hippocampus. Variance in gray-matter volume of these brain areas significantly correlated with depressive symptoms, after statistically adjusting for the effects of age, postnatal stress and obstetric complications. Prenatal stress showed a positive linear relationship with functional connectivity between the left MTL and the pregenual cortex. Moreover, connectivity between the left MTL and the left medial-orbitofrontal cortex partially explained variance in the depressive symptoms of offspring. In young women, exposure to prenatal stress showed a relationship with the morphometry and functional connectivity of brain areas involved in the pathophysiology of depressive disorders. These data provide evidence in favor of the hypothesis that early exposure to stress affects brain development and identified the MTL and amygdalae as possible targets of such exposure.
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Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and... more
Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and their unaffected sisters. The aim of this work was to study the prevalence of childhood obsessive-compulsive traits in patients with lifetime AN, their unaffected sisters and healthy women. A total of 116 AN patients, 32 healthy sisters and 119 controls were assessed by the EATATE Interview to assess traits such as perfectionism, inflexibility, rule-bound traits, drive for order and symmetry, and excessive doubt and cautiousness. Both self-report and maternal reports were collected. AN patients reported more childhood obsessive-compulsive traits than their healthy sisters and controls. In contrast, no differences between healthy controls and unaffected sisters emerged. In patients with AN, a dose-response relationship was found between the number of c...
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To investigate the volume and functional connectivity of dorsal and ventral striatal nuclei in anorexia nervosa (AN) and their relationship with early exposure to obstetric complications. Fifty-one patients with lifetime AN (35 acute, 16... more
To investigate the volume and functional connectivity of dorsal and ventral striatal nuclei in anorexia nervosa (AN) and their relationship with early exposure to obstetric complications. Fifty-one patients with lifetime AN (35 acute, 16 recovered) and 34 healthy controls underwent high-resolution and resting-state functional magnetic resonance imaging. The AN group showed reduced functional connectivity of the putamen compared with healthy women, and this reduction was more evident in patients with lifetime binge eating/purging. Both acute and recovered AN groups showed a larger left accumbens area compared with that of healthy women. The functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with number of obstetric complications in the AN group. This study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks, and reveals the possible role of obstetric complications in the...
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Although there is evidence about the role played by stressful life events (SE) in the pathogenesis of eating disorders, few studies to date have explored this problem in binge eating disorder (BED). The aim of the present study was to... more
Although there is evidence about the role played by stressful life events (SE) in the pathogenesis of eating disorders, few studies to date have explored this problem in binge eating disorder (BED). The aim of the present study was to examine SE preceding the onset of BED. A retrospective interview-based design was used to compare 107 patients with BED and 107 patients with bulimia nervosa (BN), matched for duration of illness. Compared with patients with BN, those with BED reported a greater number of traumatic events in the 6 months preceding onset, revealing more often three types of events: bereavement, separation from a family member and accidents. The presence of SE before onset showed a dose-response relationship with the severity of psychopathology at the time of referral for treatment. Study of SE in patients with BED may be important for better understanding of the pathogenetic pathway to this disorder and to provide adequate treatment.
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To provide data about the role of obstetric complications (OCs) in a large and well-characterized sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). The new sample consists of 150 patients with AN and 35 patients with... more
To provide data about the role of obstetric complications (OCs) in a large and well-characterized sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). The new sample consists of 150 patients with AN and 35 patients with BN, and 73 healthy women; statistical analyses were performed on the new sample alone and on the larger sample created by merging the new dataset with the previous one (264 AN, 108 BN, and 624 healthy women). All data about OCs were collected blind to diagnostic status. OC rates in the replication sample were similar to those of our previous studies. In the whole sample, the risk of developing AN was significantly associated with the occurrence and number of pregnancy, delivery, hypoxic, and dysmaturity complications. The risk of developing BN was significantly associated with dysmaturity complications. Signs of retarded fetal growth (being small and short for gestational age, short head circumference) significantly distinguished BN patients from both AN and healthy individuals. Significantly higher number of OCs were found in the binge eating/purging type of AN, in comparison with restricting AN patients. Our study provides further evidence of the role of OCs as putative risk factors for the development of eating disorders, showing different pathways between AN and BN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
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A change in neural connectivity of brain structures implicated in the memory of negative life events has been hypothesized to explain the enhancement of memory encoding during the processing of negative stimuli in depressed patients.... more
A change in neural connectivity of brain structures implicated in the memory of negative life events has been hypothesized to explain the enhancement of memory encoding during the processing of negative stimuli in depressed patients. Here, we investigated the effects of the interaction between negative life events and the 5-HTTLPR genotype - a polymorphism of the serotonin transporter gene - on the functional and structural connectivity of the hippocampal area in 34 healthy women. All participants were genotyped for the presence of the 5-HTTLPR short variant and for the A/G single-nucleotide polymorphism; they underwent clinical assessment including structured diagnostic interviews to exclude the presence of psychiatric disorders and to assess the presence of stressful life events. Resting state functional magnetic resonance imaging and diffusion tensor imaging scans were performed. We found significant interactions between stressful events and the 5-HTTLPR genotype in both the functional connectivity of the parahippocampus with the posterior cingulate cortex and the structural connectivity between the hippocampus and both the amygdala and the putamen. In addition, we found several genotype-related differences in the relationship between functional/structural connectivity of the hippocampal area and the ability to update expectations or stress-related phenotypes, such as anxiety symptoms. If confirmed by future studies, these mechanisms may clarify the role of the 5HTTLPR genotype as a risk factor for depression, in interaction with negative events.
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Anorexia nervosa is characterized by high levels of perseveration and inflexibility, which interfere with successful treatments. Dopamine (DA) signalling seems to play a key role in modulating the prefrontal cortex, since both DA... more
Anorexia nervosa is characterized by high levels of perseveration and inflexibility, which interfere with successful treatments. Dopamine (DA) signalling seems to play a key role in modulating the prefrontal cortex, since both DA deficiency and excess nega tively influence the efficiency of cognitive functions. The present study explores the effect of a functional polymorphism (Val158Met) in the catechol-O-methyltransferase (COMT) gene on the set-shifting abilities and prefrontal functional connectivity of patients with anorexia nervosa. All participants performed the Wisconsin Card Sorting Task, and a subsample underwent resting-state functional magnetic resonance imaging. We included 166 patients with DSM-IV lifetime anorexia nervosa and 140 healthy women in our study. Both underweight and weight-recovered patients with anorexia nervosa showed high levels of perseveration, but only in the underweight group did the Val158Met polymorphism affect cognitive performance, showing the U-shaped curve characteristic of increased DA signalling in the prefrontal cortex. Underweight patients with anorexia nervosa who are Met homozygotes had significantly higher levels of perseveration and increased prefrontal functional connectivity than underweight patients in the other genotype groups, indicating abnormal regional cortical processing. Although our data show that grey matter reduction in starving patients with anorexia nervosa did not explain our findings, the cross-sectional design of the present study did not allow us to distinguish between the effects of starvation and those of low estrogen levels. Starvation affects DA release in the prefrontal cortex of patients with anorexia nervosa with different effects on executive functioning and prefrontal functional connectivity according to the COMT genotype. This observation has several therapeutic implications that need to be addressed by future studies.
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Although body image disturbance is considered one of the core characteristics of anorexia nervosa (AN), the exact nature of this complex feature is poorly understood. Task-related functional magnetic resonance imaging studies can only... more
Although body image disturbance is considered one of the core characteristics of anorexia nervosa (AN), the exact nature of this complex feature is poorly understood. Task-related functional magnetic resonance imaging studies can only partially explore the multimodal complexity of body consciousness, which is a complex cognition underpinned by aspects of visual perception, proprioception, and touch. The aim of the present study was to explore the functional connectivity of networks involved in visuospatial and somatosensory processing in AN. Twenty-nine subjects with AN, 16 women who had recovered from it, and 26 healthy women underwent a resting-state functional magnetic resonance imaging scan and neuropsychological assessment of their visuospatial abilities using the Rey-Osterrieth Complex Figure Test. Both AN groups showed areas of decreased connectivity in the ventral visual network, a network involved in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;what?&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; pathway of visual perception. Even more interestingly, the AN group, but not the recovered AN group, displayed increased coactivation in the left parietal cortex, encompassing the somatosensory cortex, in an area implicated in long-term multimodal spatial memory and representation, even in the absence of visual information. A neuropsychological assessment of visuospatial abilities revealed that aspects of detail processing and global integration (central coherence) showed correlations with connectivity of this brain area in the AN group. Our findings show that AN is associated with double disruption of brain connectivity, which shows a specific association with visuospatial difficulties and may explain the failure of the integration process between visual and somatosensory perceptual information that might sustain body image disturbance.
Research Interests:
Research Interests: Criminology, Psychology, Traumatic Stress, Depression, Forecasting, and 50 moreJapan, Adolescent, Comorbidity, Israel, Mental Illness, War, Middle East, Italy, Prospective studies, Disasters, Humans, Latent variable, Earthquakes, Major Depressive Disorder, Family Violence, Posttraumatic stress disorder, Survivors, Child Abuse, Female, Male, Veterans, Young Adult, Patient Compliance, Follow-up studies, Battered Women, Depressive Disorder, Differential Diagnosis, Learned Helplessness, Risk factors, Mental Disorder, Clinical Sciences, Aged, Prevalence, Middle Aged, Arousal, Major Depression, Questionnaires, Adult, Risk Factors, Depressive Symptoms, Brief Symptom Inventory, Psychological Models, Partner Violence, Heart Transplantation, Wounds and Injuries, Cross Sectional Studies, Military Personnel, Logistic Models, Life Change Events, and General Hospital Psychiatry
We report a striking finding about naming and categorization of pictures and reading aloud and categorization of words. The categorization of a word before reading it aloud leads to an increase in response time as compared with the... more
We report a striking finding about naming and categorization of pictures and reading aloud and categorization of words. The categorization of a word before reading it aloud leads to an increase in response time as compared with the condition in which naming is not conditional on the categorization of the word. Quite differently, no cost is associated with the conditional naming of pictures. Results are discussed in terms of multiple procedures operating on pictorial and verbal stimuli to retrieve phonological forms.
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There is consistent evidence that anorexia nervosa (AN) is associated with an impairment of set-shifting abilities and central coherence. No study to date investigated handedness in AN. Our aim was to study set-shifting abilities, central... more
There is consistent evidence that anorexia nervosa (AN) is associated with an impairment of set-shifting abilities and central coherence. No study to date investigated handedness in AN. Our aim was to study set-shifting abilities, central coherence, and handedness in subjects with lifetime AN, in a sample of unaffected sisters and in healthy controls, in order to explore their suitability as endophenotypes of AN. The Edinburgh Handedness Inventory and several neuropsychological tasks (Wisconsin Card Sorting Test, Trail Making Test, Rey-Osterrieth Complex Figure Test, Overlapping Figures Test, Object Assembly and Block Design) were administered to 153 subjects with lifetime AN, 28 unaffected sisters and 120 healthy controls. AN subjects and their healthy sisters showed poorer performances on most tasks investigating set-shifting and central coherence. In addition, we did not find any differences between long-term recovered subjects, weight-restored AN patients and those in an acute phase of their illness. AN subjects were significantly more likely to be left-handed than healthy controls (OR=2.8, 95% C.I. 1.1-7.2). Set-shifting and central coherence seem to be promising cognitive endophenotypes that might help in the understanding of the pathogenetic processes involved in AN. Further studies on larger samples are needed to explore the generalizability and implications of our findings concerning handedness.
Research Interests: Cognitive Science, Neuropsychology, Handedness, Cognitive Neuroscience, Adolescent, and 16 moreAnorexia Nervosa, Endophenotypes, Executive Functioning, Humans, World, Female, Young Adult, Siblings, Clinical Sciences, Middle Aged, Adult, Analysis of Variance, Odds ratio, Neurosciences, Functional Laterality, and Neuropsychological Tests
To investigate clinical and psychological features of patients with anorexia nervosa (AN) with a previous history of bulimia nervosa. Three hundred thirty-three patients with a full diagnosis of AN were assessed by the Structured Clinical... more
To investigate clinical and psychological features of patients with anorexia nervosa (AN) with a previous history of bulimia nervosa. Three hundred thirty-three patients with a full diagnosis of AN were assessed by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Eating Disorders Inventory, and the Hopkins Symptom Checklist. Twenty-four patients (7%) reported a previous diagnosis of bulimia nervosa and were compared with a control group of 48 patients without a history of bulimia, matched for diagnostic subtype. Among the patients with a history of bulimia nervosa, 11 were of the restricting type and 13 of the binge eating/purging type. Among restricting anorexic patients, those with a history of bulimia reported greater age of onset, more psychiatric symptoms, more family psychiatric morbidity, and a higher rate of sexual abuse. On the contrary, among patients with the AN bingeing-purging subtype, the presence of a previous bulimia nervosa was not associated with any of the investigated variables. Patients with restricting AN who report a history of previous bulimia nervosa are not frequent among those referring to an outpatient eating disorders unit. However, our findings in this small group of subjects confirm that a lifetime history of bingeing and purging in patients with eating disorder, irrespective of when it occurs, is always associated with more psychopathology compared with those restricting patients with AN who have never had a period of bingeing and purging.
Research Interests:
The aim of the present study was to investigate the predictive factors for the development of binge eating in restricting anorexia nervosa patients who underwent an outpatient treatment. The sample was a group of 168 patients with... more
The aim of the present study was to investigate the predictive factors for the development of binge eating in restricting anorexia nervosa patients who underwent an outpatient treatment. The sample was a group of 168 patients with restricting anorexia nervosa, consecutively admitted to an outpatient unit. All the patients underwent a routine baseline assessment. Information regarding binge eating onset and duration of treatment was prospectively recorded in clinical records. Twenty-three patients developed binge episodes during outpatient treatment. High scores on the Eating Disorders Inventory body dissatisfaction subscale and early age at menarche significantly predict the risk of developing binge eating. High levels of ineffectiveness, as measured by the Eating Disorders Inventory, and early age at menarche are significant predictors of a shortened time to develop binge eating. The identification of subjects at risk for developing binge eating should be considered an important step for a successful treatment of restricting anorexic patients.
Research Interests: Psychology, Cognitive Science, Treatment Outcome, Body Image, Adolescent, and 22 moreComorbidity, Anorexia Nervosa, Italy, Prospective studies, Humans, Child, Personality Assessment Inventory, Female, Cognitive Therapy, Male, Menarche, The, Risk factors, Clinical Sciences, Adult, Prognosis, Age Factors, Risk Factors, Binge eating, Bulimia, Ambulatory Care, and Age of Onset
This study aims to explore the time trends in age at onset of anorexia nervosa and bulimia nervosa. The sample was composed of 1,666 anorexia nervosa subjects and 793 bulimia nervosa subjects (according to DSM-IV criteria) without... more
This study aims to explore the time trends in age at onset of anorexia nervosa and bulimia nervosa. The sample was composed of 1,666 anorexia nervosa subjects and 793 bulimia nervosa subjects (according to DSM-IV criteria) without previous anorexia nervosa consecutively referred to our outpatient unit in the period between 1985 and 2008. Time trends in illness onset were analyzed according to the year of birth of subjects. In both anorexia nervosa and bulimia nervosa, age at onset showed a significant decrease according to year of birth. A regression model showed a significant independent effect of socioeconomic status, age at menarche, and number of siblings in predicting age at onset lower than 16 years. Age at onset of anorexia nervosa and bulimia nervosa is decreasing in younger generations. The implications of our findings in terms of long-term outcome remain to be understood. Biologic and sociocultural factors explaining this phenomenon need to be explored in future studies.
Research Interests: Adolescent, Anorexia Nervosa, Bulimia Nervosa, Pregnancy, Humans, and 18 moreChild, Personality Assessment Inventory, Female, Male, Menarche, Risk factors, Aged, Middle Aged, Adult, Sex Factors, Clinical Psychiatry, Age Factors, Risk Factors, Gestational Age, Ambulatory Care, Age of Onset, Age at Onset, and Psychiatric Status Rating Scales
Research Interests:
Research Interests: History, Personality, Nonparametric Statistics, Eating Disorders, Treatment, and 17 moreTreatment Outcome, Body Image, Anorexia Nervosa, Humans, Female, Young Adult, Temperament, Exercise, Body Mass Index, Feeding Behavior, Questionnaires, Analysis of Variance, Prognosis, Body Weight, Weight Gain, Novelty Seeking, and Ambulatory Care
Although perinatal complications are hypothesized to be risk factors for the development of anorexia nervosa (AN), no study to date explored this issue using a discordant sibling design. This type of design allows to explore whether the... more
Although perinatal complications are hypothesized to be risk factors for the development of anorexia nervosa (AN), no study to date explored this issue using a discordant sibling design. This type of design allows to explore whether the risk for obstetric complications is itself a consequence of the genetic vulnerability for AN (covariation model) or whether obstetric complications increase the risk of AN independently of (additive model), or in interaction with (interaction model), the disorder’s genetic liability. The presence of perinatal complications was assessed through review of the obstetric records of 60 AN subjects, 60 unaffected sisters, and 70 healthy subjects. Unaffected sisters and healthy controls were compared in relation to perinatal characteristics and complications. There was no evidence for an elevated rate of complications in unaffected siblings of AN patients. Mothers with a positive psychiatric history tended to have more perinatal complications. Perinatal complications seem to be independent risk factors that may interact with, but are not caused by, familial risk factors for AN. In terms of prevention, a particular attention should be paid to mothers with a lifetime history of psychiatric disorders.
Research Interests: Genetics, Cognitive Science, Family, Adolescent, Anorexia Nervosa, and 18 morePregnancy, Humans, Anoxia, Female, Male, Siblings, Mothers, Mental Disorders, Risk factors, Clinical Sciences, Newborn Infant, Odds ratio, Interaction model, Risk Factors, Healthy Subjects, Environment, Neurosciences, and Age of Onset
The aim of the study is to evaluate the frequency and characteristics of full and partial post-traumatic stress disorder (PTSD) among 66 World War II Nazi prisoners of war, some of whom had been deported to death camps. The Structured... more
The aim of the study is to evaluate the frequency and characteristics of full and partial post-traumatic stress disorder (PTSD) among 66 World War II Nazi prisoners of war, some of whom had been deported to death camps. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and major depression. The Dissociative Experiences Scale and the 58-item version of the Hopkins Symptom Checklist were also administered. Partial PTSD was defined as the presence of at least one symptom in each of the clusters defined by DSM-IV. Forty-eight percent of the subjects have a partial PTSD, while 20% reported the full syndrome. When compared to subjects with full PTSD, those with partial PTSD showed a significantly lower frequency of comorbid depression and lower levels of psychological distress, as measured by the Symptom Checklist. No differences were found with regards to dissociative symptoms and help-seeking. The problem of definition of PTSD partial syndromes deserves more attention in the literature.
Research Interests: Cognitive Science, Psychopathology, World War II, Comorbidity, Post traumatic stress disorder, and 16 moreItaly, Dissociation, Humans, Major Depressive Disorder, Female, Male, Dissociative experiences scale, Help Seeking, Concentration Camps, Clinical Sciences, Aged, Prisoners, Major Depression, Psychological distress, Severity of Illness Index, and Psychiatric Status Rating Scales
Recent studies have hypothesized that perinatal complications might increase the risk of developing eating disorders. However, it is unclear which pathways might link obstetric complications and eating disorders. The present study aimed... more
Recent studies have hypothesized that perinatal complications might increase the risk of developing eating disorders. However, it is unclear which pathways might link obstetric complications and eating disorders. The present study aimed at exploring the relationship between obstetric complications and temperament in eating disordered subjects. The sample was selected among subjects who took part in a prevalence study carried out on a representative sample of the general population and from among people with anorexia and bulimia nervosa referred to an outpatient specialist unit. Subjects who were born in the two obstetric wards of Padua Hospital between 1971 and 1979 and who completed the Tridimensional Personality Questionnaire were included. A blind analysis of the obstetric records of the whole sample was performed. The final sample was composed of 66 anorexia nervosa, 44 bulimia nervosa, and 257 control subjects. Among the different groups of obstetric complications, only the group that included preterm birth and other signs of neonatal immaturity or dysmaturity displayed a significant relationship with harm avoidance. The use of a mediation path analytic model revealed a significant, but incomplete, mediation effect of harm avoidance in explaining the link between neonatal dysmaturity and the development of eating disorders. Maternal weight gain during pregnancy seemed to have a protective effect on harm avoidance. The presence of signs of neonatal dysmaturity at birth seems to influence the development of high levels of harm avoidance in eating disorders.