Longitudinal Assessment of Eating-related Anxiety in Anorexia Nervosa

神经性厌食症饮食相关焦虑的纵向评估

• 批准号: 10447413
• 负责人: Kimberly Smith
• 金额: $ 18.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10447413
• 关键词: Address; Admission activity; American; Amygdaloid structure; Anorexia Nervosa; Anxiety; Behavior; Behavior Disorders; Behavior Therapy; Behavioral; Biological; Biological Markers; Body mass index; Brain; Brain imaging; Budgets; Calories; Carbohydrates; Caring; Choice Behavior; Clinical; Consumption; Data; Data Analyses; Disease; Disease remission; Eating; Eating Behavior; Eating Disorders; Emotions; Enteral Feeding; Environment; Exposure to; Faculty; Fatty acid glycerol esters; Food; Fright; Functional Magnetic Resonance Imaging; Goals; Grant; Hospitals; Individual; Inpatients; Institution; Interdisciplinary Study; Length of Stay; Machine Learning; Medical Research; Mentors; Nature; Neurobiology; Patients; Pattern; Protocols documentation; Psychiatry; Psychometrics; Recovery; Refractory; Relapse; Research; Research Personnel; Research Training; Resistance; Risk Factors; Starvation; Statistical Methods; Stimulus; Techniques; Testing; Therapeutic; Thinking; Time; Training; Training Programs; Translational Research; Treatment outcome; United States; Universities; Weight; Weight Gain; Writing; anxiety treatment; base; career; career development; classical conditioning; clinical practice; clinically relevant; collaborative environment; design; experimental study; food avoidance; food consumption; habituation; improved; instrument; interdisciplinary approach; medical schools; neural circuit; neural patterning; neurobehavioral; neuroimaging; neuromechanism; nutrition; personalized care; personalized medicine; phenomenological models; programs; public health relevance; reduced food intake; relating to nervous system; response; restrictive eating; skills; social; statistics; tool; treatment program; weight restoration

Project Summary. Anorexia nervosa (AN) is a behavioral disorder marked by self-starvation and fear of weight gain. Weight restoration to a BMI of 19-21 remains the mainstay of treatment for severe AN despite relapse rates in the first year of up to 50%. The mechanisms underlying these high relapse rates remain unknown. Meal- associated anxiety is a striking feature in patients with AN. As the disorder develops, eating behaviors are in- creasingly driven by what appears to be a conditioned avoidance of energy dense foods, known as fear foods, suggesting that exposure-based approaches to treatment may help drive remission. However, in many intensive treatment programs, tube feeding over meal-based nutrition is increasingly the approach. Thus, the need is great for determining what mechanisms and approaches underly the successful treatment of AN and what neurobehavioral factors render individuals responsive versus resistant to treatment. Research: Ex- periments will address the extent to which habituation of learned aversions to fear foods following meal-based exposure generalizes across similar types of foods (Aim 1). Task-based fMRI combined with this behavioral approach will allow the determination of the neural substrates of habituated anxiety responses (Aim 2a). Finally, a machine-learning approach will be used to predict anxiety ratings based on baseline neural activation and identify individuals responsive vs resistant to treatment (Aim 2b). By demonstrating the significance of addressing food-related anxiety as a primary treatment target and examining the neural circuitry activated by fear foods, this project has potential to 1) alter how AN is treated across multiple levels of care and social eating settings, and 2) enhance understanding of the neurobiology that sustains treatment refractoriness. Career Development: The training plan will provide the PI with a) clinically relevant training in the phenomenology of AN, clinical course, and validated instruments used to assess eating disorders important to formulating clinically relevant hypotheses and data interpretation, b) hands-on training in advanced statistical methods for fMRI data, c) opportunity to integrate her training in factors that influence food choice with obtained results, and d) training in grant writing and career development to launch an independent research career. Environment: Johns Hopkins is an excellent environment for collaborative, interdisciplinary, and translational research in healthy and disease states and is focused on mentoring junior faculty. The Johns Hopkins Hospital is ranked #1 in the nation for Psychiatry, with the School of Medicine being the leading research medical institution in the United States and the Eating Disorder Program nationally recognized as a leading program for eating disorder treatment. Career Goal: The proposed research and training program is targeted to meet the PI's overall career goal of becoming an independent academic researcher investigating the biological basis of eating disorders at a university setting by providing the skills and pilot data necessary for larger R01 proposals to examine neural mechanisms underlying the driven nature of eating disorder behaviors with the goal of improving existing treatments and personalizing care.

项目摘要。神经性厌食症 (AN) 是一种以自我饥饿和害怕体重为特征的行为障碍 获得。尽管复发率较高，体重恢复至 BMI 19-21 仍然是严重 AN 的主要治疗方法 第一年高达50%。这些高复发率背后的机制仍然未知。一顿饭- 相关焦虑是 AN 患者的一个显着特征。随着疾病的发展，饮食行为会发生变化： 越来越多地受到似乎有条件地避免摄入高能量食物（称为恐惧食物）的驱动， 表明基于暴露的治疗方法可能有助于缓解病情。然而，在许多密集 治疗方案中，管饲取代以膳食为主的营养越来越成为一种方法。因此，需要的是 非常适合确定成功治疗 AN 的机制和方法 哪些神经行为因素使个体对治疗产生反应或抵抗。研究：前- 实验将解决在以膳食为基础的食物后习得性厌恶恐惧食物的习惯程度 暴露泛化于相似类型的食品（目标 1）。基于任务的功能磁共振成像与这种行为相结合 该方法将允许确定习惯性焦虑反应的神经基质（目标 2a）。最后， 机器学习方法将用于根据基线神经激活来预测焦虑等级 识别对治疗有反应或有抵抗力的个体（目标 2b）。通过论证解决问题的重要性 将与食物相关的焦虑作为主要治疗目标，并检查由恐惧食​​物激活的神经回路，这 该项目有潜力 1) 改变多层次护理和社交饮食环境中 AN 的治疗方式，以及 2）增强对维持治疗不应性的神经生物学的理解。职业发展： 培训计划将为 PI 提供 a) AN 现象学、临床课程、 以及用于评估饮食失调的经过验证的工具，对于制定临床相关假设很重要 和数据解释，b) 功能磁共振成像数据高级统计方法的实践培训，c) 有机会 将影响食物选择因素的培训与所取得的结果相结合，以及 d) 资助写作培训 和职业发展以开展独立的研究生涯。环境： 约翰霍普金斯大学是一个非常好的 健康和疾病状态下协作、跨学科和转化研究的环境 专注于指导初级教师。约翰·霍普金斯医院的精神病学专业在全国排名第一，其中 医学院是美国领先的研究医疗机构和饮食失调 该计划被全国公认为饮食失调治疗的领先计划。职业目标：拟定 研究和培训计划旨在实现 PI 成为独立研究人员的总体职业目标 学术研究人员在大学环境中调查饮食失调的生物学基础，提供 更大的 R01 提案所需的技能和试点数据，以检查驱动背后的神经机制 饮食失调行为的本质，​​旨在改善现有治疗和个性化护理。