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）是一种行为障碍，以自我饥饿和对体重的恐惧为标志 获得。重量恢复为19-21的BMI仍然是严重治疗的主要治疗方法 在最高50％的第一年。这些高复发率的基础机制仍然未知。一顿饭- 相关的焦虑是AN患者的惊人特征。随着疾病的发展，饮食行为无关 在似乎有条件地避免能量密集的食物（称为恐惧食品）的情况下， 表明基于暴露的治疗方法可能有助于缓解。但是，在许多密集型 治疗计划，基于进餐的营养的管道越来越多地是这种方法。因此，需求是 非常适合确定成功治疗的基本机制和方法 哪些神经行为因素使个人反应迅速而对治疗。研究：前 内部将解决学习厌恶恐惧以害怕食物之后食物的习惯的程度 暴露在类似类型的食物上概括（AIM 1）。基于任务的fMRI与此行为相结合 方法将允许确定习惯焦虑反应的神经底物（AIM 2A）。最后， 机器学习方法将用于根据基线神经激活和 识别个人反应能力与对治疗的抵抗力（AIM 2B）。通过证明解决的意义 食物有关的焦虑作为主要治疗目标并检查恐惧食品激活的神经回路，这是 项目有潜力1）改变如何在多个护理和社交饮食环境中对AN进行处理，以及 2）增强对维持治疗难治性的神经生物学的理解。职业发展： 培训计划将为PI提供a）临床相关的临床相关培训。 并经过验证用于评估饮食失调的仪器，用于制定临床相关的假设 和数据解释，b）fMRI数据的高级统计方法的动手培训，c）机会 将她在影响食物选择的因素与获得的结果的因素中结合在一起，d）授予写作培训 和职业发展以启动独立研究职业。环境：约翰·霍普金斯（Johns Hopkins）很棒 健康和疾病状态中的合作，跨学科和翻译研究的环境， 专注于指导初级教师。约翰·霍普金斯医院在全美排名全国的精神病学中排名第一， 医学院是美国领先的研究医疗机构和饮食失调 全国公认为饮食失调治疗的领先计划的计划。职业目标：提议 研究和培训计划的目标是实现PI成为独立的总体职业目标 通过提供 较大的R01提案所需的技能和试验数据，以检查驱动驱动的神经机制 饮食失调行为的性质，目的是改善现有治疗和个性化护理。