Neural predictors of outcome during relapse prevention treatment for anorexia nervosa

神经性厌食症复发预防治疗期间结果的神经预测因素

• 批准号: 10582173
• 负责人: Alexandra Felicia Muratore
• 金额: $ 25.33万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582173
• 关键词: Acute; Address; Adult; Advanced Development; Anorexia Nervosa; Architecture; Area; Behavior Therapy; Behavioral; Biological Markers; Body Weight decreased; Characteristics; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Corpus striatum structure; Data; Development; Dorsal; Eating; Eating Behavior; Food; Foundations; Fright; Functional Magnetic Resonance Imaging; Funding Mechanisms; Goals; Habits; Heterogeneity; Hospitalization; Hospitals; Incentives; Individual; Individual Differences; Inpatients; Intervention; Knowledge; Learning; Mediating; Mental disorders; Modeling; Morbidity - disease rate; National Institute of Mental Health; Neurobiology; Obsessive-Compulsive Disorder; Outcome; Patients; Pattern; Population; Prediction of Response to Therapy; Prevention program; Prevention strategy; Proxy; Psychiatry; Randomized; Recovery; Relapse; Research; Resistance; Rest; Rewards; Role; Scanning; Science; Strategic Planning; System; Testing; Treatment outcome; Variant; Weight; Work; biomarker development; brain based; clinical development; clinical predictors; clinically relevant; cognitive control; design; food restriction; functional MRI scan; human old age (65+); improved; maladaptive behavior; mortality; neural; neural circuit; neural patterning; neuroimaging; neuropathology; novel; outcome prediction; personalized medicine; predicting response; predictive marker; prevention clinical trial; programs; rate of change; relapse prediction; relapse prevention; relapse risk; repetitive behavior; response; restrictive eating; treatment choice; treatment program; treatment response; trial comparing; weight restoration

Anorexia nervosa (AN) is a devastating psychiatric illness with significant morbidity and mortality rates, and relapse rates ranging from 40-80% after acute treatment. Extreme restriction of food intake is the central behavioral disturbance in illness, and confers significantly greater risk for relapse. Illness follows a heterogeneous course and clinical predictors of response to treatment are largely unknown. Maladaptive behavior in AN has behavioral and neural features suggesting habitual control. Yet, brain-based factors that relate to long-term outcomes and treatment response have not been studied. In other areas of psychiatry, both neural predictors of persistent illness and neural predictors of treatment response have been identified through patterns of neural activity and neural connectivity. By studying neural predictors of outcome in AN, this study addresses a critical gap in knowledge about the treatment of AN. This developmental study will leverage an existing clinical trial providing relapse prevention treatment for AN for individuals with AN who normalized weight as inpatients in our treatment program. The intervention, Relapse Prevention and Changing Habits (REACH+), targets habitual control of maladaptive behavior, especially restriction of food intake. REACH+ compares different versions of cognitive and behavioral psychotherapeutic interventions in a randomized design. The proposed R21 will acquire fMRI data from patients hospitalized for AN who have achieved full weight restoration, prior to starting REACH+ treatment. To identify neural predictors of outcome, we will acquire fMRI activity during a task with established utility in capturing the maladaptive restriction that predicts relapse in AN (Food Choice Task) as well as functional connectivity at rest. We will test whether these neural markers predict weight slope after hospital discharge, an established marker of longer-term outcome, to test for biomarkers of relapse. In addition, we will acquire fMRI activity during a cognitive control task with established utility in predicting response to cognitive behavior therapy (in non-AN populations). We will explore whether individual differences in cognitive control-related activity, as well as other patterns of resting state connectivity, moderate response to variations in behavioral and cognitive interventions included in REACH+. By evaluating how neural activity predicts outcome, this work is responsive to the NIMH call for the development of clinically relevant biomarkers of recovery and relapse in AN. This study will establish new avenues for research in personalized medicine in AN.

神经性厌食症（AN）是一种毁灭性的精神病，发病率和死亡率很高，并且 急性治疗后40-80％的复发率。食物摄入的极端限制是中心 疾病中的行为干扰，并赋予复发风险明显更大。疾病随后 对治疗反应的异质过程和临床预测因素在很大程度上未知。适应不良 具有行为和神经特征的行为表明习惯控制。然而，基于大脑的因素 尚未研究与长期结局和治疗反应有关的。在其他精神病学领域，两者都 通过 神经活动和神经连通性的模式。通过研究结果的神经预测因子，本研究 解决有关治疗的知识的关键差距。 这项发展研究将利用现有的临床试验，为预防复发治疗 适用于我们的治疗计划中的人将体重标准化为住院患者的人。干预， 预防复发和改变习惯（覆盖+），针对适应不良行为的习惯控制， 特别限制食物摄入量。触及+比较不同版本的认知和行为 随机设计中的心理治疗干预措施。 拟议的R21将从住院的患者那里获取fMRI数据，以达到全部体重 恢复，在开始到达+治疗之前。为了确定结果的神经预测指标，我们将获得fMRI 在捕获适应不良限制的任务期间的活动，该限制可预测 （食物选择任务）以及休息时的功能连通性。我们将测试这些神经标记是否预测 出院后的重量坡度是长期结局的既定标记，以测试生物标志物的生物标志物 复发。此外，我们将在认知控制任务中获得fMRI活动，并在 预测对认知行为疗法的反应（在非人群中）。我们将探讨个人是否 认知控制相关活动的差异以及其他静止状态连接的模式，中等 对REACH+中包括的行为和认知干预措施的变化的响应。通过评估神经如何 活动预测结果，这项工作对NIMH呼吁开发临床相关的呼吁 恢复和复发的生物标志物。这项研究将建立个性化研究的新途径 an。