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Anorexia nervosa (AN) and bulimia nervosa (BN) are complex psychiatric conditions, in which both psychological and metabolic factors have been implicated. Critically, the experience of stress can precipitate loss-of-control eating in both conditions, suggesting an interplay between mental state and metabolic signaling. However, associations between psychological states, symptoms and metabolic processes in AN and BN have not been examined.
Eighty-five women (n = 22 AN binge/purge subtype, n = 33 BN, n = 30 controls) underwent remote salivary cortisol sampling and a 2-day, inpatient study session to examine the effect of stress on cortisol, gut hormones [acyl-ghrelin, peptide tyrosine tyrosine (PYY) and glucagon-like peptide-1] and food consumption. Participants were randomized to either an acute stress induction or control task on each day, and plasma hormones were serially measured before a naturalistic, ad libitum meal.
Cortisol-awakening response was augmented in AN but not in BN relative to controls, with body mass index explaining the most variance in post-awakening cortisol (36%). Acute stress increased acyl-ghrelin and PYY in AN compared to controls; however, stress did not alter gut hormone profiles in BN. Instead, a group-by-stress interaction showed nominally reduced cortisol reactivity in BN, but not in AN, compared to controls. Ad libitum consumption was lower in both patient groups and unaffected by stress.
Findings extend previous reports of metabolic dysfunction in binge-eating disorders, identifying unique associations across disorders and under stress. Moreover, we observed disrupted homeostatic signaling in AN following psychological stress, which may explain, in part, the maintenance of dysregulated eating in this serious illness.
Grey matter and other structural brain abnormalities are consistently
reported in first-onset schizophrenia, but less is known about the extent
of neuroanatomical changes in first-onset affective psychosis
To determine which brain abnormalities are specific to (a) schizophrenia
and (b) affective psychosis
We obtained dual-echo (proton density/T2-weighted) magnetic resonance
images and carried out voxel-based analysis on the images of 73 patients
with first-episode psychosis (schizophrenia n=44,
affective psychosis n=29) and 58 healthy controls
Both patients with schizophrenia and patients with affective psychosis
had enlarged lateral and third ventricle volumes. Regional cortical grey
matter reductions (including bilateral anterior cingulate gyrus, left
insula and left fusiform gyrus) were evident in affective psychosis but
not in schizophrenia, although patients with schizophrenia displayed
decreased hippocampal grey matter and increased striatal grey matter at a
more liberal statistical threshold
Both schizophrenia and affective psychosis are associated with volumetric
abnormalities at the onset of frank psychosis, with some of these evident
in common brain areas
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