Abstract
Several lines of evidence suggest that anxiety plays a key role in the development and maintenance of anorexia nervosa (AN) in children. The purpose of this study was to examine cortical GABA(A)-benzodiazepine receptor binding before and after treatment in children beginning intensive AN treatment. Brain single-photon emission computed tomography (SPECT) measurements using 123I-iomazenil, which binds to GABA(A)-benzodiazepine receptors, was performed in 26 participants with AN who were enrolled in a multimodal treatment program. Sixteen of the 26 participants underwent a repeat SPECT scan immediately before discharge at conclusion of the intensive treatment program. Eating behavior and mood disturbances were assessed using Eating Attitudes Test with 26 items (EAT-26) and the short form of the Profile of Mood States (POMS). Clinical outcome scores were evaluated after a 1-year period. We examined association between relative iomazenil-binding activity in cortical regions of interest and psychometric profiles and determined which psychometric profiles show interaction effects with brain regions. Further, we determined if binding activity could predict clinical outcome and treatment changes. Higher EAT-26 scores were significantly associated with lower iomazenil-binding activity in the anterior and posterior cingulate cortex. Higher POMS subscale scores were significantly associated with lower iomazenil-binding activity in the left frontal, parietal cortex, and posterior cingulate cortex (PCC). “Depression–Dejection” and “Confusion” POMS subscale scores, and total POMS score showed interaction effects with brain regions in iomazenil-binding activity. Decreased binding in the anterior cingulate cortex and left parietal cortex was associated with poor clinical outcomes. Relative binding increases throughout the PCC and occipital gyrus were observed after weight gain in children with AN. These findings suggest that cortical GABAergic receptor binding is altered in children with AN. This may be a state-related change, which could be used to monitor and guide the treatment of eating disorders.
Highlights
Anorexia nervosa (AN) typically presents in females during adolescence
The aims of this study were to [1] determine if gamma-aminobutyric acid (GABA)(A) receptor binding is associated with AN symptoms and anxiety in children initiating clinical treatment for AN; [2] determine which brain regions are involved; [3] determine if measures of GABA(A) receptor binding can predict a participant’s clinical outcome; and [4] determine if these measures change with successful treatment
Relative baseline iomazenilbinding activity in the ACC and left parietal gyrus in participants with a poor clinical outcome were significantly lower than those with a good clinical outcome. This is the first investigation on single-photon emission computed tomography (SPECT) 123I-iomazenil brain imaging in children with AN
Summary
Anorexia nervosa (AN) typically presents in females during adolescence. It is a serious psychiatric illness conferring substantial morbidity and mortality, which manifests as disturbances in eating habits, excessive preoccupation with weight, restricted caloric intake, and body image distortion [1]. Some research regarding the outcome of childhood AN is encouraging in terms of mortality and recovery from AN [2], long-term comorbid psychiatric disorders, such as anxiety disorders and affective disorders, represent unfavorable prognostic factors [3]. Anxiety is present in the majority of children with AN prior to abnormal eating or body image distortions [4]. Anxiety in children with AN is associated with decreased body mass index (BMI) [5, 6]. Trait anxiety scales in children show significant positive correlations with eating disorder psychopathology such as “drive for thinness,” “body dissatisfaction,” and “perfectionism” [5]
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