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Research Paper

Neural signature of behavioural inhibition in women with bulimia nervosa

Mandy Skunde, Stephan Walther, Joe J. Simon, Mudan Wu, Martin Bendszus, Wolfgang Herzog and Hans-Christoph Friederich
J Psychiatry Neurosci September 01, 2016 41 (5) E69-E78; DOI: https://doi.org/10.1503/jpn.150335
Mandy Skunde
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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  • For correspondence: [email protected]
Stephan Walther
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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Joe J. Simon
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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Mudan Wu
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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Martin Bendszus
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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Wolfgang Herzog
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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Hans-Christoph Friederich
From the Departments of General Internal Medicine and Psychosomatics (Skunde, Walther, Simon, Wu, Herzog, Friederich) and General Adult Psychiatry (Walther), Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; the Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Friederich, Simon); the Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China (Wu); and the Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany (Bendszus)
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  • Fig. 1
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    Fig. 1

    Group comparison of brain activation during the general no-go task. Differences in group activation between healthy controls and patients with bulimia nervosa with a high frequency of binge eating (controls > high-BN) during the contrast no-go_circle–go_square. The significance threshold was set at p < 0.05, cluster-level uncorrected. The SPM t-map was rendered on a T1-weighted template image supplied with mricron (Colin brain). The colour scale represents the t-scores.

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    Fig. 2

    Brain activation extracted from the significant clusters of the whole brain analysis (regions of interest) for the general and food-specific no-go task in healthy controls and bulimia nervosa subgroups. Bar charts depicting percent signal change from the significant clusters (right postcentral gyrus, right caudate nucleus) for the controls and patients during the no-go_circle–go_square (light colour) and the no-go_food–go_nonfood (dark colour) contrasts. Error bars depict standard errors of the mean (SEM). High-BN = patients with bulimia nervosa with a high frequency of binge eating; low-BN = patients with bulimia nervosa with a low frequency of binge eating.

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    Table 1

    Clinical characteristics of study participants

    Group; mean ± SD or %
    CharacteristicControl, n = 29Bulimia, n = 28t55p value
    BDI-II total3.59 ± 3.1325.63 ± 12.439.248< 0.001
    DEBQ
     Restrained eating11.79 ± 8.1328.89 ± 7.768.119< 0.001
     Emotional eating7.28 ± 4.7428.45 ± 8.0512.148< 0.001
     External eating18.38 ± 6.6825.14 ± 7.313.649< 0.001
    BIS-11
     Total score58.48 ± 6.4461.81 ± 8.961.6060.11
     Attentional impulsiveness14.52 ± 2.0817.89 ± 3.714.229< 0.001
     Motor impulsiveness21.28 ± 3.0219.00 ± 3.68−2.5370.014
     Nonplanning impulsiveness22.69 ± 3.5324.93 ± 5.121.9150.06
    Objective binge eating episodes/wk—3.71 ± 2.53——
    Purging-type (self-induced vomiting, laxative misuse, diuretics)—85.71——
    Disorder duration, yr—10.19 ± 11.35——
    Antidepressants—25.00——
    Current psychotherapy—53.57——
    Subclinical bulimia*—3.57——
    • BDI = Beck Depression Inventory-II; BIS-11 = Barratt Impulsiveness Scale; DEBQ = Dutch Eating Behaviour Questionnaire; SD = standard deviation.

    • ↵* Patient with subclinical bulimia nervosa with no binge eating episodes during the 28 d before participation.

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    Table 2

    Group differences regarding behavioural performance in the no-go task

    Group; mean ± SD
    MeasureControl, n = 29Bulimia, n = 28t55p value
    Correct%
     Go_square98.73 ± 3.2599.04 ± 1.940.4260.67
     No-go_circle83.46 ± 10.4177.12 ± 12.32−2.1010.040
     Go_nonfood98.67 ± 3.6898.47 ± 3.41−0.2140.83
     No-go_food81.25 ± 9.2178.91 ± 8.58−0.9930.33
    RT, ms
     Go_square357.88 ± 38.06358.86 ± 41.620.0930.93
     No-go_circle322.28 ± 42.70326.02 ± 49.580.3060.76
     Go_nonfood415.28 ± 38.83412.80 ± 40.67−0.2360.81
     No-go_food377.32 ± 48.72389.76 ± 57.980.8780.38
    • RT = reaction time; SD = standard deviation.

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    Table 3

    Whole brain results of the comparison between healthy controls (n = 29) and patients with bulimia nervosa with severe symptoms (n = 14) for the general no-go task

    MNI coordinates
    RegionLateralityt valuexyzBACluster size
    Controls > bulimia nervosa
    Postcentral gyrus (parietal lobe)*R5.0533−25383141
    Precentral gyrus (frontal lobe)*R4.0415−28704
    Postcentral gyrus (parietal lobe)*R3.9933−28664/6
    Caudate nucleus†R4.5518111836
    Putamen†R4.01271710
    • BA = Brodmann area; FWE = family-wise error; MNI = Montreal Neurological Institute; R = right.

    • ↵* Results significant at p < 0.05 cluster-level, FWE-corrected; cluster-defining threshold p < 0.001, uncorrected. Cluster size k > 10 voxels.

    • ↵† Results significant at p < 0.05 cluster-level uncorrected, cluster-defining threshold p < 0.001 uncorrected. Cluster size k > 10 voxels.

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Journal of Psychiatry and Neuroscience: 41 (5)
J Psychiatry Neurosci
Vol. 41, Issue 5
1 Sep 2016
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Neural signature of behavioural inhibition in women with bulimia nervosa
Mandy Skunde, Stephan Walther, Joe J. Simon, Mudan Wu, Martin Bendszus, Wolfgang Herzog, Hans-Christoph Friederich
J Psychiatry Neurosci Sep 2016, 41 (5) E69-E78; DOI: 10.1503/jpn.150335

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Neural signature of behavioural inhibition in women with bulimia nervosa
Mandy Skunde, Stephan Walther, Joe J. Simon, Mudan Wu, Martin Bendszus, Wolfgang Herzog, Hans-Christoph Friederich
J Psychiatry Neurosci Sep 2016, 41 (5) E69-E78; DOI: 10.1503/jpn.150335
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