عملکرد تصمیم گیری به عنوان یک پیش بینی کننده نتیجه درمان در بی اشتهایی عصبی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33740||2006||9 صفحه PDF||سفارش دهید||5525 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 145, Issues 2–3, 7 December 2006, Pages 179–187
The pathological eating behaviour of patients with anorexia nervosa reflects a deficit in planning real-life strategies that can be observed in an experimental setting through the Gambling Task, a tool designed to detect and measure decision-making abilities. We examined the role of Gambling Task performance as a predictor of treatment outcome in anorectic patients, and we evaluated changes in decision-making after clinical improvement. Performance on the Gambling Task was evaluated, and a clinical–nutritional assessment of 38 anorectic patients was carried out before and after a cognitive–behavioural and drug treatment program. Task performance of anorectic patients was compared with that of 30 healthy control participants. Patients who had a better decision-making profile at baseline showed significantly greater improvement in nutritional status. The decision-making deficiency of some anorectic patients is probably linked to those individual features that contribute to the phenomenological expression of the disorder and to its different treatment outcomes.
The pathological eating behaviour of patients with anorexia nervosa (AN) reflects an impairment in planning real-life strategies. This deficit could account for the inability of some AN patients to take a long-term perspective and their preference to opt for choices that yield high immediate gains in spite of higher future losses (Cavedini et al., 2004a). The preference of AN patients for choices that are advantageous in the short-term but not in the long run is confirmed from their impaired performance on tasks modelling real-life decision-making processes. For example, during the acute phase of illness, AN patients are impaired on the Gambling Task (GT) (Cavedini et al., 2004a), a measure of decision-making propensities (Bechara et al., 1994). Their poor performance on this neuropsychological test does not appear to be related to illness severity, thus suggesting the absence of any relationship between nutritional status, severity of symptoms and general cognitive impairment in these patients (Lauer et al., 1999). Similar decision-making impairments, detected in real life as well as in the laboratory with the GT, can also be found in patients with obsessive–compulsive disorder (Cavedini et al., 2002 and Cavallaro et al., 2003), to the extent that several authors suggested that AN could be considered as a form of obsessive–compulsive disorder (Halmi et al., 2003). Indeed, evidence from clinical, family and genetic studies suggests the inclusion of AN within the obsessive–compulsive spectrum (Matsunaga et al., 1999, Cavallini et al., 2000 and Bellodi et al., 2001). However, the decision-making profile of patients with obsessive–compulsive disorder, as reflected by their performance on the GT, shows important individual differences. A further investigation observed that those subjects who perform poorly on the GT go on to show a poor clinical outcome to pharmacological anti-obsessive treatment with serotonin re-uptake inhibitors (Cavedini et al., 2002), indicating the GT may be a predictor of clinical outcome and suggesting the identification of obsessive–compulsive patients with specific traits significantly associated to clinical outcome (Erzegovesi et al., 2001 and Alonso et al., 2001). It would be valuable if similar cognitive deficits in AN patients could be used to predict clinical outcome and aid in the development of optimal treatment strategies (Fassino et al., 2001). The present study is a continuation of our studies on decisional processes in obsessive–compulsive spectrum disorders and stems from our previous study on AN (Cavedini et al., 2004a). A subgroup of the patients in the current study (n = 12, 28.5%) were also included in the earlier report.