An fMRI Study of Self-regulation in Adolescents With Bulimia Nervosa

Study Overview
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Brief Summary
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The aim of this project is to use both multimodal MRI and behavioral measures to investigate how changes in frontostriatal neural systems contribute to the development and persistence of Bulimia Nervosa (BN). Findings from this study will have wide-ranging importance for our understanding of the development and treatment of BN.

Detailed Description
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Patients with Bulimia Nervosa (BN) have difficulty regulating impulsive behaviors as suggested by their binge-eating and purging, as well as the high incidence of drug abuse and shoplifting in this population. Understanding dysfunction in the frontostriatal circuitry that mediates self-regulatory control processes will aid development of new therapeutics for the impulsivity associated with BN. We are conducting a longitudinal study to better understand the development and persistence of BN. Participation in this study includes 4 sections: Neuropsychological Tests, Diagnostic interviews, Pregnancy Test, and MRI scan. All efforts are made to coordinate procedures into one day, and they require between 4 and 5 hours of the participant's time. The option of splitting participation into two study days is also offered for participants who find it more convenient. Participants are compensated with $100 in the form of a check, which is mailed to their home address. Participants will be invited back for follow-up visits.

Official Title
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An fMRI Study of Self-regulation in Adolescents With Bulimia Nervosa

Conditions
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Eating Disorders

Intervention / Treatment
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* Other: MRI
* Behavioral: Neuropsychological Testing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current or prior DSM IV diagnosis of Bulimia Nervosa or Sub-threshold Bulimia Nervosa (those who meet all DSM-IV criteria for BN, but engage in subjective binge-eating episodes and binge/purge at a frequency of at least once per week for 3 months, whereas meeting full DSM-IV criteria for BN requires binge eating and purging twice per week for 3 months) Major Depression For control adolescents, no current or past history of an eating disorder Exclusion Criteria: Ferromagnetic implants (e.g., pacemaker) Metal braces or retainers IQ less than 80 Any other current major Axis I disorder, other than major depressive disorder (MDD) History of concussion, seizure disorder, or other neurological illness Claustrophobia Pregnant

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adolescents with Bulimia Nervosa or subclinical BN<br>Adolescents with Bulimia Nervosa or subclinical Bulimia Nervosa | Other: MRI<br>* Magnetic Resonance Imaging scans<br>* Other names: Anatomical Images, DTI, and MRS;Behavioral: Neuropsychological Testing<br>* Neuropsychological tests<br>* Other names: Weather Prediction Task;|
| Healthy control adolescents<br>Healthy control adolescents | Other: MRI<br>* Magnetic Resonance Imaging scans<br>* Other names: Anatomical Images, DTI, and MRS;Behavioral: Neuropsychological Testing<br>* Neuropsychological tests<br>* Other names: Weather Prediction Task;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Magnetic Resonance Imaging Scans | This study will use magnetic resonance imaging (MRI) to assess the structure (cortical thickness) of neural circuit regions involved in Bulimia Nervosa (BN). | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Conners Continuous Performance Test-II (CPT-II) | The Conners Continuous Performance Test-II (CPT-II) is a standardized measure of attention and impulsivity. The following variables (T-scores) were used: Omissions: the number of times the participant failed to respond to a target. High T-score indicates a worse outcome. Commissions: the number of times the participant responded but no target was presented. High T-score indicates a worse outcome. Hit Reaction Time: time between the presentation of the stimulus and participant's response. A fast reaction time (low T-score) and high commission errors points to difficulties with impulsivity. A slow reaction time (high T-score) with high commission and omission errors, indicates inattention in general. Hit Reaction Time Standard Error: levels of inconsistency in response speed. High T-score indicates a worse outcome. Detectability: discrimination for target and nontarget. High T-score indicates a worse outcome. Population mean (standard deviation) = 50 (10) | Baseline | 
| Stroop Word-Color Interference | The Stroop Word-Color Interference Test is a neuropsychological test assessing the ability to inhibit cognitive interference. The test contains three parts: word page (the names of colors printed in black ink), color page (rows of X's printed in colored ink) and word-color page (the words from the first page are printed in the colors from the second page; however, the word meanings and ink colors are mismatched).The subject's task is to look at each sheet and move down the columns, reading words or naming the ink colors as quickly as possible, within a given time limit (45 seconds). Three scores, as well as an interference score, are generated using the number of items completed on each page, with higher scores reflecting better performance and less interference on reading ability. Scores range 0-100. | Baseline | 
| Weather Prediction Task | The Weather Prediction Task is a measure of probabilistic learning using experimental analysis of weather prediction. In this task, participants try to predict either rain or shine based on the presentation of cards whose cue-outcome associations vary probabilistically. Accuracy score (i.e. percentage of correct response) was used in our analyses. A higher score indicates better outcome. Values range 0-100%, with 50% being chance level. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bulimia Nervosa, Bulimia, Eating Disorders, fMRI, Magnetic Resonance Imaging