Brain Changes In Anorexia Nervosa

Anorexia Nervosa (AN) is a serious and frequent psychiatric condition with the highest mortality rate within psychiatric diseases. It often starts during adolescence and affects young patients whose brain maturity is still incomplete but brain changes are often underconsidered although AN appears at a critical point of development. Brain regions involved in the pathophysiology of AN are still in debate. However, the illness is often associated with enlargement of the cortical sulci and ventricles as well as with deficits in grey and white matter volumes. Functional modifications have also been evidenced: mainly global hypometabolism (PET), hypoperfusions (SPECT) and recent fMRI studies have shown that the function of the insular and cingulate cortices, in particular, differ in AN. Neuropsychological studies have also shown neurocognitive impairments concerning executive functions, episodic and working memory as well as attentional deficits. In 1999, Geneva University Hospitals set up a medical-psychiatric unit located in the district general hospital. This structure allows dealing with severe somatic problems as medical and nursing staffs are psychiatric and somatic specialists. AN patients are over 16, often hospitalised for the first time and have very low BMI (< 14). From the clinical observation of these patients who show significant attentional deficits, we explored whether cerebral abnormalities were present with structural MRI and Neuropsychological assessments. We will describe the preliminary results of our clinical experience and consider their implication for the understanding of AN mechanisms. We will also discuss the links between psychopathology and brain impairments that could lead to more efficient treatments. Disclosure of interest The authors have not supplied their declaration of competing interest.