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Novel brain-directed treatment strategies for eating disorders
S159
Educational update sessions
E.03. Novel treatment approaches for eating disorders E.03.01 Translational approaches for the treatment of obesity R. Adan1 ° , G. Van der Plasse1 , R. Van Zessen1 , K. De Git1 , R. Pandit1 , L. Boekhoudt1 , J. Verharen1 1 UMCU, Translational Neuroscience, Utrecht, The Netherlands Dieting in order to lose weight is counteracted by reduced thermogenesis and by increased motivation for food reward. In both falling levels of leptin play a key role. We addressed how and where in the brain leptin affects food reward and thermogenesis. Therefore we recorded the activity of dopamine neurons in the brain reward system using in vivo electrophysiology and fiber photometry during food reward seeking and we brought these neurons under control of opto- and chemogenetics during sucrose seeking. We found ventral tegmental dopamine neurons projecting to the nucleus accumbens to mediate motivation to seek a sucrose reward. We further aim to identify the neurons mediating the effect of leptin on food reward and food choice by determining how leptin receptor expressing neurons affect food reward. Unraveling the transcriptome of these neurons may eventually lead to the identification of novel drug targets to treat obesity. We also focused on the effect of leptin on the dorsomedial hypothalamus (DMH) in rats withdrawn from an obesogenic diet and found that leptin affects neurons projecting to the brainstem in the control of thermogenesis. Chemogenetic activation of these leptin sensitive neurons increased thermogenesis. We conclude that decreased leptin signaling in the DMH is underlying reduced thermogenesis during dieting. A drug that acts like leptin on these neurons may normalise thermogenesis during dieting. Disclosure statement: This work was supported by EU FP7 projects NeuroFast, Full4Health and NudgeIT
E.03.02 Novel brain-directed treatment strategies for eating disorders J. Treasure1 ° 1 King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity. In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety, compulsivity and problems in social functioning [1]. New approaches which target each of these areas are being developed. Amongst the more specific food related interventions food inhibition training and attention bias modification studies are being tested in pilot studies [2]. Also there is renewed interest
in the newer modifications to exposure treatment that are now available. These training approaches are also being applied to some of the wider areas of abnormal psychosocial functioning such as interpretation and attentional bias towards social threat which contribute to the problems in interpersonal relationships and isolation that compound the problem [3]. The role of oxytocin which targets both of these domains is being examined. In single dose studies it has been found to moderate attentional processes to salient cues [4] and more protracted forms of treatment. In addition a variety of neuromodulation approaches (direct current stimulation (DCS), trans magnetic stimulation (TMS) and deep brain stimulation (DBS)) are being evaluated [5]. Although psychotherapy is the mainstay of treatment it is possible that supplementing this with some of these new approaches will provide added benefit. References [1] Treasure, J., Stein, D., Maguire, S., 2015. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention In Psychiatry, vol 9, no. 3, pp. 173–184. [2] Turton, R., Bruidegom, K., Cardi, V., Hirsch, C.R., Treasure, J., 2016. Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews vol 61, pp. 132–155. [3] Cardi, V., Esposito, M., Bird, G., Rhind, C., Yiend, J., Schifano, S., Hirsch, C., Treasure, J., 2015. A preliminary investigation of a novel training to target cognitive biases towards negative social stimuli in Anorexia Nervosa. J Affect Disord. 188: p. 188−93. [4] Kim, Y.R., Eom, J.S., Yang, J.W., Kang, J., Treasure, J., 2015. The Impact of Oxytocin on Food Intake and Emotion Recognition in Patients with Eating Disorders: A Double Blind Single Dose WithinSubject Cross-Over Design. PLoS ONE 10(9): e0137514. doi: 10.1371/ journal.pone.0137514. [5] Treasure, J., Cardi, V., Leppanen, J., Turton, R., 2015. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 12−01, Volume 152, Pages 456–465.
E.04. Bipolar − an update on clinical treatment and lithium mechanisms E.04.01 Bipolar disorder new data as aid for clinical practice E. Vieta1 ° , M. Garriga2 1 Clinical Institute of Neuroscience Hospital Clinic- University of Barcelona, Bipolar Disorders Program- IDIBAPS- CIBERSAM, Barcelona, Spain; 2 Clinical Institute of Neuroscience Hospital Clinic- University of Barcelona, Bipolar Disorders Program- CIBERSAM, Barcelona, Spain Over the past 30 years, the armamentarium for the treatment of bipolar disorder has increased in quantity and quality, and patients are treated at a much earlier stage, resulting in the practical disappearance of catatonic and severely bizarre psychotic manic and depressive syndromes in the Western world [1]. We have learned to use the available therapies as monotherapies or, most commonly, in combination. Guidelines have been developed to reduce the variability of clinical practice, and clinicians have
Educational update sessions
E.03. Novel treatment approaches for eating disorders E.03.01 Translational approaches for the treatment of obesity R. Adan1 ° , G. Van der Plasse1 , R. Van Zessen1 , K. De Git1 , R. Pandit1 , L. Boekhoudt1 , J. Verharen1 1 UMCU, Translational Neuroscience, Utrecht, The Netherlands Dieting in order to lose weight is counteracted by reduced thermogenesis and by increased motivation for food reward. In both falling levels of leptin play a key role. We addressed how and where in the brain leptin affects food reward and thermogenesis. Therefore we recorded the activity of dopamine neurons in the brain reward system using in vivo electrophysiology and fiber photometry during food reward seeking and we brought these neurons under control of opto- and chemogenetics during sucrose seeking. We found ventral tegmental dopamine neurons projecting to the nucleus accumbens to mediate motivation to seek a sucrose reward. We further aim to identify the neurons mediating the effect of leptin on food reward and food choice by determining how leptin receptor expressing neurons affect food reward. Unraveling the transcriptome of these neurons may eventually lead to the identification of novel drug targets to treat obesity. We also focused on the effect of leptin on the dorsomedial hypothalamus (DMH) in rats withdrawn from an obesogenic diet and found that leptin affects neurons projecting to the brainstem in the control of thermogenesis. Chemogenetic activation of these leptin sensitive neurons increased thermogenesis. We conclude that decreased leptin signaling in the DMH is underlying reduced thermogenesis during dieting. A drug that acts like leptin on these neurons may normalise thermogenesis during dieting. Disclosure statement: This work was supported by EU FP7 projects NeuroFast, Full4Health and NudgeIT
E.03.02 Novel brain-directed treatment strategies for eating disorders J. Treasure1 ° 1 King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity. In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety, compulsivity and problems in social functioning [1]. New approaches which target each of these areas are being developed. Amongst the more specific food related interventions food inhibition training and attention bias modification studies are being tested in pilot studies [2]. Also there is renewed interest
in the newer modifications to exposure treatment that are now available. These training approaches are also being applied to some of the wider areas of abnormal psychosocial functioning such as interpretation and attentional bias towards social threat which contribute to the problems in interpersonal relationships and isolation that compound the problem [3]. The role of oxytocin which targets both of these domains is being examined. In single dose studies it has been found to moderate attentional processes to salient cues [4] and more protracted forms of treatment. In addition a variety of neuromodulation approaches (direct current stimulation (DCS), trans magnetic stimulation (TMS) and deep brain stimulation (DBS)) are being evaluated [5]. Although psychotherapy is the mainstay of treatment it is possible that supplementing this with some of these new approaches will provide added benefit. References [1] Treasure, J., Stein, D., Maguire, S., 2015. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention In Psychiatry, vol 9, no. 3, pp. 173–184. [2] Turton, R., Bruidegom, K., Cardi, V., Hirsch, C.R., Treasure, J., 2016. Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews vol 61, pp. 132–155. [3] Cardi, V., Esposito, M., Bird, G., Rhind, C., Yiend, J., Schifano, S., Hirsch, C., Treasure, J., 2015. A preliminary investigation of a novel training to target cognitive biases towards negative social stimuli in Anorexia Nervosa. J Affect Disord. 188: p. 188−93. [4] Kim, Y.R., Eom, J.S., Yang, J.W., Kang, J., Treasure, J., 2015. The Impact of Oxytocin on Food Intake and Emotion Recognition in Patients with Eating Disorders: A Double Blind Single Dose WithinSubject Cross-Over Design. PLoS ONE 10(9): e0137514. doi: 10.1371/ journal.pone.0137514. [5] Treasure, J., Cardi, V., Leppanen, J., Turton, R., 2015. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 12−01, Volume 152, Pages 456–465.
E.04. Bipolar − an update on clinical treatment and lithium mechanisms E.04.01 Bipolar disorder new data as aid for clinical practice E. Vieta1 ° , M. Garriga2 1 Clinical Institute of Neuroscience Hospital Clinic- University of Barcelona, Bipolar Disorders Program- IDIBAPS- CIBERSAM, Barcelona, Spain; 2 Clinical Institute of Neuroscience Hospital Clinic- University of Barcelona, Bipolar Disorders Program- CIBERSAM, Barcelona, Spain Over the past 30 years, the armamentarium for the treatment of bipolar disorder has increased in quantity and quality, and patients are treated at a much earlier stage, resulting in the practical disappearance of catatonic and severely bizarre psychotic manic and depressive syndromes in the Western world [1]. We have learned to use the available therapies as monotherapies or, most commonly, in combination. Guidelines have been developed to reduce the variability of clinical practice, and clinicians have