Neural Responsivity to Food Cues in Patients With Unmedicated First-Episode Psychosis

Abstract

ImportanceSchizophrenia is associated with a reduced life expectancy of 15 to 20 years owing to a high prevalence of cardiometabolic disorders. Obesity, a key risk factor for the development of cardiometabolic alterations, is more prevalent in individuals with schizophrenia. Although obesity is linked to the altered reward processing of food cues, no studies have investigated this link in schizophrenia without the confounds of antipsychotics and illness chronicity.ObjectiveTo investigate neural responsivity to food cues in first-episode psychosis without the confounds of antipsychotic medication or illness chronicity.Design, Setting, and ParticipantsA case-control study was conducted from January 31, 2015, to September 30, 2018, in London, United Kingdom, of 29 patients with first-episode psychosis who were not taking antipsychotic medication and 28 matched controls.Main Outcomes and MeasuresParticipants completed a food cue paradigm while undergoing a functional magnetic resonance imaging scan. Neural activation was indexed using the blood oxygen level–dependent hemodynamic response. The Dietary Instrument for Nutrition Education was used to measure diet, and the International Physical Activity Questionnaire was used to measure exercise.ResultsThere were no significant differences in age, sex, or body mass index between the 29 patients (25 men and 4 women; mean [SD] age, 26.1 [4.8] years) and 28 controls (22 men and 6 women; mean [SD] age, 26.4 [5.5] years). Relative to controls, patients consumed more saturated fat (t46 = –3.046; P = .004) and undertook less high-intensity (U = 304.0; P = .01) and low-intensity (U = 299.5; P = .005) weekly exercise. There were no group differences in neural responses to food vs nonfood cues in whole-brain or region-of-interest analyses of the nucleus accumbens, insula, or hypothalamus. Body mass index was inversely correlated with the mean blood oxygen level–dependent signal in the nucleus accumbens in response to food vs nonfood cues in controls (R = –0.499; P = .01) but not patients (R = 0.082; P = .70).Conclusions and RelevanceRelative to controls, patients with first-episode psychosis who were not taking antipsychotic medication consumed more saturated fat and showed an altered association between body mass index and neural response to food cues in the absence of differences in neural responses to food cues. These findings highlight how maladaptive eating patterns and alterations in the association between body mass index and neural responses to food cues are established early in the course of schizophrenia.

The neural and molecular basis of working memory function in psychosis: a multimodal PET-fMRI study

“…The regional specificity of our findings may therefore indicate that WM impairments in schizophrenia are linked to alterations in the disinhibition of synaptic transmission, arising from striatal CB1R dysfunction on GABAergic interneurons. This adds to other neurochemical evidence implicating the striatum in the pathophysiology of schizophrenia [62][63][64][65][66].…”

Assessment of Appetite-Regulating Hormones Provides Further Evidence of Altered Adipoinsular Axis in Early Psychosis

“…Another study demonstrated that FEP patients have significantly higher levels of prolactin, fasting glucose, glycosylated hemoglobin and insulin resistance compared to individuals at clinical high risk of psychosis (42). It cannot also be excluded that results of our study simply reflect the effects of environmental factors or unhealthy lifestyle characteristics that are highly prevalent in early psychosis and include nutritional deficiencies as well as low exercise activity (43)(44)(45). There are some important limitations of this study that need to be acknowledged.…”

Exploring Patterns of Disturbed Eating in Psychosis: A Scoping Review

“…The characteristics of these studies and a summary of their main findings can be found in Table 6 . Six studies used functional magnetic resonance imaging (fMRI) along with visual analog scales (VAS) and/or eating questionnaires [ 82 , 83 , 84 , 85 , 86 , 87 ] and one study used structural MRI to study brain morphology [ 88 ]. One study was conducted on AP-naïve ( n = 22) patients [ 88 ], and one was conducted on patients who were AP-naïve ( n = 9) or had been medication free for at least six weeks ( n = 20) [ 86 ] ( Section 3.2 ).…”

“…In a recent fMRI study, Borgan et al (2019) investigated neural responsiveness to appetitive stimuli in untreated FEP patients and HCs [ 86 ]. Comparing fMRI blood oxygen level dependent (BOLD) signaling response to appetitive stimuli between groups, the authors found that patients consistently exhibited the same regional patterns of neural activity observed in controls, indicative of normal neural responses to food cues.…”