title: Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa.
abstract: Anorexia nervosa is a psychiatric disorder of unknown etiology. Understanding associations between behavior and neurobiology is important in treatment development. Using a novel monetary reward task during functional magnetic resonance brain imaging, the authors tested how brain reward learning in adolescent anorexia nervosa changes with weight restoration.
  
  
  
  Female adolescents with anorexia nervosa (N=21; mean age, 16.4 years [SD=1.9]) underwent functional MRI (fMRI) before and after treatment; similarly, healthy female control adolescents (N=21; mean age, 15.2 years [SD=2.4]) underwent fMRI on two occasions. Brain function was tested using the reward prediction error construct, a computational model for reward receipt and omission related to motivation and neural dopamine responsiveness.
  
  
  
  Compared with the control group, the anorexia nervosa group exhibited greater brain response 1) for prediction error regression within the caudate, ventral caudate/nucleus accumbens, and anterior and posterior insula, 2) to unexpected reward receipt in the anterior and posterior insula, and 3) to unexpected reward omission in the caudate body. Prediction error and unexpected reward omission response tended to normalize with treatment, while unexpected reward receipt response remained significantly elevated. Greater caudate prediction error response when underweight was associated with lower weight gain during treatment. Punishment sensitivity correlated positively with ventral caudate prediction error response.
  
  
  
  Reward system responsiveness is elevated in adolescent anorexia nervosa when underweight and after weight restoration. Heightened prediction error activity in brain reward regions may represent a phenotype of adolescent anorexia nervosa that does not respond well to treatment. Prediction error response could be a neurobiological marker of illness severity that can indicate individual treatment needs.
authors.affiliation: From the Department of Psychiatry, University of Colorado School of Medicine, and the Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora; and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco.
authors.forename: Marisa
authors.initials: M
authors.lastname: DeGuzman
authors.affiliation: From the Department of Psychiatry, University of Colorado School of Medicine, and the Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora; and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Shott
authors.affiliation: From the Department of Psychiatry, University of Colorado School of Medicine, and the Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora; and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco.
authors.forename: Tony T
authors.initials: TT
authors.lastname: Yang
authors.affiliation: From the Department of Psychiatry, University of Colorado School of Medicine, and the Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora; and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco.
authors.forename: Justin
authors.initials: J
authors.lastname: Riederer
authors.affiliation: From the Department of Psychiatry, University of Colorado School of Medicine, and the Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora; and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco.
authors.forename: Guido K W
authors.initials: GKW
authors.lastname: Frank
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D059031:Anticipation, Psychological / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D004298:Dopamine / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009042:Motivation / Q000502:physiology*; D009415:Nerve Net / Q000503:physiopathology; D066230:Patient-Specific Modeling; D012201:Reward; D013851:Thinness / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D015430:Weight Gain / Q000502:physiology*; D055815:Young Adult
chemical_list: D004298:Dopamine
keywords: Adolescents; Anorexia nervosa; Brain Imaging; Eating Disorders; Prediction Error; Reward