Regional cerebral blood flow changes associated with interoceptive awareness in the recovery process of anorexia nervosa Ryohei Matsumoto a,b, ⁎ , Yurinosuke Kitabayashi a , Jin Narumoto a , Yoshihisa Wada a , Akiko Okamoto a , Yo Ushijima c , Chihiro Yokoyama a , Tatsuhisa Yamashita a,d , Hidehiko Takahashi b , Fumihiko Yasuno b , Tetsuya Suhara b , Kenji Fukui a a Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan b Clinical Neuroimaging Section, Department of Molecular Neuroimaging, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, 233-8555, Japan c Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan d Department of Clinical Research, Maizuru Medical Center, National Hospital Organization, Maizuru, 625, 8502, Japan Received 12 January 2006; received in revised form 13 March 2006; accepted 30 March 2006 Available online 14 June 2006 Abstract Background: An abnormality in regional cerebral blood flow (rCBF) in anorexia nervosa (AN) patients has been reported. There are very few studies that have investigated the rCBF changes in the recovery process of AN. Methods: For eight female AN patients, we performed 123 I-IMP single photon emission computed tomography (SPECT) and four psychological assessments (Eating Disorder Inventory (EDI), Eating Attitude Test (EAT), Self-Rating Depression Scale (SDS) and State-Trait Anxiety Inventory (STAI)) both before and after inpatient-behavioral therapy. SPECT images were analyzed using statistical parametric mapping software. We also performed correlational analysis between rCBF and clinical variables. Results: Following treatment, the patients showed significant body weight recovery. They showed significant improvement in EAT, SDS, STAI and a subscale of EDI – interoceptive awareness (IA) – but not in total EDI or other EDI subscales. Significant rCBF increases were observed in the precuneus, posterior cingulate cortex (PCC), right dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and medial prefrontal cortex (MPFC) by the treatment. Significant correlation was observed between rCBF of right DLPFC and IA score before treatment. Conclusions: Changes of rCBF in right DLPFC, ACC, MPFC, PCC and precuneus were related to the AN recovery process and might be associated with improvement of IA following treatment. © 2006 Elsevier Inc. All rights reserved. Keywords: Anorexia nervosa; Behavioral therapy; Interoceptive awareness; Regional cerebral blood flow; Single photon emission computed tomography (SPECT) 1. Introduction Anorexia nervosa (AN) is characterized by the refusal to maintain a minimally normal body weight and an intense fear of gaining weight or becoming fat despite being underweight. Disturbance in the perception of body shape and weight and in identifying internal emotions and states is an essential feature of AN (Garfinkel et al., 1995). Imaging studies have been used to provide functional information regarding receptor mapping (Frank et al., 2002), cerebral glucose metabolism (Delvenne et al., 1999; Delvenne et al., 1996) and task-related regional cerebral blood flow Progress in Neuro-Psychopharmacology & Biological Psychiatry 30 (2006) 1265 – 1270 www.elsevier.com/locate/pnpbp Abbreviations: AN, anorexia nervosa; rCBF, regional cerebral blood flow; SPECT, single photon emission computed tomography; EDI, Eating Disorder Inventory; EAT, Eating Attitude Test; SDS, Self-Rating Depression Scale; STAI, State-Trait Anxiety Inventory; IA, interoceptive awareness; PCC, posterior cingulate cortex; DLPFC, right dorsolateral prefrontal cortex; ACC, anterior cingulate cortex; MPFC, medial prefrontal cortex. ⁎ Corresponding author. Department of Psychiatry, Graduate School of Medical Science Kyoto Prefectural, University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan. Tel.: +81 75 251 5612; fax: +81 75 251 5839. E-mail address: rmat@nirs.go.jp (R. Matsumoto). 0278-5846/$ - see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.pnpbp.2006.03.042