Recent research suggests that obesity is linked to prominent alterations in learning and decision-making. This general difference may also underlie the preference for immediately consumable, highly palatable but unhealthy and high-calorie foods. Such poor food-related inter-temporal decision-making can explain weight gain; however, it is not yet clear whether this deficit can be generalized to other domains of inter-temporal decision-making, for example financial decisions. Further, little is known about the stability of decision-making behavior in obesity, especially in the presence of rewarding cues. To answer these questions, obese and lean participants (n = 52) completed two sessions of a a computerized monetary delay discounting task, including a novel priming paradigm. In the first session, general differences between groups in financial delay discounting were measured. In the second session, I tested the general stability of discount rates. Additionally, participants were primed by affective visual cues of different contextual categories before making financial decisions. I found that the obese group showed stronger discounting of future monetary rewards than the lean group, but groups did not differ in their general stability between sessions nor in their sensitivity toward changes in reward magnitude. In the obese group, a fast decrease of subjective value over time was directly related to a higher tendency for opportunistic eating. Obese in contrast to lean people were primed by the affective cues, showing a sex-specific pattern of priming direction. The findings demonstrate that environments rich of cues, aiming at inducing unhealthy consumer decisions, can be highly detrimental for obese people. It also underscores that obesity is not merely a medical condition but has a strong cognitive component, meaning that current dietary and medical treatment strategies may fall too short.:1. Introduction 1.1 Obesity as a global epidemic 1.2 Etiology of the obesity epidemic 1.3 The cognitive component – impulsivity as a potential risk factor for the development of obesity 1.4 Impulsivity 1.4.1 Impulsivity and obesity – current knowledge 1.4.2 Outlook: impulsivity and eating behavior in obesity 1.5 Delay discounting 1.5.1 Neurological correlates of delay discounting 1.6 Delay discounting and obesity 1.6.1 First aim of the present thesis: establishing a general difference in delay discounting task performance between lean and obese 1.7 General stability of decision-making preferences 1.7.1 Stability towards external cues / Priming 1.7.2 Priming and obesity 1.8 Aim of this thesis 2. Original publication 3. Summary 3.1 Introduction and research questions 3.2 Methods 3.3 Results and discussion 3.4 Implications 4. Bibliography 5. Anlagen

Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery.

The purpose of the current study is to evaluate whether ACT techniques, such as acceptance activities, has an impact on an individual’s delayed and/or probabilistic discounting behavior measured by discounting tasks and other self-reported measures related to eating behaviors and health. Participants in an intervention and control group completed a monetary food and disease delay discounting survey before and after completing either a brief ACT session or completing a control activity. Thirty-six undergraduates participated in the present study and a pre-, post-control groups design was utilized to evaluate the effects of the intervention. Independent t-tests were conducted, and the results of those analyses showed that ACT was no effective in decreasing discounting on the monetary food, and disease discounting survey pre-test AUC 0.9147 (SD=0.1295) and post-test survey AUC 0.8794 (SD=0.1737). There were no statistically significant changes for the ACT or control group Implications of these findings and future research are discussed. Keywords: ACT, discounting, obesity, students

Objective: The strong association between ADHD and cigarette smoking and the known effects of nicotine on cognition has lead to interest in the role of cholinergic function in ADHD cognitive deficits. We have previously demonstrated that acute nicotine improves behavioral inhibition in adolescents with ADHD. This study examined acute nicotine in young adults with ADHD-Combined type on cognitive domains including behavioral inhibition, delay aversion, and recognition memory. Methods: 15 non-smoking young adults (20 ± 1.7 years) diagnosed with ADHD-C received acute nicotine (7 mg patch for 45 min) and placebo on separate days. Cognitive tasks included the Stop Signal Task, Choice Delay task, and the High-Low Imagery Task (a verbal recognition memory task). Three subjects experienced side effects and their data was excluded from analysis of cognitive measures. Results: There was a significant (p < .05) positive effect of nicotine on the Stop Signal Reaction Time measure of the Stop Signal Task. The SSRT was improved without changes in GO reaction time or accuracy. There was a trend (p = .09) for nicotine to increase tolerance for delay and a strong trend (p = .06) for nicotine to improve recognition memory. Conclusions: Non-smoking young adults with ADHD-C showed improvements in cognitive performance following nicotine administration in several domains that are central to ADHD. The results from this study support the hypothesis that cholinergic system activity may be important in the cognitive deficits of ADHD and may be a useful therapeutic target.

Psychiatric disorders may co-occur in the same individual. These include, for example, substance abuse or obsessive-compulsive disorder with schizophrenia, and movement disorders or epilepsy with affective dysfunctional states. Medications may produce iatrogenic effects, for example cognitive impairments that co-occur with the residual symptoms of the primary disorder being treated. The observation of comorbid disorders in some cases may reflect diagnostic overlap. Impulsivity, impulsiveness or impulsive behaviour is implicated in a range of diagnostic conditions including substance abuse, affective disorder and obsessive-compulsive disorder. These observations suggest a need to re-evaluate established diagnostic criteria and disorder definitions, focusing instead on symptoms and symptom-profiles.

Introduction : En France, le TDA/H de l'adulte reste aujourd'hui encore controversé. L'absence de consensus sur l'existence même du trouble en tant qu'entité diagnostique singulière, et les nombreux débats idéologiques dont il est l'objet, placent le TDA/H dans un flou théorique, avec pour conséquence, une méconnaissance du trouble chez l'adulte, une négligence diagnostique et une prise en charge limitée voire inexistante de cette population. Or, le TDA/H engendre une multitude d'impacts psychologiques et fonctionnels considérables, provoquant une souffrance psychologique, et des altérations fonctionnelles variées. L'abondance de données sur le TDA/H de l'enfant, en contraste avec la pauvreté des études françaises sur le trouble chez l'adulte, souligne l'importance d'apports spécifiques à cette population. Cette recherche s'inscrit dans une approche intégrative du TDA/H de l'adulte, réunissant une méthodologie quantitative à la fois catégorielle et dimensionnelle. Nous avons étudié la dimension impulsive du TDA/H, à travers les prévalences des comorbidités psychiatriques et addictives, les troubles du contrôle des impulsions, et l'aspect dimensionnel de deux traits de personnalité (impulsivité et recherche de sensations) chez des adultes présentant un Trouble Déficit de l'Attention avec ou sans Hyperactivité (TDA/H).Méthode : 199 adultes âgés entre 18 et 65 ans (m= 34.3 ans) issus de consultations psychiatriques spécialisées du TDA/H de l'adulte, ont été diagnostiqués (hétéroévaluation) par une approche à la fois catégorielle (DSM-IV-T-R) et dimensionnelle (ASRS-v1.1 ; CAARS ; WURS-61). Les 199 participants ont été répartis en deux groupes, en fonction de la forme présentée. A savoir, soit une forme inattentive prédominante (TDA/n=83), soit une forme mixte (TDAH/n=116). La prévalence de troubles psychiatriques et addictifs (MINI) et de troubles du contrôle des impulsions (MIDI) associés au TDA/H, a été évaluée dans les deux groupes. De plus, deux traits de personnalité, à savoir l'impulsivité (BIS-11 ; EIFD) et la recherche de sensations (ERS), ainsi que l'altération du fonctionnement global (WFIRS-SR) ont été évalués par le biais d'une approche dimensionnelle (autoévaluations). Résultats : Les résultats de prévalence des comorbidités ont conclu à une prépondérance des troubles de l'humeur (spécifiquement la dysthymie), et des troubles anxieux (spécifiquement l'anxiété généralisée). On relève par ailleurs, pour les troubles addictifs, des prévalences majoritaires de troubles du contrôle des impulsions (spécifiquement l'achat pathologique), suivies par les troubles liés à l'usage de substances psychoactives (spécifiquement l'abus d'alcool), et les troubles du comportement alimentaire (spécifiquement la boulimie). La catégorisation diagnostique distinguant les deux groupes, a conclu à l'absence de différence significative concernant la prévalence des comorbidités. Seule le nombre moyen de comorbidités addictives a distingué les deux groupes (TDAH > TDA). Concernant les traits de personnalité, impulsif, et de recherche de sensations, si les deux groupes ont montré des profils dimensionnels parallèles, les scores des TDAH ont tous été significativement supérieurs à ceux des TDA. Même constat pour les niveaux d'altération du fonctionnement, qui bien que comparables au vu de la nature des dimensions altérées, ont tous été supérieurs pour les TDAH (vs TDA).Conclusion : L'impulsivité définit le TDA/H, et les manifestations impulsives inhérentes au trouble, s'apprécient au travers des profils psychiatriques et addictifs, mais également au travers des profils de personnalité. / Introduction: Attention Deficit/Hyperactivity Disorder (ADH/D) still remains controversial in France, leading to a misreading of the disorder, a lack of diagnosis, and treatment, despite the considerable impacts in patients' life, psychological as well as functional. If AD/HD is recognized in children, the lack of studies in adults needed an input of new perspectives, especially in the psychological and psychopathological fields.We focused on the impulsive dimension of AD/HD, by evaluating psychiatric and additive comorbidities, two personality dimensions (Impulsivity and Sensation Seeking), and levels of functioning impairments in several dimensions, among adults, presenting an Attentional Disorder with or without Hyperactivity. Method: 199 respondents aged between 18 and 65 (mean= 34.3 years), coming from psychiatric consultations specialized in adult ¿AD/HD, received diagnosis of AD/HD (ASRS-v1.1; CAARS; WURS-61) and were classified in two groups depending on the form of disorder presented, either ADHD or just AD. The two groups, ADHD (n=116) and AD (n=83) were evaluated for the prevalence of psychiatric and addictive comorbidities, including impulse control disorders (MINI, MIDI), personality dimensions (BIS-11; FIDI; SSS) and functioning impairment level (WFIRS-RS). Our procedure allowed both categorial and dimensional assessments of AD/HD diagnosis. Results: We found as majority psychiatric comorbidities, mood disorders (specifically dysthymia), anxiety disorders (specifically generalized anxiety), and impulse control disorders (pathological buying) among the additive comorbidities. No significant difference was found in terms of prevalence between the two groups. In addition, the personality dimensions (impulsivity and sensation seeking) and the functioning impairment levels (7 dimensions) were all significantly higher for the ADHD group (vs AD group). However, all the respondents displayed identical score profiles in the two groups, concluding that, only the intensity levels of impulsivity, sensation seeking and impairment functioning, discriminate the two groups.Conclusion: Impulsivity is the core manifestation of AD/HD, appearing through high prevalence of psychiatric comorbidities (through mood lability and pathological anxiety) addictive disorders (whether related to psychoactive drugs or behaviors), as well as impulsive personality trait, and some functional impairments (specifically those related to daily life skills). Our procedure shows that a dimensional evaluation of AD/HD diagnosis should always complete a categorial one, in order to evaluate the extent of the impulsive dimension in AD/HD. This study provides first data on psychological and psychopathological profiles of French AD/HD adults and future researches are needed to complete these data.

Alcohol use disorders are a major health problem in the United States; approximately 7.4% of the population meets the criteria for alcohol abuse or dependence. However, Reed, Levin, and Evans (2012) reported a lack in research regarding alcoholism's risk factors and how these influence Alcoholics Anonymous involvement. Though there is evidence for several risk factors, researchers have found mixed results regarding gender and impulsivity. Social learning theory was the theoretical foundation of this study and guided the exploration and interpretation of these risk factors. Therefore, the purpose of this quantitative, nonexperimental study was to understand the relationship that impulsivity (as measured from the Barratt Impulsiveness Scale-15) and gender contribute to involvement (as measured by the Alcoholics Anonymous Involvement scale), as well how impulsivity may moderate gender-based differences. Based on this goal, the target population included individuals who have been a part of the Alcoholics Anonymous program in an urban location in a Western state. This study followed a purposive sampling procedure to target this population, which resulted in a final sample of 136 participants. A series of analyses including chi squares, t-tests, and an ANCOVA did not provide any evidence that involvement depended on gender or impulsivity. This study provides a better understanding of how gender and impulsivity influence attendance and will enhance intervention practices and improve outcomes for people suffering from alcohol addiction. By increasing knowledge on Alcoholics Anonymous involvement, and why it works for some and not for others, the study provides support for professionals, families, and communities involved with participants of the program.

Indiana University-Purdue University Indianapolis (IUPUI) / Increased delay discounting (DD) has been associated with and is theorized to contribute to alcoholism and substance abuse. It is also been associated with numerous other mental disorders and is believed to be a trans-disease process (i.e., a process that occurs in and contributes to multiple different pathologies). Consequently insights gained from studying DD are likely to apply to many different diseases. Studies on the neurobiological underpinnings of DD have two main interpretations. The first interpretation is that two different neurobehavioral systems exist, one favoring delayed rewards (executive system) and one favoring immediate rewards (impulsive system), and the system with the greater relative activation determines choice made by an individual. Alternatively, a single valuation system may exist. This system integrates different information about outcomes and generates a value signal that then guides decision making. Preclinical investigations have steered clear of these two different interpretations and rather focused on the role of individual structures in DD. One such structure, the rat mPFC, may generate an outcome representation of delayed rewards that is critically involved in attributing value to delayed rewards. Moreover, there is evidence indicating the rat mPFC may correspond to the primate dlPFC, an executive system structure. The current body of work set about testing the hypotheses that the mPFC is necessary for attributing value to delayed rewards and that decreasing the activity in an executive system area, and thus the executive system, shifts inter-temporal preference towards immediate rewards. To this end the rat mPFC was inactivated using an hM4Di inhibitory designer receptor exclusively activated by designer drugs (DREADD; experiment 1) or microinjections of tetrodotoxin (TTX; experiment 2) while animals completed an adjusting amount DD task. Activation of the hM4Di inhibitory DREADD receptor caused a decrease in DD, opposite of what was predicted. Electrophysiological recordings revealed a subpopulation of neurons actually increased their firing in response to hM4Di receptor activation, potentially explaining the unpredicted results. Microinjections of TTX to completely silence neural activity in the mPFC failed to produce a change in DD. Together both results indicate that mPFC activity is capable of manipulating but is not necessary for DD and the attribution of value to the delayed reward. Consequently, a secondary role for the rat mPFC in DD is proposed in line with single valuation system accounts of DD. Further investigations determining the primary structures responsible for sustaining delayed reward valuation and how manipulating the mPFC may be a means to decrease DD are warranted, and continued investigation that delineates the neurobiological processes of delayed reward valuation may provide valuable insight to both addiction and psychopathology.

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