- Patients with bulimia nervosa showed clinical improvement at follow-up, including reduced depressive symptoms and externally driven eating behaviour.
- Network-Based Statistic identified a 23-edge component with reduced functional connectivity at follow-up, primarily involving dorsal attention, ventral attention/salience, and somatomotor networks.
- Group by Time analysis showed greater connectivity decrease in patients versus controls (β = -0.053, p = 0.027), indicating treatment period network reconfiguration.
CNS Neurosci Ther. 2026 Sep;32(9):e71129. doi: 10.1002/cns.71129.
ABSTRACT
BACKGROUND: Fluoxetine is an established pharmacological intervention for bulimia nervosa (BN); however, the macroscopic functional network remodeling underlying its efficacy in suppressing eating impulsivity remains poorly understood.
METHODS: Fifty-eight patients with BN and 58 healthy controls assessed at both baseline and follow-up underwent resting-state functional magnetic resonance imaging (rs-fMRI). Network-Based Statistic (NBS) analysis with edgewise paired comparisons was used to identify whole-brain connectivity changes in patients with BN. The resulting BN-derived component was subsequently examined in both groups using a Group × Time analysis. Exploratory brain-behavior associations within BN were examined using Spearman and partial Spearman correlations.
RESULTS: During follow-up, patients with BN showed significant improvements in depressive symptoms and externally driven eating behavior. Within-group NBS analysis identified a 23-edge component showing reduced functional connectivity in BN at follow-up, with network-level family-wise error correction (p < 0.05). This component primarily involved dorsal attention, ventral attention/salience, and somatomotor networks. Whole-brain NBS analysis in healthy controls did not identify a significant longitudinal component. When mean connectivity of the BN-derived component was extracted in both groups, connectivity decreased more strongly in BN than in healthy controls (Group × Time β = -0.053, p = 0.027).
CONCLUSIONS: The follow-up period in patients with BN was accompanied by clinical improvement and reduced functional connectivity among attention-, salience-, and sensorimotor-related systems. These findings provide preliminary evidence of treatment-period-associated functional network reconfiguration in BN.
TRIAL REGISTRATION: ChiCTR2200066885.
PMID:42678299 | DOI:10.1002/cns.71129
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