The state-trait disjunction of anhedonia in schizophrenia: Potential affective, cognitive and social-based mechanisms

Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia

Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max- 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.

Childhood Neglect rather than Abuse Is More Strongly Associated with Anhedonia across Major Depression and Obsessive-Compulsive Disorder Patients and University Students

Background. According to the dimensional model of adversity, the deprivation and threat dimensions of CT influence distinct neural circuits and have different developmental outcomes. The present study compared neglect and abuse subtypes which are representative of deprivation and threat dimensions of CT prediction of anhedonia in MDD and OCD patients and university students. Methods. A total of 305 patients with MDD, 152 patients with OCD, and 2110 university students fulfilled the Childhood Trauma Questionnaire to identify neglect and abuse subtypes of CT. Different aspects of anhedonia were measured. Hierarchical linear regression analysis was conducted to identify subtypes of trauma as predictors of different aspects of anhedonia in MDD and OCD patients and university students, respectively. Results. Childhood neglect, not abuse, showed association with anticipatory and state anhedonia in OCD patients and anticipatory, consummatory, physical, and state anhedonia in MDD patients and university students. Both childhood neglect and abuse were associated with social anhedonia in university students, but the neglect type showed greater magnitude. In terms of more specific categories, emotional neglect was the type of CT demonstrating strongest magnitude of association with most of the anhedonia aspects. Conclusions. Findings revealed that deprivation, rather than threat, was the more influential adversity dimension for the individuals’ anhedonia presentations.

How processing emotion affects language control in bilinguals

Research has shown that several variables affect language control among bilingual speakers but the effect of affective processing remains unexplored. Chinese-English bilinguals participated in a novel prime-target language switching experiment in which they first judged the affective valence (i.e., positive or negative) of auditorily presented words and then named pictures with neutral emotional valence in either the same (non-switch trial) or different language (switch trial). Brain activity was monitored using functional magnetic resonance imaging (fMRI). The behavioral performance showed that the typical switch cost (i.e., the calculated difference between switch and non-switch trials) emerged after processing positive words but not after negative words. Brain imaging demonstrated that processing negative words immediately before non-switch picturing naming trials (but not for switch trials) increased activation in brain areas associated with domain-general cognitive control. The opposite patterns were found after processing positive words. These findings suggest that an (emotional) negative priming effect is induced by spontaneous exposure to negative words and that these priming effects may be triggered by reactive emotional processing and that they may interact with higher level cognitive functions.

Anticipated Pleasure and Displeasure for Future Social and nonsocial Events: A Scale Development Study

Background and Hypothesis

People with schizophrenia (SCZ) or schizotypal traits (ST) have difficulties in anticipating future pleasure and displeasure in social situations. However, no self-report scale has been developed to specifically capture these abilities. This study aimed to develop and validate the Social Affective Forecasting Scale (SAFS), and to examine how anticipated pleasure and displeasure are associated with ST and clinical symptoms in SCZ.

Study Design

Study 1 recruited a main sample of 666 college students and a validation sample of 927 college students to complete the SAFS and other measurements for anhedonia. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), parallel analysis, and measurement invariance analysis were conducted. Study 2 recruited 2655 college students, 47 people with SCZ and 47 matched controls to complete the SAFS. Correlation analysis, regression analysis, and independent t-tests were performed.

Study Results

Both EFA and CFA indicated a 4-factor model which was supported by parallel analysis in the validation sample. The SAFS showed good internal consistency, convergent validity, and strong invariance across sex. Interpersonal features of ST and negative symptoms in SCZ were associated with reduced anticipated pleasure for positive social events.

Conclusions

The SAFS appears to be a reliable scale for evaluating anticipated pleasure and displeasure for future social and nonsocial events, and can be applied to study social anhedonia in individuals with ST and individuals with SCZ.

Two Factors, Five Factors, or Both? External Validation Studies of Negative Symptom Dimensions in Schizophrenia

OBJECTIVES

Negative symptom studies frequently use single composite scores as indicators of symptom severity and as primary endpoints in clinical trials. Factor analytic and external validation studies do not support this practice but rather suggest a multidimensional construct. The current study used structural equation modeling (SEM) to compare competing dimensional models of negative symptoms to determine the number of latent dimensions that best capture variance in biological, psychological, and clinical variables known to have associations with negative symptoms.

METHODS

Three independent studies (total n = 632) compared unidimensional, two-factor, five-factor, and hierarchical conceptualizations of negative symptoms in relation to cognition, psychopathology, and community functioning (Study 1); trait emotional experience and defeatist performance beliefs (Study 2); and glutamate and gamma-aminobutyric acid levels in the anterior cingulate cortex quantified using proton magnetic resonance spectroscopy (Study 3).

RESULTS

SEM favored the five-factor and hierarchical models over the unidimensional and two-factor models regardless of the negative symptom measure or external validator. The five dimensions-anhedonia, asociality, avolition, blunted affect, and alogia-proved vital either as stand-alone domains or as first-order domains influenced by second-order dimensions-motivation and pleasure and emotional expression. The two broader dimensions sometimes masked important associations unique to the five narrower domains. Avolition, anhedonia, and blunted affect showed the most domain-specific associations with external variables across study samples.

CONCLUSIONS

Five domains and a hierarchical model reflect the optimal conceptualization of negative symptoms in relation to external variables. Clinical trials should consider using the two dimensions as primary endpoints and the five domains as secondary endpoints.

Attentional processing biases to threat in schizophrenia: Evidence from a free-viewing task with emotional scenes

Attentional biases to threatening stimuli have been suggested to play a key role in the onset and course of schizophrenia. However, current research has not completely demonstrated this assumption. The aim of this eye-tracking study was to shed light on the underlying psychological mechanisms of schizophrenia by examining the attentional processing of socio-emotional information. Forty-four individuals with schizophrenia and 47 healthy controls were assessed in a 3-s free-viewing task with a social scene (i.e., happy, threatening, or neutral) in competition with a non-social one to determine the effects of emotional information on the different stages of the attentional processing. The location and latency of initial fixations (i.e., initial orienting), the firs-pass fixations and gaze duration (i.e., attentional engagement), and the percentage of total duration and total fixations (i.e., attentional maintenance) were analyzed. It was found that the schizophrenia group showed longer first-pass gaze duration, as well as higher percentage of total fixations and total duration toward threatening scenes in relation to the non-social ones, compared to controls. Therefore, an attentional bias toward threatening scenes in schizophrenia was found in the attentional maintenance and engagement, but not in the initial orienting of attention. Of note, the threat-related attentional bias was not associated with positive symptoms of schizophrenia. These findings offer empirical support to affective-information processing models stating that threatening information may confer psychological vulnerability to develop schizophrenia. Moreover, the results can improve psychological treatments, such as attentional bias modification paradigms or cognitive-behavior interventions managing maladaptive schemas related to threat.

Momentary Manifestations of Negative Symptoms as Predictors of Clinical Outcomes in People at High Risk for Psychosis: Experience Sampling Study

BACKGROUND

Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet.

OBJECTIVE

This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR.

METHODS

Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups.

RESULTS

Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=-4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=-0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005).

CONCLUSIONS

Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis.

Elucidating negative symptoms in the daily life of individuals in the early stages of psychosis

BACKGROUND

It remains poorly understood how negative symptoms are experienced in the daily lives of individuals in the early stages of psychosis. We aimed to investigate whether altered affective experience, anhedonia, social anhedonia, and asociality were more pronounced in individuals with an at-risk mental state for psychosis (ARMS) and individuals with first-episode psychosis (FEP) than in controls.

METHODS

We used the experience sampling methodology (ESM) to assess negative symptoms, as they occurred in the daily life of 51 individuals with FEP and 46 ARMS, compared with 53 controls.

RESULTS

Multilevel linear regression analyses showed no overall evidence for a blunting of affective experience. There was some evidence for anhedonia in FEP but not in ARMS, as shown by a smaller increase of positive affect (BΔat-risk v. FEP = 0.08, p = 0.006) as the pleasantness of activities increased. Against our expectations, no evidence was found for greater social anhedonia in any group. FEP were more often alone (57%) than ARMS (38%) and controls (35%) but appraisals of the social situation did not point to asociality.

CONCLUSIONS

Overall, altered affective experience, anhedonia, social anhedonia and asociality seem to play less of a role in the daily life of individuals in the early stages of psychosis than previously assumed. With the experience of affect and pleasure in daily life being largely intact, changing social situations and appraisals thereof should be further investigated to prevent development or deterioration of negative symptoms.

Childhood trauma is associated with elevated anhedonia and altered core reward circuitry in major depression patients and controls

Childhood trauma (CT) is a well-established risk factor for major depressive disorder (MDD). However, the underlying mechanism linking CT and MDD remains not fully understood. The present study tested the hypothesis that CT have effects on specific types of anhedonia in depression via reward system. To do so, we evaluated different aspects of anhedonia and resting-state functional connectivity (FC) in reward system among 66 patients with MDD (44 with moderate-to-severe and 22 with no or low CT), and 57 healthy controls (HC; 23 with moderate-to-severe and 34 with no or low CT). Results showed that MDD patients with moderate-to-severe CT suffered more severe state anhedonic depression than patients with no or low level of CT. Individuals with moderate-to-severe CT, irrespective of MDD diagnosis, had elevated physical, social and anticipatory but not consummatory trait anhedonia, and demonstrated decreased left nucleus accumbens (NAcc)-right orbital frontal cortex (OFC) and left ventral caudate-left OFC connectivity compared to those with no or low exposure. Left NAcc-right OFC connectivity mediated relationship between CT and state anhedonia in MDD. The total altered ventral striatum (VS)-OFC connectivity mediated links between CT and physical trait anhedonia in HC. These findings highlight specific types of anhedonia and the core reward system as targets of CT. Blunted hedonic responses via decreased coupling within core reward system may be involved in the mechanism of depression following CT. Implications for clinical interventions are also discussed.

Altered hippocampal-prefrontal functional network integrity in adult macaque monkeys with neonatal hippocampal lesions

The dorsolateral prefrontal cortex (DLPFC) and ventral lateral prefrontal cortex (VLPFC) play critical but different roles in working memory (WM) processes. Resting-state functional MRI (rs-fMRI) was employed to investigate the effects of neonatal hippocampal lesions on the functional connectivity (FC) between the hippocampus (H) and the DLPFC and VLPFC and its relation to WM performance in adult monkeys. Adult rhesus monkeys with neonatal H lesions (Neo-H, n = 5) and age- and gender-matched sham-operated monkeys (Neo-C, n = 5) were scanned around 10 years of age. The FC of H-DLPFC and H-VLPFC in Neo-H monkeys was significantly altered as compared to controls, but also switched from being positive in the Neo-C to negative in the Neo-H. In addition, the altered magnitude of FC between right H and bilateral DLPFC was significantly associated with the extent of the hippocampal lesions. In particular, the effects of neonatal hippocampal lesion on FC appeared to be selective to the left hemisphere of the brain (i.e. asymmetric in the two hemispheres). Finally, FC between H and DLPFC correlated with WM task performance on the SU-DNMS and the Obj-SO tasks for the control animals, but only with the H-VLPFC and SU-DNMS task for the Neo-H animals. In conclusion, the present rsfMRI study revealed that the neonatal hippocampal lesions significantly but differently altered the integrity in the functional connectivity of H-DLPFC and H-VLPFC. The similarities between the behavioral, cognitive and neural alterations in Neo-H monkeys and Schizophrenia (SZ) patients provide a strong translational model to develop new therapeutic tools for SZ.

Role for Positive Schizotypy and Hallucination Proneness in Semantic Processing

Semantic processing underpins the organization of verbal information for both storage and retrieval. Deficits in semantic processing are associated with both the risk for and symptoms presented in schizophrenia. However, studies are mixed and could reflect the confounding effects of medication and symptom heterogeneity. Therefore, we considered whether two risk phenotypes, positive schizotypy and hallucinatory predisposition, present in the general population were associated with differential responding profiles for a semantic processing task. One hundred and eighty-three participants completed the Schizotypal Personality Questionnaire, Launay-Slade Hallucination Scale, National Adult Reading Test, a handedness measure, and a computerized semantic relatedness judgment task. Pairs of words were related through their dominant or subordinate meanings, or unrelated. Participants were divided into four groups using a mean split on cognitive-perceptual (positive) schizotypy and hallucination proneness. Significant differences between groups were found for reaction time on the semantic relatedness task, with the high cognitive-perceptual schizotypy groups responding significantly slower to all word pairs compared to their low scoring counterparts. There was some evidence that high hallucination proneness was associated with significantly faster reaction times which may reflect disinhibitive processes, however additional support is required. The results suggest that these two components of psychosis risk are associated with different patterns of responding to semantic processing. More diffuse activation of semantic information appeared to be associated with positive schizotypy, while those predisposed to hallucinations appeared to respond quicker. These results have significant implications in the re-conceptualization of hallucination proneness as distinct from positive schizotypy. Additional research is required to investigate the association between psychotic-like experiences separate from personality variables such as positive schizotypy and semantic processing.

Body and Social Anhedonia of Depression: A Bifactor Model Analysis

The purpose of this study was to develop a statistical model of anhedonia of depression. The study included 748 healthy controls (350 women, 46.79%, age 21.27 ± 4.72) and 80 patients (32 women, 40%, age 38.36 ± 16.42). The Physical Anhedonia Scale (PhAS), the Social Anhedonia Scale (CSAS), the Positive and Negative Affect Scale (PANAS) and the Beck Depression Inventory(BDI) were administered. Classical Measurement Theory (CTT) and Item Response Theory (IRT) were applied to the collected data. We observed that the general factor of depression status was significantly related with positive emotion (r = -0.37, P < 0.05), negative emotion (r = 0.62, P < 0.05) and BDI (r = 0.48, P < 0.01). A significant difference also was observed between controls and patients. The bifactor model of anhedonia of depression provided a better fit to the data than a unidimensional model. The bifactor model appears to be useful to describe anhedonia in depression.

A meta-analysis of self-reported anticipatory and consummatory pleasure in the schizophrenia-spectrum

OBJECTIVE

Recent conceptual frameworks propose anhedonia reflects abnormalities in the temporal dynamics of positive emotion in schizophrenia, characterized by intact consummatory and impaired anticipatory pleasure. A comprehensive meta-analysis can directly test this theory using self-report data.

METHOD

A meta-analysis was performed on studies reporting Temporal Experience of Pleasure Scale (TEPS) data from healthy controls and schizophrenia or schizotypy groups. The TEPS was examined as it contains subscales to measure both consummatory and anticipatory pleasure separately. Statistical heterogeneity and study bias were examined. Meta-regressions evaluated moderators.

RESULTS

53 studies were retrieved (7,797 participants). Results revealed small effect sizes for comparisons of combined schizophrenia/schizotypy and control groups for both consummatory and anticipatory pleasure. Within-group comparisons of pleasure conditions were nonsignificant. The percentage of male schizophrenia/schizotypy participants significantly moderated anticipatory and consummatory pleasure for the combined sample and schizotypy alone; male participants were found to report reduced pleasure. There was only minor evidence of bias; sensitivity analysis confirmed result robustness. Exploratory outlier removal for schizophrenia within-group pleasure comparisons revealed a statistically significant difference between reported anticipatory and consummatory pleasure, with consummatory pleasure reduced relative to anticipatory (i.e., in the opposite direction of the majority of experimental research findings).

CONCLUSIONS

These findings provided only modest support for the temporal dynamics of positive emotion conceptualization because they revealed no evidence for: 1) specific anticipatory pleasure deficits in schizophrenia-spectrum participants compared to controls; 2) significant reductions in anticipatory pleasure relative to consummatory pleasure in schizophrenia-spectrum participants.

Revisiting anticipatory hedonic processing in patients with schizophrenia: An examination between representation activation and maintenance

BACKGROUND

Anticipatory anhedonia is one of the key deficits found in patients with schizophrenia (SCZ). However, the underlying mechanism of this deficit remains unclear. The present study examined whether representation activation and maintenance capacity influenced anticipatory experiences in SCZ patients.

METHODS

We recruited 46 SCZ patients (26 males) and 45 matched healthy controls (24 males). The Reward Representation Activation and Maintenance (RRAM) Task was administrated to assess anticipatory experience and representation activation and maintenance capacity.

RESULTS

SCZ patients exhibited lower subjective arousal than controls in anticipation of rewards with high probability when representation activation and maintenance were difficult to accomplish. SCZ patients also tended to reduce their button presses more than HC when they were required to maintain reward representation.

CONCLUSIONS

Our findings suggest that representation activation and maintenance may partially account for anticipatory anhedonia observed in SCZ patients.

Network structure of anticipatory pleasure and risk features: Evidence from a large college sample

Investigating the relationship between anticipatory pleasure deficits and risk features of mental disorders not only theoretically benefits the understanding of anhedonia, but could also facilitate early detection and intervention of mental disorders. Using network analysis, the present study examined the pattern of relationship between anticipatory pleasure and risk features of schizophrenia spectrum, depressive, anxiety, autism spectrum, and obsessive-compulsive disorders in a large sample of college students (n = 2152). It was found that interpersonal features of schizotypal personality traits and poor social skills of autistic traits showed strong correlation with low social anticipatory pleasure. Depressive symptoms severity was weakly associated with reduced abstract anticipatory pleasure, while obsessive-compulsive traits were weakly associated with high contextual anticipatory pleasure. No significant correlation was found between anxiety symptoms severity and anticipatory pleasure. Social anticipatory pleasure had the highest strength centrality among all anticipatory pleasure components, while interpersonal features of schizotypal personality traits had the highest strength centrality in the whole network. Our findings suggest that impaired anticipatory pleasure, especially social anticipatory pleasure, is a particular feature of schizotypal personality traits and autistic traits. Our findings may have implications for intervention in that the social component may be a target to improve anhedonia in individuals with schizotypal and autistic traits, while interpersonal features may be a key treatment target given that it was central to the relationship between anticipatory pleasure and risk features.

Trait emotional experience in individuals with schizophrenia and youth at clinical high risk for psychosis

BACKGROUND

Disturbances in trait emotions are a predominant feature in schizophrenia. However, less is known about (a) differences in trait emotion across phases of the illness such as the clinical high-risk (CHR) phase and (b) whether abnormalities in trait emotion that are associated with negative symptoms are driven by primary (i.e. idiopathic) or secondary (e.g. depression, anxiety) factors.

AIMS

To examine profiles of trait affective disturbance and their clinical correlates in individuals with schizophrenia and individuals at CHR for psychosis.

METHOD

In two studies (sample 1: 56 out-patients diagnosed with schizophrenia and 34 demographically matched individuals without schizophrenia (controls); sample 2: 50 individuals at CHR and 56 individuals not at CHR (controls)), participants completed self-report trait positive affect and negative affect questionnaires, clinical symptom interviews (positive, negative, disorganised, depression, anxiety) and community-based functional outcome measures.

RESULTS

Both clinical groups reported lower levels of positive affect (specific to joy among individuals with schizophrenia) and higher levels of negative affect compared with controls. For individuals with schizophrenia, links were found between positive affect and negative symptoms (which remained after controlling for secondary factors) and between negative affect and positive symptoms. For individuals at CHR, links were found between both affect dimensions and both types of symptom (which were largely accounted for by secondary factors).

CONCLUSIONS

Both clinical groups showed some evidence of reduced trait positive affect and elevated trait negative affect, suggesting that increasing trait positive affect and reducing trait negative affect is an important treatment goal across both populations. Clinical correlates of these emotional abnormalities were more integrally linked to clinical symptoms in individuals with schizophrenia and more closely linked to secondary influences such as depression and anxiety in individuals at CHR.

DECLARATION OF INTEREST

None.

Late electrophysiological potentials and emotion in schizophrenia: A meta-analytic review

INTRODUCTION

There is mixed evidence about emotional processing abnormalities in schizophrenia and schizoaffective disorder, with self-reports and clinician ratings indicating significant differences between patients and controls, but studies of in-the-moment, self-reported emotional experience finding only small differences between these groups. The current meta-analysis synthesizes statistics from studies measuring the P3 and LPP, two event-related potential (ERP) components sensitive to attentional allocation, to examine whether patients exhibit ERP response abnormalities to neutral and valenced visual stimuli.

METHODS

Standardized mean amplitudes and standard errors of P3 and/or LPP waveforms (300-2000 ms) in response to neutral and valenced images were calculated for 13 studies (total n = 339 individuals with schizophrenia, 331 healthy controls).

RESULTS

In response to neutral images, there were very small, non-significant differences in ERP amplitudes between patient and control groups (k = 9; Hedges' g = -0.06, 95% CI: -055, 0.43, p = 0.81). In contrast, patients showed a small, significant reduction in ERP amplitudes compared to controls in response to negative images (k = 13; Hedges' g = -0.32, 95% CI: -0.59, -0.05, p = 0.02) and a small, but nonsignificant, reduction in amplitudes in response to positive images (k = 7; Hedges' g = -0.27, 95% CI: -0.71, 0.18, p = 0.24).

CONCLUSIONS AND IMPLICATIONS

The current review indicates that compared to controls, patients have slightly diminished P3 and LPP amplitudes in response to positive and negative stimuli. This small reduction may reflect decreased attention allocation, possibly indicating an abnormality during a distinct stage of early processing related to evaluating the motivational salience of a stimulus.

Affective forecasting and accuracy in social anhedonia: Predicted and experienced emotion for a social interaction

OBJECTIVE

Previous research suggests people with social anhedonia (SocAnh) exhibit deficits in anticipated pleasure for social stimuli relative to controls. However, previous research has relied on hypothetical social stimuli and has focused on anticipated pleasure without examining negative affect.

METHOD

Participants were informed that they would complete an "enjoyable" sharing task with a peer and were asked to forecast positive and negative affect during the interaction. After the interaction, participants reported their experienced emotions.

RESULTS

We found SocAnh and controls anticipated and experienced similar levels of positive affect and that both groups underpredicted positive affect. The SocAnh group anticipated and experienced more negative affect than controls and was more accurate in forecasting negative affect.

CONCLUSION

This is the first study to show that SocAnh is associated with the heightened anticipation of negative affect and that experiencing heightened negative affect during social interactions could drive reduced motivation and desire to engage in future social interaction.

The subjective-objective deficit paradox in schizotypy extends to emotion regulation and awareness

There is an emerging subjective-objective deficit paradox in schizotypy. Individuals with schizotypy report severe subjective complaints in several key functional domains commensurate with that of individuals with schizophrenia. However, objective assessments of the same domains show relatively intact performance. We examined whether this subjective-objective deficit paradox extends to two closely linked affective processes: emotion regulation and awareness. Individuals with elevated social anhedonia (SocAnh; n = 61) and elevated perceptual aberration/magical ideation (PerMag; n = 73) were compared to control participants (n = 81) on subjective and objective measures of emotion regulation and awareness. Subjective measures included self-report questionnaires assessing regulatory ability, attention to emotion, and emotional clarity. Implicit emotion regulation was assessed by the Emotion Regulation-Implicit Association Test (ER-IAT) while objective emotional awareness was assessed by the Levels of Emotional Awareness Scale (LEAS), a performance-based test. Results showed that both SocAnh and PerMag groups reported notable deficits in almost all subjective measures relative to controls (composite ds > 0.55). In contrast, performance on ER-IAT and LEAS was very similar to controls (composite ds < 0.11). The current study suggests that the subjective-objective deficit paradox extends to emotion regulation and awareness, highlighting the importance of higher-order cognitive bias in understanding emotional abnormalities in schizotypy.

Anticipatory pleasure for future experiences in schizophrenia spectrum disorders and major depression: A systematic review and meta-analysis

OBJECTIVES

Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure.

METHODS

Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review.

RESULTS

A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders.

CONCLUSIONS

Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder.

PRACTITIONER POINTS

Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.

Emotional response in schizophrenia to the "36 questions that lead to love": Predicted and experienced emotions regarding a live social interaction

Evidence suggests that individuals with schizophrenia (SZ) report anticipatory pleasure deficits compared to controls and that these deficits are linked to decreased motivation to engage socially. However, these deficits have been identified via self-report measures of hypothetical pleasant stimuli, leaving it unclear whether they exist in reference to actual social situations. To address this issue, we created a live social interaction that minimized the reliance of higher-order cognitive processes. SZ and control participants were told that they would be playing an "enjoyable sharing game" with another study participant (who was actually a confederate) that involved asking and answering questions (36 interpersonal closeness generation questions; Aron et al., 1997). Participants then reported their current mood and the emotions they anticipated experiencing during the pleasant social interaction. Immediately following the interaction, they reported their experienced emotions. We found that the SZ group anticipated more negative emotion (d = 1.0), but were less accurate in forecasting negative emotion (d = .81), than controls, and these effects were large. There were small, non-significant group differences in anticipation, experience, and accuracy in forecasting of positive emotion (all ds < .29). Also, social anhedonia was positively correlated with anticipated negative affect and negatively associated with experienced positive emotion. At the same time, controls reported finding the interaction to be a more positive emotional experience overall, d = 0.75. This is the first study to show that "anticipatory pleasure deficits" in SZ might actually be heightened anticipated negative emotion and that inaccurate forecasting could be linked to decreased social motivation.

The valuation of social rewards in schizophrenia

Social impairment in schizophrenia is often thought to reflect poor social cognition. Here we examine responses to social rewards, an aspect of social functioning that is not featured prominently in the literature. The goal of this experiment was to explore whether people with schizophrenia (a) undervalue social rewards, and (b) whether the undervaluation of social rewards was related to motivation and pleasure deficits in schizophrenia and decreased social functioning. People with schizophrenia and healthy participants completed a game (Shore & Heerey, 2011) to explore preferences for different types of social (polite and genuine smiles) and nonsocial (monetary) rewards from computerized opponents. Preferences for reward types were quantified for each participant based on choice behavior during the game. Participants also completed a smile discrimination task to assess their ability to discriminate these types of smiles. Analyses revealed that people with schizophrenia (N = 41) treated genuine smiles as significantly less rewarding than did healthy participants (N = 29), despite showing a similar preference for monetary rewards. The undervaluation of social rewards was not related to the ability to discriminate between the smiles. The current findings provide preliminary evidence of reduced social reward valuation among individuals with schizophrenia, which may have implications for behavior in face-to-face social interactions. (PsycINFO Database Record

Aberrant Tendency of Noncurrent Emotional Experiences in Individuals at Ultra-High Risk for Psychosis

OBJECTIVE

This study aimed to investigate whether aberrant tendency of noncurrent emotion was present in individuals at ultra-high risk (UHR) for psychosis and to explore its associations with various clinical profiles.

METHODS

Fifty-seven individuals at UHR and 49 normal controls were enrolled. The tendency of experiencing noncurrent emotion was assessed using various noncurrent emotional self-reported formats, including trait [Neuroticism and Extraversion of the Eysenck Personality Questionnaire], hypothetical (Chapman's Revised Physical and Social Anhedonia Scales), and retrospective [AnhedoniaAsociality Subscale of the Scale for the Assessment of Negative Symptoms (SANS)] measures. Self-related beliefs (Self-Perception Scale), clinical positive and negative symptoms (SA Positive Symptoms and SANS), psychosocial function (Global Functioning Scale: Role Function and Global Functioning Scale: Social Function) were also examined.

RESULTS

Subjects at UHR for psychosis reported more trait unpleasant and less trait pleasant emotions, more hypothetical physical and social anhedonia, and more retrospective anhedonia than normal controls. In UHR, self-perception was correlated to trait unpleasant emotion and hypothetical physical and social anhedonia. Negative symptoms in UHR were associated with hypothetical physical anhedonia and retrospective anhedonia. Global social functioning was related to trait pleasant emotion, hypothetical physical and social anhedonia, and retrospective anhedonia. Neurocognitive function, positive symptoms, and global role functioning were not related with any noncurrent emotional experience measures in UHR.

CONCLUSION

These findings suggest that the aberrant tendency of noncurrent emotional experience may be present at the 'putative' prodromal phase and are grossly associated with self-related beliefs and psychosocial functioning but not neurocognitive functioning.

Anhedonia reflects impairment in making relative value judgments between positive and neutral stimuli in schizophrenia

Anhedonia (i.e., diminished capacity to experience pleasure) has traditionally been viewed as a core symptom of schizophrenia (SZ). However, modern laboratory-based studies suggest that this definition may be incorrect, as hedonic capacity may be intact. Alternative conceptualizations have proposed that anhedonia may reflect an impairment in generating mental representations of affective value that are needed to guide decision-making and initiate motivated behavior. The current study evaluated this hypothesis in 42 outpatients with SZ and 19 healthy controls (CN) who completed two tasks: (a) an emotional experience task that required them to indicate how positive, negative, and calm/excited they felt in response to a single emotional or neutral photograph; (b) a relative value judgment task where they selected which of 2 photographs they preferred. Results indicated that SZ and CN reported similar levels of positive emotion and arousal in response to emotional and neutral stimuli; however, SZ reported higher negative affect for neutral and pleasant stimuli than CN. In the relative value judgment task, CN displayed clear preference for stimuli differing in valence; however, SZ showed less distinct preferences for positive over neutral stimuli. Findings suggest that although in-the-moment experiences of positive emotion to singular stimuli may be intact in SZ, the ability to make relative value judgments that are needed to guide decision-making is impaired. Original conceptualizations of anhedonia as a diminished capacity for pleasure in SZ may be inaccurate; anhedonia may more accurately reflect a deficit in relative value judgment that results from impaired value representation.

Mediation effect of beliefs about pleasure and emotional experience between social anhedonia and prediction of pleasant events

Few studies have examined whether there is a relationship between social anhedonia and prediction of future events and the role of beliefs about pleasure and emotional experience. In this study, 513 college students were recruited to complete a set of self-reported questionnaires, including the Revised Social Anhedonia Scale (CSAS), the Temporal Experience of Pleasure Scale (TEPS), the Belief about Pleasure Scale (BAPS) and the Beck Depression Inventory. Moreover, a checklist of 100 daily life events was also administrated to all participants. Mediation analysis found that social anhedonia had a direct impact on prediction of pleasant events. Emotional experience partly mediated the relationship between social anhedonia and subjective prediction of pleasant events. However, beliefs about pleasure had no significant mediation effect between social anhedonia and prediction of pleasant events, but were shown to influence the subjective prediction of pleasant events completely through emotional experience. These findings suggest that beliefs about pleasure and emotional experience may be considered promising factors for interventions in individuals with anhedonia.

Neuroleptic-free youth at ultrahigh risk for psychosis evidence diminished emotion reactivity that is predicted by depression and anxiety

Although abnormalities in emotional response have long been considered a core feature of the chronic phase of schizophrenia, few investigations have examined emotional response in individuals at ultrahigh-risk (UHR) for psychosis. We investigated whether neuroleptic-free UHR (n=29) and healthy control (n=32) participants differed in emotional reactivity and emotion regulation on a laboratory-based task that required reporting levels of positive and negative affect to pleasant, unpleasant, and neutral stimuli. Results indicated that the UHR group evidenced reduced emotional reactivity, including decreased positive emotion to pleasant stimuli and decreased negative emotion to unpleasant stimuli. Furthermore, within the UHR group, attenuated positive emotion to pleasant stimuli was associated with greater severity of depression and anxiety. There were no group differences in self-reported emotion regulation effectiveness to unpleasant or pleasant stimuli. Findings suggest that UHR youth display a profile of emotional experience abnormalities that differs from the chronic phase of illness, which can be characterized as reduced positive emotion reactivity to pleasant stimuli (i.e., anhedonia) that may be driven by mood and anxiety symptoms.

Interaction between compound genetic risk for schizophrenia and high birth weight contributes to social anhedonia and schizophrenia in women

Schizophrenia is a highly heritable disease, but despite extensive study, its genetic background remains unresolved. The lack of environmental measures in genetic studies may offer some explanation. In recent Finnish studies, high birth weight was found to increase the risk for familial schizophrenia. We examined the interaction between a polygenic risk score for schizophrenia and high birth weight on social anhedonia and schizophrenia in a general population birth cohort. The study sample included 4223 participants from the 1966 Northern Finland Birth Cohort. As a replication sample we used 256 participants from a systematically collected sample of Finnish schizophrenia families. The polygenic risk score comprised of variants published in the large genome-wide meta-analysis for schizophrenia. We found the association between the polygenic risk score and social anhedonia stronger among those with high birth weight, and the same phenomenon was seen for schizophrenia among women, suggesting a gene-environment interaction. Similar results were found within the replication sample. Our results suggest a role for gene-environment interactions in assessing the risk of schizophrenia. Failure to take environmental effects into account may be one of the reasons why identifying significant SNPs for schizophrenia in genome-wide studies has been challenging.

Associations between anhedonia and marijuana use escalation across mid-adolescence

BACKGROUND AND AIMS

Anhedonia-a transdiagnostic psychopathological trait indicative of inability to experience pleasure-could lead to and result from adolescent marijuana use, yet this notion has not been tested. This study aimed to estimate the association of: (1) anhedonia at age 14 with rate of change in marijuana use over an 18-month follow-up, and (2) marijuana use at age 14 with rate of change in anhedonia over follow-up. Secondary aims were to test whether gender, baseline marijuana use history and peer marijuana use moderated these associations.

DESIGN

Observational longitudinal cohort repeated-measures design, with baseline (age 14 years), 6-month, 12-month and 18-month follow-up assessments.

SETTINGS

Ten public high schools in Los Angeles, CA, USA, 2013-15.

PARTICIPANTS

Students [n = 3394; 53.5% female, mean (standard deviation) age at baseline = 14.1 (0.42)].

MEASUREMENTS

Self-report level of anhedonia on the Snaith-Hamilton Pleasure Scale and frequency of marijuana use in the past 30 days.

FINDINGS

Parallel process latent growth curve models adjusting for confounders showed that baseline anhedonia level was associated positively with the rate of increase in marijuana use frequency across follow-ups [β, 95% confidence interval (CI) = 0.115 (0.022, 0.252), P = 0.03]. Baseline marijuana use frequency was not related significantly to the rate of change in anhedonia across follow-ups [β, 95% CI = -0.015 (-0.350, 0.321), P = 0.93]. The association of baseline anhedonia with faster marijuana use escalation was amplified among adolescents with (versus without) friends who used marijuana at baseline [β, 95% CI = 0.179 (0.043, 0.334) versus 0.064 (-0.071, 0.187), interaction P = 0.04], but did not differ by gender or baseline ever marijuana use.

CONCLUSIONS

In mid-adolescence, anhedonia is associated with subsequent marijuana use escalation, but marijuana use escalation does not appear to be associated with subsequent anhedonia.

Cognitive functioning in schizotypy through the lens of the accessibility model

INTRODUCTION

Individuals with schizotypy self-report subjective cognitive complaints commensurate with deficits reported by individuals with schizophrenia. In contrast to schizophrenia, objective deficits in memory are modest in individuals with schizotypy, as compared to their self-reported cognitive complaints. It has been proposed that abnormalities in semantic memory systems may underlie this dysjunction.

METHODS

This study employed a modified verbal memory paradigm in a sample of 87 individuals with psychometrically defined schizotypy. Appraisals of memory performance were evaluated across global (i.e. drawing on semantic memory systems and assessing perceived typical performance) and situation-specific (i.e. drawing on episodic memory systems) epochs. Objective memory performance was assessed using a verbal recall paradigm.

RESULTS

Individuals with schizotypy did not differ in situation-specific appraisals or in objective memory performance. Global appraisals of memory performance predicted negative and disorganised schizotypy scores. No other measure of memory performance predicted any facet of schizotypy. Individuals with schizotypy appraised their global memory performance higher than controls at a medium effect.

CONCLUSIONS

Higher order global appraisals of cognitive performance, subsumed within semantic networks, may be important in the subjective-objective paradox in schizotypy, suggesting the importance of considering demand characteristics when assessing measures of neurocognitive performance in individuals with schizotypy.

Visual memory uniquely predicts anhedonia in schizophrenia but not bipolar disorder

OBJECTIVE

Deficits in memory have been suggested as an influential mechanism of anhedonia, because while pleasant experiences may be enjoyed in-the-moment, the cognitive processes involved in reporting anticipated or remembered enjoyable experiences is thought to be impaired. This study will determine whether any aspects of memory, including visual memory, verbal memory or working memory, are significantly predictive of anhedonia in a sample of schizophrenia, psychotic bipolar disorder and healthy controls.

METHODS

The study included 38 individuals with schizophrenia, 19 individuals with bipolar disorder with psychosis, and 43 age-matched healthy controls. All participants completed a self-report social and physical anhedonia questionnaire along with a cognitive screening battery, which assessed the domains of attention/vigilance, working memory, verbal learning, visual learning, and reasoning and problem-solving.

RESULTS

Anhedonia scores were regressed onto domain scores to determine which areas of cognition uniquely predicted level of anhedonia in each group. For the schizophrenia group, physical anhedonia was significantly predicted by worse visual memory performance. The regression models did not find significant cognitive predictors of physical or social anhedonia in the bipolar disorder or control groups.

CONCLUSIONS

This study found a significant relationship between visual memory and physical anhedonia in schizophrenia patients that was not present in a sample of psychotic bipolar patients or healthy controls, adding to an accumulating body of evidence that visual memory is related to anhedonia in schizophrenia. This relationship may be explained by underlying abnormalities in the orbitofrontal cortex in schizophrenia.

[A history and overview of anhedonia in endogenous mental disorders]

Anhedonia is the inability to experience pleasure. This disorder is heterogeneous across psychiatric disorders and is difficult for measuring and submitting to scientific analysis. Over the last several decades there has been increasing interest in the role that anhedonia plays in various psychopathologies. This article reviews the recent literature on anhedonia and its psychopathological features, which are important for prognosis in affective disorders and schizophrenia. Attempts to dissect various subtypes of anhedonia observed in negative syndrome and depression are reviewed as well.

THE POSITIVITY OFFSET THEORY OF ANHEDONIA IN SCHIZOPHRENIA

Prior studies have concluded that schizophrenia patients are not anhedonic because they do not report reduced experience of positive emotion to pleasant stimuli. The current study challenged this view by applying quantitative methods validated in the Evaluative Space Model of emotional experience to test the hypothesis that schizophrenia patients evidence a reduction in the normative "positivity offset" (i.e., the tendency to experience higher levels of positive than negative emotional output when stimulus input is absent or weak). Participants included 76 schizophrenia patients and 60 healthy controls who completed an emotional experience task that required reporting the level of positive emotion, negative emotion, and arousal to photographs. Results indicated that although schizophrenia patients evidenced intact capacity to experience positive emotion at high levels of stimulus input, they displayed a diminished positivity offset. Reductions in the positivity offset may underlie volitional disturbance, limiting approach behaviors toward novel stimuli in neutral environments.

Attention and memory bias to facial emotions underlying negative symptoms of schizophrenia

INTRODUCTION

This study assessed bias in selective attention to facial emotions in negative symptoms of schizophrenia and its influence on subsequent memory for facial emotions.

METHODS

Thirty people with schizophrenia who had high and low levels of negative symptoms (n = 15, respectively) and 21 healthy controls completed a visual probe detection task investigating selective attention bias (happy, sad, and angry faces randomly presented for 50, 500, or 1000 ms). A yes/no incidental facial memory task was then completed. Attention bias scores and recognition errors were calculated.

RESULTS

Those with high negative symptoms exhibited reduced attention to emotional faces relative to neutral faces; those with low negative symptoms showed the opposite pattern when faces were presented for 500 ms regardless of the valence. Compared to healthy controls, those with high negative symptoms made more errors for happy faces in the memory task. Reduced attention to emotional faces in the probe detection task was significantly associated with less pleasure and motivation and more recognition errors for happy faces in schizophrenia group only.

CONCLUSIONS

Attention bias away from emotional information relatively early in the attentional process and associated diminished positive memory may relate to pathological mechanisms for negative symptoms.

[Negative symptoms, emotion and cognition in schizophrenia]

For a long time, treatment of schizophrenia has been essentially focussed on positive symptoms managing. Yet, even if these symptoms are the most noticeable, negative symptoms are more enduring, resistant to pharmacological treatment and associated with a worse prognosis. In the two last decades, attention has shift towards cognitive deficit, as this deficit is most robustly associated to functional outcome. But it appears that the modest improvement in cognition, obtained in schizophrenia through pharmacological treatment or, more purposely, by cognitive enhancement therapy, has only lead to limited amelioration of functional outcome. Authors have claimed that pure cognitive processes, such as those evaluated and trained in lots of these programs, may be too distant from real-life conditions, as the latter are largely based on social interactions. Consequently, the field of social cognition, at the interface of cognition and emotion, has emerged. In a first part of this article we examined the links, in schizophrenia, between negative symptoms, cognition and emotions from a therapeutic standpoint. Nonetheless, investigation of emotion in schizophrenia may also hold relevant premises for understanding the physiopathology of this disorder. In a second part, we propose to illustrate this research by relying on the heuristic value of an elementary marker of social cognition, facial affect recognition. Facial affect recognition has been repeatedly reported to be impaired in schizophrenia and some authors have argued that this deficit could constitute an endophenotype of the illness. We here examined how facial affect processing has been used to explore broader emotion dysfunction in schizophrenia, through behavioural and imaging studies. In particular, fMRI paradigms using facial affect have shown particular patterns of amygdala engagement in schizophrenia, suggesting an intact potential to elicit the limbic system which may however not be advantageous. Finally, we analysed facial affect processing on a cognitive-perceptual level, and the aptitude in schizophrenia to manipulate featural and configural information in faces.

Social Anhedonia Is Not Just Extreme Introversion: Empirical Evidence of Distinct Constructs

Social anhedonia and introversion, two closely related constructs associated with decreased positive emotions and decreased sociability, are common in schizophrenia-spectrum personality disorders. In light of a myriad of mixed findings regarding positive emotionality in anhedonia, there has been a call to reconceptualize "anhedonia." To clarify the nature of social anhedonia, we used confirmatory factor analysis to investigate the relationship between social anhedonia and introversion. Findings were consistent with the conceptualization of social anhedonia as a separate construct from introversion-the best fitting model was one in which social anhedonia and introversion measures loaded separately. Also consistent with the conceptualization of social anhedonia as separate, we found evidence that it was associated with aspects of alexithymia above and beyond any relationship with introversion. Overall, these results have implications for the understanding of social anhedonia and for the use of it as a discriminating factor between personality disorders characterized by introversion.

Social and nonsocial affective processing in schizophrenia - An ERP study

BACKGROUND

Despite social cognitive dysfunction that may be observed in patients with schizophrenia, the knowledge about social and nonsocial affective processing in schizophrenia is scant. The aim of this study was to examine neurophysiological and behavioural responses to neutral and negative stimuli with (faces, people) and without (animals, objects) social content in schizophrenia.

METHODS

Twenty-six patients with schizophrenia (SCZ) and 21 healthy controls (HC) completed a visual oddball paradigm with either negative or neutral pictures from the Nencki Affective Picture System (NAPS) as targets while EEG was recorded. Half of the stimuli within each category presented social content (faces, people).

RESULTS

Negative stimuli with social content produced lower N2 amplitude and higher mean LPP than any other type of stimuli in both groups. Despite differences in behavioural ratings and alterations in ERP processing of affective stimuli (lack of EPN differentiation, decreased P3 to neutral stimuli) SCZ were still able to respond to specific categories of stimuli similarly to HC.

CONCLUSIONS

The pattern of results suggests that with no additional emotion-related task demands patients with schizophrenia may present similar attentional engagement with negative social stimuli as healthy controls.

Event-related potentials (ERPs) and hemodynamic (functional near-infrared spectroscopy, fNIRS) as measures of schizophrenia deficits in emotional behavior

Recent research evidences supported the significant role of multimethodological neuroscientific approach for the diagnosis and the rehabilitative intervention in schizophrenia. Indeed both electrophysiological and neuroimaging measures in integration each other appear able to furnish a deep overview of the cognitive and affective behavior in schizophrenia patients (SPs). The aim of the present review is focused on the emotional dysfunctional response taking into account the multimeasures for emotional behavior, i.e., the event-related potentials (ERPs) and the hemodynamic profile functional near-infrared spectroscopy (fNIRS). These measures may be considered as predictive measures of the SPs' deficits in emotional behavior. The integration between ERP and fNIRS may support both the prefrontal cortical localization anomaly and the attentional bias toward some specific emotional conditions (mainly negative).

Functional neural correlates of social approval in schizophrenia

Social approval is a reward that uses abstract social reinforcers to guide interpersonal interactions. Few studies have specifically explored social reward processing and its related neural substrates in schizophrenia. Fifteen patients with schizophrenia and fifteen healthy controls participated in a two-part study to explore the functional neural correlates of social approval. In the first session, participants were led to believe their personality would be assessed based on their results from various questionnaires and an interview. Participants were then presented with the results of their supposed evaluation in the scanner, while engaging in a relevant fMRI social approval task. Subjects provided subjective reports of pleasure associated with receiving self-directed positive or negative feedback. Higher activation of the right parietal lobe was found in controls compared with individuals with schizophrenia. Both groups rated traits from the high social reward condition as more pleasurable than the low social reward condition, while intergroup differences emerged in the low social reward condition. Positive correlations were found in patients only between subjective ratings of positive feedback and right insula activation, and a relevant behavioural measure. Evidence suggests potential neural substrates underlying the cognitive representation of social reputation in schizophrenia.

Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: A systematic review

BACKGROUND

Anhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions.

OBJECTIVE

To review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia.

METHOD

Following PRISMA guidelines, PubMed and PsycInfo were searched using the terms "schizophrenia" and "anhedonia". Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct.

RESULTS

80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures.

CONCLUSIONS

Promising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development.

Anhedonia in schizophrenia: The role of subjective experiences

BACKGROUND

High levels of anhedonia have been found in patients with schizophrenia; specifically they report higher levels of social anhedonia rather than physical anhedonia, and further, in the anticipatory rather than consummatory facets of pleasure. Nonetheless, contrasting results emerged regarding the underlying mechanisms of this deficit. Basic Symptoms (BS) disturb subjective experiences present for most of the illness' course; this impacts patients' daily lives leading to a loss of the ability to organize the experience of the self and the world in a fluid and automatic way. Considering the role played by negative emotions in the subjective evaluation of anhedonia, the aim of the study is to clarify the role of BS in the assessment of anhedonia in a sample of patients with schizophrenia (n=53) compared with healthy controls (n=46).

METHODS

Participants completed a self-administered trait questionnaire evaluating social anhedonia (Revised-Social Anhedonia Scale), physical anhedonia (Physical Anhedonia Scale), and the consummatory and anticipatory pleasure experiences (Temporal Experience of Pleasure Scale). BS were evaluated with the Frankfurter Beschwerde-Frageboden (FBF) whereas psychopathology was assessed with the Positive and Negative Syndromes Scale.

RESULTS

Patients scored higher than healthy controls in social, physical and anticipatory anhedonia, but not in consummatory anhedonia and these relationships were mediated by the FBF. Basic Symptoms of Memory, Overstimulation and Lack of Automatism were related to some facets of anhedonia, independently from depressive symptoms.

CONCLUSIONS

We hypothesize that a subjective cognitive deficit and a reduced ability in information processing, could prevent patients from retaining a positive experience from past pleasant activities. Therefore the lack of pleasure would be, at least in part, related to an avoidance of potentially stressful new scenarios.

Predicting the future in schizophrenia: The discrepancy between anticipatory and consummatory pleasure

When predicting future emotions we use inaccurate biases which rely on our most salient and recent experiences. In schizophrenia, there appears to be a specific deficit in this anticipatory process which is associated with reduced motivation and engagement. The nature of this deficit and how it differs to the general population is unclear. This study introduces a new task examining the discrepancy between anticipated and experienced pleasure and investigates its potential usefulness to characterise the pleasure deficit in people with schizophrenia. Forty-eight healthy controls and 50 individuals with schizophrenia completed the Components of Pleasure Task (COP) which uses a range of images to generate anticipatory and experiential ratings. Participants also completed measures of mood and symptoms. Individuals with schizophrenia had a larger anticipatory-consummatory discrepancy score. This was due to under-anticipating highly pleasant stimuli and over-anticipating low pleasantness stimuli. People with schizophrenia are blunted compared to controls when anticipating stimuli, considering highly and lowly rated stimuli alike. A greater discrepancy between anticipated and experienced pleasure may contribute to negative symptoms such as poor motivation and social withdrawal. Reducing the discrepancy between experienced and anticipated pleasure may be a target for interventions aiming to reduce negative symptoms.

Anhedonia and the relative reward value of drug and nondrug reinforcers in cigarette smokers

Anhedonia-a psychopathologic trait indicative of diminished interest, pleasure, and enjoyment-has been linked to use of and addiction to several substances, including tobacco. We hypothesized that anhedonic drug users develop an imbalance in the relative reward value of drug versus nondrug reinforcers, which could maintain drug use behavior. To test this hypothesis, we examined whether anhedonia predicted the tendency to choose an immediate drug reward (i.e., smoking) over a less immediate nondrug reward (i.e., money) in a laboratory study of non-treatment-seeking adult cigarette smokers. Participants (N = 275, ≥10 cigarettes/day) attended a baseline visit that involved anhedonia assessment followed by 2 counterbalanced experimental visits: (a) after 16-hr smoking abstinence and (b) nonabstinent. At both experimental visits, participants completed self-report measures of mood state followed by a behavioral smoking task, which measured 2 aspects of the relative reward value of smoking versus money: (1) latency to initiate smoking when delaying smoking was monetarily rewarded and (2) willingness to purchase individual cigarettes. Results indicated that higher anhedonia predicted quicker smoking initiation and more cigarettes purchased. These relations were partially mediated by low positive and high negative mood states assessed immediately prior to the smoking task. Abstinence amplified the extent to which anhedonia predicted cigarette consumption among those who responded to the abstinence manipulation, but not the entire sample. Anhedonia may bias motivation toward smoking over alternative reinforcers, perhaps by giving rise to poor acute mood states. An imbalance in the reward value assigned to drug versus nondrug reinforcers may link anhedonia-related psychopathology to drug use.

Experiential pleasure deficits in different stages of schizophrenia

Prior research has found dampened anticipatory pleasure but relatively intact consummatory pleasure in people with first-episode and more chronic schizophrenia, but no study has examined anticipatory and consummatory pleasure across the schizophrenia spectrum. To confirm the factor structure of the Chinese version of the Temporal Experience Pleasure Scale (TEPS), which measures four components of anhedonia, we recruited 364 people with schizophrenia for confirmatory factor analysis. To examine anhedonia in people across the schizophrenia spectrum, we recruited people with first-episode (n=76) and chronic schizophrenia (n=45), people with schizotypal traits (n=210), first-degree relatives (n=45) of people with schizophrenia and healthy controls. Deficit in abstract anticipatory pleasure appeared to be most severe in people with chronic schizophrenia, while dampened abstract consummatory pleasure was observed in people with schizotypal personality features and in people with chronic schizophrenia. In addition, both abstract anticipatory and abstract consummatory pleasure were negatively correlated with negative schizotypal personality features and schizophrenia symptoms. Our results suggest that deficits in anticipatory pleasure are present across the schizophrenia spectrum, particularly in the abstract domain.

Evaluation of anhedonia with the Snaith-Hamilton Pleasure Scale (SHAPS) in adult outpatients with major depressive disorder

Anhedonia or inability to experience pleasure not only is a core symptom of major depressive disorder (MDD), but also is identified as an important component of the positive valence system in the NIMH Research Domain Criteria. The Snaith-Hamilton Pleasure Scale (SHAPS) has been developed for the assessment of hedonic experience or positive valence, but has not been well-studied in depressed outpatient populations. The current study examined the reliability and validity of the SHAPS using a sample of adult outpatients with treatment resistant MDD. Data for the current study were obtained from 122 adult outpatients with a diagnosis of MDD and non-response to adequate treatment with an SSRI and who participated in Project TReatment with Exercise Augmentation for Depression (TREAD). A Principal Components Analysis was used to define the dimensionality of the SHAPS. Convergent and discriminant validity were evaluated via correlations of the SHAPS total score with "gold standard" measures of depression severity and quality of life. The SHAPS was found to have high internal consistency (Cronbach's coefficient α = .82). A Principal Components Analysis suggests that the SHAPS is mainly "unidimensional" and limited to hedonic experience among adult outpatients with MDD. Convergent and discriminant validity were assessed by examining the Spearman rank-order correlation coefficient between the SHAPS total score and the HRSD17 (rs = 0.22, p < .03), IDS-C30 (rs = 0.26, p < .01), IDS-SR30 (rs = 0.23, p < .02), QIDS-C16 (rs = 0.22, p < .03), QIDS-SR16 (rs = 0.17, p < .10), QLES-Q (rs = -0.32, p < .002), and the pleasure/enjoyment item (sub-item 21) of the IDS-C (rs = 0.44, p < .0001) and IDS-SR (rs = 0.38, p < .0002). The self-administered SHAPS showed modest sensitivity (76%) and specificity (54%) with the self-administered pleasure/enjoyment single item (sub-item 21) of IDS-SR30. The current study shows that the SHAPS is a reliable and valid instrument to assess hedonic experience or positive valence in adult outpatients with MDD and provides a broader assessment of this important domain.

Measuring Anhedonia in Adolescents: A Psychometric Analysis

Anhedonia-the reduced capacity to experience pleasure-is a trait implicated in mental and physical health. Yet, psychometric data on anhedonia measures in adolescents are absent. We conducted an in-depth psychometric analysis of the Snaith-Hamilton Pleasure Scale (SHAPS; Snaith et al., 1995 )-a self-report measure of anticipated pleasure response to 14 pleasant experiences-in adolescents. Adolescents (N = 585, M age = 14.5) completed the SHAPS and other paper-and-pencil surveys. Item response theory models were used to evaluate the psychometric performance of each SHAPS item. Correlations of the SHAPS with other personality and psychopathology measures were calculated to evaluate construct validity. Results showed that (a) certain items (e.g., reported pleasure from basic experiences like "seeing smiling faces" or "smelling flowers") provided more information about latent anhedonia than others; and (b) SHAPS scales exhibited construct-consistent convergent and discriminant validity (i.e., stronger correlations with low positive affect constructs, weaker correlations with negative affect). Reporting diminished pleasure from basic pleasant experiences accurately indicates adolescent anhedonia, which is important for future scale development and understanding the phenomenology of anhedonia in teens. These data support using the SHAPS for assessing anhedonia in epidemiological research and school-based universal prevention programming in general adolescent populations.