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

Disentangling negative and positive symptoms in schizophrenia and autism spectrum disorder

Autism spectrum disorder (ASD) and schizophrenia (SZ) share traits, especially in social skills and negative symptoms, and to a lesser degree positive symptoms. Differential diagnosis can be challenging and discerning expressive and experiential negative symptoms may provide knowledge with potential diagnostic and functional relevance that can guide treatment. Two exploratory factor analyses (EFA) were conducted to reveal the underlying dimensions of negative and positive symptoms using the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms & Negative Symptoms (SAPS/SANS) and the Autism Diagnostic Observation Schedule-Generic (ADOS-G). Three factors emerged from the negative symptom EFA (70.5 % variance): NF1) Expressive Negative; NF2) Experiential Negative; and NF3) Preoccupation, Absorption & Expressive Affective Flattening. Three positive factors emerged (68.6 % variance): PF1) Hallucinations-Delusions; PF2) Grandiosity; and PF3) Thought Disorder-ADOS positive Symptoms. SZ showed higher PF1 scores, and ASD had higher PF3 scores. No differences between groups were observed in the negative factors. Across groups, all negative factors were inversely associated with quality of life. Only NF1 and NF2 and PF1 were detrimentally related to social functioning. A discriminant function analysis using all factors classified correctly 84.4 % of participants, with PF1, NF1 followed by NF2 being the best predictors of diagnosis. Expressive negative followed by Experiential negative symptoms are of diagnostic value independent of and beyond SZ-related positive symptoms and are related with detrimental functioning. Findings confirm the need to distinctively target negative symptoms, and specific SZ-related and ASD-related positive symptoms, and especially the use of several assessment tools for diagnostic classification.

Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure

BACKGROUND

The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants.

DESIGN

A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g.

RESULTS

Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure.

CONCLUSIONS

Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.

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.

Social affective forecasting and social anhedonia in schizophrenia-spectrum disorders: a daily diary study

Social anhedonia (SA) is a trait-like phenomenon observed across schizophrenia-spectrum disorders (SSDs). While in-the-moment social pleasure experiences are intact in SSDs, anticipatory pleasure experiences may be disrupted. Thus, the prediction of future emotions in social situations, or social affective forecasting (SAF), may play a role in SA. Therefore, we utilized daily diary methods to examine SAF in SSD and the association between SAF and SA in 34 SSD and 43 non-SSD individuals. SAF was calculated as the absolute difference between anticipatory and consummatory ratings of 13 positive and negative emotions for daily social interactions reported across eight days. Results suggest that individuals with SSDs are less accurate in forecasting negative, but not positive emotions, for future social interactions. Further, poorer forecasting accuracy of negative emotions were associated with elevated levels of SA and lower social pleasure. Together, these data suggest that inaccuracies in forecasting negative emotions may be a worthwhile intervention target for reducing SA in SSDs.

Mechanisms Underlying Motivational Dysfunction in Schizophrenia

Negative symptoms are a debilitating feature of schizophrenia which are often resistant to pharmacological intervention. The mechanisms underlying them remain poorly understood, and diagnostic methods rely on phenotyping through validated questionnaires. Deeper endo-phenotyping is likely to be necessary in order to improve current understanding. In the last decade, valuable behavioural insights have been gained through the use of effort-based decision making (EBDM) tasks. These have highlighted impairments in reward-related processing in schizophrenia, particularly associated with negative symptom severity. Neuroimaging investigations have related these changes to dysfunction within specific brain networks including the ventral striatum (VS) and frontal brain regions. Here, we review the behavioural and neural evidence associated with negative symptoms, shedding light on potential underlying mechanisms and future therapeutic possibilities. Findings in the literature suggest that schizophrenia is characterised by impaired reward based learning and action selection, despite preserved hedonic responses. Associations between amotivation and reward-processing deficits have not always been clear, and may be mediated by factors including cognitive dysfunction or dysfunctional or self-defeatist beliefs. Successful endo-phenotyping of negative symptoms as a function of objective behavioural and neural measurements is crucial in advancing our understanding of this complex syndrome. Additionally, transdiagnostic research–leveraging findings from other brain disorders, including neurological ones–can shed valuable light on the possible common origins of motivation disorders across diseases and has important implications for future treatment development.

Pain Avoidance and Its Relation to Neural Response to Punishment Characterizes Suicide Attempters with Major Depression Disorder

Diminished neural responses to punitive stimulus related to high level of pain avoidance may be biomarkers in distinguishing patients with history of suicide attempts from those without such histories. Outpatients with Major Depression Disorder (MDD, n=44) and healthy controls (HCs, n=28) were administered the Beck Depression Inventory-I (BDI-I), the Three-Dimensional Psychological Pain Scale (TDPPS), and the Beck Scale for Suicide Ideation (BSS), and then patients were allocated to two groups: suicide attempts (MDD-SA, n=12) and suicidal ideation (MDD-SI, n=32). All participants were required to complete the measurements and performed the Monetary Incentive Delay (MID) task with recording of electroencephalography synchronously. The MDD-SA group scored higher in the BDI-I, total TDPPS, pain avoidance subscale, and BSS-W scores than the MDD-SI and healthy control groups. Pain avoidance subscale scores had the highest correlations with SA than other inventory scores. The P3 elicited by negative feedback under punitive condition was significantly larger than those of reward and neutral conditions in the MDD-SA group, whereas no significant differences were found between the MDD-SI and HC groups. The P3 elicited by punitive and reward cues was negatively correlated to the total TDPPS and pain avoidance scores, and the P3 elicited by positive feedback in reward and punitive conditions was negatively correlated to the total TDPPS and painful feeing scores. Pain avoidance is a strong behavioral index in distinguishing suicide attempters from suicide ideators. The P3 patterns elicited by punitive cue and feedback may represent psychological pain processing which contribute to suicide act.

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.

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

Anticipatory pleasure for future rewards is attenuated in patients with schizophrenia but not in individuals with schizotypal traits

The anhedonia paradox is consistently observed in individuals with schizophrenia. However, the underlying mechanism of the dissociation between trait and state hedonic capacity remains unclear. In the present study, we aimed to re-examine anhedonia in patients with schizophrenia (SCZ) and individuals with high schizotypy (HS) using the Monetary Incentive Delay (MID) task to assess different dimensions of anticipatory and consummatory pleasure. We recruited 44 SCZ patients, 46 matched healthy controls (HC), 30 individuals with HS and 35 with low schizotypy (LS). The modified MID task was used to measure anticipatory and consummatory pleasure in terms of valence and arousal ratings. To measure the predictive value of anticipatory pleasure, participants were asked to predict their hedonic experience before the MID task. For SCZ patients, there was no significant Group main effect or Group × Prize interaction on consummatory pleasantness to reward received or loss avoidance. As expected, SCZ patients (particularly male patients) reported less pleasantness and arousal to future rewards in both the prediction and feeling dimensions compared with HC. Additionally, male patients reported less anticipatory and consummatory negativity than HC. Individuals with HS predicted more arousing experience to high-rewards than LS individuals. They also reported and predicted more negativity to in-the-moment and future monetary losses. Further, the negative dimension of schizotypy predicted low levels of pleasantness and arousal towards future rewards, but the positive dimension predicted increased arousing experience towards future rewards. In conclusion, the anhedonia paradox in schizophrenia could be partially accounted for by the dissociation between anticipatory and consummatory pleasure.

Exploring the relationship between the anticipation and experience of pleasure in people with schizophrenia: An experience sampling study

BACKGROUND

It has been hypothesised that a reduction in anticipatory pleasure contributes to reduced levels of functioning in people with schizophrenia. Previous research on anticipatory pleasure, however, reports mixed findings and has not yet examined the link between anticipatory pleasure and activity. The aim of this study is to examine how pleasure anticipation is related to difficulties engaging in activity in people with schizophrenia.

METHOD

A healthy control group (n = 44) and a group of individuals with schizophrenia (n = 36) completed an experience sampling study using portable devices. Participants rated motivation, mood, functional, leisure and social activity levels; anticipatory and consummatory pleasure seven times a day for six consecutive days. Multi-level regression models were constructed to examine the role of anticipatory pleasure and/or motivation in predicting future activities.

RESULTS

The findings showed no evidence for a motivation or pleasure deficit in people with schizophrenia. Yet, people with schizophrenia did fewer functional activities and spent more time "resting" or "doing nothing". In the control group, expectation was the only significant predictor of future activity. In contrast, none of the parameters assessed could predict experiences occurring in people with schizophrenia.

CONCLUSIONS

In contrast with controls people with schizophrenia did not show a link between their predictions and the activities they engaged in. This appears to be an important process influencing functioning in people with psychosis. Future interventions targeting reduced functioning should focus on reinforcing the link between pleasure anticipation and goal-directed behaviour.

Anhedonia in depression and schizophrenia: A transdiagnostic challenge

BACKGROUND

Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ).

AIMS

To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework.

METHODS

In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD. A literature search was conducted in OVID Medline, PsycINFO and EMBASE databases between 2000 and 2017.

RESULTS

While certain subgroups share commonalities, there are also important differences. SZ may be characterized by a disorganization, rather than a deficiency, in reward processing and cognitive function, including inappropriate energy expenditure and focus on irrelevant cues. In contrast, MDD has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience. Understanding the roles of neurotransmitters and aberrant brain circuitry is necessary to appreciate differences in reward function in SZ and MDD.

CONCLUSION

Anhedonia as a clinical presentation of reward circuit dysregulation is an important and relatively undertreated symptom of both SZ and MDD. In order to improve patient outcomes and quality of life, it is important to consider how anhedonia fits into both diagnoses.

Anticipated pleasure for positive and negative social interaction outcomes in schizophrenia

While recent research suggests that people with schizophrenia anticipate less pleasure for non-social events, considerably less is known about anticipated pleasure for social events. In this study, we investigated whether people with and without schizophrenia differ in the amount and updating of anticipated pleasure over the course of repeated interactions as well as the influence of emotional displays. Thirty-two people with schizophrenia and 29 controls rated their anticipated pleasure over the course of repeated interactions with smiling, scowling, or neutral social partners that had either positive or negative outcomes. Compared to controls, people with schizophrenia anticipated a lower amount of pleasure during interactions with smiling, but not neutral social partners that had positive outcomes. However, the groups did not differ in the amount or updating of anticipated pleasure during interactions that had negative outcomes. Both groups anticipated more pleasure over the course of repeated interactions with smiling partners and less pleasure over the course of repeated interactions with scowling partners compared to interactions with neutral partners. We discuss how less anticipated pleasure for interactions with smiling social partners may be linked to difficulties in social engagement among people with schizophrenia.

Investigating consummatory and anticipatory pleasure across motivation deficits in schizophrenia and healthy controls

Anhedonia has traditionally been considered a characteristic feature of schizophrenia, but the true nature of this deficit remains elusive. This study sought to investigate consummatory and anticipatory pleasure as it relates to motivation deficits. Eighty-four outpatients with schizophrenia and 81 healthy controls were administered the Temporal Experience of Pleasure Scale (TEPS), as well as a battery of clinical and cognitive assessments. Multivariate analyses of variance were used to examine the experience of pleasure as a function of diagnosis, and across levels of motivation deficits (i.e. low vs. moderate. vs. high) in schizophrenia. Hierarchical regression analyses were also conducted to evaluate the predictive value of amotivation in relation to the TEPS. There were no significant differences between schizophrenia and healthy control groups for either consummatory or anticipatory pleasure. Within the schizophrenia patients, only those with high levels of amotivation were significantly impaired in consummatory and anticipatory pleasure compared to low and moderate groups, and compared to healthy controls. Further, our results revealed that amotivation significantly predicts both consummatory and anticipatory pleasure, with no independent contribution of group. Utilizing study samples with a wide range of motivation deficits and incorporating objective paradigms may provide a more comprehensive understanding of hedonic deficits.

Confirmatory Factor Analysis of the French Version of the Anticipatory and Consummatory Interpersonal Pleasure Scale

The Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS), a measure specifically designed to assess hedonic capacity for social and interpersonal pleasure, was used to evaluate the presence of social anhedonia in patients as well as the general population. The first goal of this study was to validate the structure of the French version of the ACIPS. The second objective was to verify whether a one, two or three factor solution is most appropriate for the ACIPS scale. The French version of the ACIPS was tested on 263 French-speaking pre-graduate students or professional volunteers. For the confirmatory factor analysis, data were treated as categorical ordinal and all the models were estimated using a robust weighted least squares estimator with adjustments for the mean and variance. Three models were estimated. A one-factor model representing a general undifferentiated "pleasure" latent construct was first tested on the 17 ACIPS items. A two-factor model distinguishing anticipatory-pleasure and consummatory-pleasure was tested next. Finally, a three-factor model including subdomains of intimate social interactions, group social interactions, and social bonding was tested. The one and two-factor models showed a somewhat poor fit to the data. However, the goodness of fit of the three factor model was adequate. These results suggest that individuals who enjoyed interaction in one of these three subdomains were more likely to enjoy doing so in the two other domains. However, on the basis of the comparison between the one and three factor models, these three types of interactions may not be considered as indistinguishable. Rather, they represent distinct and theoretically meaningful dimensions. These results show the French version of the ACIPS is a useful and valid scale to measure the capacity of savoring different kinds of social relationships.

Implication of reward alterations in the expression of negative symptoms in 22q11.2 deletion syndrome: a behavioural and DTI study

BACKGROUND

Alterations of the reward system have been proposed as one of the core mechanisms underlying the expression of negative symptoms in schizophrenia. Specifically, deficits in specific reward components and white matter (WM) integrity of the reward system have been highlighted. The putative link between negative symptoms and the hedonic experience, or structural connectivity of the reward system has never been examined in the 22q11.2 deletion syndrome (22q11DS), a condition with increased risk for psychosis.

METHOD

Anticipatory and consummatory dimensions of pleasure were assessed in participants with 22q11DS (N = 54) and healthy controls (N = 55). In patients with 22q11DS, the association between pleasure scores and positive or negative symptoms was investigated. Furthermore, WM integrity of the accumbofrontal tract was quantified using diffusion tensor imaging (DTI). Associations between DTI measures, pleasure dimensions and negative symptoms were examined.

RESULTS

Patients with 22q11DS showed reduced anticipatory and consummatory pleasure compared to controls. Furthermore, anticipatory pleasure scores were negatively correlated to negative and positive symptoms in 22q11DS. WM microstructural changes of the accumbofrontal tract in terms of increased fractional anisotropy and reduced radial anisotropy were also identified in patients. However, no significant correlation between the DTI measures and pleasure dimensions or psychotic symptoms was observed.

CONCLUSIONS

This study revealed that participants with 22q11DS differed in their experience of pleasure compared to controls. The anticipatory pleasure component appears to be related to negative and positive symptom severity in patients. Alterations of WM integrity of the accumbofrontal tract seem to be related to myelination abnormalities in 22q11DS patients.

A Review of Anticipatory Pleasure in Schizophrenia

PURPOSE OF REVIEW

Anhedonia, traditionally defined as a diminished capacity to experience pleasure, has long been considered a core symptom of schizophrenia. However, recent research calls into question whether individuals with schizophrenia are truly anhedonic, suggesting intact subjective and neurophysiological response to rewarding stimuli in-the-moment. Despite a presumably intact capacity to experience pleasure, people with schizophrenia still engage in fewer reward-seeking behaviors. This discrepancy has been explained as a dissociation between "liking" and "wanting", with dopaminergic and prefrontal influences on incentive salience leading hedonic responses to not effectively translate into motivated behavior. In the current review, the literature on a key aspect of the wanting deficit is reviewed, anticipatory pleasure.

RECENT FINDINGS

Results provide consistent evidence for impairment in some aspects of anticipatory pleasure (e.g., prospection, associative learning between reward predictive cues and outcomes), and inconsistent evidence for others (e.g., anticipatory affect and affective forecasting).

SUMMARY

Mechanisms underlying anticipatory pleasure abnormalities in schizophrenia are discussed and a new model of anticipatory pleasure deficits is proposed. Findings suggest that anticipatory pleasure may be a critical component of impairments in wanting that impact motivated behavior in schizophrenia.