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Chen W, Liang J, Qiu X, Sun Y, Xie Y, Shangguan W, Zhang C, Wu W. Differences in fractional amplitude of low-frequency fluctuations (fALFF) and cognitive function between untreated major depressive disorder and schizophrenia with depressive mood patients. BMC Psychiatry 2024; 24:313. [PMID: 38658896 PMCID: PMC11044294 DOI: 10.1186/s12888-024-05777-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Distinguishing untreated major depressive disorder without medication (MDD) from schizophrenia with depressed mood (SZDM) poses a clinical challenge. This study aims to investigate differences in fractional amplitude of low-frequency fluctuations (fALFF) and cognition in untreated MDD and SZDM patients. METHODS The study included 42 untreated MDD cases, 30 SZDM patients, and 46 healthy controls (HC). Cognitive assessment utilized the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Resting-state functional magnetic resonance imaging (rs-fMRI) scans were conducted, and data were processed using fALFF in slow-4 and slow-5 bands. RESULTS Significant fALFF changes were observed in four brain regions across MDD, SZDM, and HC groups for both slow-4 and slow-5 fALFF. Compared to SZDM, the MDD group showed increased slow-5 fALFF in the right gyrus rectus (RGR). Relative to HC, SZDM exhibited decreased slow-5 fALFF in the left gyrus rectus (LGR) and increased slow-5 fALFF in the right putamen. Changes in slow-5 fALFF in both RGR and LGR were negatively correlated with RBANS scores. No significant correlations were found between remaining fALFF (slow-4 and slow-5 bands) and RBANS scores in MDD or SZDM groups. CONCLUSIONS Alterations in slow-5 fALFF in RGR may serve as potential biomarkers for distinguishing MDD from SZDM, providing preliminary insights into the neural mechanisms of cognitive function in schizophrenia.
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Affiliation(s)
- Wensheng Chen
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Jiaquan Liang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Xiangna Qiu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Yaqiao Sun
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Yong Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Wenbo Shangguan
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Chunguo Zhang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
| | - Weibin Wu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
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Constantinou M, Karadachka K, Marstaller L, Burianová H. The effect of negative arousal on declarative memory. Neuropsychologia 2024; 193:108759. [PMID: 38096981 DOI: 10.1016/j.neuropsychologia.2023.108759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
Arousing events influence retrieval success, with a number of studies supporting a context-dependent effect of arousal on episodic memory retrieval. An improvement in speed and accuracy of episodic memories is observed when negative arousal is attached to them. In contrast, enhancing effects of negative arousal have not been reported to improve semantic memory retrieval. Episodic and semantic memory are highly interactive and yet differ based on their embedded contextual content. Although differences in brain activity exist between episodic and semantic memory, the two types of memory retrieval are part of a common long-term memory system. Considering the shared processes between episodic and semantic memory, the objectives of the current study were twofold: i) to examine, employing a novel paradigm, whether performance on episodic and semantic memory retrieval would be influenced differently by varying levels of arousal, between negative and neutral valence; and ii) to explore the neural patterns underlying these processes. Forty-seven healthy young adults were recruited and completed the experiment in the MRI scanner. The results demonstrated a negative arousal effect on the brain circuitry subserving both memory conditions as well as on behavioural performance, as indicated by better accuracy and faster reaction times. The study provides an insight into the role of negative arousal in memory processes and contributes to our understanding of the interplay between cognitive and emotional factors in memory modulation. Our work also highlights the highly interactive nature of episodic and semantic memory, and emphasises the importance in understanding how negative arousal interacts with the contextual content of a memory, on a behavioural and neurofunctional level.
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Affiliation(s)
| | - Katherine Karadachka
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands
| | | | - Hana Burianová
- Department of Psychology, Swansea University, Swansea, UK
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3
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James TA, Duarte A. Depressive symptoms are associated with reduced positivity preferences in episodic memory in aging. Neurobiol Aging 2023; 121:38-51. [PMID: 36371815 PMCID: PMC11212072 DOI: 10.1016/j.neurobiolaging.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Age-related positivity preferences are represented as greater memory benefits for positive and/or reduced benefits for negative material with age. It is unknown if positivity preferences are limited to older adults without depressive symptoms. In this fMRI study, adults across the lifespan with a range of depressive symptoms were scanned as they rated emotional intensity of images and subsequently completed a recognition memory task. Behavioral, univariate, and functional connectivity analyses provided evidence for interactive effects between age and depressive symptoms. With low depressive symptoms, typical age-related emotional preferences emerged: younger age was associated with better memory for negative images, and this benefit was reduced with older age. With increasing depressive symptoms in older age, positivity preferences were reduced, manifesting as improvements in negative memory. The neural data highlighted potential underlying mechanisms, including reductions in prefrontal cortex connectivity reflecting diminished ability to engage regulatory processes to reduce negative affect in older participants with higher depressive symptoms. These findings suggest that depressive symptoms in older adulthood reduce positivity preferences through alterations in neural networks underlying emotion regulation.
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Affiliation(s)
- Taylor A James
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Audrey Duarte
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA; Department of Psychology, University of Texas at Austin, Austin, TX, USA
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Gandhi A, Mote J, Fulford D. A transdiagnostic meta-analysis of physical and social Anhedonia in major depressive disorder and schizophrenia spectrum disorders. Psychiatry Res 2022; 309:114379. [PMID: 35123252 DOI: 10.1016/j.psychres.2021.114379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Anhedonia is a transdiagnostic construct conceptualized as physical or social, however, the extent to which these subtypes differ across psychotic and mood pathology remains poorly understood. We aimed to quantify the severity of physical and social anhedonia across Major Depressive Disorder (MDD) and Schizophrenia Spectrum Disorder (SSDs). METHODS We conducted meta-analyses of the Chapman Physical and Social Anhedonia Scales (PAS;SAS). We reviewed data from participants with MDD, and SSDs separately. RESULTS Our first meta-analysis (n = 8 studies, 409 participants) with MDD revealed elevated SAS and PAS in MDD compared to controls. Within-group differences were not significant. Depressive symptom severity moderated the between-group effect of PAS. Our second meta-analysis (n = 44 studies, 3352 participants) revealed elevated SAS and PAS in SSDs compared to controls. We detected a moderate difference between the SAS and PAS within the SSD group. Age moderated within-group differences of SAS and PAS. DISCUSSION People with SSD or MDD experience elevated SAS and PAS compared to controls. People with SSDs endorse greater challenges experiencing social rewards relative to physical rewards. People with MDD experience social and physical rewards similarly. The moderating role of depressive symptoms in MDD suggests that physical anhedonia is more state-like than social anhedonia.
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Affiliation(s)
- Arti Gandhi
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston MA, 02215, USA.
| | - Jasmine Mote
- Department of Occupational Therapy, Tufts University, 574 Boston Avenue, School of Arts and Sciences, Tufts University, Medford, MA, 02155, USA
| | - Daniel Fulford
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston MA, 02215, USA; Department of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave, Boston MA, 02215, USA
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5
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Gooding DC, Pflum M. The Transdiagnostic Nature of Social Anhedonia: Historical and Current Perspectives. Curr Top Behav Neurosci 2022; 58:381-395. [PMID: 35156185 DOI: 10.1007/7854_2021_301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we trace the historical roots of the social anhedonia (SoA) construct to current conceptualizations. We first describe the aspects of SoA that distinguish it from anhedonia in general. We summarize evidence that SoA is a transdiagnostic symptom and risk factor. Although several forms of psychopathology are associated with elevated rates of self-reported SoA, one unresolved issue is whether the processes and mechanisms underlying SoA in one disorder are the same as the processes and mechanisms underlying SoA seen in another disorder. We assert that there may be different causal factors underlying SoA across disorders. Considering both the principles of equifinality and multifinality, we offer an integrative model for social reward processing. This conceptualization considers roles for the following: attention; social cognition, including, but not limited to, social skills; reward learning and valuation; working memory; anticipation, prediction, and remembering; and motivation and effort. We conclude that SoA may be caused by multiple underlying impairments, all of which may serve as targets for intervention. This conceptualization is provided as an impetus for further research in the area.
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Affiliation(s)
- Diane Carol Gooding
- Department of Psychology and Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
| | - Madeline Pflum
- Department of Psychology and Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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Pavlidou A, Viher PV, Bachofner H, Weiss F, Stegmayer K, Shankman SA, Mittal VA, Walther S. Hand gesture performance is impaired in major depressive disorder: A matter of working memory performance? J Affect Disord 2021; 292:81-88. [PMID: 34107424 PMCID: PMC8797922 DOI: 10.1016/j.jad.2021.05.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with depression exhibit numerous interpersonal deficits. As effective use of gestures is critical for social communication, it is possible that depressed individuals' interpersonal deficits may be due to deficits in gesture performance. The present study thus compared gesture performance of depressed patients and controls and examined whether these deficits relate to cognitive and other domains of dysfunction. METHODS Gesture performance was evaluated in 30 depressed patients and 30 controls using the Test of Upper Limb Apraxia (TULIA). Clinical rating scales were assessed to determine if gesture deficits were associated with motor, cognitive or functional outcomes. RESULTS Compared to controls, depressed patients exhibited impaired gesture performance with 2/3 of the patients demonstrating gesture deficits. Within depressed patients, gesture performance was highly correlated with working memory abilities. In contrast, no association between gesture performance and gestural knowledge, psychomotor retardation, depression severity, or frontal dysfunction was observed in patients. LIMITATIONS This is a cross-sectional study and a larger size would have allowed for confident detection of more subtle, but potentially relevant effects. CONCLUSION Gesture performance is impaired in depressed patients, and appears to be related to poor working memory abilities, suggesting a disruption in the retrieval of gestural cues indicative of a distinct clinical phenomenon that might be related to social functioning.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland.
| | - Petra V Viher
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Hanta Bachofner
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Florian Weiss
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Katharina Stegmayer
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Stewart A Shankman
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Northwestern University, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
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7
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Hudson R, Green M, Wright DJ, Renard J, Jobson CEL, Jung T, Rushlow W, Laviolette SR. Adolescent nicotine induces depressive and anxiogenic effects through ERK 1-2 and Akt-GSK-3 pathways and neuronal dysregulation in the nucleus accumbens. Addict Biol 2021; 26:e12891. [PMID: 32135573 DOI: 10.1111/adb.12891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/16/2022]
Abstract
Long-term tobacco dependence typically develops during adolescence and neurodevelopmental nicotine exposure is associated with affective disturbances that manifest as a variety of neuropsychiatric comorbidities in clinical and preclinical studies, including mood and anxiety-related disorders. The nucleus accumbens shell (NASh) is critically involved in regulating emotional processing, and both molecular and neuronal disturbances in this structure are associated with mood and anxiety-related pathologies. In the present study, we used a rodent model of adolescent neurodevelopmental nicotine exposure to examine the expression of several molecular biomarkers associated with mood/anxiety-related phenotypes. We report that nicotine exposure during adolescence (but not adulthood) induces profound upregulation of the ERK 1-2 and Akt-GSK-3 signalling pathways directly within the NASh, as well as downregulation of local D1R expression that persists into adulthood. These adaptations were accompanied by decreases in τ, α, β, and γ-band oscillatory states, hyperactive medium spiny neuron activity with depressed bursting rates, and anxiety and depressive-like behavioural abnormalities. Pharmacologically targeting these molecular and neuronal adaptations revealed that selective inhibition of local ERK 1-2 and Akt-GSK-3 signalling cascades rescued nicotine-induced high-γ-band oscillatory signatures and phasic bursting rates in the NASh, suggesting that they are involved in mediating adolescent nicotine-induced depressive and anxiety-like neuropathological trajectories.
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Affiliation(s)
- Roger Hudson
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Matthew Green
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Daniel J Wright
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Justine Renard
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Christina E L Jobson
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Tony Jung
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
| | - Walter Rushlow
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario London, London, Ontario, Canada
| | - Steven R Laviolette
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, University of Western Ontario London, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario London, London, Ontario, Canada
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8
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Hsu KJ, McNamara ME, Shumake J, Stewart RA, Labrada J, Alario A, Gonzalez GD, Schnyer DM, Beevers CG. Neurocognitive predictors of self-reported reward responsivity and approach motivation in depression: A data-driven approach. Depress Anxiety 2020; 37:682-697. [PMID: 32579757 PMCID: PMC7951991 DOI: 10.1002/da.23042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/18/2020] [Accepted: 04/19/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Individual differences in reward-related processes, such as reward responsivity and approach motivation, appear to play a role in the nature and course of depression. Prior work suggests that cognitive biases for valenced information may contribute to these reward processes. Yet there is little work examining how biased attention, processing, and memory for positively and negatively valenced information may be associated with reward-related processes in samples with depression symptoms. METHODS We used a data-driven, machine learning (elastic net) approach to identify the best predictors of self-reported reward-related processes using multiple tasks of attention, processing, and memory for valenced information measured across behavioral, eye tracking, psychophysiological, and computational modeling approaches (n = 202). Participants were adults (ages 18-35) who ranged in depression symptom severity from mild to severe. RESULTS Models predicted between 5.0-12.2% and 9.7-28.0% of held-out test sample variance in approach motivation and reward responsivity, respectively. Low self-referential processing of positively valenced information was the most robust, albeit modest, predictor of low approach motivation and reward responsivity. CONCLUSIONS Self-referential processing of positive information is the strongest predictor of reward responsivity and approach motivation in a sample ranging from mild to severe depression symptom severity. Experiments are now needed to clarify the causal relationship between self-referential processing of positively valenced information and reward processes in depression.
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Affiliation(s)
- Kean J. Hsu
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC,Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX,Corresponding Author: Kean J. Hsu, Ph.D., Department of Psychiatry, Georgetown University Medical Center, 2115 Wisconsin Ave. NW, Suite 200, Washington, DC 20007 ()
| | - Mary E. McNamara
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
| | - Jason Shumake
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
| | | | - Jocelyn Labrada
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
| | - Alexandra Alario
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA
| | - Guadalupe D.S. Gonzalez
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
| | - David M. Schnyer
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
| | - Christopher G. Beevers
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX
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9
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Learning the Affective Value of Others in Schizophrenia: Examining the Role of Negative Symptoms and Cognitive Deficits. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Tan M, Shallis A, Barkus E. Social anhedonia and social functioning: Loneliness as a mediator. Psych J 2020; 9:280-289. [DOI: 10.1002/pchj.344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Melody Tan
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Amy Shallis
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Emma Barkus
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
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11
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Li X, Zhang YT, Huang ZJ, Chen XL, Yuan FH, Sun XJ. Diminished Anticipatory and Consummatory Pleasure in Dysphoria: Evidence From an Experience Sampling Study. Front Psychol 2019; 10:2124. [PMID: 31607980 PMCID: PMC6761272 DOI: 10.3389/fpsyg.2019.02124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/02/2019] [Indexed: 01/15/2023] Open
Abstract
Anhedonia, the experience of diminished pleasure, is a core feature of major depressive disorder and is often present long before the diagnosis of depression. Most previous studies have investigated anhedonia with self-report measures of trait anhedonia or with behavioral paradigms using laboratory stimuli, and the real-time characteristics of hedonic processing in subclinical depression remain under-investigated. We used the experience sampling method to evaluate momentary experience of hedonic feelings in the context of daily life. Dysphoric (n = 49) and non-dysphoric (n = 51) college students completed assessments of their current positive affect (PA), as well as state anticipatory and consummatory pleasure, 3 or 4 times a day every day for 2 weeks. The results showed that dysphoric individuals reported less state anticipatory and consummatory pleasure compared with non-dysphoric individuals. Moreover, significant time-lagged associations between anticipatory pleasure and follow-up consummatory pleasure were found in the whole sample, after adjustment for current PA. The current findings thus hold considerable promise in advancing our understanding of anhedonia as well as the important role of state anticipatory pleasure in relation to depression.
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Affiliation(s)
- Xu Li
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Central China Normal University, Wuhan, China
| | - Yu-Ting Zhang
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Central China Normal University, Wuhan, China
| | - Zhi-Jing Huang
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Central China Normal University, Wuhan, China
| | - Xue-Lei Chen
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Central China Normal University, Wuhan, China
| | - Feng-Hui Yuan
- School of Sociology, Central China Normal University, Wuhan, China
| | - Xiao-Jun Sun
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Central China Normal University, Wuhan, China
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12
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J M Bogie B, Persaud MR, Smith D, Kapczinski FP, Frey BN. Explicit emotional memory biases in mood disorders: A systematic review. Psychiatry Res 2019; 278:162-172. [PMID: 31200195 DOI: 10.1016/j.psychres.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
Research suggests that major depressive disorder (MDD) and bipolar disorder (BD) are both associated with unique emotional memory (EM) biases. To better elucidate the EM phenotypes of these disorders, we systematically reviewed the literature on non-autobiographical explicit EM biases in individuals with MDD and BD compared to healthy controls. The following databases were searched: Cochrane, Embase, HAPI, LILACs, Medline, PsycInfo and Web of Science. Grey literature and hand searches were also performed. Fourteen studies met full eligibility criteria. Eleven studies included data from an MDD sample (10 during acute depression, 1 during euthymia) and 3 studies included data from a BD sample (2 during acute mood episodes, 1 during euthymia). Only 3 of the studies in acute depression revealed a negative explicit EM bias. One study in MDD during euthymia revealed an EM deficit for negative stimuli. One of the two studies in BD (type I; BD-I) during an acute mood episode revealed a positive explicit EM bias, while the other showed no bias. One study in BD during euthymia showed an EM deficit for negative stimuli. Overall, this review concludes that current empirical evidence does not readily support the existence of an explicit EM bias in MDD during acute depression. The identification and implications of potential moderating factors on explicit EM performance in MDD and BD during both illness stages are discussed.
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Affiliation(s)
- Bryce J M Bogie
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Monisha R Persaud
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Smith
- Health Sciences Library, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Flávio P Kapczinski
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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13
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Barkus E, Badcock JC. A Transdiagnostic Perspective on Social Anhedonia. Front Psychiatry 2019; 10:216. [PMID: 31105596 PMCID: PMC6491888 DOI: 10.3389/fpsyt.2019.00216] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/25/2019] [Indexed: 12/28/2022] Open
Abstract
Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.
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Affiliation(s)
- Emma Barkus
- Cognitive Basis of Atypical Behaviour Initiative (CBABi), School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Johanna C. Badcock
- Centre for Clinical Research in Neuropsychiatry (CCRN), Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
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Gadow KD, Garman HD. Social Anhedonia in Children and Adolescents with Autism Spectrum Disorder and Psychiatry Referrals. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 49:239-250. [DOI: 10.1080/15374416.2018.1514611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Safra L, Ioannou C, Amsellem F, Delorme R, Chevallier C. Distinct effects of social motivation on face evaluations in adolescents with and without autism. Sci Rep 2018; 8:10648. [PMID: 30006527 PMCID: PMC6045598 DOI: 10.1038/s41598-018-28514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/21/2018] [Indexed: 12/03/2022] Open
Abstract
Individual differences in social motivation have an influence on many behaviours in both clinical and non-clinical populations. As such, social motivation has been identified as a biological trait that is particularly well-suited for dimensional approaches cutting across neuropsychological conditions. In the present paper, we tested whether social motivation had a similar impact in the general population and in a neuropsychological condition characterized by diminished social motivation: Autism Spectrum Disorders (ASD). More precisely, we evaluated the effect of social motivation on face evaluations in 20 adolescents with ASD and 20 matched controls using avatars parametrically varying in dominance and trustworthiness. In line with previous research, we found in the control group that participants with higher levels of social motivation relied more on perceived trustworthiness when producing likeability judgments. However, this pattern was not found in the ASD group. Social motivation thus appears to have a different effect in ASD and control populations, which raises questions about the relevance of subclinical or non-clinical populations to understand ASD.
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Affiliation(s)
- Lou Safra
- Laboratoire de Neurosciences Cognitives, Inserm unit 960, Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, Paris, 75005, France.
| | - Christina Ioannou
- Laboratoire de Neurosciences Cognitives, Inserm unit 960, Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, Paris, 75005, France
| | - Frédérique Amsellem
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Universitaire Robert Debré, Paris, 75019, France.,Génétique Humaine et Fonction Cognitive, Institut Pasteur, Paris, 75015, France
| | - Richard Delorme
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Universitaire Robert Debré, Paris, 75019, France.,Génétique Humaine et Fonction Cognitive, Institut Pasteur, Paris, 75015, France
| | - Coralie Chevallier
- Laboratoire de Neurosciences Cognitives, Inserm unit 960, Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL Research University, Paris, 75005, France.
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16
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Langvik E, Borgen Austad S. Psychometric Properties of the Snaith–Hamilton Pleasure Scale and a Facet-Level Analysis of the Relationship Between Anhedonia and Extraversion in a Nonclinical Sample. Psychol Rep 2018; 122:360-375. [DOI: 10.1177/0033294118756336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to investigate the psychometric properties of the Snaith–Hamilton Pleasure Scale (SHAPS) and look at facets of extraversion as predictors of anhedonia. SHAPS is hypothesized to be multidimensional, stable over time in a nonclinical sample, and related to extraversion on both dimension and facet level. Data collection was conducted at baseline ( N = 362) and at a 10-week follow-up ( N = 94). The structural properties of SHAPS were analyzed using principal component analysis and confirmatory factor analysis. Multiple regression explored facets of extraversion as predictors of anhedonia. The results show that SHAPS is stable across time ( r = .71, p < .001), with high internal consistency (α = .89). In the principal component analysis, a two-factor model emerged (Social and Physical anhedonia). The confirmatory factor analysis indicated that the two-factor model consisting of Physical anhedonia (α = .81) and Social anhedonia (α = .87) had a better fit than the one-factor model. Higher scores on Gregariousness and Positive emotions at baseline predicted higher scores on the SHAPS total and Social and Physical anhedonia ( p < .05). Lower scores on Assertiveness predicted higher scores on Social anhedonia ( p < .05). These results support the view of anhedonia as a multidimensional concept that should be regarded as a trait, rather than a state or mere bypassing symptom. The relationship between anhedonia and extroversion is best understood by applying a multidimensional approach to anhedonia and by focusing on the facet level of extroversion.
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Affiliation(s)
- Eva Langvik
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrun Borgen Austad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Eom TY, Bayazitov IT, Anderson K, Yu J, Zakharenko SS. Schizophrenia-Related Microdeletion Impairs Emotional Memory through MicroRNA-Dependent Disruption of Thalamic Inputs to the Amygdala. Cell Rep 2018; 19:1532-1544. [PMID: 28538174 PMCID: PMC5457478 DOI: 10.1016/j.celrep.2017.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/24/2017] [Accepted: 04/27/2017] [Indexed: 11/18/2022] Open
Abstract
Individuals with 22q11.2 deletion syndrome (22q11DS) are at high risk of developing psychiatric diseases such as schizophrenia. Individuals with 22q11DS and schizophrenia are impaired in emotional memory, anticipating, recalling, and assigning a correct context to emotions. The neuronal circuits responsible for these emotional memory deficits are unknown. Here, we show that 22q11DS mouse models have disrupted synaptic transmission at thalamic inputs to the lateral amygdala (thalamo-LA projections). This synaptic deficit is caused by haploinsufficiency of the 22q11DS gene Dgcr8, which is involved in microRNA processing, and is mediated by the increased dopamine receptor Drd2 levels in the thalamus and by reduced probability of glutamate release from thalamic inputs. This deficit in thalamo-LA synaptic transmission is sufficient to cause fear memory deficits. Our results suggest that dysregulation of the Dgcr8–Drd2 mechanism at thalamic inputs to the amygdala underlies emotional memory deficits in 22q11DS. Thalamic inputs to the lateral amygdala (LA) are impaired in 22q11DS mice Thalamo-LA disruption is sufficient to cause associative fear memory deficits Deficiency in microRNA-processing Dgcr8 causes thalamo-LA and fear memory deficits Fear memory deficits in 22q11DS mice are rescued by thalamic Drd2 inhibition
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Affiliation(s)
- Tae-Yeon Eom
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ildar T Bayazitov
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kara Anderson
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jing Yu
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Stanislav S Zakharenko
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Gethin JA, Lythe KE, Workman CI, Mayes A, Moll J, Zahn R. Early life stress explains reduced positive memory biases in remitted depression. Eur Psychiatry 2017; 45:59-64. [PMID: 28728096 PMCID: PMC5695977 DOI: 10.1016/j.eurpsy.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/12/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is contradictory evidence regarding negative memory biases in major depressive disorder (MDD) and whether these persist into remission, which would suggest their role as vulnerability traits rather than correlates of mood state. Early life stress (ELS), common in patients with psychiatric disorders, has independently been associated with memory biases, and confounds MDD versus control group comparisons. Furthermore, in most studies negative biases could have resulted from executive impairments rather than memory difficulties per se. METHODS To investigate whether memory biases are relevant to MDD vulnerability and how they are influenced by ELS, we developed an associative recognition memory task for temporo-spatial contexts of social actions with low executive demands, which were matched across conditions (self-blame, other-blame, self-praise, other-praise). We included fifty-three medication-free remitted MDD (25 with ELS, 28 without) and 24 healthy control (HC) participants without ELS. RESULTS Only MDD patients with ELS showed a reduced bias (accuracy/speed ratio) towards memory for positive vs. negative materials when compared with MDD without ELS and with HC participants; attenuated positive biases correlated with number of past major depressive episodes, but not current symptoms. There were no biases towards self-blaming or self-praising memories. CONCLUSIONS This demonstrates that reduced positive biases in associative memory were specific to MDD patients with ELS rather than a general feature of MDD, and were associated with lifetime recurrence risk which may reflect a scarring effect. If replicated, our results would call for stratifying MDD patients by history of ELS when assessing and treating emotional memories.
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Affiliation(s)
- J A Gethin
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - K E Lythe
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - C I Workman
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - A Mayes
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - J Moll
- Cognitive and Behavioral Neuroscience Unit, D'Or Institute for Research and Education (IDOR), 22280-080 Rio de Janeiro, RJ, Brazil
| | - R Zahn
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London SE5 8AZ, UK.
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Wei S, Womer F, Geng H, Jiang X, Zhou Q, Chang M, Zhou Y, Tang Y, Wang F. Similarities and differences of functional connectivity in drug-naïve, first-episode adolescent and young adult with major depressive disorder and schizophrenia. Sci Rep 2017; 7:44316. [PMID: 28287187 PMCID: PMC5347082 DOI: 10.1038/srep44316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/06/2017] [Indexed: 12/27/2022] Open
Abstract
Major depressive disorder (MDD) and schizophrenia (SZ) are considered two distinct psychiatric disorders. Yet, they have considerable overlap in symptomatology and clinical features, particularly in the initial phases of illness. The amygdala and prefrontal cortex (PFC) appear to have critical roles in these disorders; however, abnormalities appear to manifest differently. In our study forty-nine drug-naïve, first-episode MDD, 45 drug-naïve, first-episode SZ, and 50 healthy control (HC) participants from 13 to 30 years old underwent resting-state functional magnetic resonance imaging. Functional connectivity (FC) between the amygdala and PFC was compared among the three groups. Significant differences in FC were observed between the amygdala and ventral PFC (VPFC), dorsolateral PFC (DLPFC), and dorsal anterior cingulated cortex (dACC) among the three groups. Further analyses demonstrated that MDD showed decreased amygdala-VPFC FC and SZ had reductions in amygdala-dACC FC. Both the diagnostic groups had significantly decreased amygdala-DLPFC FC. These indicate abnormalities in amygdala-PFC FC and further support the importance of the interaction between the amygdala and PFC in adolescents and young adults with these disorders. Additionally, the alterations in amygdala-PFC FC may underlie the initial similarities observed between MDD and SZ and suggest potential markers of differentiation between the disorders at first onset.
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Affiliation(s)
- Shengnan Wei
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fay Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Haiyang Geng
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Qian Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Miao Chang
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yifang Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yanqing Tang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fei Wang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA
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Setterfield M, Walsh M, Frey AL, McCabe C. Increased social anhedonia and reduced helping behaviour in young people with high depressive symptomatology. J Affect Disord 2016; 205:372-377. [PMID: 27568175 DOI: 10.1016/j.jad.2016.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/13/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Social anhedonia, the decreased enjoyment of pleasant social experiences, is associated with depression. However, whether social anhedonia in depression affects prosocial behaviours is unclear. The current study aimed to examine how high levels of depressive symptomatology in young people affect responses to usually rewarding social situations, including helping behaviour. METHODS We recruited 46 females, 16 scoring high on the Beck Depression Inventory (BDI scores>20, Mage=19; HD) and 30 scoring low (BDI<10, Mage=20; LD). In a social emotion task (SET), participants were presented with social scenarios and asked to rate their expected emotional responses. Subsequently, participants' helping behaviour was measured by dropping a pile of papers near them and recording their responses. Lastly, participants completed the SET again. RESULTS The SET at time 1 revealed that HD individuals reported significantly stronger negative (p<.001) and weaker positive (p<.05) emotional responses to social situations than LD subjects. Additionally, all participants showed a significant increase in positive responses (p<.05) on the SET between time 1 and time 2. Moreover, HD subjects were less likely to engage in actual helping behaviour than LD participants. LIMITATIONS Limitations of the study are that only females were tested and that no psychiatric screening interview was conducted. CONCLUSIONS Our results indicate that young females with high levels of depression symptoms expect to respond less positively to social situations and engage less in helping behaviour compared to those with low depressive symptomatology. Social anhedonia in depression may thus contribute to decreased engagement in rewarding social situations. This, in turn, may lead to social withdrawal and might maintain depression symptoms though a lack of exposure to positive social feedback.
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Affiliation(s)
- Megan Setterfield
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, United Kingdom
| | - Mallory Walsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, United Kingdom
| | - Anna-Lena Frey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, United Kingdom
| | - Ciara McCabe
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, United Kingdom.
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