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Gupta T, Eckstrand KL, Lenniger CJ, Haas GL, Silk JS, Ryan ND, Phillips ML, Flores LE, Pizzagalli DA, Forbes EE. Anhedonia in adolescents at transdiagnostic familial risk for severe mental illness: Clustering by symptoms and mechanisms of association with behavior. J Affect Disord 2024; 347:249-261. [PMID: 37995926 PMCID: PMC10843785 DOI: 10.1016/j.jad.2023.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Anhedonia is a transdiagnostic symptom of severe mental illness (SMI) and emerges during adolescence. Possible subphenotypes and neural mechanisms of anhedonia in adolescents at risk for SMI are understudied. METHODS Adolescents at familial risk for SMI (N = 81) completed anhedonia (e.g., consummatory, anticipatory, social), demographic, and clinical measures and one year prior, a subsample (N = 46) completed fMRI scanning during a monetary reward task. Profiles were identified using k-means clustering of anhedonia type and differences in demographics, suicidal ideation, impulsivity, and emotional processes were examined. Moderation analyses were conducted to investigate whether levels of brain activation of reward regions moderated the relationships between anhedonia type and behaviors. RESULTS Two-clusters emerged: a high anhedonia profile (high-anhedonia), characterized by high levels of all types of anhedonia, (N = 32) and a low anhedonia profile (low-anhedonia), characterized by low levels of anhedonia types (N = 49). Adolescents in the high-anhedonia profile reported more suicidal ideation and negative affect, and less positive affect and desire for emotional closeness than low-anhedonia profile. Furthermore, more suicidal ideation, less positive affect, and less desire for emotional closeness differentiated the familial high-risk, high-anhedonia profile adolescents from the familial high-risk, low-anhedonia profile adolescents. Across anhedonia profiles, moderation analyses revealed that adolescents with high dmPFC neural activation in response to reward had positive relationships between social, anticipatory, and consummatory anhedonia and suicidal ideation. LIMITATIONS Small subsample with fMRI data. CONCLUSION Profiles of anhedonia emerge transdiagnostically and vary on clinical features. Anhedonia severity and activation in frontostriatal reward areas have value for clinically important outcomes such as suicidal ideation.
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Affiliation(s)
- T Gupta
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.
| | - K L Eckstrand
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - C J Lenniger
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - G L Haas
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - J S Silk
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - N D Ryan
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - M L Phillips
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - L E Flores
- Queens University, Department of Psychology, Kingston, Ontario, CA, USA
| | - D A Pizzagalli
- Harvard Medical School and McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - E E Forbes
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; University of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA; University of Pittsburgh, Department of Clinical and Translational Science, Pittsburgh, PA, USA
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Bertocci MA, Bebko G, Versace A, Iyengar S, Bonar L, Forbes EE, Almeida JRC, Perlman SB, Schirda C, Travis MJ, Gill MK, Diwadkar VA, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson DA, Frazier TW, Arnold LE, Fristad MA, Youngstrom EA, Horwitz SM, Findling RL, Phillips ML. Reward-related neural activity and structure predict future substance use in dysregulated youth. Psychol Med 2017; 47:1357-1369. [PMID: 27998326 PMCID: PMC5576722 DOI: 10.1017/s0033291716003147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Identifying youth who may engage in future substance use could facilitate early identification of substance use disorder vulnerability. We aimed to identify biomarkers that predicted future substance use in psychiatrically un-well youth. METHOD LASSO regression for variable selection was used to predict substance use 24.3 months after neuroimaging assessment in 73 behaviorally and emotionally dysregulated youth aged 13.9 (s.d. = 2.0) years, 30 female, from three clinical sites in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Predictor variables included neural activity during a reward task, cortical thickness, and clinical and demographic variables. RESULTS Future substance use was associated with higher left middle prefrontal cortex activity, lower left ventral anterior insula activity, thicker caudal anterior cingulate cortex, higher depression and lower mania scores, not using antipsychotic medication, more parental stress, older age. This combination of variables explained 60.4% of the variance in future substance use, and accurately classified 83.6%. CONCLUSIONS These variables explained a large proportion of the variance, were useful classifiers of future substance use, and showed the value of combining multiple domains to provide a comprehensive understanding of substance use development. This may be a step toward identifying neural measures that can identify future substance use disorder risk, and act as targets for therapeutic interventions.
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Affiliation(s)
- M A Bertocci
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - G Bebko
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - A Versace
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - S Iyengar
- Department of Statistics,University of Pittsburgh,Pittsburgh, PA,USA
| | - L Bonar
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - E E Forbes
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - J R C Almeida
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - S B Perlman
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - C Schirda
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - M J Travis
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - M K Gill
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - V A Diwadkar
- Department of Psychiatry and Behavioral Neuroscience,Wayne State University,Detroit, MI,USA
| | - J L Sunshine
- Department of Radiology,University Hospitals Case Medical Center/Case Western Reserve University,Cleveland, OH,USA
| | - S K Holland
- Cincinnati Children's Hospital Medical Center, University of Cincinnati,Cincinnati, OH,USA
| | - R A Kowatch
- Department of Psychiatry and Behavioral Health,Ohio State University,Columbus, OH,USA
| | - B Birmaher
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
| | - D A Axelson
- Department of Psychiatry and Behavioral Health,Ohio State University,Columbus, OH,USA
| | - T W Frazier
- Pediatric Institute,Cleveland Clinic,Cleveland, OH,USA
| | - L E Arnold
- Department of Psychiatry and Behavioral Health,Ohio State University,Columbus, OH,USA
| | - M A Fristad
- Department of Psychiatry and Behavioral Health,Ohio State University,Columbus, OH,USA
| | - E A Youngstrom
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill, NC,USA
| | - S M Horwitz
- Department of Child and Adolescent Psychiatry,New York University School of Medicine,New York, NY,USA
| | - R L Findling
- Department of Psychiatry,Johns Hopkins University,Baltimore, MD,USA
| | - M L Phillips
- Department of Psychiatry,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Pittsburgh, PA,USA
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Abstract
BACKGROUND Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence. METHOD We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty. RESULTS Evidence suggests that these vulnerabilities (a) have been associated with depression, (b) are likely to be problematic in many, but not all, anxious youth, and (c) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder. CONCLUSIONS We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.
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Affiliation(s)
- J S Silk
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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Forbes EE, Brown SM, Kimak M, Ferrell RE, Manuck SB, Hariri AR. Genetic variation in components of dopamine neurotransmission impacts ventral striatal reactivity associated with impulsivity. Mol Psychiatry 2009; 14:60-70. [PMID: 17893706 PMCID: PMC2668513 DOI: 10.1038/sj.mp.4002086] [Citation(s) in RCA: 345] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individual differences in traits such as impulsivity involve high reward sensitivity and are associated with risk for substance use disorders. The ventral striatum (VS) has been widely implicated in reward processing, and individual differences in its function are linked to these disorders. Dopamine (DA) plays a critical role in reward processing and is a potent neuromodulator of VS reactivity. Moreover, altered DA signaling has been associated with normal and pathological reward-related behaviors. Functional polymorphisms in DA-related genes represent an important source of variability in DA function that may subsequently impact VS reactivity and associated reward-related behaviors. Using an imaging genetics approach, we examined the modulatory effects of common, putatively functional DA-related polymorphisms on reward-related VS reactivity associated with self-reported impulsivity. Genetic variants associated with relatively increased striatal DA release (DRD2 -141C deletion) and availability (DAT1 9-repeat), as well as diminished inhibitory postsynaptic DA effects (DRD2 -141C deletion and DRD4 7-repeat), predicted 9-12% of the interindividual variability in reward-related VS reactivity. In contrast, genetic variation directly affecting DA signaling only in the prefrontal cortex (COMT Val158Met) was not associated with variability in VS reactivity. Our results highlight an important role for genetic polymorphisms affecting striatal DA neurotransmission in mediating interindividual differences in reward-related VS reactivity. They further suggest that altered VS reactivity may represent a key neurobiological pathway through which these polymorphisms contribute to variability in behavioral impulsivity and related risk for substance use disorders.
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Affiliation(s)
- EE Forbes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - SM Brown
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Kimak
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - RE Ferrell
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - SB Manuck
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - AR Hariri
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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