Contrasting contributions of anhedonia to obsessive-compulsive, hoarding, and post-traumatic stress disorders

Anhedonia as a Core Symptom of Depression and a Construct for Biological Research

Anhedonia is a key psychiatric symptom that has seen significant advances in its understanding in both clinical practice and research over the past few decades. Once considered primarily a feature of depression, recent studies have shown that anhedonia is also a core element of other psychiatric disorders and contributes to considerable morbidity, mortality, and suicidality. Emerging models of psychopathology and illness emphasize the transdiagnostic relevance of anhedonia. At the same time, neuroimaging research has provided deeper insights into its underlying pathophysiology, and several assessment scales with strong psychometric properties have been developed. Various treatment strategies-including psychopharmacology, neuromodulation, and psychotherapy-have demonstrated varying degrees of effectiveness. This review discusses the evolving understanding of anhedonia, its significance as both a symptom and a diagnostic marker, its prevalence, and its pathophysiological underpinnings. Additionally, the authors provide an overview of key assessment tools and explore the range of treatment approaches studied to date.

The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder

BACKGROUND

Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth.

METHODS

A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis.

RESULTS

Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged.

LIMITATIONS

Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis.

CONCLUSIONS

Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.

Using the Beck Depression Inventory to Assess Anhedonia: A Scale Validation Study

Anhedonia is central to several psychological disorders and a frequent target of psychosocial and pharmacological treatments. We evaluated the psychometric properties of two widely used anhedonia measures derived from the Beck Depression Inventory: a 3-item (BDI-Anh3) and a 4-item version (BDI-Anh4). We evaluated these measures in a large undergraduate sample, a community sample, and a clinical sample. Both the BDI-Anh3 and the BDI-Anh4 showed adequate internal consistency, with BDI-Anh4 performing somewhat better, across the three samples. Both measures showed good convergent and discriminant validity, even after controlling for shared variance with other items on the BDI. These findings indicate that both measures have sufficient reliability and validity to support their use by researchers and clinicians.

Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents

BACKGROUND

The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence.

METHODS

The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test.

RESULTS

The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific.

CONCLUSIONS

Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.

Reduced social risk-taking in depression

Evolutionary models of depression posit that depressed mood represents an adaptive response to unacceptably low social status, motivating the inhibition of social risk-taking in favor of submissive behaviors which reduce the likelihood of social exclusion. We tested the hypothesis of reduced social risk taking using a novel adaptation of the Balloon Analogue Risk Task (BART) in participants with major depressive disorder (MDD; n = 27) and never-depressed comparison participants (n = 35). The BART requires participants to pump up virtual balloons. The more the balloon is pumped up, the more money a participant gains on that trial. However, more pumps also increase the risk the balloon will burst such that all money is lost. Prior to performing the BART, participants took part in a team induction in small groups in order to prime social-group membership. Participants then completed two conditions of the BART: an Individual condition where they risked only their own money, and a Social condition, where they risked the money of their social group. The groups did not differ in their performance in the individual condition (Cohen's d = 0.07). However, the MDD group risked fewer pumps in the Social condition than the never-depressed group (d = 0.57). The study supports the notion of an aversion to social risk-taking in depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

White matter microstructure associated with anhedonia among individuals with bipolar disorders and high-risk for bipolar disorders

BACKGROUND

Anhedonia - a key symptom of depression - is highly associated with poorer outcomes and suicidal behavior. Alterations in the circuitry of reward-related brain regions have been robustly associated with anhedonia in unipolar depression, but not bipolar disorder (BD). We investigated white matter microstructures associated with anhedonia in participants with BD types I and II and first-degree relatives of patients with BD (BD-siblings).

METHODS

Eighty participants (BD types I and II: 56 [70%], and BD-siblings: 24 [30%]) underwent diffusion tensor imaging (DTI); Fractional anisotropy (FA) of different tracts were computed. Anhedonia was assessed using item 8, ("inability to feel'') of the MADRS scale. General linear models were used to compare the FA of different tracts in participants with and without anhedonia controlling for several clinical and demographic variables.

RESULTS

The mean age of the sample was 37 (± 11) years old, and 68.8% were female. Participants with anhedonia (32.5%) presented lower mean FA in the left uncinate fasciculus (UF) (p = 0.005), right temporal endings of the superior longitudinal fasciculus (SLFT) (p = 0.04), and in the left and right parietal endings of the superior longitudinal fasciculus (SLFP) (p = 0.003, and p = 0.04, respectively). Similar comparisons between participants with or without current depressive episodes and between participants with or without inner tension according to the MADRS did not show significant differences, specificity of the findings for anhedonia.

CONCLUSIONS

Lower FA in the left UF and SLF are potential neuroimaging markers of anhedonia in individuals with BD and high-risk for BD.

Cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Temporal Experience of Pleasure Scale (TEPS-Br)

INTRODUCTION

Anhedonia is a critical symptom of major depressive disorder that is defined as the reduced ability to experience pleasure. The Temporal Experience of Pleasure Scale (TEPS) is commonly used to measure anhedonia and has exhibited satisfactory reliability.

OBJECTIVES

We aim to perform cross-cultural adaptation of a Brazilian version of the TEPS and evaluate its psychometric properties.

METHOD

The cross-cultural adaptation was performed according to previously established protocols. Cronbach's alpha coefficient of internal consistency was used to establish the degree of interrelation and coherence of items. Also, we calculated the intraclass correlation coefficient to determine the stability of the scale after a proposed interval had elapsed and used exploratory factor analysis to evaluate the scale's factor structure and content validity. Principal component analysis was used to determine the factors to be retained in the factor model.

RESULTS

The participants reported that the Brazilian version of the TEPS had good comprehensibility and applicability. The results revealed a statistically significant correlation between measures. The intraclass correlation coefficient calculated was significant. The Cronbach's alpha value calculated indicated that the scale's overall internal consistency was adequate.

CONCLUSION

The Portuguese version of the TEPS scale proposed achieved good comprehensibility for the Brazilian population and its psychometric characteristics demonstrated good reliability and validity.

Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder

An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.

The Effects of Anhedonia in Social Context

Purpose of Review

Anhedonia is a transdiagnostic symptom comprising reduced subjective reward or pleasure. Anhedonia influences subjective anticipation and in-the-moment experiences. This review draws together affective learning and engagement evidence for anhedonia affecting subjective experiences of social environments.

Recent Findings

While social engagement is diminished consistently, subjective appraisals of social contexts vary across different mental health disorders. Low positive affect during social experiences or stimuli is reported in PTSD, mood, schizophrenia, and anxiety disorders. Diminished neural reward networks underpin the anticipation of social experiences in ADHD, schizophrenia spectrum, and autistic spectrum disorders. Multiple theories exist to explain how anhedonia might interfere with social environments.

Summary

Anhedonia is a barrier to engagement, motivation, and enjoyment of social contexts. While many studies characterize experiences during social contexts, learning theories provide the most promise for developing targeted interventions.

OCD Influences Evidence Accumulation During Decision Making in Males but Not Females During Perceptual and Value-Driven Choice

Individuals with obsessive-compulsive disorder (OCD) often have difficulty making decisions. Valuation and value-based judgements are particularly difficult. The mechanisms underlying these impairments are still poorly understood. Previous work has suggested that individuals with OCD require more information prior to making a choice during perceptual discrimination tasks. Little previous work has examined value-guided choice in OCD. Here we examined perceptual and value-based decision making in adults with OCD, using a novel task in which the two types of decision are tested in parallel using the same individually calibrated sets of visual stimuli (Perceptual and Value-based decision-making task, PVDM). Twenty-seven unmedicated participants with OCD (16 female) and thirty-one healthy controls (15 female) were tested. Data were analyzed using hierarchical drift-diffusion modeling (HDDM). Decision formation was altered in OCD, but differentially between genders: males with OCD, but not females, accumulated more information (i.e., were more cautious) and were less effective in evidence accumulation than age- and IQ-matched healthy males. Furthermore, males with OCD, but not females, were less likely than controls to adjust the process of evidence accumulation across decision contexts. These unexpectedly gender-dimorphic effects suggest that more attention should be paid to gender differences in studies of OCD, and of pathophysiology more broadly.

Habitual versus affective motivations in obsessive-compulsive disorder and alcohol use disorder

OBJECTIVE

To (1) confirm whether the Habit, Reward, and Fear Scale is able to generate a 3-factor solution in a population of obsessive-compulsive disorder and alcohol use disorder (AUD) patients; (2) compare these clinical groups in their habit, reward, and fear motivations; and (3) investigate whether homogenous subgroups can be identified to resolve heterogeneity within and across disorders based on the motivations driving ritualistic and drinking behaviors.

METHODS

One hundred and thirty-four obsessive-compulsive disorder (n = 76) or AUD (n = 58) patients were assessed with a battery of scales including the Habit, Reward, and Fear Scale, the Yale-Brown Obsessive-Compulsive Scale, the Alcohol Dependence Scale, the Behavioral Inhibition/Activation System Scale, and the Urgency, (lack of ) Premeditation, (lack of ) Perseverance, Sensation Seeking, and Positive Urgency Impulsive Behavior Scale.

RESULTS

A 3-factor solution reflecting habit, reward, and fear subscores explained 56.6% of the total variance of the Habit, Reward, and Fear Scale. Although the habit and fear subscores were significantly higher in obsessive-compulsive disorder (OCD) and the reward subscores were significantly greater in AUD patients, a cluster analysis identified that the 3 clusters were each characterized by differing proportions of OCD and AUD patients.

CONCLUSIONS

While affective (reward- and fear-driven) and nonaffective (habitual) motivations for repetitive behaviors seem dissociable from each other, it is possible to identify subgroups in a transdiagnostic manner based on motivations that do not match perfectly motivations that usually described in OCD and AUD patients.

Frontoparietal hyperconnectivity during cognitive regulation in obsessive-compulsive disorder followed by reward valuation inflexibility

Obsessive-compulsive disorder (OCD) is characterized by cognitive deficits and altered reward processing systems. An imbalance between cognitive and reward pathways may explain the lack of control over obsessions followed by rewarding compulsive behaviors. While the processes of emotional cognitive regulation are widely studied in OCD, the mechanisms of cognitive regulation of reward are poorly described. Our goal was to investigate the OCD impact on cognitive regulation of reward at behavioral and neural functioning levels. OCD and control participants performed a functional magnetic resonance imaging task where they cognitively modulated their craving for food pictures under three cognitive regulation conditions: indulge/increase craving, distance/decrease craving, and natural/no regulation of craving. After regulation, the participants gave each picture a monetary value. We found that OCD patients had fixed food valuation scores while the control group modulated these values accordingly to the regulation conditions. Moreover, we observed frontoparietal hyperconnectivity during cognitive regulation. Our results suggest that OCD is characterized by deficits in cognitive regulation of internal states associated with inflexible behavior during reward processing. These findings bring new insights into the nature of compulsive behaviors in OCD.

The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology

Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.

Adolescent emotional disorder symptoms and transdiagnostic vulnerabilities as predictors of young adult substance use during the COVID-19 pandemic: mediation by substance-related coping behaviors

The COVID-19 pandemic presents unique stressors (e.g. social isolation) that may increase substance use risk among young adults with a history of emotional disturbance. This study examined whether emotional disorder symptoms and transdiagnostic vulnerabilities during adolescence predicted young adult substance use during COVID-19, and whether using substances to cope with the pandemic's social conditions mediated these associations. Adolescents (N = 2,120) completed baseline surveys assessing transdiagnostic emotional vulnerabilities (anhedonia, distress intolerance, anxiety sensitivity, negative urgency) and symptoms (major depression[MD], generalized anxiety[GAD], panic disorder[PD], social phobia[SP], obsessive-compulsive disorder[OCD]) in adolescence (September-December 2016; M[SD] age = 17.45[0.38]). At follow-up (May-August 2020; M[SD] age = 21.16[0.39]), past 30-day substance use and using substances to cope with social isolation during the pandemic were reported. Adjusted models showed that baseline distress intolerance, anxiety sensitivity, negative urgency, and MD symptoms each significantly predicted higher number of past-month single-substance using days and number of substances used at follow-up (βs = 0.04-0.06). In each case, associations were mediated by tendency to use substances to cope with the pandemic (β_indirect range: 0.028-0.061). To mitigate disproportionate escalation of substance use in young adults with a history of certain types of emotional disturbance, interventions promoting healthy coping strategies to deal with the pandemic's social conditions warrant consideration.

Obsessive-Compulsive Symptoms and Other Symptoms of the At-risk Mental State for Psychosis: A Network Perspective

BACKGROUND

The high prevalence of obsessive-compulsive symptoms (OCS) among subjects at Ultra-High Risk (UHR) for psychosis is well documented. However, the network structure spanning the relations between OCS and symptoms of the at risk mental state for psychosis as assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS) has not yet been investigated. This article aimed to use a network approach to investigate the associations between OCS and CAARMS symptoms in a large sample of individuals with different levels of risk for psychosis.

METHOD

Three hundred and forty-one UHR and 66 healthy participants were included, who participated in the EU-GEI study. Data analysis consisted of constructing a network of CAARMS symptoms, investigating central items in the network, and identifying the shortest pathways between OCS and positive symptoms.

RESULTS

Strong associations between OCS and anxiety, social isolation and blunted affect were identified. Depression was the most central symptom in terms of the number of connections, and anxiety was a key item in bridging OCS to other symptoms. Shortest paths between OCS and positive symptoms revealed that unusual thought content and perceptual abnormalities were connected mainly via anxiety, while disorganized speech was connected via blunted affect and cognitive change.

CONCLUSIONS

Findings provide valuable insight into the central role of depression and the potential connective component of anxiety between OCS and other symptoms of the network. Interventions specifically aimed to reduce affective symptoms might be crucial for the development and prospective course of symptom co-occurrence.

Validation of the French Version of the Child Posttraumatic Stress Checklist in French School-Aged Children

Background: The child posttraumatic stress disorder checklist (CPC) updated to DSM-5 is a questionnaire aimed to assess posttraumatic stress disorder (PTSD) symptoms in children. It is available in both parents and child versions. The back-translation method has been used for the French translation of the CPC. It has not been yet validated in French-speaking populations. The aim of this study was to assess the psychometric properties and the validity of the CPC in a sample of French-speaking schoolchildren and their parents. Methods: The sample was composed by 176 children outpatients implicated in the Nice terrorist attack (14 July 2016) aged 7-17 (mean = 11.68 years, SD = 2.63 months) and 122 parents. Cronbach's alpha was used to test CPC internal consistency. The Spearman-correlation coefficient was performed between the French version of the CPC and the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime version (K-SADS-PL) to assess the convergent validity. An ROC curve was constructed to verify the validity of the cutoff scores. An evaluation of the sensitivity and specificity of each score and a comparison with the diagnosis of the K-SADS-PL were made. Finally, a principal component analysis with varimax rotation was computed to analyze the structure of the French version of the CPC. Results: Cronbach's alpha coefficient was 0.90 for child version and 0.91 for parent version of the CPC. There was a statistical correlation between the K-SADS-PL for PTSD and the total score of CPC for the child version (r = 0.62; p < 0.001) and for the parent version (r = 0.55; p < 0.001). The sensitivity and specificity of the children version with a threshold of >20 were 73.1 and 84.7%, respectively, using the K-SADS-PL as the diagnostic reference for PTSD. Concerning the parent version, using the same recommended cutoff score, the sensitivity, and specificity were 77 and 80.5%, respectively. Conclusions: The psychometric properties of the French CPC are good. This questionnaire appears to be valid and should be used in French-speaking children.

Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters

AIMS

The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored.

METHODS

81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender.

RESULTS

AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1.

CONCLUSION

In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

Animal models of OCD-relevant processes: an RDoC perspective

Animal models have been invaluable tools in deciphering pathophysiology in many branches of medicine. Their application in the study of complex neuropsychiatric conditions such as obsessive-compulsive disorder (OCD), however, raises vexing interpretative challenges. The Research Domain Criteria (RDoC) approach of identifying dimensions of function and dysfunction that cut across syndromic diagnoses provides one potential path forward. We review some of the domains in the current RDoC matrix that may inform our understanding of patients with obsessions and compulsions, and how work in animal model systems is helping us to understand them. We focus on three specific RDoC constructs that may be particularly informative for our understanding of OCD: potential threat, habit, and cognitive control. In each case we review selected recent studies in animal models and their potential contribution to our understanding of OCD, and suggest directions for future research, informed by the animal studies. Such mechanistic work in animal models, in parallel with clinical studies refining our understanding of the relationship between these dimensional constructs and the symptomatology of particular groups of patients, may over time help us to generate a more comprehensive understanding of the pathogenesis and complexity of obsessions and compulsions.