The nature of diminished pleasure in individuals at risk for or affected by schizophrenia

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Humour processing deficits in individuals with social anhedonia

Humour processing comprises the humour comprehension and the humour appreciation phases. Patients with schizophrenia have impaired humour processing. However, it is unclear whether such deficits affect subclinical populations such as individuals with social anhedonia. Our study recruited forty-eight individuals with high levels of social anhedonia (HSA, screened by the Revised Chapman Social Anhedonia Scale) and 50 individuals with low levels of social anhedonia (LSA). Participants completed behavioural tasks which tapped into humour comprehension and appreciation, and a set of questionnaires assessing their sense of humour, humour styles and subjective experiential pleasure. Using signal detection theory analysis, the d' and β values were generated to measure the detection of humour signal in the comprehension phase and the inner criteria of the humour appreciation respectively. The results showed that the HSA and LSA groups did not differ in humour signal detection (d') but the HSA group had significantly higher inner criteria of humour appreciation (β) than the LSA group. The β value was correlated with experiential anticipatory pleasure in all participants. The HSA group had significantly lower within-group coherence than the LSA group when processing humour. Our findings suggested that individuals with social anhedonia have impaired humour processing.

Pleasure Experience and Emotion Expression in Patients with Schizophrenia

Background

Impairments in emotional experience and expression have been observed in patients with schizophrenia. However, most previous studies have been limited to either emotional experience (especially anhedonia) or expression. Few studies have examined both the experience and expression of emotion in schizophrenia patients at the same time.

Aims

The present study aimed to examine pleasure experience and emotion expression in patients with schizophrenia. In particular, we specifically examined the relationship between emotion impairments (both pleasure experience and expression) and negative symptoms.

Methods

One hundred and fifty patients completed the Temporal Experience of Pleasure Scale and Emotional Expressivity Scale.

Results

Schizophrenia patients exhibited deficits in experiencing pleasure, but showed intact reported emotion expression. Patients with prominent negative symptoms showed reduced anticipatory pleasure, especially in abstract anticipatory pleasure.

Conclusion

The present findings suggest that patients with schizophrenia have deficits in pleasure experience, while their abilities to express emotion appear intact. Such deficits are more severe in patients with prominent negative symptoms.

Do complaints of everyday cognitive failures in high schizotypy relate to emotional working memory deficits in the lab?

BACKGROUND

Individuals high on schizotypy complain of increased cognitive failures in everyday life. However, the neuropsychological performance of this group does not consistently indicate underlying ability deficits. It is possible that current neuropsychological tests lack ecological validity. Given the increased affective reactivity of high schizotypes, they may be more sensitive to emotional content interfering with cognitive ability. This study sought to explore whether an affective n-back working memory task would elicit impaired performance in schizotypy, echoing complaints concerning real world cognition.

METHODS

127 healthy participants completed self-report measures of schizotypy and cognitive failures and an affective n-back working memory task. This task was varied across three levels of load (1- to 3-back) and four types of stimulus emotion (neutral, fearful, happy, sad). Differences between high (n=39) and low (n=48) schizotypy groups on performance outcomes of hits and false alarms were examined, with emotion and load as within-groups variables.

RESULTS

As expected, high schizotypes reported heightened vulnerability to cognitive failures. They also demonstrated a relative working memory impairment for emotional versus neutral stimuli, whereas low schizotypes did not. High schizotypes performed most poorly in response to fearful stimuli. For false alarms, there was an interaction between schizotypy, load, and emotion, such that high schizotypy was associated with deficits in response to fearful stimuli only at higher levels of task difficulty. Inclusion of self-reported cognitive failures did not account for this.

CONCLUSION

These findings suggest that the "gap" between subjective and objective cognition in schizotypy may reflect the heightened emotional demands associated with cognitive functioning in the real world, although other factors also seem to play a role. There is a need to improve the ecological validity of objective assessments, whilst also recognizing that self-reported cognitive failures tap into a range of factors difficult to assess in the lab, including emotion. Cognitive interventions for at-risk individuals will likely be more beneficial if they address emotional processing alongside other aspects of cognition.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

A Review of Anticipatory Pleasure in Schizophrenia

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

Perspective-taking abilities in the balance between autism tendencies and psychosis proneness

Difficulties with the ability to appreciate the perspective of others (mentalizing) is central to both autism and schizophrenia spectrum disorders. While the disorders are diagnostically independent, they can co-occur in the same individual. The effect of such co-morbidity is hypothesized to worsen mentalizing abilities. The recent influential 'diametric brain theory', however, suggests that the disorders are etiologically and phenotypically diametrical, predicting opposing effects on one's mentalizing abilities. To test these contrasting hypotheses, we evaluated the effect of psychosis and autism tendencies on the perspective-taking (PT) abilities of 201 neurotypical adults, on the assumption that autism tendencies and psychosis proneness are heritable dimensions of normal variation. We show that while both autism tendencies and psychosis proneness induce PT errors, their interaction reduced these errors. Our study is, to our knowledge, the first to observe that co-occurring autistic and psychotic traits can exert opposing influences on performance, producing a normalizing effect possibly by way of their diametrical effects on socio-cognitive abilities. This advances the notion that some individuals may, to some extent, be buffered against developing either illness or present fewer symptoms owing to a balanced expression of autistic and psychosis liability.

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

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

Experiential pleasure deficits in different stages of schizophrenia

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

Subjective pleasure experience in patients with recent-onset schizophrenia: A preliminary report

Little is known about subjective pleasure experience in recent-onset schizophrenia, and its relationship with neurocognitive functions. Twenty-seven recent-onset schizophrenia people and 26 controls completed the TEPS and neuropsychological tests. The results showed that schizophrenia people self-reported less anticipatory pleasure than controls. Semantic verbal fluency was apparently correlated with anticipatory pleasure.

Hedonic capacity and schizotypy: evidence for the criterion validity of the ACIPS

The association between trait hedonic capacity and schizotypal personality traits was examined in a two studies of independent nonclinical samples. In both investigations, hedonic capacity was measured using the 17-item Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS). In Study One, the young adults' (n=1345) ACIPS scores were inversely associated with their scores on the Schizotypal Personality Questionnaire (SPQ). In Study Two, two groups of individuals identified on the basis of their scores on the Schizotypal Personality Questionnaire Brief-Revised (SPQ-BR) were compared in terms of their ACIPS responses and response patterns. Our results indicate that the high schizotypal subjects (n =38) and the low schizotypal subjects (n=37) differed significantly in terms of their mean ACIPS scores, but not in terms of their mean reaction times. Despite differences in study design, both investigations indicated an association between the No Close Friends subscale of the SPQ and the ACIPS total score. These findings are considered in the context of other extant studies of schizotypal traits and the role of anhedonia in schizotypy. Overall, the findings provide further evidence for the criterion validity of the ACIPS.

Relationship between anticipatory, consummatory anhedonia and disorganization in schizotypy

BACKGROUND

The disorganized and negative dimensions of schizotypy are characterized by cognitive disorganization and anhedonia, respectively. The aim of the study was to investigate the relationships between these two dimensions of schizotypy by taking into account ambivalence and the distinction between consummatory and anticipatory anhedonia.

METHODS

Dimensional analysis and categorical analysis were performed on two different samples (N = 400 and 399) of university students. Self-reported scales were used to measure cognitive disorganization, anticipatory and consummatory anhedonia, and ambivalence. Dimensional analysis using confirmatory factorial analysis examined various models of disorganized and negative schizotypy and categorical analysis compared the scores on anticipatory, consummatory anhedonia and ambivalence scales between various groups of subjects presenting either disorganized schizotypy or negative schizotypy or free of schizotypy.

RESULTS

The disorganized dimension of schizotypy was characterized by schizotypal ambivalence and anticipatory anhedonia, while the negative dimension of schizotypy was characterized by anticipatory and consummatory anhedonia.

CONCLUSION

The results suggested firstly that ambivalence was not specific of disorganized schizotypy and secondly that anticipatory anhedonia was not specific of negative schizotypy.