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A Comparative Study of Anhedonia Components Between Major Li et al. Ann Gen Psychiatry (2015) 14:24 DOI 10.1186/s12991-015-0061-3 PRIMARY RESEARCH Open Access A comparative study of anhedonia components between major depression and schizophrenia in Chinese populations Yinghui Li1, Xiaodong Mou1, Wenhao Jiang1, Zhong Yang2, Xinhua Shen3, Zhuma Jin4, Zhiping Dai4, Yuju Liu5, Shengqin Mao1, Jian Zhang6 and Yonggui Yuan1* Abstract Background: Anhedonia is a prominent symptom of major depressive disorder (MDD) and schizophrenia. At pre- sent, it is believed that hedonic processing rather consists of the anticipatory and consummatory phase. The aim of this research is to explore the different anhedonia components in MDD and schizophrenia in Chinese populations. Methods: A Chinese version of the Temporal Experience of Pleasure Scale (TEPS) was used to evaluate 176 MDD patients, 346 schizophrenia patients, and 268 healthy controls. Additionally, the 17-item Hamilton Depression Rating Scale (HAMD-17) was used for MDD patients, while the Positive and Negative Syndrome Scale (PANSS) was applied for schizophrenia. Results: The scores of consummatory (TEPS-CON) and anticipatory pleasure (TEPS-ANT) in MDD and schizophrenia were both significantly lower than healthy controls (both P < 0.001). TEPS-CON and TEPS-ANT were negatively corre- lated with the score of HAMD-17, the duration of illness and admission times in MDD (P < 0.05 or 0.01). TEPS-CON was negatively related to PANSS total scores and negative symptoms (P < 0.05 or 0.01), but no significant correlation was found with duration of illness and admission times in schizophrenia (P > 0.05). There was no significant correlation between TEPS-ANT and any clinical variables (P > 0.05). Conclusions: The consummatory and anticipatory pleasures were both impaired in MDD and schizophrenia. Con- summatory and anticipatory anhedonia can be considered as a “state” in MDD, but as a “trait” in schizophrenia. Keywords: Anhedonia, Anticipatory pleasure, Consummatory pleasure, Major depressive disorder, Schizophrenia Background an enjoyable activity, while anticipatory pleasure revolves Anhedonia, the diminished capacity to experience pleas- around pleasure from future activities. ure, is a prominent symptom of major depressive disor- Anhedonia and depressed mood are the two core der (MDD), schizophrenia and other neuropsychiatric symptoms of MDD [1]. Hasler and colleagues [6] dem- disorders [1–4]. Almost 30 years ago, Klein [5] suggested onstrated that anhedonia together with increased stress that hedonic processing was not a unitary construct, but reactivity was the most important candidate for psycho- rather a complex of both anticipatory and consumma- pathological endophenotype of MDD. Joiner et al. [7] tory components. Consummatory pleasure reflects the found that MDD patients presented higher scores on momentary pleasure that is experienced while engaged in Beck Depression Inventory (BDI) anhedonic items than schizophrenic subjects, suggesting that anhedonia was a specific state-like feature of depressive illness. However, *Correspondence: [email protected] Pelizza and Ferrari [8] detected that anhedonia reached 1 Department of Psychosomatics and Psychiatry, ZhongDa Hospital, highly significant levels in 36.9 % of depressed patients School of Medicine, Southeast University, Nanjing 210009, People’s and 45 % of schizophrenic patients according to the Phys- Republic of China Full list of author information is available at the end of the article ical Anhedonia Scale and the Social Anhedonia Scale, © 2015 Li et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated. Li et al. Ann Gen Psychiatry (2015) 14:24 Page 2 of 7 indicating that anhedonia could not be considered as a controls; and (2) exploring the relationships between dif- distinctive state in MDD. ferent anhedonia types and clinical variables, including Accumulating evidence suggested that depression was severity, duration of illness and admission times in MDD associated with anhedonia. Pizzagalli et al. [9] found and schizophrenia. blunted reward responsiveness in patients with MDD, particularly when anhedonic symptoms were prominent. Methods Treadway et al. [10] observed an association between Participants anhedonia and reduced motivation in an effort-based This study included 176 patients with MDD, 346 patients decision-making task in MDD. Liu et al. [11] utilizing with schizophrenia and 268 healthy controls. All the the Snaith–Hamilton Pleasure Scale (SHAPS) in Chinese patients were inpatients who were recruited from six populations indicated that patients with depression dem- hospitals (one general hospital, five psychiatric hospi- onstrated more anhedonic symptoms than patients with tals): Zhongda Hospital affiliated to Southeast University, schizophrenia and non-clinical individuals. Although Changshu Mental Health Centre, Third People’s Hospi- the above studies suggested diminished hedonic capac- tal of Hai’an, Brain Hospital affiliated to Nanjing Medi- ity in MDD, they did not differentiate consummatory and cal University, Fourth People’s Hospital of Zhenjiang anticipatory anhedonia. To date, only one study distin- and Third People’s Hospital of Huzhou. Clinical diagno- guished consummatory and anticipatory anhedonia, stat- ses were determined based on the Structured Clinical ing low anticipatory pleasure but intact consummatory Interview for DSM-IV [1] by experienced psychiatrists. pleasure in depressed individuals [12]. Patients with any other concurrent Axis I disorders were In schizophrenia, anhedonia has long been considered excluded; furthermore, patients with history of mental a cardinal symptom [13] and a component of negative retardation, personality disorder, neurological disorders, symptoms [14, 15]. Studies on anhedonia in schizophre- such as stroke, head injury, seizure or diagnosis of alcohol nia have provided inconsistent results. Schizophrenia or substance abuse/dependence in the last 6 months were patients reported more severe anhedonia than healthy also excluded from the study. All patients with MDD controls on self-report measures and semistructured received antidepressant medication treatment, tricy- interviews [16–18], but had normal levels of pleasant clic antidepressants (TCAs, n = 12), selective serotonin emotions while in response to pleasurable stimuli [19, reuptake inhibitors (SSRIs, n = 86), serotonin–norepi- 20]. Distinction of deficits in anticipatory and consum- nephrine reuptake inhibitors (SNRIs, n = 43), noradren- matory pleasure may help to understand the mixed find- ergic and specific serotonergic antidepressant (NaSSA, ings on anhedonia in schizophrenia. A new self-report n = 25), other antidepressants (n = 10) and two or more questionnaire, the Temporal Experience of Pleasure Scale antidepressants (n = 12). All patients with schizophrenia (TEPS), developed by Gard et al. [21], was used to assess were treated with a regular dose of antipsychotic medi- consummatory and anticipatory pleasure. Several studies cations: typical (n = 42), atypical (n = 274) and mixed showed anticipatory, but not consummatory anhedonia (n = 30). Healthy controls were recruited from ZhongDa in schizophrenia [22–24]. However, the study of Strauss Hospital, including 216 health examination clients, 32 et al. [25] had the opposite result. Buck and Lysaker [26] nurses and 20 doctors. All healthy controls were screened suggested that anticipatory pleasure predicted concur- by experienced psychiatrists to ascertain that they did rent and prospective levels of positive symptoms, emo- not have any neuropsychiatric symptoms. tional discomfort and interpersonal function, whereas consummatory pleasure predicted only concurrent posi- Measures tive symptoms. General Situation Questionnaire In summary, little attention has been paid to detect the A self-designed questionnaire was used to investigate the consummatory and anticipatory pleasure impairment in general condition of participants, including demographi- MDD, and there were inconsistent results on consumma- cal information, course of illness, admission times and tory and anticipatory pleasure in schizophrenia. Moreo- type of medications. ver, there has been no study to compare the difference between MDD and schizophrenia on consummatory and The Temporal Experience of Pleasure Scale (TEPS) anticipatory pleasure. The TEPS is composed of 18 items rated on a Likert-type In this study, we assessed consummatory and antici- scale ranging from 1 (Very True for me) to 6 (Very False patory pleasure using TEPS in MDD and schizophre- for me) and yields two subscales measuring anticipatory nia. The present study has two main aims: (1) examining (TEPS-ANT) and consummatory (TEPS-CON) pleas- the discrimination of consummatory and anticipatory ure. Lower scores indicate greater levels of anhedonia pleasure between MDD or schizophrenia and healthy [21]. The Chinese version of TEPS has been proved to Li et al. Ann Gen Psychiatry (2015) 14:24 Page 3 of 7 possess adequate validations and reliability in previous with schizophrenia
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