Skip to main content
SpringerLink
Log in

Anhedonia in schizophrenia

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

This review highlights key issues and recent progress in understanding the epidemiology, phenomenology, etiology, and treatment of anhedonia in schizophrenia. A reduced pleasure capacity has been recognized as an important feature of the illness since the time of Kraepelin and Bleuler. However, it remains poorly understood for many reasons, including the phenotypic heterogeneity of schizophrenia, the multidimensionality and multifactorial etiology of anhedonia, and the dif-ficulties inherent in the scientific analysis of subjective emotional experiences. We do know that anhedonia is common in schizophrenia, that it has significant negative consequences, and that current treatments are insuf-ficient. Better assessment tools, greater understanding of biological and psychosocial mechanisms, and novel pharmacologic and psychosocial interventions are sorely needed. Anhedonia has received increasing attention in recent years, and there is optimism that the new Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative on negative symptoms will catalyze rapid progress in the near future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Harvey PD, Koren D, Reichenberg A, et al.: Negative symptoms and cognitive deficits: What is the nature of their relationship? Schizophr Bull 2006, 32:250–258.

    Article  PubMed  Google Scholar 

  2. Ribot TH: The Psychology of Emotions. London: Scott; 1897.

    Google Scholar 

  3. Kraepelin E: Dementia Praecox and Paraphrenia. Translated by Barclay RM. Huntington, NY: Krieger; 1971 (1919).

    Google Scholar 

  4. Bleuler E: Dementia Praecox or the Group of Schizophrenias. Translated by Zinkin J. New York: International Universities Press; 1950 (1911).

    Google Scholar 

  5. Meehl PE: Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962, 17:827–838.

    Article  Google Scholar 

  6. Horan WP, Kring AM, Blanchard JJ: Anhedonia in schizophrenia: a review of assessment strategies. Schizophr Bull 2006, 32:259–273. An excellent review of conceptual and methodological issues relevant to assessing anhedonia in schizophrenia. Existing measures are described and their strengths and limitations discussed.

    Article  PubMed  Google Scholar 

  7. Schurhoff F, Szoke A, Bellivier F, et al.: Anhedonia in schizophrenia: a distinct familial subtype? Schizophr Res 2003, 61:59–66.

    Article  PubMed  Google Scholar 

  8. Suslow T, Roestel C, Ohrmann P, et al.: The experience of basic emotions in schizophrenia with and without affective negative symptoms. Compr Psychiatry 2003, 44:303–310.

    Article  PubMed  Google Scholar 

  9. Gooding DC, Tallent KA, Matts CW: Clinical status of at-risk individuals 5 years later: further validation of the psychometric high-risk strategy. J Abnorm Psychol 2005, 114:170–175.

    Article  PubMed  Google Scholar 

  10. Katsanis J, Iacono WG, Beiser M: Anhedonia and perceptual aberration in first-episode psychotic patients and their relatives. J Abnorm Psychol 1990, 99:202–206.

    Article  PubMed  CAS  Google Scholar 

  11. Rey ER, Bailer J, Brauer W, et al.: Stability trends and longitudinal correlations of negative and positive syndromes within a three-year follow-up of initially hospitalized schizophrenics. Acta Psychiatr Scand 1994, 90:405–412.

    PubMed  CAS  Google Scholar 

  12. Herbener ES, Harrow M: The course of anhedonia during 10 years of schizophrenic illness. J Abnorm Psychol 2002, 111:237–248.

    Article  PubMed  Google Scholar 

  13. Herbener ES, Harrow M, Hill SK: Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia. Schizophr Res 2005, 75:97–105. A unique long-term, multi-follow-up study of anhedonia in schizophrenia that found that a trait measure of physical anhedonia is stable over time but becomes increasingly associated with functional impairments. Together with Milev et al. [14], it highlights the functional impact of negative symptoms throughout the course of illness.

    Article  PubMed  Google Scholar 

  14. Milev P, Ho BC, Arndt S, et al.: Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 2005, 162:495–506.

    Article  PubMed  Google Scholar 

  15. Kirkpatrick B, Fenton WS, Carpenter WT, Jr, et al.: The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006, 32:214–219. Summarizes the conclusions of the recent NIMH consensus development conference on negative symptoms. The committee has created a roadmap for developing methods to assess negative symptoms and conduct clinical trials targeting this domain; this will have a significant impact on the future course of pharmaceutical and academic research programs.

    Article  PubMed  Google Scholar 

  16. Blanchard JJ, Cohen AS: The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull 2006, 32:238–245.

    Article  PubMed  Google Scholar 

  17. Andreasen NC: Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry 1982, 39:784–788.

    PubMed  CAS  Google Scholar 

  18. Cohen AS, Dinzeo TJ, Nienow TM, et al.: Diminished emotionality and social functioning in schizophrenia. J Nerv Ment Dis 2005, 193:796–802.

    Article  PubMed  Google Scholar 

  19. Horan WP, Green MF, Kring AM, et al.: Does anhedonia in schizophrenia reflect faulty memory for subjectively experienced emotions? J Abnorm Psychol 2006, In press.

  20. Rector NA, Beck AT, Stolar N: The negative symptoms of schizophrenia: a cognitive perspective. Can J Psychiatry 2005, 50:247–257. The authors review psychological contributions to anhedonia and related negative symptoms from a cognitive perspective and discuss the role of cognitive-behavioral therapy in the treatment of these symptoms.

    PubMed  Google Scholar 

  21. Gard DE, Germans Gard M, Kring AM, et al.: Anticipatory and consummatory components of the experience of pleasure: a scale development study. J Res Pers 2006, In press. The authors discuss the distinction between anticipatory and consummatory anhedonia and describe initial validation studies of a new scale they have designed to measure these constructs. Given increasing interest in this important distinction, the scale is likely to be widely used.

  22. Gard DE, Kring AM, Germans MK, et al.: Emotion in the daily life of patients with schizophrenia. Poster presented at Annual Meeting of the Society for Research in Psychopathology. Boulder, CO; November 30–December 3, 2000.

  23. Myin-Germeys I, Delespaul PA, de Vries MW: Schizophrenia patients are more emotionally active than is assumed based on their behavior. Schizophr Bull 2000, 26:847–854.

    PubMed  CAS  Google Scholar 

  24. Aghevli MA, Blanchard JJ, Horan WP: The expression and experience of emotion in schizophrenia: a study of social interactions. Psychiatry Res 2003, 119:261–270. A study using affiliative and assertive role plays in a laboratory setting. Extends evidence of abnormal affect but intact subjective emotion to the social realm, in which traditional views would predict patients with schizophrenia would experience the greatest anhedonia.

    Article  PubMed  Google Scholar 

  25. Kring AM, Neale JM: Do schizophrenic patients show a disjunctive relationship among expressive, experiential, and psychophysiological components of emotion? J Abnorm Psychol 1996, 105:249–257.

    Article  PubMed  CAS  Google Scholar 

  26. Hempel RJ, Tulen JH, van Beveren NJ, et al.: Physiological responsivity to emotional pictures in schizophrenia. J Psychiatr Res 2005, 39:509–518.

    Article  PubMed  Google Scholar 

  27. Plailly J, d’Amato T, Saoud M, Royet JP: Left temporolimbic and orbital dysfunction in schizophrenia during odor familiarity and hedonicity judgments. Neuroimage 2006, 29:302–313.

    Article  PubMed  Google Scholar 

  28. Taylor SF, Phan KL, Britton JC, et al.: Neural response to emotional salience in schizophrenia. Neuropsychopharmacology 2005, 30:984–995.

    Article  PubMed  Google Scholar 

  29. Kirkpatrick B, Buchanan RW, Ross DE, et al.: A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry 2001, 58:165–171.

    Article  PubMed  CAS  Google Scholar 

  30. Gur RE, Kohler CG, Ragland JD, et al.: Flat affect in schizophrenia: relation to emotion processing and neurocognitive measures. Schizophr Bull 2006, 32:279–287.

    Article  PubMed  Google Scholar 

  31. Iancu I, Poreh A, Lehman B, et al.: The Positive and Negative Symptoms Questionnaire: a self-report scale in schizophrenia. Compr Psychiatry 2005, 46:61–66.

    Article  PubMed  Google Scholar 

  32. Berridge KC, Robinson TE: Parsing reward. Trends Neurosci 2003, 26:507–513.

    Article  PubMed  CAS  Google Scholar 

  33. van der Heiden W, Konnecke R, Maurer K, et al.: Depression in the long-term course of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2005, 255:174–184.

    Article  Google Scholar 

  34. Kontaxakis VP, Kollias CT, Havaki-Kontaxaki BJ, et al.: Physical anhedonia in the acute phase of schizophrenia. Ann Gen Psychiatry 2006, 5:1.

    Article  PubMed  Google Scholar 

  35. Barch DM: The relationships among cognition, motivation, and emotion in schizophrenia: how much and how little we know. Schizophr Bull 2005, 31:875–881.

    Article  PubMed  Google Scholar 

  36. Wittmann BC, Schott BH, Guderian S, et al.: Rewardrelated FMRI activation of dopaminergic midbrain is associated with enhanced hippocampus-dependent longterm memory formation. Neuron 2005, 45:459–467.

    Article  PubMed  CAS  Google Scholar 

  37. Kayton L, Koh SD: Hypohedonia in schizophrenia. J Nerv Ment Dis 1975, 161:412–420.

    Article  PubMed  CAS  Google Scholar 

  38. Brebion G, David AS, Jones H, et al.: Hallucinations, negative symptoms, and response bias in a verbal recognition task in schizophrenia. Neuropsychology 2005, 19:612–617.

    Article  PubMed  Google Scholar 

  39. Awad AG, Voruganti LN: Neuroleptic dysphoria: revisiting the concept 50 years later. Acta Psychiatr Scand Suppl 2005, 111(Suppl 427):6–13.

    Article  Google Scholar 

  40. Artaloytia JF, Arango C, Lahti A, et al.: Negative signs and symptoms secondary to antipsychotics: a double-blind, randomized trial of a single dose of placebo, haloperidol, and risperidone in healthy volunteers. Am J Psychiatry 2006, 163:488–493.

    Article  PubMed  Google Scholar 

  41. Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13:261–276.

    PubMed  CAS  Google Scholar 

  42. Smith AJ, Becker S, Kapur S: A computational model of the functional role of the ventral-striatal D2 receptor in the expression of previously acquired behaviors. Neural Comput 2005, 17:361–395.

    Article  PubMed  Google Scholar 

  43. Abi-Dargham A: Do we still believe in the dopamine hypothesis? New data bring new evidence. Int J Neuropsychopharmacol 2004, 7(Suppl 1):S1-S5.

    Article  PubMed  CAS  Google Scholar 

  44. Juckel G, Schlagenhauf F, Koslowski M, et al.: Dysfunction of ventral striatal reward prediction in schizophrenia. Neuroimage 2006, 29:409–416. A functional MRI study of neural activity during reward processing in schizophrenia. Together with the positron emission tomography study in Taylor et al. [28], this provides the first functional neuroimaging evidence that clearly connects reduced activity in the mesolimbic dopamine system to negative symptoms in schizophrenia.

    Article  PubMed  Google Scholar 

  45. Laruelle M: The role of endogenous sensitization in the pathophysiology of schizophrenia: implications from recent brain imaging studies. Brain Res Brain Res Rev 2000, 31:371–384.

    Article  PubMed  CAS  Google Scholar 

  46. Kalivas PW, Volkow ND: The neural basis of addiction: a pathology of motivation and choice. Am J Psychiatry 2005, 162:1403–1413.

    Article  PubMed  Google Scholar 

  47. vanNimwegen L, de Haan L, van Beveren N, et al.: Adolescence, schizophrenia and drug abuse: a window of vulnerability. Acta Psychiatr Scand Suppl 2005, 111(Suppl 427):35–42.

    Article  Google Scholar 

  48. Erhart SM, Marder SR, Carpenter WT: Treatment of schizophrenia negative symptoms: future prospects. Schizophr Bull 2006, 32:234–237.

    Article  PubMed  Google Scholar 

  49. Nathans-Barel I, Feldman P, Berger B, et al.: Animalassisted therapy ameliorates anhedonia in schizophrenia patients. A controlled pilot study. Psychother Psychosom 2005, 74:31–35.

    Article  PubMed  Google Scholar 

  50. Bryson G, Lysaker P, Bell M: Quality of life benefits of paid work activity in schizophrenia. Schizophr Bull 2002, 28:249–257.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Neuropsychiatry Program, University of Pennsylvania, 10 Gates Building, 3400 Spruce Street, 19104, Philadelphia, PA, USA

    Daniel H. Wolf MD, PhD

Authors
  1. Daniel H. Wolf MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel H. Wolf MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wolf, D.H. Anhedonia in schizophrenia. Curr Psychiatry Rep 8, 322–328 (2006). https://doi.org/10.1007/s11920-006-0069-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-006-0069-0

Keywords

Search

Navigation