Anhedonia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]

Overview

Anhedonia forms one of major criteria in the diagnosis of depression, but, it also seen in negative symptom of schizophrenia, psychosis. Anhedonia is studies in neuropsychiatrie disorders, substance use disorder, parkinson's disease, overeating, and various risky behaviors.

Causes

Sexual Anhedonia

Sexual anhedonia is caused by:

  • Hyperprolactinaemia
  • Hypoactive sexual desire disorder (HSDD), also called inhibited sexual desire
  • Spinal cord injury
  • Multiple sclerosis
  • Use (or previous use) of SSRI antidepressants[1]
  • Use (or previous use) of antidopaminergic neuroleptics (anti-psychotics)[2][3]
  • Fatigue
  • Physical illness

Comorbidity

Anhedonia is present in several forms of psychopathology.[4] However, social anhedonia is not a necessary symptom criterion of any disorder. Social anhedonia manifests similarly in a variety of different mental illness, but for differing reasons. Most frequently, social anhedonia is associated with schizophrenia and schizophrenia spectrum disorders (including schizotypal personality disorder, paranoid personality disorder, and antisocial personality disorder). Social anhedonia has also been implicated in other psychological disorders:

Depression

Social anhedonia is observed in both depression and schizophrenia. However, social anhedonia is state related to the depressive episode and the other is trait related to the personality construct associated with schizophrenia. These individuals both tend to score highly on self-report measures of social anhedonia. Blanchard, Horan, and Brown (2001) demonstrated that, although both the depression and the schizophrenia patient groups can look very similar in terms of social anhedonia cross sectionally, over time as individuals with depression experience symptom remission, they show fewer signs of social anhedonia, while individuals with schizophrenia do not.[5] Blanchard and colleagues (2011) found individuals with social anhedonia also had elevated rates of lifetime mood disorders including depression and dysthymia compared to controls.[6]

Social Anxiety

As mentioned above, social anxiety and social anhedonia differ in important ways. However, social anhedonia and social anxiety are also often comorbid with each other. People with social anhedonia may display increased social anxiety and be at increased risk for social phobias and generalized anxiety disorder.[7] It has yet to be determined what the exact relationship between social anhedonia and social anxiety is, and if one potentiates the other.[8] Individuals with social anhedonia may display increased stress reactivity, meaning that they feel more overwhelmed or helpless in response to a stressful event compared to control subjects who experience the same type of stressor. This dysfunctional stress reactivity may correlate with hedonic capacity, providing a potential explanation for the increased anxiety symptoms experienced in people with social anhedonia.[9] In an attempt to separate out social anhedonia from social anxiety, the Revised Social Anhedonia Scale [10] didn’t include items that potentially targeted social anxiety.[11] However, more research must be conducted on the underlying mechanisms through which social anhedonia overlaps and interacts with social anxiety. The efforts of the “social processes” RDoC initiative will be crucial in differentiating between these components of social behavior that may underlie mental illnesses such as schizophrenia.[12]

Primary relevance in schizophrenia & schizophrenia spectrum disorders

Social anhedonia is a core characteristic of schizotypy, which is defined as a continuum of personality traits that can range from normal to disordered and contributes to risk for psychosis and schizophrenia.[13] Social anhedonia is a dimension of both negative and positive schizotypy.[14] It involves social and interpersonal deficits, but is also associated with cognitive slippage and disorganized speech, both of which fall into the category of positive schizotypy.[15][16][17] Not all people with schizophrenia display social anhedonia [18] and likewise, people who have social anhedonia may never be diagnosed with a schizophrenia-spectrum disorder if they do not have the positive and cognitive symptoms that are most frequently associated with most schizophrenia-spectrum disorders.[19]

Social anhedonia may be a valid predictor of future schizophrenia-spectrum disorders;[19][20] young adults with social anhedonia perform in a similar direction to schizophrenia patients in tests of cognition and social behavior tests, showing potential predictive validity.[15][21] Social anhedonia usually manifests in adolescence, possibly because of a combination of the occurrence of critical neuronal development and synaptic pruning of brain regions important for social behavior and environmental changes, when adolescents are in the process of becoming individuals and gaining more independence.

References

  1. Csoka, Antonei; Bahrick, Audrey; Mehtonen, Olli-Pekka (2007). "Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors". Journal of Sexual Medicine. 5 (1): 227–233. doi:10.1111/j.1743-6109.2007.00630.x. PMID 18173768.
  2. Tupala, E; Haapalinna, A; Viitamaa, T; Männistö, PT; Saano, V (1999). "Effects of repeated low dose administration and withdrawal of haloperidol on sexual behaviour of male rats". Pharmacology & toxicology. 84 (6): 292–5. doi:10.1111/j.1600-0773.1999.tb01497.x. PMID 10401732.
  3. Martin-Du Pan, R (1978). "Neuroleptics and sexual dysfunction in man. Neuroendocrine aspects". Schweizer Archiv fur Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie. 122 (2): 285–313. PMID 29337.
  4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000). Washington, DC, American Psychiatric Association.
  5. Blanchard, J.J., Horan, W.P., & Brown, S.A. (2001). Diagnostic differences in social anhedonia: A longitudinal study of schizophrenia and major depressive disorder. Journal of Abnormal Psychology, 110, 363-371.
  6. Blanchard, J.J., Collins, L.M., Aghevli, M., Leung, W.W. & Cohen, A.S. (2011). Social anhedonia and schizotypy in a community sample: the Maryland longitudinal study of schizotypy. Schizophrenia Bulletin, 37, 587-602.
  7. Rey, G., Jouvent, R., & Dubal, S. (2009). Schizotypy, depression, and anxiety in physical and social anhedonia. Journal of clinical psychology, 65(7), 695–708. doi:10.1002/jclp.20577
  8. Horan, W. P., Kring, A. M., & Blanchard, J. J. (2006). Anhedonia in schizophrenia: a review of assessment strategies. Schizophrenia bulletin, 32(2), 259–273. doi:10.1093/schbul/sbj009
  9. Horan, W. P., Brown, S. A., & Blanchard, J. J. (2007). Social anhedonia and schizotypy: the contribution of individual differences in affective traits, stress, and coping. Psychiatry research, 149(1-3), 147–156. doi:10.1016/j.psychres.2006.06.002
  10. Eckblad, M.L., Chapman, L.J., Chapman, J.P., & Mishlove, M. (1982). The Revised Social Anhedonia Scale. Unpublished test
  11. Kwapil, T R. (1998). Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. Journal of abnormal psychology, 107(4), 558–565
  12. http://www.nimh.nih.gov/research-funding/rdoc/index.shtml
  13. Meehl PE. Schizotaxia, schizotypy, schizophrenia. The American Psychologist 1962;17(12):827–838
  14. Kwapil, Thomas R, Barrantes-Vidal, N., & Silvia, P. J. (2008). The dimensional structure of the Wisconsin Schizotypy Scales: factor identification and construct validity. Schizophrenia bulletin, 34(3), 444–457. doi:10.1093/schbul/sbm098
  15. 15.0 15.1 Gooding, D C, Tallent, K. A., & Hegyi, J. V. (2001). Cognitive slippage in schizotypic individuals. The Journal of nervous and mental disease, 189(11), 750–756
  16. Kerns, J. G. (2006). Schizotypy facets, cognitive control, and emotion. Journal of abnormal psychology, 115(3), 418–427. doi:10.1037/0021-843X.115.3.418
  17. Collins, L. M., Blanchard, J. J., & Biondo, K. M. (2005). Behavioral signs of schizoidia and schizotypy in social anhedonics. Schizophrenia research, 78(2-3), 309–322. doi:10.1016/j.schres.2005.04.021
  18. Chapman, L. J., Chapman, J. P., & Raulin, M. L. (1976). Scales for physical and social anhedonia. Journal of abnormal psychology, 85(4), 374–382
  19. 19.0 19.1 Chapman, L. J., Chapman, J. P., Kwapil, T. R., Eckblad, M., & Zinser, M. C. (1994). Putatively psychosis-prone subjects 10 years later. Journal of abnormal psychology, 103(2), 171–183
  20. Rey, G., Jouvent, R., & Dubal, S. (2009). Schizotypy, depression, and anxiety in physical and social anhedonia. Journal of clinical psychology, 65(7), 695–708
  21. Gooding, Diane C, Tallent, K. A., & Matts, C. W. (2005). Clinical status of at-risk individuals 5 years later: further validation of the psychometric high-risk strategy. Journal of abnormal psychology, 114(1), 170–175



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