Gaillard R, Gourion D, Llorca P M
Inserm UMR S894, service hospitalo-universitaire, laboratoire de physiopathologie des maladies psychiatriques, centre de psychiatrie et neurosciences, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
Encephale. 2013 Sep;39(4):296-305. doi: 10.1016/j.encep.2013.07.001. Epub 2013 Aug 12.
Anhedonia, or markedly diminished interest or pleasure, is a hallmark symptom of major depression, schizophrenia, and other neuropsychiatric disorders. The term "anhedonia" was introduced by the French psychologist Ribot in 1896 to describe the counterpart to analgesia in his patients, for which "it was impossible to find the least pleasure". Over the last decades, the clinical definition of anhedonia has remained relatively unchanged, but recently, behavioral neurosciences have significantly changed our knowledge of reward-related processes. Now, the construct of anhedonia reflects deficits in hedonic capacity, and is closely linked to the processes of reward valuation, decision-making, anticipation, and motivation. The neural circuits underlying these reward-related mechanisms include essentially the ventral striatum and prefrontal cortical regions. Here, we review the clinical concepts, neural bases and psychopharmacological data related to the deficits of hedonia in depression. Understanding anhedonia will facilitate diagnosis and treatment management.
快感缺失，即兴趣或愉悦感显著减退，是重度抑郁症、精神分裂症及其他神经精神疾病的标志性症状。“快感缺失”一词由法国心理学家里博于1896年提出，用于描述其患者中与痛觉缺失相对应的情况，即“完全找不到丝毫乐趣”。在过去几十年里，快感缺失的临床定义相对保持不变，但最近，行为神经科学显著改变了我们对奖赏相关过程的认识。如今，快感缺失这一概念反映了享乐能力的缺陷，并与奖赏评估、决策、预期和动机过程密切相关。这些奖赏相关机制背后的神经回路主要包括腹侧纹状体和前额叶皮质区域。在此，我们综述与抑郁症中快感缺失缺陷相关的临床概念、神经基础和精神药理学数据。了解快感缺失将有助于诊断和治疗管理。
