Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.
Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.
CNS Neurosci Ther. 2018 Jul;24(7):615-623. doi: 10.1111/cns.12854. Epub 2018 Apr 23.
Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ).
To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework.
In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD. A literature search was conducted in OVID Medline, PsycINFO and EMBASE databases between 2000 and 2017.
While certain subgroups share commonalities, there are also important differences. SZ may be characterized by a disorganization, rather than a deficiency, in reward processing and cognitive function, including inappropriate energy expenditure and focus on irrelevant cues. In contrast, MDD has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience. Understanding the roles of neurotransmitters and aberrant brain circuitry is necessary to appreciate differences in reward function in SZ and MDD.
Anhedonia as a clinical presentation of reward circuit dysregulation is an important and relatively undertreated symptom of both SZ and MDD. In order to improve patient outcomes and quality of life, it is important to consider how anhedonia fits into both diagnoses.
快感缺失作为奖赏回路的失调，存在于重性抑郁障碍（MDD）和精神分裂症（SZ）中。
阐明精神分裂症（SZ）和抑郁症（MDD）在快感缺失方面的临床和神经生物学差异，同时协调在研究领域标准（RDoC）框架下将快感缺失评估为跨诊断特征的挑战和益处。
在这篇综述中，我们总结了在 SZ 和 MDD 中检查快感缺失或其潜在奖赏缺陷的出版物中的数据。在 2000 年至 2017 年期间，在 OVID Medline、PsycINFO 和 EMBASE 数据库中进行了文献检索。
虽然某些亚组具有共同之处，但也存在重要差异。SZ 可能表现为奖赏处理和认知功能的紊乱，而不是缺陷，包括不适当的能量消耗和对不相关线索的关注。相比之下，MDD 的特点是预期快感、奖赏关联的发展以及对过去经验信息的整合存在缺陷。理解神经递质和异常大脑回路的作用对于理解 SZ 和 MDD 中奖赏功能的差异是必要的。
快感缺失作为奖赏回路失调的临床表现，是 SZ 和 MDD 中一种重要且相对治疗不足的症状。为了改善患者的预后和生活质量，重要的是要考虑快感缺失如何适用于两种诊断。
