Section of Comparative Medicine, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
J Psychiatr Res. 2019 Feb;109:202-213. doi: 10.1016/j.jpsychires.2018.11.029. Epub 2018 Dec 1.
Anhedonia is a transdiagnostic construct that can occur independent of other symptoms of depression; its role in neuropsychiatric disorders that are not primarily affective, such as obsessive compulsive disorder (OCD), hoarding disorder (HD), and post-traumatic stress disorder (PTSD) has received limited attention. This paper addresses this gap. First, the data revealed a positive contribution of anhedonia, beyond the effects of general depression, to symptom severity in OCD but not in HD or PTSD. Second, anhedonia was operationalized as a reduced sensitivity to rewards, which allowed employing the value based decision making framework to investigate effects of anhedonia on reward-related behavioral outcomes, such as increased risk aversion and increased difficulty of making value-based choices. Both self-report and behavior-based measures were used to characterize individual risk aversion: risk perception and risk-taking propensities (measured using the Domain Specific Risk Taking scale) and risk attitudes evaluated using a gambling task. Data revealed the positive theoretically predicted correlation between anhedonia and risk perception in OCD; effects on self-reported risk taking and behavior-based risk aversion were non-significant. The same relations were weaker in HD and absent in PTSD. Response time during a gambling task, an index of difficulty of making value-based choices, significantly correlated with anhedonia in individuals with OCD and individuals with HD, even after controlling for general depression, but not in individuals with PTSD. The results suggest a unique contribution of one aspect of anhedonia in obsessive-compulsive disorder and confirm the importance of investigating the role of anhedonia transdiagnostically beyond affective and psychotic disorders.
快感缺失是一种跨诊断的结构，可以独立于其他抑郁症状出现；它在非主要情感障碍的神经精神疾病中的作用，如强迫症（OCD）、囤积症（HD）和创伤后应激障碍（PTSD），受到的关注有限。本文旨在解决这一差距。首先，数据显示，快感缺失除了对 OCD 症状严重程度有影响外，对 HD 或 PTSD 没有影响。其次，快感缺失被定义为对奖励的敏感性降低，这使得可以利用基于价值的决策框架来研究快感缺失对与奖励相关的行为结果的影响，例如增加风险厌恶和增加基于价值的选择的难度。本研究使用自我报告和行为测量来描述个体的风险厌恶程度：风险感知和风险倾向（使用特定领域风险倾向量表测量）和使用赌博任务评估的风险态度。数据显示，快感缺失与 OCD 中的风险感知存在正相关，这与理论预测一致；但对自我报告的风险承担和基于行为的风险厌恶的影响不显著。在 HD 中，这种关系较弱，在 PTSD 中则不存在。在赌博任务中的反应时间，即基于价值的选择的难度指标，与 OCD 和 HD 个体的快感缺失显著相关，即使在控制了一般抑郁后也是如此，但在 PTSD 个体中则没有。结果表明，快感缺失的一个方面在强迫症中有独特的贡献，并证实了在情感和精神病性障碍之外，跨诊断研究快感缺失作用的重要性。
