School of Psychology, Deakin University, Melbourne, Victoria, Australia.
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Br J Clin Psychol. 2019 Nov;58(4):357-383. doi: 10.1111/bjc.12218. Epub 2019 Mar 10.
Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure.
Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review.
A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders.
Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder.
Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.
快感缺失可能是精神障碍，尤其是精神分裂症和抑郁症患者快感缺失和功能障碍的一个重要维度；然而，不一致的研究结果限制了结论的得出。我们对现有的比较精神病组和健康对照组在预期快感方面的研究进行了首次系统综述和荟萃分析。
系统检索了学术搜索完整、科学直接和 CINAHL 数据库，截至 2018 年 6 月 9 日，以获取相关的同行评议文章、书籍章节和论文。还对参考文献进行了手工搜索。综述共纳入 36 项研究。
在精神分裂症谱系障碍（k=32，1851 名患者和 1449 名对照，g=-0.42[95%置信区间为-0.53 至-0.31]，p<0.001）中观察到中等程度的缺陷，在重度抑郁症（k=415 名患者和 506 名对照，g=-0.87[95%置信区间为-1.23 至-0.51]，p<0.001）中观察到较大的缺陷，抑郁症的效应明显更大（p<0.05）。元回归显示，精神分裂症谱系中的异质性部分通过预测更大缺陷的更长病程和更低认知功能来解释。在抑郁症中，有证据表明，排除对照组的精神病史可能与更大的影响有关。有证据表明，小型研究偏倚夸大了精神分裂症谱系障碍的估计值。
在这些疾病中，预期快感存在缺陷，在重度抑郁症中更为明显。这些发现表明，可能有一个治疗靶点可以将引发和维持疾病的认知、情感和行为因素联系起来。
预期快感在精神分裂症谱系和重度抑郁症中受损。特别关注增强预期快感可能会提高对奖励行为和社会心理功能的动机。综述中只有少数关于重度抑郁症的研究。考虑到效应的异质性，可能需要进一步研究预期快感的更多调节因素。
