Department of Pharmacology, University of Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada.
J Psychiatr Res. 2021 Feb;134:200-207. doi: 10.1016/j.jpsychires.2020.12.031. Epub 2020 Dec 11.
Anhedonia, a deficit in the ability to experience pleasure, is a cardinal symptom of major depressive episodes. In contrast to adolescent major depressive disorder, there is limited research examining anhedonia in the context of depression among adolescents with bipolar disorder (BD). We therefore examined clinical characteristics of anhedonia in a large sample of adolescents with BD.
Participants were 197 adolescents, aged 13-20 years old, with BD type I, II or not otherwise specified. Diagnoses were determined using a semi-structured interview. Anhedonia severity was rated from one to six on the Depression Rating Scale (DRS). Adolescents were divided into "severe" and "non-severe" anhedonia groups based on the DRS item scoring. The association of anhedonia with clinical and demographic variables was evaluated in univariate analyses followed by logistic regression analyses for variables with p ≤ 0.1.
Threshold anhedonia was evident among 90.9% during their most severe depressive episode. Significant factors associated with severe most severe lifetime anhedonia ("lifetime anhedonia") included: female sex, lifetime history of self-injurious behavior, physical abuse, affective lability, higher lifetime depression severity, comorbid anxiety disorders, family history of ADHD, and second-generation antipsychotic use. In regression analyses, severe lifetime anhedonia was independently associated with female sex, comorbid anxiety disorders, most severe lifetime mania severity, and lifetime second-generation antipsychotic use.
The vast majority of adolescents with BD experience anhedonia. More severe anhedonia is associated with indicators of greater illness severity. Future research is warranted to evaluate the neurobiological underpinnings of anhedonia among adolescents with BD.
快感缺失，即体验愉悦的能力受损，是重性抑郁发作的一个主要症状。与青少年单相抑郁障碍不同，针对双相情感障碍（BD）青少年抑郁障碍中快感缺失的研究十分有限。因此，我们在一个大样本的 BD 青少年中研究了快感缺失的临床特征。
参与者为 197 名年龄在 13-20 岁的青少年，诊断为 I 型、II 型或未特定的 BD。使用半结构式访谈进行诊断。使用抑郁评定量表（DRS）对快感缺失的严重程度进行 1-6 分的评定。根据 DRS 项目评分，将青少年分为“严重”和“非严重”快感缺失组。在单变量分析中评估快感缺失与临床和人口统计学变量的关系，然后对 p≤0.1 的变量进行逻辑回归分析。
在他们最严重的抑郁发作期间，90.9%的青少年存在阈下快感缺失。与严重的终生最严重快感缺失（“终生快感缺失”）相关的显著因素包括：女性性别、终生自伤行为史、躯体虐待、情感不稳定、更高的终生抑郁严重程度、共患焦虑障碍、ADHD 家族史和第二代抗精神病药物的使用。在回归分析中，严重的终生快感缺失与女性性别、共患焦虑障碍、最严重的终生躁狂严重程度和终生第二代抗精神病药物的使用独立相关。
绝大多数 BD 青少年都经历过快感缺失。更严重的快感缺失与更大的疾病严重程度指标相关。未来的研究需要评估 BD 青少年快感缺失的神经生物学基础。
