Neural correlates of reward processing in schizophrenia - Relationship to apathy and depression

Section of Experimental Psychopathology, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany.
Schizophrenia Research (Impact Factor: 3.92). 12/2009; 118(1-3):154-61. DOI: 10.1016/j.schres.2009.11.007
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ABSTRACT The present study employs a new framework to categorise the heterogeneous findings on the relationship between impaired reward processing and negative and affective symptoms of schizophrenia. Based on previous behavioural and neuroimaging studies we postulate that "wanting" (i.e. anticipation) of a reward is specifically related to apathy, whereas "liking" (i.e. hedonic impact) is related to anhedonia and depression--symptoms commonly observed in schizophrenia. Fifteen patients with schizophrenia or schizoaffective disorder treated with atypical antipsychotic drugs and fifteen healthy controls performed a probabilistic monetary incentive delay task while undergoing functional magnetic resonance imaging. At the group level we found no significant differences between patients and controls in neural activation during anticipation or receipt of a reward. However, in patients with schizophrenia specific relationships between ventral-striatal activation and symptoms were observed. Ventral-striatal activation during reward anticipation was negatively correlated with apathy, while activation during receipt of reward was negatively correlated with severity of depressive symptoms. These results suggest that the link between negative symptoms and reward anticipation might specifically relate to apathy, i.e. a lack of motivation and drive. Impaired hedonic reward processing might contribute to the development of depressive symptoms in patients with schizophrenia, but it is not directly associated with self-rated anhedonia. These results indicate the necessity of more specifically differentiating negative and affective symptoms in schizophrenia in order to understand the role of the reward system in their pathogenesis.

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Available from: Joe Simon, Feb 13, 2015
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    • "This supports the finding that antipsychotic medication may have a bigger impact on anticipatory rather than consummatory pleasure. It appears that reduced activation of the ventral striatum in response to rewarding cues may be more pronounced in those people taking typical antipsychotics but not those taking atypical antipsychotics; with this effect being correlated with negative symptom severity in those taking typical antipsychotics only (Juckel et al., 2006a; Kirsch et al., 2007; Schlagenhauf et al., 2008; Simon et al., 2010; Walter et al., 2009). The limited behavioural studies have consistently reported no association between medication type/dosage and anticipatory pleasure (Choi et al., 2013; Trémeau et al., 2010). "
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    ABSTRACT: Anhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions. To review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia. Following PRISMA guidelines, PubMed and PsycInfo were searched using the terms "schizophrenia" and "anhedonia". Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct. 80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures. Promising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development. Copyright © 2015. Published by Elsevier B.V.
    Schizophrenia Research 09/2015; DOI:10.1016/j.schres.2015.08.013 · 3.92 Impact Factor
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    • "Moreover, reanalyzing data from a set of studies, Hägele and colleagues showed that depression, schizophrenia and alcohol disorders were all associated with reduced activity in the right ventral striatum with this effect correlated with depressive symptoms as measured by the Beck Depression Inventory (Hägele et al., 2015). However, given that patient groups were not matched to each other or to controls in age and gender in the study by Hägele and colleagues we sought to replicate and extend it using a specifically-designed study with matched groups; we also wished to relate neural responses to additional key symptoms, as previous work has indicated that ventral striatum (de)activation could also relate to other symptoms such as anhedonia (Simon et al., 2010; Stoy et al., 2012) and more generally, to positive (Nielsen et al., 2012), and negative (Juckel et al., 2006a; Waltz et al., 2009) symptoms. "
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    ABSTRACT: In the research domain framework (RDoC), dysfunctional reward expectation has been proposed to be a cross-diagnostic domain in psychiatry, which may contribute to symptoms common to various neuropsychiatric conditions, such as anhedonia or apathy/avolition. We used a modified version of the Monetary Incentive Delay (MID) paradigm to obtain functional MRI images from 22 patients with schizophrenia, 24 with depression and 21 controls. Anhedonia and other symptoms of depression, and overall positive and negative symptomatology were also measured. We hypothesized that the two clinical groups would have a reduced activity in the ventral striatum when anticipating reward (compared to anticipation of a neutral outcome) and that striatal activation would correlate with clinical measures of motivational problems and anhedonia. Results were consistent with the first hypothesis: two clusters in both the left and right ventral striatum were found to differ between the groups in reward anticipation. Post-hoc analysis showed that this was due to higher activation in the controls compared to the schizophrenia and the depression groups in the right ventral striatum, with activation differences between depression and controls also seen in the left ventral striatum. No differences were found between the two patient groups, and there were no areas of abnormal cortical activation in either group that survived correction for multiple comparisons. Reduced ventral striatal activity was related to greater anhedonia and overall depressive symptoms in the schizophrenia group, but not in the participants with depression. Findings are discussed in relation to previous literature but overall are supporting evidence of reward system dysfunction across the neuropsychiatric continuum, even if the specific clinical relevance is still not fully understood. We also discuss how the RDoC approach may help to solve some of the replication problems in psychiatric fMRI research.
    Frontiers in Psychology 08/2015; 6. DOI:10.3389/fpsyg.2015.01280 · 2.80 Impact Factor
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    • "This inconsistency of findings may be partly explained by the fact that schizophrenia patients are a heterogeneous group. Importantly, several of these studies found an association between reduced striatal responses to reward receipt and increased negative or depressive symptoms (Waltz et al., 2009, 2010; Simon et al., 2010). "
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    ABSTRACT: Anhedonia, the lack of pleasure, has been shown to be a critical feature of a range of psychiatric disorders. Yet, it is currently measured primarily through subjective self-reports and as such has been difficult to submit to rigorous scientific analysis. New insights from affective neuroscience hold considerable promise in improving our understanding of anhedonia and for providing useful objective behavioral measures to complement traditional self-report measures, potentially leading to better diagnoses and novel treatments. Here, we review the state-of-the-art of hedonia research and specifically the established mechanisms of wanting, liking, and learning. Based on this framework we propose to conceptualize anhedonia as impairments in some or all of these processes, thereby departing from the longstanding view of anhedonia as solely reduced subjective experience of pleasure. We discuss how deficits in each of the reward components can lead to different expressions, or subtypes, of anhedonia affording novel ways of measurement. Specifically, we review evidence suggesting that patients suffering from depression and schizophrenia show impairments in wanting and learning, while some aspects of conscious liking seem surprisingly intact. Furthermore, the evidence suggests that anhedonia is heterogeneous across psychiatric disorders, depending on which parts of the pleasure networks are most affected. This in turn has implications for diagnosis and treatment of anhedonia.
    Frontiers in Behavioral Neuroscience 03/2015; 9. DOI:10.3389/fnbeh.2015.00049 · 3.27 Impact Factor
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