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A Scale for the Assessment of Hedonic Tone the Snaith–Hamilton Pleasure Scale



Hedonic tone and its absence, anhedonia, are important in psychopathological research, but instruments for their assessment are lengthy and probably culturally biased. A new scale was constructed from the responses of a large sample of the general population to a request to list six situations which afforded pleasure. The most frequent items were reviewed and those likely to be affected by cultural setting, age, or sex were removed. A pilot study led to an abbreviated scale of 14 items, covering four domains of pleasure response. This questionnaire was subjected to psychometric evaluation in new samples from the general population and psychiatric patients. The scale was found to have a score range that would distinguish a 'normal' from an 'abnormal' response. Validity and reliability were found to be satisfactory. The new scale, the Snaith-Hamilton Pleasure Scale (SHAPS), is an instrument which may be recommended for psychopathological research.
British Journal of Psychiatry (1995), 167, 99—103
The role of hedonic tone, that is, the ability to
experiencepleasure,hasattracted attention in the
study of psychopathology (Loas & Piersen, 1989).
In the presentcentury,thesignificanceof hedonic
tone had beeneclipsed(Snaith, 1993),but attention
to it was revived by a study (Klein, 1974)which
proposedthat low hedonic tone isa central feature
of a type of mood disorder which is likely to respond
to antidepressantmedication.An alternativeview
had been proposed(Meehl, 1962), which considered
that low hedonic tone is a personality trait pre
disposing to the development of schizophrenia and
depressive disorder. Interest in the significance of
thestatewasincreasedbyitsinclusionasoneof the
central features of major depressivedisorder in
DSM—III—R(American Psychiatric Association,
The significance of hedonic tone requires further
clarification. For this to occur theremust beprecise
definition and the provision of accurate methods for
screeningand assessment.Several‘¿pleasure'scales
exist, the bestknown of which arethoseof Fawcett
et a! (1983)and Chapmanet a! (1976).There is also
a pleasure scale for children (Kazdin, 1989).
Problemswith thesescalesarise from their length
and probable cultural bias: for instance,items
include such statements as “¿Poetsalways exaggerate
thebeautiesof nature―(Chapman),“¿Whilefishing
you feel a tug on your line andwatcha six-pound
fish jump out of the water with your bait in its
mouth―,“¿Yourneighbours rave about the way you
keep up your house and yard―(Fawcett), “¿Your
teacher makes you the King/Queen for the day
Thereisa needfora simplerscale,unlikelytobe
affectedby socialclass,sex,age,dietaryhabitsand
nationality. It should be capable of ready translation
intootherlanguages.Sinceit willbea self-assessment
scale the statements must be simple and easy to
understand. The scale should cover a wide range of
domains of pleasure.
The construction of such a pleasurescalewasthe
purposeof this study.
Selection of items
In order to obtain a representativesampleof items,
100 members of the general public were asked to
submit a list of five situations which causedthem
pleasure.Theywereinformed of the purposeof the
study and asked to avoid items which were unlikely to
beapplicabletomostpeople,forexamplea particular
sporting activity, alcoholic drinks, sexualactivity,
andparticulararticlesof diet.The respondentswere
of both sexes, of age range 15—80years, and from
a widerangeof socialclass.Fifty-five replieswere
returned, and from thesea provisional list of 20 items
wasdrawnup. The itemscoveredthedomainsof
socialinteraction, food and drink, sensoryexperiences,
achievement, and pastimes. Subjects were instructed
to indicate the degree to which each item caused them
pleasureon a four-pointscale;inorderto avoid
response set, some items were phrased in negative
This questionnaire was given to a number of
people from the general population and some
A Scale for the Assessment of Hedonic Tone
The Snaith—Hamilton Pleasure Scale
Background.Hedonictone andits absence,anhedonia,areimportantin psychopathological
research, but instruments for their assessment are lengthy and probably culturally biased.
Method. A new scalewas constructedfrom the responsesof a large sampleof the general
population to a request to list six situations which afforded pleasure.The mostfrequent items
were reviewed and those likely to be affected by cultural setting, age, or sex were removed.
A pilot study led to an abbreviated scale of 14 items, covering four domains of pleasure
response. This questionnaire was subjected to psychometric evaluation in new samples from
the general population and psychiatric patients.
Results. The scale was found to have a score range that would distinguish a ‘¿normal'from
an ‘¿abnormal'response.Validityand reliabilitywere foundto be satisfactory.
Conclusions. The new scale, the Snaith—HamiltonPleasure Scale (SHAPS),is an instrument
whichmay be recommended forpsychopathologicalresearch.
populationscoring>4 onGHQ127-111Psychiatric
psychiatricpatients.It becameclearthat the negative
wording caused confusion, so these items were
deleted;theproblemof responsesetwasovercome
by varying the order of responses. The resulting
14-item scale appears in the Appendix. Instead of
using a Likert-style scoring device, it was decided to
adopt the simpler method, used in the General
HealthQuestionnaire(GHQ), in whicheitherof the
‘¿Disagree'responsesscoresI point andeitherof the
‘¿Agree'responses scores 0 points. Thus, the score
range is 0—14.
Establishment of the revised scale
This was undertaken among members of the general
public and selected psychiatric in-patients.
of 102 members of staff, students and hospital
visitors.Itwas importantto establishscoreson
an emotionally healthy sample, so the GHQ-30
(Goldberg, 1972) was also administeredand the
responses of those scoring over 4 on the GHQ were
discarded, reducing the sample to 82. For the
purpose of a retest reliability estimate, 30
respondentsrepeatedthe questionnaireafter a few
days, without sight of the previous record. The
samplewas approximately equally divided between
menand women,coveredtherangeof socialclass,
and had an agerangeof 20—80years.
Since the purpose of the study was to establish
scalescoresfor hedonictone, clinicians were asked
to put forward names of patients who clearly
suffered from a defect of this state and who were
willing and capableof completing a self-assessment
scale. The majority, but not all, of the patients
suffered from a major depressiveillness. Forty-six
participated (18 men: 28 women range 17-81). Those
patients who during the study had undergone
considerable improvement in their clinical state
were asked to repeat the ratings, and 30 patients
did so.
The patientswere assessedby pairs of raters
using the Montgomery—Asberg(1979), not to
provide an overall depressionscore,but because
the set of 10 constructson the MADRS, all
ratedon six-pointscales,includesan ‘¿Inabilityto
feel' item. The researcherswere instructed to use
thisitemtoassesshedonictone,which isprobably
the manner for itsuse in routineapplication
of the MADRS. By summing the scoresof the
two raters,scales(0—12)of relevantpsycho
pathologicalconstructswere produced:depressed
mood, depressedappearance, inner tension, appetite,
sleep, lassitude, ability to concentrate, suicidal
preoccupation,pessimism,and hedonictone.Raters
remainedblind to the patients'completionof the
pleasure scale.
Non-parametric statisticswere usedincluding, for
the measuresof correlation,the Spearman rank
method.A levelof 1 in 50 (P<zO.02)was accepted
as indicating statistical significance.
The face validity of the pleasure scale rests upon the
wordingof its items.The contentvalidityis based
on its coverageof arangeof domains of pleasure.
The distribution of the scale scores is shown in
Table 1.
2, whereasthe majority of patients with reduced
hedonictonescoredmorethan2. Inspectionof the
itemswhich weresometimesselectedby membersof
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
thegeneralpopulationasfailingto elicit a pleasure
responsedidnotrevealapreponderanceof anyitem.
No sexdifferencewasapparentin responsesto the
Criterion va!idity(i.e. that the scaleisa preferential
measure of hedonic tone rather than some other
construct) is indicated by the following correlations
with the MADRS item ratings: hedonic tone + 0.36
(P< 0.02), suicidalpreoccupation+ 0.38 (P<0.02),
anxiety + 0.34 (NS), depressedmood —¿0.04 (NS),
lassitude+0.08 (NS), appetite+ 0.10 (NS), sleep
+ 0.01 (NS), and pessimism + 0.27 (NS). The rating
of suicidal preoccupation probably represents a
measure of overall severity of illness and thus the
significant correlation is explained; the borderline
significance of the correlation with anxiety is
interestingand requiresconfirmationina different
sample and setting.The absenceof a significant
associationwith depressedmood was somewhat
and low hedonictonearedifferentconstructs.The
receiveroperatingcharacteristics(ROC)(Fig. 1)show
the performanceof the scaleat differentcut-off
pointsagainsttwo levelsofdiminishedhedonictone:
(a)‘¿perceptible'(ratingover2 on theMADRS item),
(b) ‘¿clinicallysignificant'(ratingover 4 on the
MADRS item).The ROC aresatisfactoryat both
levels,witha confirmationthata cut-offscoreof
1 - specificity
2 provides the best discrimination between ‘¿normal'
and ‘¿abnormal'levelof hedonictone.
The utility of a scalerefersto the easeof admii
stration and acceptanceby the population for which
it is designed.No respondentsexpresseddifficulty
in comprehension of the scale or returned incomplete
The sensitivityto changeof clinicalstatuswas
examined by inspection of the ratings of those
patients who had repeatratings of normal hedonic
tone.At initial rating, themedianscorewas5(range
0—13);themedianscoreon repeattestwas0 (range
0—2).The significanceof the change(McNemar
x2=18.05, P<0.001) indicates that the scale is
sensitive to change in clinical status of hedonic tone.
Scores on a mental state measure should vary
according to clinical status. Therefore the test
retest procedure to establish reliability in the patient
sample is not possible since clinical status may change
over a few days. Therefore this aspect of reliability
wastestedby inspectionof the scoresof members
of the general population who repeated the scale after
severaldays:of the30respondentsonly two recorded
a ‘¿normal'(2 or less)scoreon oneoccasionand an
‘¿abnormal'(> 2) scoreon the otheroccasion.The
split-halfcorrelationin thesampleof patients(first
seven with second seven items) was significant
(r= 0.74, P< 0.01). The estimation of internal
consistency of the scale was estimated by the Kuder
Richardsonformulaapplicableto non-parametricdata
(Guilford, 1954) (comparable to the Cronbach
method): for the sampleof patientsthis figure was
0.857, which shows satisfactory internal consistency.
Relationshipof the scalescoreswith agerevealed
no significance in either sample.
The study presents a brief assessment scale, to be
calledtheSnaith-Hamilton PleasureScale(SHAPS),
for estimation of the degree to which a person is able
to experience pleasure or the anticipation of a
pleasurableexperience.The items relate to experiences
likely to beencounteredby mostpeople.It is thought
thattranslationinto otherlanguagesfor use in
oftheSHAPS, althoughthisremainstobeestablished.
The phrasing of the items is expected to overcome
thedifficulty whena subjectisnot ableto experience
thesituationcurrently. Thereisonecircumstancefor
which the SHAPS would not be valid, and this is
its use with blind people, since four of the items
depend upon visual experience. The effect of removal
oftheitemsand useof a partialscalecannotyetbe
recommended but may prove to be valid.
0 0.2 0.4 0.6 0.8 1
Fig. I Receiver operating characteristics (ROC) of the SHAPS at
two levelsof diminishedhedonictone(cut-offpointof 2/3, -—
and *; cut-off pointof 4/5, -- -- and **).
The SHAPS covers four domains of hedonic 2. I wouldenjoybeingwith myfamily or closefriends:
experience: interest/pastimes, social interaction, Definitelyagree [
sensory experience, and food/drink. Each of these Agree [ I
is based on only a few items and it is not at present Disagree [
recommendedthat subscoresindicatingthesedomains Stronglydisagree [ I
should beused.Further study is now required,but it
is likely that the SHAPS will prove to be a valid 3. 1wouldfind pleasurein myhobbiesandpastimes:
measure of hedonic tone. Strongly disagree I I
It should be noted that children's scoresremain Disagree [ I
to beestablished,but for adolescentsand adult age A@ee [ I
and sexhave no major effect on scores. Stronglyagree [
Performanceof the SHAPS among physically ill
peoplemust beestablished;theability to experience 4. I wouldbeableto enjoymyfavouritemeal:
pleasure is certainly an important aspect of the con- Definitely agree [ I
cept of ‘¿qualityof life'; the relation of scoresto more A@Jee [ I
generalmeasuresof thisconceptwill beanimportant Disagree [ I
area of study and possible application for the scale. Strongly disagree [ I
Hedonictoneiscertainlyanimportantaspectof many
aspects of psychiatric disorders. It may be that 5@I would enjoy a warm bath or refreshing shower:
hedonictoneprovidesanimportant link constructbe- Definitelyagree [ I
tweendepressiveillnessandsuchstatesasobsessional Agree [ I
disorders; Andreasen (1982) recognised lowered Disagree I I
hedonic tone to be one of the components of the Strongly disagree I I
‘¿negative'phase of schizophrenia. The SHAPS may
therefore be of aid in unravelling interconnections 6. 1would fmdpleasurein thescentof flowersor thesmell
ofa freshseabreezeorfreshlybakedbread:
between different psychiatric disorders. Further
progress in research into psychiatric disorder will Strongly disagree [ I
certainlybe aidedby more accuratedefinitionand Disagree [ I
measurementofpsychopathologicalconceptsaswell Agree [ I
asby theredefinitionof diagnosticcategoriesbased Stronglyagree [ I
upon combinations of symptoms (Birley, 1990; Van 7. I would enjoy seeingother people'ssmiling faces:
Praag, 1992; Costello, 1992). Definitely agree [ I
Agree [ I
Acknowledgements Disagree I I
Strongly disagree I I
We are gratefulto otherswho assistedin assemblageof data:
Dr L. Almond, Dr T. Oakleyand Dr M. Radcliffe. 8. I would enjoy looking smart when I have made an
effort with my appearance:
Strongly disagree I I
Appendix. This scale may be reproduced under its Disagree [ I
proper title for personal use and research. Reproduction Agree
in any book or manual or for commercial purpose must Strongly agree [ I
be negotiatedwiththeBHtlshJournalofPsychiatry. 9. I would enjoy reading a book, magazine or newspaper:
This questionnaire is designed to measure your ability to
experiencepleasurein thelastfew days. Definitelyagree I I
it is important to read each statement very carefully. Agree I I
Tickoneoftheboxes[ Itoindicatehow much youagree Disagree [ I
ordisagreewitheachstatement. Stronglydisagree [ I
I. I would enjoy my favourite television or radio 10. 1would enjoy a cup of tea or coffee or my favourite
programme: drink:
Strongly disagree [ I Strongly disagree I I
Disagree [ I Disagree I I
Agree [ I Agree E I
Strongly agree I I Strongly agree I I
I I . I would find pleasurein small things, e.g. bright sunny ANDREASEN,N. C. (1982) Negativesymptomsin schizophrenia:
day, a telephone call from a friend: definition and reliability. Archives of General Psychiatry, 39,
Strongly disagree I I BIRLEY,J. L. T. (1990) DSM—III:from left to right or from right
Disagree [ J to left? British Journal of Psychiatry, 157, 116—118.
Agree I I CHAPMAN,C., CHAPMAN,i. P. & RAULIN,M. L. (1976)Scalesfor
Strongly disagree [ I physicalandsocialanhedonia.Journalof Abnormal Psychology,
85, 374—382.
I 2. 1would beable to enjoy a beautiful landscapeor view: COSTELLO,C. G. (1992)Researchonsymptomsversusresearchin
. syndromes. British Journal of Psychiatry, 160, 304—308.
Definitely agree I I FAWCETF,J., CLARK,D. C., SHEFThER,A., el al (1983)Assessing
Agree I I anhedonia in psychiatric practice. Archives of General
Disagree I I Psychiatrv, 40, 79—84.
. GOLDBERG, D. (1972) Detection of Psychiatric Illness by
Strongly disagree I I @uestionnaire.Oxford: Oxford University Press.
13. 1 would get pleasure from helping others: GUILFORD,J. P. (1954) Psychometric Methods (2nd edn). New
York: McGraw Hill.
Strongly disagree I I HARDY,P., JOUVEN,R., LANCRENON,S., et al (1986) L'échellede
Disa ree@@ plaisir-désplaisir.L'EncEphale, 12, 149—154.
g KAZDIN,A. E. (1989) Evaluation of the pleasure scale in
Agree I I the assessment of anhedonia in children. Journal of the
Strongly agree [ I American Academy of Child and Adolescent Psychiatry. 28,
14. 1would feel pleasure when I receive praise from other KLEIN,Ii F. (1974) Endogenomorphic depression. Archives of
people: General Psychiatry, 31, 447—454.
LOAS, G. & PIERSEN, A. (1989) L'anhédonie en psychiatric: revue.
Definitely agree I I Annaks Medico-Psychologiques, 147, 705-717.
Agree E I MEEHL,P. E. (1962)Schizotaxia,schizotypy,schizophrenia.
Disaoree I I American Psychologist, 17, 827—838.
. MONTGOMERY, S. A. & ASBERG, M. A. (1979) A new depression
Strongly disagree I I scale designedto be sensitiveto change. British Journal of
Psychiatry, 134, 382—389.
References SNAITH,R. P. (1993)AlihUlOma:the forgottensymptomof
psychopathology. Psychological Medicine, 23, 957—966.
AMERICAN PSYCHIATRICASSOCIATION(1987) Diagnostic and Statistical VAN PRAAG, H. M. (1992) Reconquest of the subjective: against
Manual of Psychiatric Disorders (3rd edn) (DSM-1Il). the waning of psychiatric diagnosis. British Journal of
Washington, DC: APA. Psychiatry, 160, 266—271.
R. P. Snaith, FRCPsych,S. Morley, PhD,Division of Psychiatryand Behavioural Sciences,Clinical Sciences
Building, St James's University Hospital, Leeds; M. Hamilton, MRCPsych,A. Humayan, MBBS, D.
Hargreaves, MBChB,P. Trigwell, MRCPsych,Leeds Regional Psychiatric Rotational Training Scheme
Correspondence: Dr R. P. Snaith, Division of Psychiatry and Behavioural Sciences, Clinical Sciences Building, St James's
University Hospital, Leeds LS9 7TF
(First received 14 February 1994, final revision 20 September 1994, accepted 22 September 1994)

Supplementary resources (2)

... The current study used the Snaith-Hamilton Pleasure Scale (SHAPS) to assess anhedonia (Snaith et al., 1995). The SHAPS contains 14 items (e.g., "I find pleasure in my hobbies and pastimes"). ...
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Previous studies show that neuroticism has a significant impact on depression in college students. However, the mechanisms linking neuroticism and depression remain unclear. This study investigates whether neuroticism influences depression through the mediation of negative cognitive bias and anhedonia and whether there are gender differences in this mechanism. A total of 1085 Chinese college students were surveyed using the Self-rating Depression Scale, the neuroticism scale of the Eysenck Personality Questionnaire the Negative Cognitive Bias Questionnaire, and the Snaith-Hamilton Pleasure Scale. The data were analyzed using structural equation modeling and a multigroup comparison by gender. The results showed that neuroticism positively predicted the level of depression in college students. Negative cognitive bias and anhedonia played a chain-mediating role in the relationship between neuroticism and depression. Furthermore, there were gender differences in the mechanisms of neuroticism influenced depression. The direct effect of neuroticism on the level of depression was stronger in males, whereas negative cognitive bias mediated the relationship between neuroticism and depression only in females. These findings extend our insight into the mechanisms underlying the association between neuroticism and depression in college students and suggest focusing on gender-specific predictors of depression in college students to develop gender-specific interventions to reduce depression.
... Low levels of positive affect represent one aspect of anhedonia (i.e., low levels of positive emotions). We will also measure reactive anhedonia (i.e., blunted response to the occurrence of pleasurable events) using the Snaith Hamilton Pleasure Scale [68,69] (SHAPS). Stress will be assessed using the Perceived Stress Scale [70] (PSS-4). ...
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Background Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. Method/design The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. Discussion Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. Trial registration, NCT03413423. Registered 29 January 2018. .
... Enrolled patients completed the following instruments: the PBI [40], the Hamilton rating scale for depression (HAMD-17) [41], the patient health questionnaire-9 (PHQ-9) [42], the Hamilton Anxiety Scale (HAMA) [43], the Snaith-Hamilton pleasure scale (SHAPS) [44], and the digit symbol substitution test (DSST) [45] on the ESCID website. Magnetic resonance imaging was then completed within one week of completing these instruments. ...
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Background: There is a high correlation between the risk of major depressive disorder (MDD) and adverse childhood experiences (ACEs) such as adverse parenting (AP). While there appears to be an association between ACEs and changes in brain structure and function, there have yet to be multimodal neuroimaging studies of associations between parenting style and brain developmental changes in MDD patients. To explore the effect of AP on brain structure and function. Methods: In this cross-sectional study, 125 MDD outpatients were included in the study and divided into the AP group and the optimal parenting (OP) group. Participants completed self-rating scales to assess depressive severity, symptoms, and their parents’ styles. They also completed magnetic resonance imaging within one week of filling out the instruments. The differences between groups of gender, educational level, and medications were analyzed using the chi-squared test and those of age, duration of illness, and scores on scales using the independent samples t-test. Differences in gray matter volume (GMV) and resting-state functional connectivity (RS-FC) were assessed between groups. Results: AP was associated with a significant increase in GMV in the right superior parietal lobule (SPL) and FC between the right SPL and the bilateral medial superior frontal cortex in MDD patients. Limitations: The cross-cultural characteristics of AP will result in the lack of generalizability of the findings. Conclusions: The results support the hypothesis that AP during childhood may imprint the brain and affect depressive symptoms in adulthood. Parents should pay attention to the parenting style and avoid a style that lacks warmth.
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Psilocybin therapy is an emerging intervention for depression that may be at least as effective as standard first-line treatments i.e., Selective Serotonin Reuptake Inhibitors (SSRIs). Here we assess neural responses to emotional faces (fear, happy, and neutral) using Blood Oxygen-Level Dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) in two groups with major depressive disorder: 1) a ‘psilocybin group’ that received two dosing sessions with 25mg plus six weeks of daily placebo, and 2) an ‘escitalopram group’ that received six weeks of the SSRI escitalopram, plus two dosing sessions with an inactive/placebo dose of 1mg psilocybin. Both groups had an equal amount of psychological support throughout. An emotional face fMRI paradigm was completed at baseline (pre-treatment) and at the six-week post-treatment primary endpoint (three weeks following psilocybin dosing sessions). An analysis examining the interaction between patient group (psilocybin vs. escitalopram) and time-point (pre-vs. post-treatment) showed a robust effect in a distributed network of cortical brain regions. Follow-up analyses showed that post-treatment BOLD responses to emotional faces of all types were significantly reduced in the escitalopram group, with no change, or even a slight increase, in the psilocybin group. Specific analyses of the amygdala showed a reduction of response to fear faces in the escitalopram group, but no effects for the psilocybin group. Despite large improvements in depressive symptoms in the psilocybin group, psilocybin-therapy had only a minor effect on brain responsiveness to emotional stimuli. We suggest that reduced emotional responsiveness may be a biomarker of SSRIs’ antidepressant action that is not shared by psilocybin-therapy.
Background Anhedonia is hypothesized to be associated with blunted mesocorticolimbic dopamine (DA) functioning in samples with major depressive disorder. The purpose of this study was to examine linkages between striatal DA, reward circuitry functioning, anhedonia, and, in an exploratory fashion, self-reported stress, in a transdiagnostic anhedonic sample. Methods Participants with (n=25) and without (n=12) clinically impairing anhedonia completed a reward-processing task during simultaneous positron emission tomography and magnetic resonance (PET-MR) imaging with [11C]raclopride, a DA D2/D3 receptor antagonist that selectively binds to striatal DA receptors. Results Relative to controls, the anhedonia group exhibited decreased task-related DA release in the left putamen, caudate, and nucleus accumbens and right putamen and pallidum. There were no group differences in task-related brain activation (fMRI) during reward processing after correcting for multiple comparisons. General functional connectivity (GFC) findings revealed blunted fMRI connectivity between PET-derived striatal seeds and target regions in the anhedonia group. Associations were identified between anhedonia severity and the magnitude of task-related DA release to rewards in the left putamen, but not mesocorticolimbic GFC. Conclusions Results provide evidence for reduced striatal DA functioning during reward processing and blunted mesocorticolimbic network functional connectivity in a transdiagnostic sample with clinically significant anhedonia.
Background In a recent clinical trial examining the comparative efficacy of psilocybin therapy (PT) versus escitalopram treatment (ET) for major depressive disorder, 14 of 16 major efficacy outcome measures yielded results that favored PT, but the Quick Inventory of Depressive Symptomatology, Self-Report, 16 items (QIDS-SR 16 ) did not. Aims The present study aims to (1) rationally and psychometrically account for discrepant results between outcome measures and (2) to overcome psychometric problems particular to individual measures by re-examining between-condition differences in depressive response using all outcome measures at item-, facet-, and factor-levels of analysis. Method Four depression measures were compared on the basis of their validity for examining differences in depressive response between PT and ET conditions. Results/Outcomes Possible reasons for discrepant findings on the QIDS-SR 16 include its higher variance, imprecision due to compound items and whole-scale and unidimensional sum-scoring, vagueness in the phrasing of scoring options for items, and its lack of focus on a core depression factor. Reanalyzing the trial data at item-, facet-, and factor-levels yielded results suggestive of PT’s superior efficacy in reducing depressed mood, anhedonia, and a core depression factor, along with specific symptoms such as sexual dysfunction. Conclusion/Interpretation Our results raise concerns about the adequacy of the QIDS-SR 16 for measuring depression, as well as the practice of relying on individual scales that tend not to capture the multidimensional structure or core of depression. Using an alternative approach that captures depression more granularly and comprehensively yielded specific insight into areas where PT therapy may be particularly useful to patients and clinicians.
Objective: Homework is a key theoretical component of cognitive-behavioral therapies, however, the effects of homework on clinical outcomes have largely been evaluated between-persons rather than within-persons. Methods: The effects of homework completion on treatment response were examined in a randomized trial comparing Behavioral Activation Treatment for Anhedonia (BATA, n = 38), a novel psychotherapy, to Mindfulness-Based Cognitive Therapy (MBCT, n=35). The primary endpoint was consummatory reward sensitivity, measured weekly by the Snaith Hamilton Pleasure Scale (SHAPS), up to 15 weeks. Multilevel models evaluated change in SHAPS scores over time and the effects of clinician-reported and participant-reported homework. Results: BATA and MBCT resulted in significant, equivalent reductions in SHAPS scores. Unexpectedly, participants who completed greater mean total amounts of homework did not improve at a faster rate (i.e., no between-person effect). However, sessions with greater than average participant-reported homework completion were associated with greater than average reductions in SHAPS scores (i.e., a within-person effect). For clinician-reported homework, this effect was only evident within the BATA condition. Conclusion: This study shows psychotherapy homework completion relates to symptomatic improvement in cognitive-behavioral treatments for anhedonia when session-to-session changes are examined within-person. On the contrary, we found no evidence that total homework completion predicted greater improvements between-person. When possible, psychotherapy researchers should evaluate their constructs of interest across multiple sessions (not just pre/post) to allow more direct tests of hypotheses predicted by theoretical models of individual change processes.
This report reviews conflicts in delineating the phenomena of depression with an emphasis on the central criterion role of the symptomatic pattern of the nonprecipitated (endogenous) depression. Depressions with similar symptomatology, regardless of precipitation or severity, are labeled endogenomorphic. A specific causal model is presented that has testable consequences in drug treatment and maintenance studies. This is a mixed model, combining both categorical and dimensional constructs.
• Recently, a renaissance of interest in "negative symptoms," eg, affective flattening or impoverishment of speech and language, has occurred. Although some investigators believe that these symptoms are important indicators of outcome, of response to treatment, and perhaps of a distinct, underlying pathologic process, research on the negative-symptom syndrome in schizophrenia has been handicapped because no standard instrument existed to assess it. This investigation reports on the developed Scale for the Assessment of Negative Symptoms. When symptoms are defined by objective behavioral indices, they have excellent interrater reliability. Furthermore, the five symptom complexes defined by the scale (affective flattening, alogia, avolition, anhedonia, and attentional impairment) have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
• In two studies of depressed, manic, schizophrenic, and normal subjects, a scale for measuring the intensity of subjects' pleasureable responses to normally enjoyable situations (the Pleasure Scale) evidenced good internal reliability and moderate agreement with the Chapman Anhedonia Scale and indexes of depressive symptom severity. Only the depressed patients showed extremely anhedonic responses. Although more than half the depressed patients evidenced pleasure scores in the normal range, about 18% of them seemed more anhedonic than any normal subject. A mixture analysis resolved depressed patient scores into two distinct distributions: a normal-range distribution (88% of depressives) and an extremely anhedonic distribution (12%). The findings provide some support for the existence of a qualitatively distinct subtype of major depression that has been variously defined as "endogenomorphic" or "melancholic."
"I hypothesize that the statistical relation between schizotaxia, schizotypy, and schizophrenia is class inclusion: All schizotaxics become on all actually existing social learning regimes, schizotypic in personality organization; but most of these remain compensated. A minority, disadvantaged by other… constitutional weaknesses, and put on a bad regime by schizophrenogenic mothers… are thereby potentiated into clinical schizophrenia. What makes schizotaxia etiologically specific is its role as a necessary condition… . It is my strong personal conviction that… schizophrenia, while its content is learned, is fundamentally a neurological disease of genetic origin." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
Devised 2 true–false scales to measure anhedonia, the lowered ability to experience pleasure: a 40-item Physical Anhedonia (PA) scale and a 48-item Social Anhedonia (SA) scale. After scale development using 371 college students, the final version was given to 505 normal adults stratified by social class, age (18–45), and sex, and to 123 male schizophrenics. The potential artifacts of social desirability, acquiescence, and random responding were ruled out. Coefficient alpha values for PA and for SA were .74 and .85 for male normal Ss and .82 and .85 for male schizophrenics. Schizophrenics scored more anhedonic than normal Ss on both PA and SA. Schizophrenics' scores on PA fell into 2 clusters of scores, one resembling the total distribution of the normal Ss, and a 2nd cluster consisting of scores that were more anhedonic than those of the normal Ss. Anhedonics were more often poor premorbid and hedonics more often good premorbid. The PA scale may be useful for testing the hypotheses, advanced by several theorists, that anhedonia is genetically transmitted and that nonpsychotic anhedonics are at high risk for schizophrenia. (25 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychiatric research over the past three decades has now acquired the esteem it clearly deserves. Since empirical research presupposes definition of the object one studies and availability of instruments to measure it, operationalisation of diagnosis and development of psychometric instruments have become major concerns for psychiatry. This progress was promoted to a large degree by biological psychiatry. The search for biological underpinnings of abnormal human behaviour and the study of the efficacy and mechanism of action of biological treatments are both contingent on the use of standardised diagnoses and objective measurement. Biological psychiatry moved in recent years from a minority position into the mainstream, and its methods became the standard approach, especially in research.
Research on symptoms may often be more fruitful than research on syndromes because: (a) the validities of psychiatric diagnoses remain questionable; (b) interview assessments of a large number of symptoms are inadequate; (c) the diagnostic approach results in problems of misclassification and confounding; (d) the dimensional/categorical issue may be more readily resolved with research using a symptom approach; (e) useful animal models of symptoms are more likely to be developed than useful animal models of syndromes; and (f) symptoms may be better phenotypes than syndromes in genetic research.
DSM-III has largely been based upon essentialist notions of increasingly accurate and 'valid' definitions of diseases. A nominalist approach would facilitate study of aetiological factors and variables in the natural history of diseases.
The Pleasure Scale for Children, a measure developed to assess anhedonia in school-age children, was evaluated. Psychometric properties and concurrent validity of the scale were evaluated with 232 child psychiatric inpatient children (ages 6-13) and their parents. Based on prior research with adults, predictions were made that children with a diagnosis of major depression would evince greater anhedonia on the scale and that anhedonic children (low Pleasure Scale scores) would show a negative attributional style in relation to rewarding experiences. The results indicated that the Pleasure Scale was internally consistent, yielded moderate to high item-total score correlations, appeared to reflect a single dimension, and correlated positively and significantly with other measures of pleasurable affect. Depressed children showed greater anhedonia, as reflected in lower total Pleasure Scale scores and in their pattern of responding to individual items on the scale. Children high in anhedonia, independently of their diagnosis, showed less active involvement in seeking rewards, were higher in their expectations of negative outcomes, and were more likely to attribute unrewarding outcomes to their own behavior than to external causes. Overall, the results provide initial support for the construct validity of the scale. Further research to evaluate nonclinic samples, to develop alternative assessment strategies, to examine developmental differences in reporting pleasurable experiences, and to study the relation of anhedonia to subtypes and clinical course of depression is briefly discussed.