Patients with schizophrenia demonstrate dissociation between affective experience and motivated behavior

Schizophrenia Bulletin, 2013

Comprehensive Psychiatry, 2003

A diminished ability to experience emotion could be a key characteristic of the negative symptomatology in schizophrenia. We examined the frequency of basic emotions in everyday life as well as emotion control in various groups of chronic schizophrenic patients. Self-report questionnaires (Differential Emotions Scale [DES], Emotion Control Questionnaire [ECQ]) were provided to healthy controls and three groups of schizophrenia patients (n ‫؍‬ 88), i.e., affectively flat patients, anhedonic patients, and patients not suffering from affective negative symptoms. Patients with affective negative symptoms experienced the positive emotions interest and joy less frequently than healthy subjects or patients without affective negative symptoms. All schizophrenia patients felt fear more often and tended to feel disgust more frequently than healthy subjects. The frequency of guilt and anger experiences increased with the chronicity of the disease. Anhedonic patients manifested more emotion inhibition than healthy controls and exhibited an affectivity pattern consistent with Meehl's model of anhedonia.

2016

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Comprehensive Psychiatry

Background: Anhedonia, a symptom prevalent in schizophrenia patients, is thought to arise either within negative symptomatology or from secondary sources, such as depression. The common co-occurrence of these diseases complicates the assessment of anhedonia in schizophrenia. Method: In a sample of 40 outpatients with chronic schizophrenia, we explored both the validity of the Snaith-Hamilton Pleasure Scale (SHAPS) self-report for anhedonia assessment and those factors influenced its scoring. We assessed negative symptoms using the Brief Negative Symptom Scale (BNSS), depression symptoms using the Calgary Depression Scale for Schizophrenia (CDSS) and cognitive impairment using the Brief Assessment of Cognition in Schizophrenia (BACS), before exploring associations between these scales. Results: The SHAPS was validated for use in schizophrenia. SHAPS scores were not associated with negative symptoms or cognitive impairment, but were linked to a single Depression symptom: Hopelessness (r = 0.52, p b 0.001). Conclusions: SHAPS scores, therefore, appear to only reflect anticipatory anhedonia arising from the affective domain. We advocate the development of multi-faceted self-report measures to more holistically assess anhedonia in schizophrenia.

Schizophrenia Research, 2014

Motivational impairment is a critical factor that contributes to functional disability in schizophrenia and undermines an individual's ability to engage in and adhere to effective treatment. However, little is known about the developmental trajectory of deficits in motivation and whether these deficits are present prior to the onset of psychosis. We assessed several components of motivation including anticipatory versus consummatory pleasure (using the Temporal Experience of Pleasure Scale (TEPS)), and behavioral drive, behavioral inhibition, and reward responsivity (using the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS)). A total of 234 participants completed study measures, including 60 clinical high risk (CHR) participants, 60 recent-onset schizophrenia participants (RO), 78 chronic schizophrenia participants (SZ) and 29 healthy controls (HC) age matched to the CHR group. CHR participants endorsed greater deficits in anticipatory pleasure and reward responsivity, relative to HC comparison participants and individuals diagnosed with schizophrenia. Motivational deficits were not more pronounced over the course of illness. Depressed mood was uniquely associated with impairments in motivation in the CHR sample, but not the schizophrenia participants. The results suggest that CHR individuals experience multiple contributors to impaired motivation, and thus multiple leverage points for treatment.

Schizophrenia …, 2009

Background: Ambivalence and anhedonia have long been identified as schizophrenic symptoms. However, ambivalence has rarely been studied, and in most evocative studies, schizophrenia participants are not anhedonic. Affective neurosciences posit two evaluative systems (one for Positivity and one for Negativity), the coactivation of which produces ambivalence, and point to two asymmetries in affective processing: Positivity Offset (which measures our capacity to explore the environment) and Negativity Bias (a measure of reactivity to intense threat). These characteristics have not received much attention in schizophrenia research.

Background: 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. Objective: To review systematically the empirical evidence for each TEP model component and propose evidence based therapeutic targets for anhedonia and amotivation in schizophrenia. Method: 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. Results: 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. Conclusions: 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.

American Journal of Psychiatry, 2011

Schizophrenia Bulletin, 1998

This study examines the relationship between anhedonia and the trait dimensions of positive affect (PA) and negative affect (NA) in schizophrenia. The relationship between poor social functioning in schizophrenia and these individual differences in affectivity is also examined. Schizophrenia outpatients (n = 37) and normal controls (n = 15) were assessed at a baseline evaluation and again approximately 90 days later. Consistent with the hypothesized decrease in hedonic capacity in schizophrenia, patients reported significantly greater physical and social anhedonia and less PA than controls. However, the schizophrenia group also reported significantly greater NA and social anxiety than did controls. In support of the dispositional view of these individual differences in affectivity, trait measures demonstrated test-retest reliability, and group differences between the schizophrenia group and controls were stable over the 90-day followup period. Within the schizophrenia group, physical and social anhedonia were comparably negatively correlated with trait PA; however, social but not physical anhedonia was significantly positively correlated with NA and social anxiety. Poor social functioning in the schizophrenia group was associated with greater physical and social anhedonia and greater NA and social anxiety. Alternatively, greater trait PA was related to better social functioning. These findings indicate that schizophrenia is characterized by both low PA and elevated NA and that these affective characteristics are a stable feature of the illness. The results also suggest important links between affect and social functioning in schizophrenia.

Frontiers in psychology, 2012

Evolving theories of schizophrenia emphasize a "disconnection" in distributed frontostriatal-limbic neural systems, which may give rise to breakdowns in cognition and emotional function. We discuss these diverse domains of function from the perspective of disrupted neural circuits involved in "cold" cognitive vs. "hot" affective operations and the interplay between these processes. We focus on three research areas that highlight cognition-emotion dysinteractions in schizophrenia: First, we discuss the role of cognitive deficits in the "maintenance" of emotional information. We review recent evidence suggesting that motivational abnormalities in schizophrenia may in part arise due to a disrupted ability to "maintain" affective information over time. Here, dysfunction in a prototypical "cold" cognitive operation may result in "affective" deficits in schizophrenia. Second, we discuss abnormalities in the detection and ascription of salience, manifest as excessive processing of non-emotional stimuli and inappropriate distractibility. We review emerging evidence suggesting deficits in some, but not other, specific emotional processes in schizophrenia -namely an intact ability to perceive emotion "in-the-moment" but poor prospective valuation of stimuli and heightened reactivity to stimuli that ought to be filtered. Third, we discuss abnormalities in learning mechanisms that may give rise to delusions, the fixed, false, and often emotionally charged beliefs that accompany psychosis. We highlight the role of affect in aberrant belief formation, mostly ignored by current theoretical models. Together, we attempt to provide a consilient overview for how breakdowns in neural systems underlying affect and cognition in psychosis interact across symptom domains. We conclude with a brief treatment of the neurobiology of schizophrenia and the need to close our explanatory gap between cellular-level hypotheses and complex behavioral symptoms observed in this illness.

Clinical Psychological Science, 2017

Prior studies have concluded that schizophrenia patients are not anhedonic because they do not report reduced experience of positive emotion to pleasant stimuli. The current study challenged this view by applying quantitative methods validated in the evaluative space model of emotional experience to test the hypothesis that schizophrenia patients evidence a reduction in the normative “positivity offset” (i.e., the tendency to experience higher levels of positive than negative emotional output when stimulus input is absent or weak). Participants included 76 schizophrenia patients and 60 healthy controls who completed an emotional experience task that required reporting the level of positive emotion, negative emotion, and arousal to photographs. Results indicated that although schizophrenia patients evidenced intact capacity to experience positive emotion at high levels of stimulus input, they displayed a diminished positivity offset. Reductions in the positivity offset may underlie v...

Psychiatry …, 2011

Research has indicated that people with schizophrenia have deficits in reward representation and goaldirected behavior, which may be related to the maintenance of emotional experiences. Using a laboratorybased study, we investigated whether people with schizophrenia were able to maintain an emotional experience when given explicit instructions to do so. Twenty-eight people with schizophrenia and 19 people without completed a behavioral task judging their emotional experience of pictures held over a three second delay. This emotion maintenance task was compared to a subsequent in-the-moment emotion experience rating of each picture. In addition, all participants completed an analogous brightness experience maintenance and rating task, and patients completed a standardized visual working memory task. Participants with schizophrenia showed normal in-the-moment emotion experience of the emotion pictures; however, they showed decreased performance on emotion maintenance (for both positive and negative emotion) compared to participants without schizophrenia, even after controlling for brightness maintenance. The emotion maintenance deficit was not associated with visual brightness performance nor with performance on the visual working memory task; however, negative emotion maintenance was associated with an interview-based rating of motivation. These findings suggest that some aspects of impaired emotion maintenance in schizophrenia may be related to deficits in motivated behavior.

Acta Psychopathologica, 2017

This article proposes that the traditional presumption of affective dysfunction or dysregulation in schizophrenia may not be entirely accurate. Rather, it is argued, the experience of cognitive and perceptual symptoms, coupled with the individual's perception of the challenges associated with their condition may provide a richer and more useful understanding of the emotional experience and expression of persons dealing with schizophrenia. Some of the important implications of this view are discussed in regard to therapy and other interventions.

Psychiatry Research, 2011

Recent research has distinguished between anticipatory and consummatory pleasure. In the current study, we examined the psychometric properties of the Temporal Experience of Pleasure Scale (TEPS) to determine whether reliability and validity findings reported in previous research replicate in an additional sample of schizophrenia patients. Participants included 86 individuals with schizophrenia and 59 demographically matched healthy controls. Inconsistent with previous research, patients differed from controls in their reports of consummatory (TEPS-CON), but not anticipatory (TEPS-ANT) pleasure. We also failed to replicate some important correlational findings reported in previous research indicating relationships between the TEPS-ANT subscale and external validators. Analyses of the stability of the TEPS subscales were conducted in a subgroup of patients (n = 19), and indicated excellent stability for the TEPS-CON (ICC = 0.93), but somewhat lower stability for the TEPS-ANT subscale (ICC = 0.74). These findings suggest that additional studies are needed using the TEPS, as well as other measures, to determine the nature of anhedonia in individuals with schizophrenia.

Schizophrenia Bulletin, 2000

Flat affect is a core symptom of schizophrenia. To date, researchers have focused primarily on emotional expression. Only recently has the emotional experience of patients with schizophrenia been studied in laboratory settings. The goal of this study is to assess emotional experience in the complex world of daily life. A structured time-sampling technique, the Experience Sampling Method, was used to collect data. Schizophrenia subjects (n = 58) were compared to 65 nonpatient controls. Patients were divided into blunted and nonblunted subgroups on the basis of Brief Psychiatric Rating Scale (BPRS) behavioral ratings of flat affect. Schizophrenia subjects experienced more intense and more variable negative emotions than controls. For the positive emotions, we found less intensity and less variability in the schizophrenia subjects. No difference in patterns of affect was found between the blunted and the nonblunted schizophrenia subgroups. Our findings suggest that patients with schizophrenia are more emotionally active than has been assumed based on behavioral observations.