-
General Hospital Psychiatry 2023Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to... (Review)
Review
IMPORTANCE
Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to 52% of patients exhibiting demoralization syndrome. Given established evidence linking demoralization in patients with cancer to physical symptom burden, quality of life, sleep disturbance, and suicidality, assessment and treatment of demoralization syndrome is critical for optimizing clinical and psychosocial outcomes.
OBSERVATIONS
The term "demoralization" is highly relevant to the care of patients with cancer facing life-limiting illnesses. Indeed, demoralization can be conceptualized as a feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others. Despite a considerable overlap in symptoms, demoralization and depression should be regarded as distinct and independent clinical syndromes. Patients who are demoralized but not clinically depressed often describe a sense of subjective incompetence and do not report anhedonia (i.e., loss of interest and inability to enjoy things). Although the definition of demoralization is now included as a distinct syndrome in the International Classification of Diseases (ICD)-11, it has been neglected by the current U.S. official nosology in psychiatry, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As such, demoralization syndrome may be under- or misdiagnosed and treated ineffectively in the oncology setting, potentially prolonging suffering and influencing cancer outcomes.
CONCLUSIONS AND RELEVANCE
Optimization of methods to diagnose and assess demoralization syndrome is critical to underpin rigorous studies evaluating the efficacy of psychotherapeutic and pharmacological interventions for patients with cancer experiencing demoralization. Our review supports the use of specific diagnostic criteria for demoralization in cancer patients, introduces methodological considerations relevant to treatment studies, and presents a novel measurement approach to the assessment of demoralization severity with the Clinical Interview for Demoralization (CIDE).
Topics: Humans; Demoralization; Quality of Life; Neoplasms; Emotions; Suicidal Ideation
PubMed: 37950966
DOI: 10.1016/j.genhosppsych.2023.10.004 -
Eating Disorders 2023Anhedonia is theorized as being relevant to binge eating spectrum disorders (BESDs) by palatable foods substituting the pleasure typically obtained from day-to-day...
Anhedonia is theorized as being relevant to binge eating spectrum disorders (BESDs) by palatable foods substituting the pleasure typically obtained from day-to-day activities. The current study examined whether anhedonia is associated with eating pathology at baseline and whether it predicts cognitive behavioral therapy (CBT) outcomes alone and when controlling for non-anhedonia depression symptoms. Ninety-three individuals from two randomized controlled trials completed the Eating Disorder Examination and Beck Depression Inventory-II at pre-, mid-, and post-treatment. Results showed that anhedonia was positively associated with global eating pathology at baseline, and larger pre- to mid-treatment anhedonia and non-anhedonia reductions predicted larger pre- to post-treatment global eating pathology reductions, though the anhedonia association was no longer significant when controlling for non-anhedonia depression. Anhedonia appears to be related to global eating pathology in CBT for BESDs, but not loss of control eating. Further research is needed to elucidate the relationship between anhedonia and BESDs.
Topics: Humans; Binge-Eating Disorder; Treatment Outcome; Cognitive Behavioral Therapy
PubMed: 36394391
DOI: 10.1080/10640266.2022.2141701 -
Neuropsychology Review Sep 2023Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and... (Review)
Review
Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and non-stroke population controls. This systematic review aimed to synthesize these findings with results from other methodological approaches that contribute to an understanding of phenomenological differences. Articles were identified via a systematic search of seven databases and additional manual searching. A narrative synthesis approach was adopted because of the high methodological heterogeneity. Twelve articles comparing the symptomatology of depression between stroke and non-stroke controls were included. Three distinct methodological approaches, relevant to the aim, were identified: comparisons of profiles among groups with similar overall depression severity, comparisons of the strengths of correlations between a symptom and depression, and comparisons of latent symptom severity. The symptomatology of depression was generally similar between the groups, including somatic symptoms, despite the hypothesized interference of comorbid physical stroke effects. Despite high heterogeneity, there was a tentative indication that post-stroke depression manifests with comparatively less severe/prevalent anhedonia. Possible mechanisms for the observed similarities and differences are explored, including suggestions for future research.
PubMed: 37667057
DOI: 10.1007/s11065-023-09611-5 -
Psychological Medicine Jul 2023Anhedonia is apparent in different mental disorders and is suggested to be related to dysfunctions in the reward system and/or affect regulation. It may hence be a...
BACKGROUND
Anhedonia is apparent in different mental disorders and is suggested to be related to dysfunctions in the reward system and/or affect regulation. It may hence be a common underlying feature associated with symptom severity of mental disorders.
METHODS
We constructed a cross-sectional graphical Least Absolute Shrinkage and Selection Operator (LASSO) network and a relative importance network to estimate the relationships between anhedonia severity and the severity of symptom clusters of major depressive disorder (MDD), anxiety sensitivity (AS), attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) in a sample of Dutch adult psychiatric patients ( = 557).
RESULTS
Both these networks revealed anhedonia severity and depression symptom severity as central to the network. Results suggest that anhedonia severity may be predictive of the severity of symptom clusters of MDD, AS, ADHD, and ASD. MDD symptom severity may be predictive of AS and ADHD symptom severity.
CONCLUSIONS
The results suggest that anhedonia may serve as a common underlying transdiagnostic psychopathology feature, predictive of the severity of symptom clusters of depression, AS, ADHD, and ASD. Thus, anhedonia may be associated with the high comorbidity between these symptom clusters and disorders. If our results will be replicated in future studies, it is recommended for clinicians to be more vigilant about screening for anhedonia and/or depression severity in individuals diagnosed with an anxiety disorder, ADHD and/or ASD.
Topics: Adult; Humans; Anhedonia; Depressive Disorder, Major; Autism Spectrum Disorder; Syndrome; Cross-Sectional Studies; Attention Deficit Disorder with Hyperactivity
PubMed: 35348051
DOI: 10.1017/S0033291722000575 -
Journal of Neural Transmission (Vienna,... Sep 2023The brain is built with hemispheric asymmetries in structure and function to enable fast neuronal processing. In neuroimaging studies, several mental disorders have been... (Review)
Review
The brain is built with hemispheric asymmetries in structure and function to enable fast neuronal processing. In neuroimaging studies, several mental disorders have been associated with altered or attenuated hemispheric asymmetries. However, the exact mechanism linking asymmetries and disorders is not known. Here, studies in animal models of mental disorders render important insights into the etiology and neuronal alterations associated with both disorders and atypical asymmetry. In this review, the current literature of animal studies in rats and mice focusing on anxiety and fear, anhedonia and despair, addiction or substance misuse, neurodegenerative disorders as well as stress exposure, and atypical hemispheric asymmetries is summarized. Results indicate overall increased right-hemispheric neuronal activity and a left-sided behavioral bias associated with symptoms of anxiety, fear, anhedonia, behavioral despair as well as stress exposure. Addiction behavior is associated with right-sided bias and transgenic models of Alzheimer's disease indicate an asymmetrical accumulation of fibrillar plaques. Most studies focused on changes in the bilateral amygdala and frontal cortex. Across studies, two crucial factors influencing atypical asymmetries arose independently of the disorder modeled: sex and developmental age. In conclusion, animal models of mental disorders demonstrate atypical hemispheric asymmetries similar to findings in patients. Particularly, increased left-sided behavior and greater right-hemispheric activity were found across models applying stress-based paradigms. However, sex- and age-dependent effects on atypical hemispheric asymmetries are present that require further investigation. Animal models enable the analysis of hemispheric changes on the molecular level which may be most effective to detect early alterations.
Topics: Rats; Animals; Mice; Rodentia; Anhedonia; Brain; Neuroimaging; Mental Disorders; Functional Laterality; Magnetic Resonance Imaging
PubMed: 36842091
DOI: 10.1007/s00702-023-02610-z -
Frontiers in Pharmacology 2023The core symptoms of depression are anhedonia and persistent hopelessness. Selective serotonin reuptake inhibitors (SSRIs) and their related medications are commonly... (Review)
Review
The core symptoms of depression are anhedonia and persistent hopelessness. Selective serotonin reuptake inhibitors (SSRIs) and their related medications are commonly used for clinical treatment, despite their significant adverse effects. Traditional Chinese medicine with its multiple targets, channels, and compounds, exhibit immense potential in treating depression. Autophagy, a vital process in depression pathology, has emerged as a promising target for intervention. This review summarized the pharmacological mechanisms of antidepressants by regulating autophagy. We presented insights from recent studies, discussed current research limitations, and proposed new strategies for basic research and their clinical application in depression.
PubMed: 38026940
DOI: 10.3389/fphar.2023.1287234 -
European Journal of Trauma &... Jun 2024Anhedonia describes the inability or difficulty of experiencing or seeking pleasure. Previous research has demonstrated a relationship between posttraumatic stress...
Anhedonia describes the inability or difficulty of experiencing or seeking pleasure. Previous research has demonstrated a relationship between posttraumatic stress disorder (PTSD) or experiencing trauma and anhedonia symptoms; however, little to no work has been done to understand the evolution of anhedonia symptoms after trauma. We aimed to identify anhedonia trajectories following traumatic injury. One hundred ninety-five participants were recruited from the emergency department of a Level-1 Trauma Center after experiencing a traumatic injury. To measure anhedonia symptoms, participants completed the Snaith-Hamilton Pleasure Scale (SHAPS) at 2-weeks, 3-months, and 6-months post-injury. Using latent class mixture modeling, we ran a trajectory analysis with three timepoints of SHAPS scores and compared mental and physical health outcomes across trajectories. Most of the sample fell in the resilient trajectory (85%), while the remainder were in a remitting trajectory (7%) where symptoms decreased over time, and a delayed (6%) trajectory where symptoms did not emerge until 3-months after injury. In the resilient trajectory, there was consistently low levels of PTSD, pain, depression, and anxiety relative to the other trajectories. In the delayed trajectory, depression and PTSD were chronically elevated and pain levels were consistent but mild. In the remitting trajectory, PTSD and depression symptoms decreased over time. Identified anhedonia trajectories mirrored trajectories commonly reported for PTSD symptoms after injury. Evaluating anhedonia trajectories and how they relate to mental health outcomes may inform targeted interventions for traumatic injury patients.
PubMed: 38799039
DOI: 10.1016/j.ejtd.2024.100408 -
Molecular Psychiatry Dec 2023Leading professional health bodies have called for the wider adoption of Patient Reported Outcome Measures, such as quality of life, in research and clinical practice as...
Leading professional health bodies have called for the wider adoption of Patient Reported Outcome Measures, such as quality of life, in research and clinical practice as a means for understanding why the global burden of depression continues to climb despite increased rates of treatment use. Here, we examined whether anhedonia-an often recalcitrant and impairing symptom of depression-along with its neural correlates, was associated with longitudinal changes in patient-reported quality of life among individuals seeking treatment for mood disorders. We recruited 112 participants, including n = 80 individuals with mood disorders (58 unipolar, 22 bipolar) and n = 32 healthy controls (63.4% female). We assessed anhedonia severity along with two electroencephalographic markers of neural reward responsiveness (scalp-level 'Reward Positivity' amplitude and source-localized reward-related activation in the dorsal anterior cingulate cortex), and assessed quality of life at baseline, 3- and 6-month follow-up. Anhedonia emerged as a robust correlate of quality of life cross-sectionally and longitudinally among individuals with mood disorders. Furthermore, increased neural reward responsiveness at baseline was associated with greater improvements in quality of life over time, and this improvement was mediated by longitudinal improvements in anhedonia severity. Finally, differences in quality of life observed between individuals with unipolar and bipolar mood disorders were mediated by differences in anhedonia severity. Our findings indicate that anhedonia and its reward-related neural correlates are linked to variability in quality of life over time in individuals with mood disorders. Treatments capable of improving anhedonia and normalizing brain reward function may be necessary for improving broader health outcomes for individuals seeking treatment for depression.ClinicalTrials.gov identifier: NCT01976975.
Topics: Adult; Female; Humans; Male; Middle Aged; Anhedonia; Bipolar Disorder; Cross-Sectional Studies; Depression; Electroencephalography; Gyrus Cinguli; Longitudinal Studies; Mood Disorders; Prospective Studies; Quality of Life; Reward
PubMed: 37402852
DOI: 10.1038/s41380-023-02165-1 -
Assessment Jan 2024This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the...
This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.
Topics: Humans; Adult; Adolescent; Depression; Psychiatric Status Rating Scales; Anhedonia; Psychopathology; Suicidal Ideation
PubMed: 37081793
DOI: 10.1177/10731911231167446 -
Neuron Dec 2023Repeated reward intake decreases its subjective pleasantness, which is a common phenomenon called reward devaluation. In this issue of Neuron, Yuan et al. unravel that...
Repeated reward intake decreases its subjective pleasantness, which is a common phenomenon called reward devaluation. In this issue of Neuron, Yuan et al. unravel that blunted inhibitory response of anterior cingulate cortex (ACC) encodes this process, whose hypersensitization leads to anhedonia.
Topics: Humans; Prefrontal Cortex; Anhedonia; Emotions; Neurons; Reward; Gyrus Cinguli; Magnetic Resonance Imaging
PubMed: 38061329
DOI: 10.1016/j.neuron.2023.10.019