Targeting Anhedonia May Help Functioning in Patients With Schizophrenia

Anhedonia appears to be a rational treatment target for improving global functioning in patients with schizophrenia, suggest study findings published online ahead of print in JAMA Psychiatry.

“Improved understanding of the boundaries and connections between positive symptoms, negative symptoms, and role functioning in schizophrenia is critical, given limited empirical support for clear distinctions among these clinical areas,” researchers wrote. “This study’s use of network psychometrics to investigate differential associations and structural overlap between positive symptoms, negative symptoms, and functional domains in schizophrenia may contribute to such understanding.”

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The cross-sectional study used network analysis and community detection methods to examine the interplay of positive symptoms, negative symptoms, and functional domains in 979 clinically stable outpatients with schizophrenia or schizoaffective disorder in the United States. The average age of patients was 46 years, and more than two-thirds were men. Some 40% self-identified as African American, 3% as Asian, 0.7% as Native American, 0.8% as Pacific Islander, 42.1% as White, and 12.8% as more than 1 race.

In the most comprehensive network analysis, anhedonia had the highest expected influence of any variable, according to the study. Anhedonia had connections with negative symptoms, positive symptoms, and functional domains.

Community detection analyses revealed a trio of clusters related to positive symptoms; negative symptoms and work functioning; functional domains; and avolition, anhedonia, and work functioning.

“Hallucinations and delusions replicated in 1000 bootstrapped samples (100%), while bizarre behavior and thought disorder replicated in 390 (39%) and 570 (57%), respectively,” researchers reported. “In contrast, negative symptoms and work functioning replicated between 730 (73%) and 770 (77%) samples, respectively, and the remaining functional domains in 940 samples (94%).”

Given the high centrality of anhedonia and its connections with functional domains, the researchers concluded it could be an appropriate target for treatment.

“Interventions for work functioning may benefit from a specialized approach that focuses primarily on avolition,” they added.

Reference

Abplanalp SJ, Braff DL, Light GA, Nuechterlein KH, Green MF; Consortium on the Genetics of Schizophrenia-2. Understanding connections and boundaries between positive symptoms, negative symptoms, and role functioning among individuals with schizophrenia: a network psychometric approach. JAMA Psychiatry. Published online August 17, 2022. doi: 10.1001/jamapsychiatry.2022.2386