抑郁症:一种进化心理学的视角

探讨了抑郁症的进化机制。由进化机制支配的依恋和社会地位行为可能是某些严重抑郁症的基础,尤其是与长期压力相关的抑郁症。虽然抑郁症有不同的性质,但某些核心症状是为了调节行为、情绪以及传达对威胁的敏感性而进化形成的,如行为退缩、低自尊、快感丧失等。     

青少年抑郁的快感缺失的神经机制研究

抑郁逐渐低龄化使得青少年抑郁备受关注。快感缺失,作为抑郁的一种核心临床症状,已成为抑郁最具前景的内表型之一。然而,青少年抑郁的快感缺失的神经机制迄今仍不清楚。本研究首先汇总两种神经机制模型即三元模型和社会挫折模型;其次,在多种奖励加工如金钱奖励、努力动机奖励、未来奖励和社会奖励条件下,概述青少年抑郁的快感缺失的神经机制前沿进展。未来可以深入探索努力动机奖励和未来奖励在预测青少年抑郁中的作用,加强研究青春期阶段与性别是如何交互影响早期抑郁快感缺失,将无创伤电磁刺激应用于青少年抑郁干预中,进一步澄清青少年抑郁的快感缺失的神经发展机制。     

心理虐待与儿童快感缺失的关系：认知重评的中介作用

本研究选取949名8～12岁儿童进行自我报告测验,并从中选取83名被试完成行为实验。研究考察了认知重评策略以及增强正性情绪的重评使用效果在心理虐待与儿童快感缺失间的中介作用。结果发现：（1）心理虐待与儿童快感缺失呈正相关,认知重评策略、增强调节认知重评效果与快感缺失均呈负相关;（2）认知重评策略在心理虐待与快感缺失间起中介作用;（3）增强调节认知重评效果在心理虐待与快感缺失间起中介作用。上述结果表明,心理虐待可通过认知重评来间接影响儿童快感缺失。     

抑郁个体对社会反馈的加工：研究现状及存在问题

抑郁症伴随着严重的社会功能障碍。本文以“社会反馈”这一重要社会性信息为切入点,综述了抑郁症患者及抑郁倾向人群对社会反馈的体验、期待及情绪调节障碍的研究现状,发现抑郁个体对社会奖赏存在快感缺失,对社会排斥、社会拒绝等负性反馈表现出过敏化,对社会奖赏的期待降低,且可能存在情绪调节困难。目前此领域存在社会与非社会反馈神经机制的异同不清楚、异常脑区与社会反馈加工障碍的因果关系难以确定以及无法排除抑郁症患者和抑郁倾向人群存在不同社会反馈加工模式的可能性等问题。     

抑郁对社会决策的影响

从社会决策角度出发,依托博弈论的经典范式是研究抑郁症病人人际与社会功能障碍的一个切入点。Ruff和Fehr （2014）提出在社会决策中存在三类情境,即社会反馈、替代性评价、社会原则。我们从这个理论框架出发,发现抑郁症病人在社会反馈加工中存在社会性快感缺失,对社会拒绝的敏感性增强;在替代性评价过程中,共情和心理理论能力减弱;抑郁症病人对决策中的社会原则（公平、合作）存在适应不良现象,如过度利他性。未来的研究一方面可进一步探索抑郁症病人的社会性快感缺失现象,另一方面可采用经颅电/磁刺激与脑成像技术结合或超扫描技术,提高研究结果的解释力和生态效度。     

男性气质的陨落:男性抑郁症

抑郁是男性心理健康的一个静默的面向,男性抑郁的表现经常被忽视,但却又具有极大的破坏性,即具有较高的自杀率。国外研究已经提供了一些对于可能起到导致男性罹患抑郁症的影响因素以及相关的洞察,比如污名、男性性别角色规范,较低的求助行为和应对方式等,其中男性气质是男性抑郁症的一个重要决定因素,国内针对男性抑郁症的研究有限,更多以抑郁症性别差异研究呈现,对于男性气质研究更多见于社会文化领域。笔者回顾了相关文献对现有研究做了尝试性的总结,并在最后提出展望和一些与男性抑郁症相关的研究建议。     

老年抑郁症的症状、诊断及测量

对老年抑郁症的症状、诊断和测量的探讨有利于寻找更有效的治疗方法。文章在简要讨论老年抑郁症主要症状以及诊断特点的基础上,重点介绍老年抑郁症的测量工具。文章指出,开展老年抑郁症研究的多学科研究,运用认知神经科学方法深入研究老年抑郁症,制订相对独立的老年抑郁症的分类标准,结合老年抑郁症患者身心特点开发更简便可靠的老年抑郁症量表,将有利于老年抑郁症的进一步研究。     

抑郁症神经成像研究的临床转化:预防、诊断和治疗的新取向

抑郁症的预防、诊断和治疗是临床所面临的主要问题,其效果的提升有待超越传统方法,寻求新的方法和技术。其中抑郁症的神经成像转化研究为此提供了一个新的突破口,该研究取向旨在将抑郁症的神经成像基础研究的发现转化为临床运用。文章综述了其在抑郁症的预防、诊断和治疗上的潜在运用价值。未来方向需要更好地促进抑郁症神经成像转化研究的双向自由流通、强调将新的方法转化到日常的临床实践和健康决策上去、促进多学科的合作和相关人才的培养,以及进一步探究转化过程中所面临的特定基础和临床主题。     

经颅直流电刺激在抑郁症治疗中的应用

已有的神经影像学研究成果揭示, 抑郁症发作的重要原因之一是大脑前额叶皮层结构和功能受损。经颅直流电刺激(tDCS)作为一种无创脑刺激, 选取前额叶皮层作为刺激区域, 通过调节皮层兴奋性来治疗抑郁症, 能够有效缓解抑郁症状和改善受损的认知功能, 疗效明显且持久稳定。针对tDCS在抑郁症治疗研究中的问题, 未来可从有效性、个体差异以及预防干预等六个方面进一步研究, 以期tDCS作为一种具有潜力的治疗手段, 在临床上有更为广泛地应用。     

缰核在抑郁症中的作用:研究和治疗的新途径

缰核是哺乳动物神经系统中连接前脑和中脑的重要节点,这一古老的核团因其与抑郁症的密切联系,近来获得国内外研究者的关注.缰核接受来自边缘系统、基底神经节等的传入信号,向下投射到中脑5-羟色胺系统和多巴胺系统.在应激条件下缰核免疫活动增强,向下游的投射信号增强,以此调节单胺类递质释放,参与抑郁症的发病机制,并且参与抗抑郁治疗的起效途径.这些证据提示缰核在抑郁症中具有重要作用,将成为研究和治疗的新途径.未来研究应从缰核与上下游核团的神经联系、与丘脑-垂体-肾上腺轴的相互影响、以及与免疫激活的交互作用等方面进一步探索,为研究抑郁症病理机制和治疗方法提供线索.     

Trait anhedonia is a transdiagnostic correlate of internalizing problems during adolescence

Developmental research documents that anhedonia, or diminished interest in usual activities, is associated with a diverse array of emotional problems in childhood and adolescence. Meanwhile, official nosologies desginate anhedonia as a more specific characteristic of major depressive disorder. Using a quantitative model of the internalizing domain, we compared the strength of transdiagnostic versus diagnosis-specific pathways from anhedonia to major depression (and other internalizing conditions) during adolescence. We recruited 241 youth ages 14–17 who completed semistructured interviews of anxiety and depressive disorders, as well as several self-report surveys of trait anhedonia and neuroticism. Confirmatory factor analysis of diagnostic correlations revealed good fit for a unidimensional model of the 10 internalizing conditions we assessed. This overarching internalizing dimension was statistically significantly correlated with trait anhedonia (r = 0.17) and neuroticism (r = 0.59). In contrast, anhedonia was virtually unrelated to major depression (r = −0.02), net the internalizing dimension. Thus, in this sample, the connection between anhedonia and major depression was explained by a transdiagnostic dimension presumed to underlie all internalizing problems. Compared to neuroticism, however, anhedonia had a more limited association with internalizing, consistent with established personality models of anxiety and depression. We conclude that these data are consistent with conceptualizing anhedonia predominantly as a transdiagnostic correlate of internalizing conditions, rather than a specific marker of major depression, in developmental psychopathology research and clinical interventions for young people.     

Midline theta dissociates agentic extraversion and anhedonic depression

The agency facet of extraversion is related to individual differences in reward anticipation and has been linked to the neurotransmitter dopamine. Dopamine has also been associated with components of anhedonia, which is one of the cardinal symptoms of depression and refers to lack of responsiveness to pleasurable stimuli. This raises the question whether low agency is associated with anhedonia symptoms in depression and if agency and anhedonia are characterized by similar neurobiological mechanisms. To address this hypothesis, we tested whether questionnaire measures of agency and anhedonia are correlated within depressed (n = 20) and non-depressed (n = 22) participants. Further, we investigated whether dopamine-related signatures in the EEG recorded during a gambling task (feedback-evoked theta activity, and frontal versus posterior theta activity) similarly relate to agency and anhedonia. Results indicated that anhedonia was significantly elevated in the depression group, and negatively correlated with agency. However, while theta activity evoked by negative vs. positive feedback was sensitive to anhedonia and depression status but unrelated to agency, frontal versus parietal theta activity predicted agency, but was unrelated to anhedonia and depression. Together, this double dissociation suggests that in spite of considerable phenotypical overlap, anhedonia and agency may be linked to partially distinct neurobiological markers.     

Relationships Among Sleep Disturbance,Reward System Functioning,Anhedonia, and Depressive Symptoms

Recent models propose reward system dysfunction as a key mediator of the relationship between sleep and depression and anhedonia. This study explored interrelationships among sleep disturbance, depressive symptoms, anhedonia, and reward responsiveness. Two-hundred and sixty undergraduate students completed questionnaires and a daily diary paradigm assessing sleep, reward responsiveness, depression, anhedonia, and positive affect over 1 week. Baseline sleep disturbance was associated with depressive symptoms, anhedonia, and reward responsiveness. Daily diary sleep parameters showed differential associations with anticipatory versus consummatory reward responsiveness and positive affect. Poorer sleep quality, shorter sleep duration, and longer awakening after sleep onset predicted blunted anticipatory and consummatory reward responsiveness, while increased sleep onset latency and lower sleep efficiency predicted only decreased consummatory reward responsiveness. All sleep indices, except sleep onset latency, were associated with positive affect. Findings demonstrate unique associations between disparate sleep disturbance and reward responsiveness elements, highlighting new treatment mechanisms for anhedonia and depression.     

Reliability of the Chronic Mild Stress paradigm: Implications for research and animal welfare

The Chronic Mild Stress (CMS) model for depression has become central to the empirical literature on depression. There are however inconsistencies in the literature concerning the robustness of the phenomenon of anhedonia following CMS procedures. We report that not only did our procedures (modeled on the original reports) fail to induce an anhedonia, but in fact led to increased sucrose consumption. Furthermore, corticosterone levels following CMS procedures were lower than following control procedures. Given that this is not the first report of such findings, it is important to evaluate whether and which aspects of the experimental methodology are necessary or sufficient to induce the state of anhedonia.     

Mediating effect of environmental rewards on the relation between goal-directed behaviour and anhedonia

Depression can be explained by certain behavioural patterns, especially low levels of environmental rewards; it is generally accompanied by infrequent goal-directed behaviour, increased depressed mood, and anhedonia. However, no research has statistically examined the mediating effect of environmental rewards on the relation between goal-directed behaviour and the symptoms of depressed mood or anhedonia. This study sought to determine whether such a mediating effect of environmental rewards is present in cross-sectional study. The participants included 101 patients diagnosed with major depressive disorders. Data were collected through three questionnaires measuring depression and behavioural patterns that maintain depression: the Center for Epidemiologic Studies Depression Scale (CES-D), the Environmental Reward Observation Scale (EROS), and the Behavioral Activation for Depression Scale—Short Form (BADS-SF). Mediation analysis was conducted using depressed mood and anhedonia as dependent variables, environmental rewards as the mediating variable, and goal-directed behaviour as the independent variable. Environmental rewards significantly mediated the relationship between goal-directed behaviour and anhedonia but not that between goal-directed behaviour and depressed mood. No significant relationships were found among depressed mood, goal-directed behaviour and environmental rewards. From these results, we conclude that low levels of environmental rewards accompanied by infrequent goal-directed behaviour can lead to increased anhedonia but not depressed mood.

     

Associations Among Smoking,Anhedonia, and Reward Learning in Depression

Depression and cigarette smoking co-occur at high rates. However, the etiological mechanisms that contribute to this relationship remain unclear. Anhedonia and associated impairments in reward learning are key features of depression, which also have been linked to the onset and maintenance of cigarette smoking. However, few studies have investigated differences in anhedonia and reward learning among depressed smokers and depressed nonsmokers. The goal of this study was to examine putative differences in anhedonia and reward learning in depressed smokers (n = 36) and depressed nonsmokers (n = 44). To this end, participants completed self-report measures of anhedonia and behavioral activation (BAS reward responsiveness scores) and as well as a probabilistic reward task rooted in signal detection theory, which measures reward learning (Pizzagalli, Jahn, & O'Shea, 2005). When considering self-report measures, depressed smokers reported higher trait anhedonia and reduced BAS reward responsiveness scores compared to depressed nonsmokers. In contrast to self-report measures, nicotine-satiated depressed smokers demonstrated greater acquisition of reward-based learning compared to depressed nonsmokers as indexed by the probabilistic reward task. Findings may point to a potential mechanism underlying the frequent co-occurrence of smoking and depression. These results highlight the importance of continued investigation of the role of anhedonia and reward system functioning in the co-occurrence of depression and nicotine abuse. Results also may support the use of treatments targeting reward learning (e.g., behavioral activation) to enhance smoking cessation among individuals with depression.     

The Association Between Anhedonia,Suicide Ideation,and Suicide Attempts: A Replication in a Persian Student Sample

Research suggests that anhedonia, a common symptom of depression, may be uniquely associated with suicidal behavior. However, little research has examined this association across cultures. To address this limitation, this study attempted to replicate a recent anhedonia and suicide study (conducted in a western culture) in a Persian sample using the Specific Loss of Interest and Pleasure Scale, Persian version. Participants consisted of 404 students who were recruited from a Persian university. Surprisingly, our results indicated that anhedonia levels were more than double those found in similar American student sample. Despite this marked difference in anhedonia symptoms, we found that anhedonia was associated with suicide risk, even when it was statistically accounting for other depressive symptoms. These findings suggest that anhedonia is a robust predictor of suicide risk across these two cultures. Further, anhedonia may be a particularly important treatment target among Persian students.     

Anhedonia in prolonged schizophrenia spectrum patients with relatively lower vs. higher levels of depression disorders: Associations with deficits in social cognition and metacognition

This study has sought to explore whether there are at least two subtypes of anhedonia in schizophrenia: one closely linked with depression and another that occurs in the absence of depression which is related to a general paucity of internal experience. Participants were 163 adults with schizophrenia who completed assessments of depression, anhedonia, executive functioning, positive and negative symptoms, social cognition and metacognition. A cluster analysis based on participants’ depression and anhedonia symptom scores produced three groups: High Depression/High Anhedonia (n = 52), Low Depression/Low Anhedonia (n = 52), and Low Depression/High Anhedonia (n = 59). An ANCOVA and post hoc comparisons controlling for positive and negative symptoms found that the Low Depression/High Anhedonia group had poorer metacognition and social cognition than other groups. These findings point to the possibility of a subtype of anhedonia in schizophrenia, one occurring in the relative lesser levels of depression, and tied to deficits in the ability to think about oneself and others.     

Experience of pregnancy and delivery as predictors of postpartum depression

This research examined experiences of pregnancy and delivery as predictors of three subscales identified within the Edinburgh Postnatal Depression Scale (nonspecific depression, anhedonia, and anxiety). Mothers of babies under 1 year (N = 415) completed the Edinburgh Postnatal Depression Scale (EPDS) and gave information as to number of pregnancies, number of children, and their ratings of the difficulty of the course of pregnancy and delivery. Number of pregnancies and number of children did not predict scores on any of these subscales. Difficulty in the course of pregnancy was a significant positive predictor of nonspecific depression, and difficulty of delivery was a significant positive predictor of anxiety. Neither of these variables significantly predicted anhedonia. These results provide evidence of the heterogeneity of postpartum depression, indicating that risk factors differentially influence subscales of the EPDS.