Anhedonia, self-experience in schizophrenia, and implications for treatment

Anhedonia - the inability to experience pleasure - is a symptom of several psychiatric disorders such as depression, drug and alcohol dependence, but also schizophrenia. The concept of anhedonia played a major role in psychiatric and psychoanalytic explanations of psychotic behavior. The relationship between notions of anhedonia and of mental evolution and regression (in the work of Myerson and Bleuler) is discussed. The non-evolutionist views of Rado and Meehl are described. Then the concept of anhedonia is discussed in relationship to the phenomenological approach of Sass and Parnas, who view anhedonia as one manifestation of a self-disturbance or self-disorder that is fundamental in schizophrenia. Concerning treatment of anhedonia, it was often hypothesized that anhedonia is associated with a dysfunction of the mesolimbic dopaminergic reward system. However, studies in humans and non-human animal models indicate that dysfunction of central dopaminergic neurotransmission interferes with the process of motivation rather than with the ability to experience pleasure; the latter may be more mediated by the opioidergic and serotonergic neurotransmission. Understanding the neurobiological correlates of motivation and pleasure may provide new options to treat anhedonia in patients with schizophrenia.