Anhedonia and sensitivity to punishment in schizophrenia, depression and opiate use disorder

From a behavioural perspective anhedonia is defined as diminished interest in the engagement of pleasurable activities. Despite its presence across a range of psychiatric disorders, the cognitive processes that give rise to anhedonia remain unclear.

Here we examine whether anhedonia is associated with learning from positive and negative outcomes in patients diagnosed with major depression, schizophrenia and opiate use disorder alongside a healthy control group. Responses in the Wisconsin Card Sorting Test - a task associated with healthy prefrontal cortex function - were fitted to the Attentional Learning Model (ALM) which separates learning from positive and negative feedback.

Learning from punishment, but not from reward, was negatively associated with anhedonia beyond other socio-demographic, cognitive and clinical variables. This impairment in punishment sensitivity was also associated with faster responses following negative feedback, independently of the degree of surprise.

Future studies should test the longitudinal association between punishment sensitivity and anhedonia also in other clinical populations controlling for the effect of specific medications.

Together the results reveal that anhedonic subjects, because of their negative expectations, are less sensitive to negative feedbacks; this might lead them to persist in actions leading to negative outcomes.