[Clinical characteristics of chronic schizophrenic patients presenting with severe anhedonia]

The aim of the present study is first to test the existence of a sub-group of chronic schizophrenics characterized by a severe anhedonia and secondly to determine the characteristics of that sub-group. 150 patients meet the DSM III-R and RDC criteria for chronic schizophrenia and 151 healthy subjects constituted the control group. The subjects filled out the Physical Anhedonia Scale of Chapman (PAS), the Fawcett Clark Pleasure Capacity Scale-Physical Pleasure (FCPCS-PP) and the abridged form of the Beck Depression Inventory (BDI). The distributions of the PAS and FCPCS-PP were studied using a test of normality. In the normal group the distributions of the anhedonia scales were unimodal and in the schizophrenic group the distributions were not. The schizophrenics were dichotomized into anhedonic schizophrenics (PAS scores higher or equal to 29) and hedonic schizophrenics (PAS scores lower than 29) and these subgroups were compared on socio-clinical variables and PANSS, BPRS and BDI scores using chi 2 square tests or Mann and Whitney tests. They were 32 subjects in the anhedonic sub-group and 128 subjects in the hedonic sub-group. They were not significant differences between the sub-groups concerning the sex-ratio, educative level, age, mean duration of the illness, mean number of hospitalization and the mean dose of antipsychotics. The proportions of depressive and deficit syndromes did not differ between the two sub-groups but the proportion of "negatives" (using the composite score of the PANSS) was greater in the anhedonic sub-group. A discriminant analysis has been done on the items of the BPRS, PANSS and BDI and the results have shown that the anhedonic schizophrenics had more hallucinatory behavior, disorientation, blunted affect, social withdrawal, cognitive distorsions and less anxiety and displeasure than hedonic schizophrenics. Our results allow to identify a sub-group of chronic schizophrenia characterized by a severe anhedonia and will be confirmed by others studies using prospective methodology.