Imaging emotion in schizophrenia: not finding feelings in all the right places.

摘要

Many patients with schizophrenia have difficulties initiating and sustaining goal-directed behavior. Perhaps the simplest way to explain this problem is to invoke the concept of anhedonia: patients do not pursue goals because goal attainment is just not that rewarding. That is, there is a real reduction in the capacity to experience pleasure, and this undermines motivation. This tight coupling of the experience of pleasure and volition informs most approaches to negative symptom rating scales, with which interviewers typically ask about the frequency of social contacts and recreational activities and how much enjoyment a person derives from these experiences. Patients who do not evidence any pursuit of these types of activities receive the most severe ratings for anhedonia. Thus, lack of pleasure-seeking behavior is interpreted as reflecting a lack of capacity for pleasurable emotional experience.