Capacity For Pleasure Research Articles

Does Neurosurgery for Obsessive-Compulsive Disorder Produce Personality Change?

Seventeen patients suffering from intractable obsessive-compulsive disorder treated with neurosurgery were assessed before surgery and a mean 10 +/- 5.1 years after surgery. Change in personality was assessed using a special 34-item schedule on patients and informants. The majority of subjects had not noted any significant changes in personality. The subjects were rated by themselves and their informants to have improved overall in the following characteristics: they were less obsessional, cried less, demonstrated a greater depth of feelings, laughed more, were more sociable, and were less anxious or dependent. Six subjects were judged by informants to have improved in their degree of obsessionality, which was distinguishable from the impact on obsessive-compulsive symptoms. The traits that showed an overall negative change were initiative/drive and energy level. Four subjects (2/4 open and 2/13 stereotactic surgery) were judged to have a negative personality change. Ratings of neuroticism, anxiety, depression, and capacity for pleasure showed significant improvement. We conclude that while most obsessive-compulsive disorder patients treated with stereotactic surgery do not experience a personality change, a small proportion report a positive or negative impact. Of note is the improvement in obsessionality in some patients, and an adverse personality change of the "frontal lobe type" in a few patients.

Decreased hedonic responsiveness during a brief depressive mood swing

Female volunteers completed the Fawcett-Clark Pleasure Capacity Scale (FCPCS) and rated the pleasantness and desirability of a taste stimulus (cheese), before and during a depressive mood swing. Mood change was induced by reading negative self-referent statements, with additional ‘booster’ periods of mood induction to prolong the duration of the mood swing. The mood induction procedure (MIP) caused a decrease in contentment and alertness, as derived from a set of visual analogue mood scales, and also decreased hedonic capacity, as measured by responses to the taste stimulus and by the FCPCS. No changes on any measure were shown by a control group who read an equivalent set of positive self-referent statements. Prior to the MIP, there were no significant correlations between mood measures and hedonic measures, or between taste responses and the FCPCS. However, there were significant correlations between the size of the changes in these various measures following the depressive MIP. The results suggest that hedonic capacity is responsive to acute depressive mood swings.

Anhedonia and blunted affect in major depressive disorder.

The relation between anhedonia and affective flattening was studied in 61 normal subjects and 61 major depressives. Affective flattening and anhedonia were defined by the following self-rating scales: Fawcett-Clark Pleasure Capacity Scale (FCPCS), Hardy Displeasure Capacity Scale (HDCS), FCPCS-PP (subscale of physical pleasure), and HDCS-PD (subscale of physical displeasure). The depressives are more sensitive to displeasure and more anhedonic than controls. Concerning physical stimulations (FCPCS-PP and HDCS-PD) in the depressed group, anhedonia and affective flattening are not linked, suggesting that physical anhedonia is not secondary to low emotional reactivity (affective flattening) and constitutes an independent dimension.

Physical anhedonia and subtypes of major depressive disorder

SummaryA study was conducted on a group of 73 patients suffering from major depressive disorder (DSMIII) compared with 120 normal subjects using a subscale of physical pleasure (Fawcett Clark pleasure capacity scale-physical pleasure, FCPCS-PP). The major depressives were significantly more anhedonic than the normals and the distribution of the FCPCS-PP scores in these subjects was unimodal.

Decreased intracranial self-stimulation in a new animal model of endogenous depression

Neonatal treatment of rats with clomipramine may produce adult animals which model endogenous depression. We report here that a major factor of depression in humans, the diminished capacity for pleasure, appears present in these rats. At age 7 months, bar-press responding for rewarding hypothalamic stimulation is reduced across a range of intensities. At age 4 or 5 months this effect is not seen, although other behavioral abnormalities are present at the younger age. The delayed onset of diminished intracranial self-stimulation may relate to the gradual insidious onset of endogenous depression in humans.

The relationship between sensation seeking and anhedonia

The present study investigates the relationship between sensation seeking and anhedonia, a pathological reduction in pleasure capacity. Previous studies have shown that hospitalized schizophrenics manifest lower levels of sensation seeking than do other psychiatric and non-psychiatric populations. The presence of anhedonia in schizophrenic and pre-schizophrenic populations has also been noted, leading to the development of measures of anhedonia designed to locate schizophrenia-prone individuals. The present study found an inverse relationship between Zuckerman's Sensation Seeking Scale and the Physical Anhedonia Scale, which has been used as a measure of psychosis vulnerability. These findings suggest that lowered levels of sensation seeking may be indicative of physical anhedonia and may also play a role in proneness to schizophrenia.

Depression, Affect and Negative Symptoms in Schizophrenia

The relationship of depression with affect deficit in schizophrenic patients continues to challenge both the clinician and the researcher. Often there is considerable difficulty in differentiating these two affect states in a reliable and valid fashion. On the observational level, depressed affect often appears somewhat restricted, having lost the full range of the euthymic state. On a subjective level, schizophrenic patients often complain of anhedonia, a defect in pleasure capacity which is shared by patients who are depressed. On the prognostic level, there is a large body of literature that links depressive features in acute schizophrenics to favourable subsequent course (Astrup & Noreik, 1966; Vaillant, 1964). We were, therefore, interested in investigating the relationship of depression with impaired affect and with positive/negative symptoms in young acute schizophrenic patients. We used a systematic multidimensional study of affect impairment among 37 young acute schizophrenic patients in a prospective, longitudinal approach over a 2-year span. In addition to a detailed assessment of the affect profile, including depression, both at baseline and on follow-up, we rated patients clinically for a positive and negative syndrome as well as general psychopathology, and we conducted premorbid and outcome measurements.

Do Negative Symptoms Respond to Pharmacological Treatment?

The introduction of neuroleptic (or anti-psychotic) medication into clinical practice was a major advance in the treatment of schizophrenia. Numerous well-controlled, double-blind clinical trials have established the therapeutic efficacy of these agents in both the acute and long-term treatment of schizophrenia (Klein et al, 1980; Kane & Lieberman, 1987). In general, the therapeutic benefit of medication has been assessed in terms of the relative reduction in the more florid signs and symptoms of schizophrenia (e.g. hallucinations, delusions, thought disorder, agitation, and hostility) and the ability of maintenance medication to reduce the rate of recurrence of these symptoms and in turn rates of rehospitalisation. At the same time it has been quite apparent that anti-psychotic drugs do not necessarily eliminate some of the major chronic disabilities of patients with this illness, disabilities reflected in impoverished affect, lack of drive and ambition, impaired spontaneity, reduced ability to relate to others, and diminished pleasure capacity. These symptoms have at times been described as negative in that they reflect an absence of or reduction in certain aspects of psychologic, cognitive, and emotional functioning in an attempt to distinguish them from the distortions or exaggerations in normal function which characterise positive symptoms (Strauss & Carpenter, 1974; Jackson, 1904).

Cerebral laterality and depression: differences in perceptual asymmetry among diagnostic subtypes.

Examined the influence of diagnostic subtype of depression on perceptual asymmetry for dichotic listening and visual tachistoscopic tasks. A total of 65 unmedicated patients with major depressive disorders and 30 normal controls were tested on a verbal and nonverbal task in each modality. Patients diagnosed according to the DSM-III with melancholia had abnormal perceptual asymmetry for dichotic nonsense syllable and complex tone tasks. In contrast, patients having a nonmelancholic "atypical depression" (reactivity of mood with preserved pleasure capacity and associated features) did not differ from normal controls on these tasks, but had an increased incidence of left handedness. Bipolar depression (history of hypomania) differed from unipolar depression in showing abnormal perceptual asymmetry for a tachistoscopic dot enumeration task. Alterations of perceptual asymmetry in melancholia and bipolar depression were consistent with hypothesized right hemisphere dysfunction.

Learning and memory from three to eleven months: A longitudinal study

Neonatal treatment of rats with clomipramine may produce adult animals which model endogenous depression. We report here that a major factor of depression in humans, the diminished capacity for pleasure, appears present in these rats. At age 7 months, bar-press responding for rewarding hypothalamic stimulation is reduced across a range of intensities. At age 4 or 5 months this effect is not seen, although other behavioral abnormalities are present at the younger age. The delayed onset of diminished intracranial self-stimulation may relate to the gradual insidious onset of endogenous depression in humans.

Personality indicators of psychosocial adjustment in first-year medical students

One aspect of the Rush Medical College Longitudinal Study is concerned with the identification of personality traits that predict various kinds of psychosocial adjustments and impairments among medical students and physicians. Two orthogonal traits, masculinity and femininity, were selected for study as independent variables because of their implications for mental health and their relevance to the work of physicians. Ninety percent ( N = 106) of a class of first-year medical students completed measures of masculinity and femininity during orientation and, 8 months later, completed a broad array of dependent measures of psychological well-being, interpersonal satisfaction, humanistic attitudes and alcohol consumption. Analyses of the data revealed strong and consistent main effects of masculinity on depression, confidence, pleasure capacity, extraversion, locus of control, neuroticism and interpersonal satisfaction. Femininity was associated with depression, pleasure capacity, extraversion, neuroticism, interpersonal satisfaction, concern for the opinion of others and humane attitudes toward patient care. Low femininity was also associated with high alcohol consumption. These results suggest that masculinity and femininity scores may help to identify at the outset medical students at risk for impairment, and that androgynous individuals (who are high in both masculinity and femininity) may be especially well-suited to assume the demanding and varied roles that physicians are called on to play.

Is capacity for pleasure associated with executive career success?

Executives with a low capacity for pleasure were examined to determine if they evidence less occupational and social success than those with normal or high capacity. Data on pleasure capacity and depressive symptoms were collected from 88 senior executive officers, and scores were compared with independent ratings of career success. The 11% of executives with serious work-related or personal problems showed significantly higher pleasure scores than the rest. It is hypothesized that the relatively high pleasure scores of the least successful executives reflect a defensive process of denial or reaction formation rather than an excessively joyful personality trait. A longitudinal study of executives is proposed to clarify whether the high pleasure capacity scores of the least successful executives change situationally over time.

Differences between anhedonic and normally hedonic depressive states.

In this study of 101 patients who met DSM-III criteria for major depression, those with extreme anhedonia (N = 23) were younger, more depressed, and less neurotic than the patients with a normal-range capacity for pleasurable experiences (N = 78). The anhedonic depressed patients recovered more rapidly; at discharge they consequently had levels of symptom severity equal to those of the hedonic patients, yet they remained significantly more anhedonic. The anhedonic patients exhibited loss of pleasure in appetite, sex, social contacts, and work, which suggests a global dulling of the capacity for pleasure.

F. Y. edgeworth’s mathematical ethics

Edgeworth’s utopia was elitist; it might even be called racist, except that he never attempted to state what outward characteristics differentiated the higher from the lower-evolved groups—unlike many of his contemporaries. He was certainly a male chauvinist, having claimed that men have a greater capacity for both pleasure and work than women [see 1881, 78–79]. These pecularities of Edgeworth’s beliefs, however, are either explicit in his assumptions or else they appear as “scholia,” so to speak, which do not enter into his formal argument at all. They need not denigrate the more general thesis of Edgeworth’s book: that mathematics may profitably be applied to that realm of philosophical investigation known in the nineteenth century as the “moral sciences.” For the “economical calculus” Edgeworth made his point; mathematical economics is a flourishing discipline in which some of Edgeworth’s early propositions are still remembered and applied. The mathematical ethics did not fare so well. Perhaps it was because Edgeworth’s own premises were unacceptable to later generations, perhaps because the obscure reasoning employed did not seem to yield any conclusions that were not already obvious from the premises, perhaps because later philosophers conceived the problems of ethics in such a different fashion that Edgeworth’s methodology was useless to them. Whatever the reasons, Edgeworth’s proposal to let mathematics show the way to the solutions of the problems of mankind exemplified the unbounded faith of an age in the power and authority of mathematical reasoning—a faith that has probably not been equalled since.

Hypohedonia in schizophrenia.

The affective disorder in schizophrenia is an important manifestation of the schizophrenic illness. Such clinical features of joylessness, interpersonal aversion, and affective blunting have been considered by Rado and Meehl to represent a neurophysiological deficit in pleasure capacity which they termed anhedonia, but is more aptly characterized by the term hypohedonia. A free-recall task employing 24 affectively laden words presented in random order over nine trials was given to a carefully selected group of nonpsychotic hospitalized schizophrenics, hospitalized nonschizophrenics, and normals. The results of the study demonstrate that normals remember pleasant words to a significantly greater extent than upleasant words. This Pollyanna tendency or the tendency to utilize pleasant words over upleasant words has been described by Osgood as a stable cross-cultural phenomenon. By contrast, the schizophrenics show a significantly lower recall of pleasant words when compared with normals, although they remember unpleasant words to a comparable degree as normals. These findings provide experimental support for the hypohedonia hypothesis in schizophrenia. The nonshcizophrenic patients recall pleasant and unpleasant words to a significantly greater degree than neutral words. They are thus affectively governed in the free-recall task and seem equally sensitized to both pleasant and unpleasant affect in their mnemonic processing.

On the concept of pain, with special reference to depression and psychogenic pain.

THIS short paper is of necessity a rather simplified account of a highly complex topic. In it we shall put forward aspects of a psychological model in which the general concept of pain as a feeling state plays a central role. Pain will be treated in this context as a theoretical concept in a more general psychopathological theory, as well as being used to describe a class of subjective states; and it will be used to encompass what has often been referred to as ‘mental pain’ as well as experiences of bodily pain. Certain theoretical aspects of the relationship between pain and depression will also be discussed. In their preceding paper Merskey and Spear [l] have surveyed much of the literature on the concept of pain in a manner which is remarkable both for its clarity and its value as a contribution to a most difficult subject. They have, of course, confined themselves in their presentation to the elucidation of Merskey’s definition of pain [2], and their conclusions fit in to some extent with those which we have arrived at from an entirely different avenue of approach. We shall presently touch on the relation between our point of view and theirs, but before doing so we should like to present a short account of the development of our own views. Some two or three years ago we applied ourselves to the study of depressive states in children [3]. We had at our disposal the detailed records [4] of a large number of children of all ages who had received intensive psychoanalytic psychotherapy at the Hampstead Child-Therapy Clinic. One of our most striking impressions was that there was a need to distinguish between two states in our group of children, states which had often been confused by workers in this field. On the one hand there was a state of manifest misery or unhappiness with which the child was strenuously struggling. He expressed discontent, often showed aggressive (and sometimes antisocial) behaviour, and in one way or another actively protested against the existing state of affairs. In sharp contrast to this, there were those states of unhappiness characterized by a mood which had both mental and bodily components. The child looked unhappy, had little interest in his surroundings and appeared withdrawn, bored or listless. He had a feeling of discontent with what was offered to him and showed little capacity for pleasure. He communicated a sense of feeling rejected or unloved, and showed a readiness to turn away from disappointing objects. He was not prepared to accept help or comfort readily, and if he did respond at all, his underlying attitude of resigned disappointment would re-emerge. He showed a tendency to regress to passive attitudes and behaviour. Insomnia and various other sleep disturbances were noted, and autoerotic or repetitive self-comforting activities described. A general feature was that the therapist reported difficulty in making sustained contact with the child at this time.