Editors' ChoicePsychiatry

Demystifying anhedonia in childhood with large-scale networks

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Science Translational Medicine  10 Apr 2019:
Vol. 11, Issue 487, eaax1723
DOI: 10.1126/scitranslmed.aax1723

Abstract

Children with anhedonia show specific alterations in large-scale brain networks.

Anhedonia refers to the loss of interest and pleasure in activities that were previously rewarding. A core feature of specific psychiatric disorders such as depression and schizophrenia, anhedonia predicts negative outcomes, including increased risk of suicide and poorer treatment response. Although the majority of research on anhedonia has focused on adults, this diminished ability to experience pleasure can manifest early in life. Delineating neural alterations related to anhedonia is an important step in enhancing risk detection and identifying potential novel targets for treatment in youth.

Leveraging a large sample of over 2800 children from the Adolescent Brain Cognitive Development study, Pornpattananangkul and colleagues mapped alterations in large-scale brain networks associated with anhedonia. The authors examined resting-state functional connectivity and activation during reward anticipation and working memory in children with and without anhedonia. Children with anhedonia displayed lower levels of connectivity between various large-scale brain networks and subcortical regions, with a primary finding of reduced connectivity between the cingulo-opercular network, which is often implicated in arousal, and the ventral striatum, which plays a central role in reward processing. Anhedonia was also associated with reduced activation in the dorsal striatum and cingulo-opercular network during reward anticipation. Providing important evidence of specificity, these findings were only observed in children with anhedonia, and not in youth with low mood, anxiety, or attention-deficit hyperactivity disorder (ADHD). In fact, there was a double dissociation such that children with anhedonia showed altered activation during reward anticipation (but not working memory), whereas children with ADHD showed altered activation during working memory (but not reward anticipation), further highlighting the specificity in context and phenotype.

The identification of these specific brain alterations provides insight into the pathophysiology of anhedonia in youth. However, despite the well-powered sample, this study focused on a community sample that may not be representative of children with psychiatric disorders and relied on a categorical assessment of anhedonia. Future research will be essential to confirm the results of the current study and continue to improve risk identification and treatment for youth with anhedonia.

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