Chronic Itch Affects Patients’ Ability to Experience Pleasure: Anhedonia in Itchy Disorders
DOI:
https://doi.org/10.2340/actadv.v104.35420Keywords:
anhedonia, itch, pruritus, psychodermatologyAbstract
Anhedonia, the reduced ability to experience pleasure, is a prevalent symptom in various psychiatric disorders, but has not been investigated in dermatological conditions, particularly those characterized by chronic itch. This study aimed to examine the prevalence and clinical correlates of anhedonia in patients with chronic itch. A cross-sectional study was conducted in 137 patients with chronic itch, classified according to the International Forum for the Study of Itch (IFSI) classification. Anhedonia was assessed using the Snaith–Hamilton Pleasure Scale (SHAPS) and Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS). Itch severity, quality of life, and psychological distress were assessed using the Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), ItchyQoL, and Hospital Anxiety and Depression Scale (HADS), respectively. The mean SHAPS score was 1.0 ± 1.7 points, and the mean ACIPS total score was 76.9 ± 16.2 points. In the study sample, 13.1% of patients were identified as anhedonic, with a higher prevalence observed in those with severe and very severe itch. Anhedonia was significantly correlated with itch severity (R = 0.2, p=0.02 for 24 h VASmean and SHAPS; R = 0.2, p = 0.01 for 24 h VASmax and SHAPS), anxiety symptoms (R = 0.3, p < 0.001 for SHAPS and HADS-anxiety), depression symptoms (R = 0.4, p < 0.001 for SHAPS and HADS-depression), and impairment in quality of life (R = 0.2, p = 0.014 for SHAPS and ItchyQoL). Anhedonia is a significant and prevalent aspect of psychological distress in patients with chronic itch. Addressing this symptom may not only improve patients’ overall mental health but also enhance the effectiveness of treatments for chronic itch. Future research is needed to elucidate further the mechanisms underlying the relationship between anhedonia and chronic itch and to develop targeted interventions for this population.
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References
Snaith RP, Hamilton M, Morley S, Humayan A, Hargreaves D, Trigwell P. A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. Br J Psychiatry 1995; 167: 99-103.
https://doi.org/10.1192/bjp.167.1.99
Franz M, Lemke MR, Meyer T, Schroeder T, Schaub RT, Wolf K. Die deutsche Version der Snaith-Hamilton-Pleasure-Skala (SHAPS-D). Anhedonie bei schizophrenen und depressiven Patienten. Fortschr Neurol Psychiatr 1998; 66: 407-413.
https://doi.org/10.1055/s-2007-995279 DOI: https://doi.org/10.1055/s-2007-995279
Gooding DC, Pflum MJ. The ACIPS: moving forward in the assessment of negative symptoms. Schizophr Res 2016; 176: 327-328.
https://doi.org/10.1016/j.schres.2016.06.002 DOI: https://doi.org/10.1016/j.schres.2016.06.002
Thomsen KR, Whybrow PC, Kringelbach ML. Reconceptualizing anhedonia: novel perspectives on balancing the pleasure networks in the human brain. Front Behav Neurosci 2015; 9: 49.
https://doi.org/10.3389/fnbeh.2015.00049 DOI: https://doi.org/10.3389/fnbeh.2015.00049
Ständer S, Streit M, Darsow U, Metze D, Luger T, Szepietowski JC. Diagnostische und therapeutische Verfahren bei chronischem Pruritus. J Dtsch Dermatol Ges 2006; 4: 350-370.
https://doi.org/10.1111/j.1610-0387.2006.05887.x DOI: https://doi.org/10.1111/j.1610-0387.2006.05887.x
Steinhoff M, Bienenstock J, Schmelz M, Luger T, Weisshaar E, Metze D. Neurophysiological, neuroimmunological, and neuroendocrine basis of pruritus. J Invest Dermatol 2006; 126: 1705-1718.
https://doi.org/10.1038/sj.jid.5700231 DOI: https://doi.org/10.1038/sj.jid.5700231
Stefaniak A, Chlebicka I, Szepietowski J. Itch in diabetes: a common underestimated problem. Adv Dermatol Allergol 2021; 38: 177-183.
https://doi.org/10.5114/ada.2019.89712 DOI: https://doi.org/10.5114/ada.2019.89712
Chlebicka I, Stefaniak AA, Matusiak Ł, Szepietowski JC. Is basal cell carcinoma an itchy tumor? Clinical characteristics of itch in basal cell carcinoma. J Clin Med 2020; 9: 2386.
https://doi.org/10.3390/jcm9082386 DOI: https://doi.org/10.3390/jcm9082386
Stefaniak AA, Zubkiewicz-Kucharska A, Matusiak Ł, Szepietowski JC. Itch in children with Type 1 diabetes: a cross-sectional study. Dermatol Ther (Heidelb) 2020; 10: 745-756.
https://doi.org/10.1007/s13555-020-00403-w DOI: https://doi.org/10.1007/s13555-020-00403-w
Stefaniak AA, Krajewski PK, Bednarska-Chabowska D, Szepietowski JC. Itch in adult population with type 2 diabetes mellitus: clinical profile, pathogenesis and disease-related burden in a cross-sectional study. Biology (Basel) 2021; 10: 1332.
https://doi.org/10.3390/biology10121332 DOI: https://doi.org/10.3390/biology10121332
Weisshaar E, Szepietowski J, Darsow U, Misery L, Wallengren J, Mettang T. European Guideline on chronic pruritus. Acta Derm Venereol 2012; 92: 563-581.
https://doi.org/10.2340/00015555-1400 DOI: https://doi.org/10.2340/00015555-1400
Szepietowski JC, Reich A. [Itch: Pathomechanism, clinical aspects, treatment.] Poznań: Termedia, 2010.
Chlebicka I, Stefaniak A, Matusiak Ł, Szepietowski JC. Burden of itch in patients with ba-sal cell carcinoma. Acta Derm Venereol 2021; 101: adv00507.
https://doi.org/10.2340/00015555-3871 DOI: https://doi.org/10.2340/00015555-3871
Reszke R, Szepietowski JC. Itch and psyche: bilateral associations. Acta Derm Venereol 2020; 100: 28-36.
https://doi.org/10.2340/00015555-3346 DOI: https://doi.org/10.2340/00015555-3346
Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Bergasa NV, Gieler U. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol 2007; 87: 291-294.
https://doi.org/10.2340/00015555-0305 DOI: https://doi.org/10.2340/00015555-0305
Reich A, Riepe C, Anastasiadou Z, Homola A, Ständer S, Szepietowski JC. Itch assessment with visual analogue scale and numerical rating scale: determination of minimal clinically important difference in chronic itch. Acta Derm Venereol 2016; 96: 978-980.
https://doi.org/10.2340/00015555-2433 DOI: https://doi.org/10.2340/00015555-2433
Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 2012; 92: 502-507.
https://doi.org/10.2340/00015555-1246 DOI: https://doi.org/10.2340/00015555-1246
Reich A, Chatzigeorkidis E, Zeidler C, Osada N, Schaap FJ, Ständer S. Tailoring the cut-off values of the visual analogue scale and numeric rating scale in itch assess-ment. Acta Derm Venereol 2017; 97: 759-760.
https://doi.org/10.2340/00015555-2642 DOI: https://doi.org/10.2340/00015555-2642
Love EM, Marrazzo GA, Kini S, Mancini AJ, Muizzuddin N, Maibach HI. ItchyQoL bands: pi-lot clinical interpretation of scores. Acta Derm Venereol 2015; 95: 114-115.
https://doi.org/10.2340/00015555-1891 DOI: https://doi.org/10.2340/00015555-1891
Zeidler C, Steinke S, Riepe C, Storck M, Thierry L, Arents BWM. Cross-European validation of the ItchyQoL in pruritic dermatoses. J Eur Acad Dermatol Venereol 2019; 33: 391-397.
https://doi.org/10.1111/jdv.15225 DOI: https://doi.org/10.1111/jdv.15225
Stumpf A, Pfleiderer B, Fritz F, Nau R, Darsow U, Ständer S. Assessment of quality of life in chronic pruritus: relationship between itchyQoL and dermatological life quality index in 1,150 patients. Acta Derm Venereol 2018; 98: 142-143.
https://doi.org/10.2340/00015555-2782 DOI: https://doi.org/10.2340/00015555-2782
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-370.
https://doi.org/10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Snaith RP, Hamilton M, Morley S, Humayan A, Hargreaves D, Trigwell P. A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. Br J Psychiatry 1995; 167: 99-103.
https://doi.org/10.1192/bjp.167.1.99 DOI: https://doi.org/10.1192/bjp.167.1.99
Gooding DC, Pflum MJ. The assessment of interpersonal pleasure: introduction of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) and preliminary findings. Psychiatry Res 2014; 215: 237-243.
https://doi.org/10.1016/j.psychres.2013.10.012 DOI: https://doi.org/10.1016/j.psychres.2013.10.012
Gooding DC, Fonseca-Pedrero E, de Albéniz AP, Ortuno-Sierra J. Spanish adaptation of the adult version of the Anticipatory and Consummatory Interpersonal Ple-asure Scale. Rev Psiquiatr Salud Ment 2016; 9: 70-77. DOI: https://doi.org/10.1016/j.rpsmen.2016.04.007
https://doi.org/10.1016/j.rpsm.2015.10.006 DOI: https://doi.org/10.1016/j.rpsm.2015.10.006
Daniels A, Wellan SA, Walter H. Learning it the hard way: how enjoying life and positive appraisal buffer the negative effects of stressors on mental health in the COVID-19 pandemic. J Affect Disord Rep 2021; 6: 100266.
https://doi.org/10.1016/j.jadr.2021.100200 DOI: https://doi.org/10.1016/j.jadr.2021.100200
Treadway MT, Zald DH. Reconsidering anhedonia in depression: lessons from translational neuroscience. Neurosci Biobehav Rev 2011; 35: 537-555.
https://doi.org/10.1016/j.neubiorev.2010.06.006 DOI: https://doi.org/10.1016/j.neubiorev.2010.06.006
Rizvi SJ, Pizzagalli DA, Sproule BA, Arnone D, Kennedy SH. Assessing anhedonia in de-pression: potentials and pitfalls. Neurosci Biobehav Rev 2016; 65: 21-35.
https://doi.org/10.1016/j.neubiorev.2016.03.004 DOI: https://doi.org/10.1016/j.neubiorev.2016.03.004
Franken IHA, Rassin E, Muris P. The assessment of anhedonia in clinical and non-clinical populations: further validation of the Snaith-Hamilton Pleasure Scale (SHAPS). J Affect Disord 2007; 99: 83-89.
https://doi.org/10.1016/j.jad.2006.08.020 DOI: https://doi.org/10.1016/j.jad.2006.08.020
Trøstheim M, Eikemo M, Meir R, Zunhammer M, Jääskeläinen IP, Leknes S. Assessment of anhedonia in adults with and without mental illness: a systematic review and meta-analysis. JAMA Netw Open 2020; 3: e2013233.
https://doi.org/10.1001/jamanetworkopen.2020.13233 DOI: https://doi.org/10.1001/jamanetworkopen.2020.13233
Gooding DC, Pflum MJ. Further validation of the ACIPS as a measure of social hedonic response. Psychiatry Res 2014; 215: 771-777.
https://doi.org/10.1016/j.psychres.2013.11.009 DOI: https://doi.org/10.1016/j.psychres.2013.11.009
Pelizza L, Ferrari A. Anhedonia in schizophrenia and major depression: state or trait? Ann Gen Psychiatry 2009; 8: 22.
https://doi.org/10.1186/1744-859X-8-22 DOI: https://doi.org/10.1186/1744-859X-8-22
Assogna F, Cravello L, Caltagirone C, Spalletta G. Anhedonia in Parkinson's disease: a systematic review of the literature. Mov Disord 2011; 26: 1825-1834.
https://doi.org/10.1002/mds.23815 DOI: https://doi.org/10.1002/mds.23815
Gooding DC, Winston TM, Pflum MJ, Burgin CJ. Individual differences in hedonic experience: further evidence for the construct validity of the ACIPS. Psychiatry Res 2015; 229: 524-532.
https://doi.org/10.1016/j.psychres.2015.05.061 DOI: https://doi.org/10.1016/j.psychres.2015.05.061
Gard DE, Kring AM, Gard MG, Horan WP, Green MF. Anhedonia in schizophrenia: distinct-ions between anticipatory and consummatory pleasure. Schizophr Res 2007; 93: 253-260.
https://doi.org/10.1016/j.schres.2007.03.008 DOI: https://doi.org/10.1016/j.schres.2007.03.008
Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984-991.
https://doi.org/10.1038/jid.2014.530 DOI: https://doi.org/10.1038/jid.2014.530
Van Beugen S, Schut C, Kupfer J, Smits T, Ferwerda M, Spillekom-van Koulil S. Perceived stigmatization among dermatological outpatients compared with controls: an observational multicentre study in 17 European countries. Acta Derm Venereol 2023; 103: e6485.
https://doi.org/10.2340/actadv.v103.6485 DOI: https://doi.org/10.2340/actadv.v103.6485
Yosipovitch G, Rosen JD, Hashimoto T. Itch: From mechanism to (novel) therapeutic approaches. J Allergy Clin Immunol 2018; 142: 1375-1390.
https://doi.org/10.1016/j.jaci.2018.09.005 DOI: https://doi.org/10.1016/j.jaci.2018.09.005
Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 2010; 78: 169-183.
https://doi.org/10.1037/a0018555 DOI: https://doi.org/10.1037/a0018555
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