The finding that patients with schizophrenia report levels of current pleasure comparable to those of healthy subjects but report less pleasure in past or hypothetical situations—the “emotion paradox”—could be due to cognitive impairments, suggest Strauss and Gold (p. 364). Problems in the encoding or retrieval of memories of pleasurable experiences may lead to distorted beliefs about the possibility of pleasure. This conceptualization suggests a role for cognitive-behavioral therapy in treating anhedonia in schizophrenia patients.
Hudak and Wisner (CME, p. 360) describe women with intrusive thoughts of harming their infants and rituals that result in avoidance of their babies. Differential diagnosis of women who develop these symptoms includes postpartum major mood disorders, obsessive-compulsive disorder, and psychosis with infanticidal thoughts. Rapid onset in the postpartum period of anxiety and obsession is common. Insight into the obsessive unreality of rituals to avoid harm is a key diagnostic feature. Treatment includes serotonergic drugs, psychoeducation to help the woman understand that she is unlikely to harm her infant, and exposure with response prevention therapy.