Steven Silverstein

University of Rochester Medical Center | URMC · Department of Psychiatry

Background and hypothesis: Deficits in performing and interpreting communicative nonverbal behaviors, such as gesture, have been linked to varied psychopathology and dysfunction. Some evidence suggests that individuals at risk for psychosis have deficits in gesture interpretation and performance; however, individuals with internalizing disorders (...

Introduction: Paranoia is a common and impairing psychosis symptom, which exists along a severity continuum that extends into the general population. Individuals at clinical high-risk for psychosis (CHR) frequently experience paranoia and this may elevate their risk for developing full psychosis. Nonetheless, limited work has examined the efficien...

Background: Persons with Posttraumatic Stress Disorder (PTSD) exhibit negative cognitions, predictive of PTSD severity. The Posttraumatic Cognitions Inventory (PTCI) is a widely-used instrument measuring trauma-related cognitions and beliefs with three subscales: negative thoughts of self (SELF), negative cognitions about the world (WORLD) and self...

Visual shape completion is a canonical perceptual organization process that integrates spatially distributed edge information into unified representations of objects. People with schizophrenia show difficulty in discriminating completed shapes but the brain networks and functional connections underlying this perceptual difference remain poorly unde...

Cognitive control deficits are associated with impaired executive functioning in schizophrenia. The Dual Mechanisms of Control framework suggests that proactive control requires sustained dorsolateral prefrontal activity, whereas reactive control marshals a larger network. However, primate studies suggest these processes are maintained by dual-enco...

The development of treatments for impaired cognition in schizophrenia has been characterized as the most important challenge facing psychiatry at the beginning of the twenty-first century. The Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) project was designed to build on the potential benefits of using ta...

The field of psychiatry is far from perfect in predicting which individuals will transition to a psychotic disorder. Here, we argue that visual system assessment can help in this regard. Such assessments have generated medium-to-large group differences with individuals prior to or near the first psychotic episode or have shown little influence of i...

One of the proposed neural mechanisms involved in working memory is coupling between the theta phase and gamma amplitude. For example, evidence from intracranial recordings shows that coupling between hippocampal theta and cortical gamma oscillations increases selectively during working memory tasks. Theta-gamma phase-amplitude coupling can also be...

Teachers face significant stressors in relation to their work, placing them at increased risk for burnout and attrition. The COVID-19 pandemic has brought about additional challenges, resulting in an even greater burden. Thus, strategies for reducing stress that can be delivered virtually are likely to benefit this population. Mental and Physical (...

Objectives: African Americans are at increased risk for trauma exposure and the development of posttraumatic stress disorder (PTSD) relative to other racial groups. Among African Americans with Serious Mental Illness (SMI), PTSD is frequently underdiagnosed and untreated. The primary objective of this study was to investigate trauma exposure, PTSD...

Contrary to popular lore, optimal visual acuity is better than 20/20. Could correcting acuity beyond 20/20 offer any benefit? An affirmative answer could present new confounds in studies of aging, development, psychiatric illness, neurodegenerative disorders, or any other population where small amounts of refractive error differences might be likel...

Self-report questionnaires have been developed to efficiently assess psychosis risk and vulnerability. Despite this, the validity of these questionnaires for assessing specific positive symptoms in those at clinical high risk for psychosis (CHR) is unclear. Positive symptoms have largely been treated as a uniform construct in this critical populati...

Schizophrenia is increasingly recognized as a systemic disease, characterized by dysregulation in multiple physiological systems (eg, neural, cardiovascular, endocrine). Many of these changes are observed as early as the first psychotic episode, and in people at high risk for the disorder. Expanding the search for biomarkers of schizophrenia beyond...

Visual shape completion is a canonical perceptual organization process that integrates spatially distributed edge information into unified representations of objects. People with schizophrenia show difficulty in discriminating completed shapes but the brain networks and functional connections underlying this perceptual difference remain poorly unde...

The predictive coding theory of psychosis posits that individuals with schizophrenia demonstrate abnormalities in the strength of top-down modulation (based on prior experience) of sensory signals. Evidence suggests that difficulty perceiving depth inversion illusions (DIIs) (i.e., more accurate perception of stimuli under conditions in which contr...

The human retina and retinal imaging technologies continue to increasingly gain the attention of schizophrenia researchers. With the same embryologic origin as the brain, the retina offers a window into neurovascular changes that may underlie disease. Recently, two technologies that have already revolutionized the field of ophthalmology, optical co...

Identifying state-sensitive measures of perceptual and cognitive processes implicated in psychosis may allow for objective, earlier, and better monitoring of changes in mental status that are predictive of an impending psychotic episode, relative to traditional self-report-based clinical measures. To determine whether a measure of visual perception...

[This corrects the article on p. 157 in vol. 4, PMID: 23565104.].

Patients with schizophrenia perform worse on neuropsychological tasks than controls. While most experts ascribe poor performance to neurocognitive impairment, an emerging literature is identifying important nonspecific mediators of neurocognitive test performance, some of which can be accounted for in trials (eg, motivation, effort, defeatist perfo...

Purpose People with vision loss are at increased risk for major depressive disorder (MDD) and subclinical depression. However, screening for depression is rarely done in eye care settings or among groups in the general population known to have vision disorders. Methods We examined the prevalence of depression, using the Patient Health Questionnair...

Purpose: Schizophrenia is associated with alterations in neural structure and function of the retina that are similar to changes seen in the retina and brain in multiple neurodegenerative disorders. Preliminary evidence suggests that retinal microvasculature may also be compromised in schizophrenia. The goal of this study was to determine, using o...

Schizophrenia is characterized by visual distortions in ~60% of cases, and visual hallucinations (VH) in ~25–50% of cases, depending on the sample. These symptoms have received relatively little attention in the literature, perhaps due to the higher rate of auditory vs. visual hallucinations in psychotic disorders, which is the reverse of what is f...

A considerable number of studies have attempted to account for the psychotic aspects of schizophrenia in terms of the influential predictive coding (PC) hypothesis. We argue that the prediction-oriented perspective on schizophrenia-related psychosis may benefit from a mechanistic model that: 1) gives due weight to the extent to which alterations in...

Objectives: Thinning of retinal layers has been documented in patients with chronic schizophrenia using standard metrics of optical coherence tomography (OCT) devices. We demonstrate the effectiveness of machine learning (ML) techniques to differentiate between schizophrenia patients and healthy controls using OCT images. Methods: Features extracte...

Visual shape completion recovers object shape, size, and number from spatially segregated edges. Despite being extensively investigated, the process's underlying brain regions, networks, and functional connections are still not well understood. To shed light on the topic, we scanned (fMRI) healthy adults during rest and during a task in which they...

Background Psychiatric diagnosis and treatment have historically taken a symptom-based approach, with less attention on identifying underlying symptom-producing mechanisms. Recent efforts have illuminated the extent to which different underlying circuitry can produce phenotypically similar symptomatology (e.g. psychosis in bipolar disorder vs schiz...

Introduction Imaging of retinal structure in psychosis spectrum disorders (PSD) is a novel approach to studying effect of this illness class on CNS structure. Studies of optical coherence tomography (OCT) have revealed significant reductions in regarding: retinal nerve fiber layer (RNFL), macular thickness (MT), ganglion cell-inner plexiform layer...

Early detection and intervention with young people at clinical high risk (CHR) for psychosis is critical for prevention efforts focused on altering the trajectory of psychosis. Early CHR research largely focused on validating clinical interviews for detecting at-risk individuals; however, this approach has limitations related to: (1) specificity (i...

Individuals with schizophrenia may fail to appropriately use temporal context and apply past environmental regularities to the interpretation of incoming sensory information. Here we use the visual system as a test bed for investigating how prior experience shapes perception in individuals with schizophrenia. Specifically, we use visual aftereffect...

People with schizophrenia often experience attentional impairments that hinder learning during psychological interventions. Attention shaping is a behavioral technique that improves attentiveness in this population. Because reinforcement learning (RL) is thought to be the mechanism by which attention shaping operates, we investigated if preshaping...

Background Motivational deficits in people with psychosis may be a result of impairments in reinforcement learning (RL). Therefore, behavioral paradigms that can accurately measure these impairments and their change over time are essential. Methods We examined the reliability and replicability of 2 RL paradigms (1 implicit and 1 explicit, each wit...

Purpose: An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life,...

People with schizophrenia exhibit increased intra-individual variability in both behavioral and neural signatures of cognition. Examination of intra-individual variability may uncover a unique functionally relevant aspect of impairment that is not captured by typical between-group comparisons of mean or median values. We and others have observed th...

Background: Parkinson's disease (PD) is known to affect retinal structure and activity. As such, retinal evaluations may be used to develop objective and possibly early PD diagnostic tools. Objective: The aim of this study was to investigate the effects of Parkinson's disease (PD) manifestation and treatment on retinal activity. Methods: Data...

Objective The retina may provide a unique window into brain structure and function as an accessible part of the central nervous system. Abnormalities in retinal cell structure and function have been associated with brain pathology (e.g., brain volume loss, cognitive impairment) in several neuropsychiatric disorders (e.g., MS, Alzheimer’s disease, P...

Background Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning mea...

Visual shape completion recovers object size, shape, and position from sparsely segregated edge elements. Studies of the process have largely focused on occipital cortex, but the role of other cortical areas and their functional interconnections remains poorly understood. To reveal the functional networks, connections, and regions of shape completi...

Our main purpose was to investigate how smoking and nicotine interacted with specific aspects of cognitive functioning. The research was conducted in two parts: (i) an investigation of cognition in heavy smokers and healthy nonsmokers, and (ii) an investigation of cognition in healthy nonsmokers enrolled in a clinical trial involving administration...

Research suggests that early identification and intervention with individuals at clinical high risk (CHR) for psychosis may be able to improve the course of illness. The first generation of studies suggested that the identification of CHR through the use of specialized interviews evaluating attenuated psychosis symptoms is a promising strategy for...

Purpose of review: Structural changes of the retina in schizophrenia and other psychotic disorders seem plausible as these conditions are accompanied by widespread morphological abnormalities of the brain. Advances in structural retinal imaging have led to the possibility of precise quantification of individual retinal layers, using optical cohere...

Working alliance (WA) is an important predictor of treatment outcomes in therapy. Forming a strong WA can be challenging with people diagnosed with schizophrenia, and differences between client-rated and clinician-rated WA have been found in this population. This project examined WA in people diagnosed with schizophrenia who completed a skills trai...

from the article: Even according to Kraepelin’s observations more than one hundred years ago1, the term dementia praecox was an exaggeration, if not a misnomer. Not all of his patients showed signs of dementia, and a subgroup even recovered. Kraepelin also acknowledged that memory impairment, the core symptom of dementia, at times reflected lack of...

Investigators have increasingly turned to studying the retina as a window into brain structure and function. In neuropsychiatric diseases, retinal cell structure as assessed by optical coherence tomography (OCT) and retinal cell function as assessed by various forms of electroretinography (ERG) indicate the presence of notable changes. In addition,...

Early intervention in psychotic spectrum disorders is critical for maximizing key clinical outcomes. While there is some evidence for the utility of intervention during the prodromal phase of the illness, efficacy of interventions is difficult to assess without appropriate risk stratification. This will require biomarkers that robustly help to iden...

Background Cognitive control mechanisms enable an individual to regulate, coordinate, and sequence thoughts and actions to obtain desired outcomes. A theory of control specialization posits that proactive control is necessary for anticipatory planning and goal maintenance and recruits sustained lateral prefrontal activity, whereas reactive control,...

Background Epidemiologic studies have shown that persons suffering from psychotic disorders are at increased risk of violent behavior. Several factors have been shown to predict violent behavior among persons with psychosis. However, prior research is limited in that these factors have not been explored simultaneously within the same study. Method...

Background Recent studies have found evidence of retinal thinning in schizophrenia spectrum disorder patients; however, it is not known whether retinal thinning is present at the first episode of psychosis or whether it is a result of the progression of the disease or related factors (e.g., emergence of medical comorbidities). We hypothesized that...

Background Cognitive impairment associated with schizophrenia (CIAS) can be a distressing feature that contributes to the burden of the disorder, as well as being a strong predictor of functional impairment. To fully assess the burden to patients living with this illness, there is a need to develop a specific measure of patient-reported outcomes ....

Despite the existence of effective behavioral interventions for people diagnosed with serious mental illness (SMI), these continue to be underutilized. Barriers to implementation include a low frequency of staff-patient interactions, as well as a lack of knowledge about, and negative attitudes toward, behavioral interventions. Therefore, we examine...

Symptoms of schizophrenia have been explained as a failure to appropriately apply past environmental regularities to the interpretation of incoming sensory information, thus leading to abnormal perceptions and beliefs. Here we use the visual system as a test bed for investigating how prior experience shapes perception in individuals with schizophre...

It is now well documented that schizophrenia is associated with impairments in visual processing at all levels of vision, and that these disturbances are related to deficits in multiple higher-level cognitive and social cognitive functions. Visual remediation methods have been slow to appear in the literature as a potential treatment strategy to ta...

Higher cognitive functioning is supported by adaptive reconfiguration of large-scale functional brain networks. Cognitive control (CC), which plays a vital role in flexibly guiding cognition and behavior in accordance with our goals, supports a range of executive functions via distributed brain networks. These networks process information dynamical...

Purpose A substantial body of research indicates that self-stigma is associated with poorer outcomes related to recovery among people with severe mental illnesses. Narrative Enhancement and Cognitive Therapy (NECT) is a structured, group-based approach which targets the effects of self-stigma. A randomized-controlled trial was conducted to examine...

Background: Differences between people with schizophrenia and psychiatrically healthy controls have been consistently demonstrated on measures of retinal function such as electroretinography (ERG), and measures of retinal structure such as optical coherence tomography (OCT). Since our 2015 review of this literature, multiple new studies have been...

Long-range horizontal connections in early vision undergird a well-studied "collinear facilitation" effect, wherein a central low-contrast target becomes more detectable when flanked by collinear elements. Collinear facilitation is weaker in schizophrenia. Might lateral connections be responsible? To consider the possibility, we had 38 schizophreni...

Background: Structural retinal architecture in living organisms became measurable with the development of optical coherence tomography (OCT) scanners. Single-layer analysis with spectral-domain OCT, among other techniques, may provide further insight into pathological changes in complex brain disorders such as psychosis spectrum disorders (PSD)....

Schizophrenia is accompanied by impaired cognition, spanning several domains including attention, processing speed, and executive function. Delayed reaction times have also been observed in schizophrenia and have been related to impairments in response selection and preparation processes (LRP) that follow perception and categorization (P3). It is u...

Background Cognitive impairment associated with schizophrenia (CIAS) can be a distressing feature that contributes to the burden of the disorder, as well as being a strong predictor of functional impairment. To fully assess the burden to patients living with this illness, there is a need to develop a specific measure of patient-reported outcomes (P...