Steven Silverstein

University of Rochester Medical Center | URMC · Department of Psychiatry

Contrary to popular lore, optimal visual acuity is typically 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 refractive error might be more likely. An affirmat...

Military personnel exposed to blasts receive repeated subconcussive head impacts. Although these events typically do not cause immediate symptoms and do not lead to medical evaluation, the cumulative effects of subconcussive impacts can be significant and can include postconcussive symptoms, changes in brain structure and function, long-term cognit...

This study investigated relations between a measure of early-stage visual function and self-reported visual anomalies in individuals at clinical high risk for psychosis (CHR-P). Eleven individuals at CHR identified via the Structured Interview for Psychosis-Risk Syndromes (SIPS) were recruited from a CHR-P research program in NYC. The sample was ~3...

Schizophrenia is a serious mental disorder with a complex neurobiological background and a well-defined psychopathological picture. Despite many efforts, a definitive disease biomarker has still not been identified. One of the promising candidate for such biomarker might be the retinal morphology. In this study Optical Coherence Tomography (OCT) da...

Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar...

Background: Trauma and posttraumatic stress disorder (PTSD) are common among individuals with serious mental illness (SMI; e.g., schizophrenia, schizoaffective disorder, bipolar disorder, treatment refractory major depressive disorder), with resultant functional impairment. Previous studies have not evaluated the factor structure of the PTSD Check...

The prediction error account of delusions has had success. However, its explanation of delusions with different contents has been lacking. Persecutory delusions and paranoia are the common unfounded beliefs that others have harmful intentions towards us. Other delusions include believing that one’s thoughts or actions are under external control, or...

Background and Hypothesis The current study investigated the extent to which changes in attentional control contribute to performance on a visual perceptual discrimination task, on a trial-by-trial basis in a transdiagnostic clinical sample. Study Design Participants with schizophrenia (SZ; N = 58), bipolar disorder (N = 42), major depression diso...

Contour Integration (CI) is the ability to integrate elemental features into objects and is a basic visual process essential for object perception and recognition, and for functioning in visual environments. It is now well documented that people with schizophrenia (SZ), in addition to having cognitive impairments, also have several visual perceptua...

There is growing evidence of disproportionate retinal thinning in schizophrenia, but doubts are still raised regarding its signifcance in the context of the neurobiology of the disease. Therefore, we examined whether these abnormalities are signifcantly associated with neurological soft signs (NSS) which are closely related to the risk of schizophr...

Objectives This study examined diagnostic profiles and trauma history among treatment‐seeking young adults with positive PTSD screens in public mental health care. Methods Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment‐seeking young adults (aged 18–35) endorsed trauma expos...

Introduction Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their assoc...

The prediction error account of delusions has had success. However, its explanation of delusions with different contents has been lacking. Persecutory delusions and paranoia are the common unfounded beliefs that others have harmful intentions towards us. Other delusions include believing that one’s thoughts or actions are under external control, or...

Background Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than contro...

Background and Hypothesis Processing speed dysfunction is a core feature of psychosis and predictive of conversion in individuals at clinical high risk (CHR) for psychosis. Although traditionally measured with pen-and-paper tasks, computerized digit symbol tasks are needed to meet the increasing demand for remote assessments. Therefore we: (1) asse...

This pilot study explored the sensitivity of retinal markers to CNS sequelae of concussive and subconcussive head hits. Three groups of college athletes were assessed at pre-season, post-season and 4-months later: Football players with a concussion history (FB+C) (n = 9), players without a concussion history (FB-C) (n = 11), and non-contact athlete...

Objectives: Early trauma exposure is common among young adults receiving public mental health services, posing increased risk for PTSD. While d supports the feasibility of PTSD screening, clinicians often fail to screen for PTSD in this population. This study aimed to examine the demographic factors, psychiatric comorbidity, and predictors of chart...

Background and hypotheses: Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more str...

Background and hypothesis: Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across...

In this paper, we provide guidance for the organization and implementation of EEG studies. This work was inspired by our experience conducting a large-scale, multi-site study, but many elements could be applied to any EEG project. Section 1 focuses on study activities that take place before data collection begins. Topics covered include: establishi...

Importance: The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective: To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large re...

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...

How does schizophrenia affect art making processes and the artwork that results from these processes? Here we discuss research dealing with this question, focusing on pictorial art, and applying ideas and methods from vision science. We briefly review the study of art by people with schizophrenia, focusing on Hans Prinzhorn’s application of Art His...

Background: Theories propose that visual impairment might increase the risk of psychosis, and vice versa. We aimed to investigate the relationship between visual impairment and psychosis in the UK Biobank cohort. Study design: In a nested case control study of ~116,000 adults, we tested whether a Schizophrenia Spectrum Disorder (SSD) diagnosis a...

Schizophrenia is a chronic psychiatric condition that is generally characterized by hallucinations, delusions, and trouble with speech and thinking. In addition, this condition is characterized by alterations in visual perception. As such, a number of groups have examined how perceptual training may be beneficial in helping those with schizophrenia...

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...

The field of psychiatry is far from perfect in predicting which individuals will transition to a psychotic disorder. Here, we argue that the 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...

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...

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...

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...

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 were c...

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...