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A Randomized Controlled Trial of the Rochester Forensic Assertive Community Treatment (FACT) Model in Minnesota

Funded by the Laura and John Arnold Foundation.  PI, J. Steven Lamberti, MD.  Co-Investigator, Robert L. Weisman, DO. 

The Rochester FACT model is designed to prevent criminal recidivism and to promote recovery among justice-involved adults with schizophrenia and related disorders through mental health and criminal justice collaboration.  The aim of this study is to build upon previous research demonstrating feasibility and promise of the Rochester FACT model by replicating the model in Minneapolis-St. Paul.  This five-year study is being conducted in collaboration with the Minnesota Department of Human Services and the Minnesota Department of Corrections.

Project Publications

  • Lamberti JS, Weisman RL, Cerulli C, et al:  A randomized controlled trial of the Rochester forensic assertive community treatment model.  Psychiatric Services, 68:1016-1024, 2017
  • Lamberti JS:  Preventing criminal recidivism through mental health and criminal justice collaboration.  Psychiatric Services, 67:1206-1212, 2016
  • Lamberti JS, Russ A, Cerulli C, et al:  Patient experiences of autonomy and coercion while receiving legal leverage in forensic assertive community treatment.  Harvard Review of Psychiatry, 22:222-230, 2014
  • Lamberti JS, Deem A, Weisman RL, et al:  The role of probation in forensic assertive community treatment.  Psychiatric Services, 62:418 - 421, 2011
  • Lamberti JS, Weisman RL:  “Forensic Assertive Community Treatment:  Origins, Current Practice and Future Directions.  In:  Reentry Planning for Offenders with Mental Disorders: Policy and Practice.  Dlucacz, H, Ed.  Civic Research Institute, Kingston, NJ.   Chapter 7:1-24, 2010

The Effects of Neurofeedback on Social Information Processing

Funded by NARSAD.  PI, David Dodell-Feder, PhD.  Co-Investigator, J. Steven Lamberti, MD.

Recent research suggests that “theory of mind” (ToM) or one’s ability to attribute and reason about the beliefs, emotions, desires, and intentions of others, and its neural bases, is impaired in people with schizophrenia spectrum disorders (SSD). Further, the extent of impairment is associated with the extent of real-world social difficulties in SSD.  These findings suggest that targeting the neural network supporting ToM may lead to improvements in social functioning.  The aim of this project is to evaluate whether neurofeedback, delivered through real-time functional magnetic resonance imaging (rt-fMRI), impacts controlled engagement of the ToM neural network in people with schizophrenia.  

Project Publications

  • Dodell-Feder D, Tully LM, Hooker, CI: Social impairment in schizophrenia: New approaches for treating a persistent problem. Current Opinion in Psychiatry, 28(3), 236-242, 2015
  • Dodell-Feder D, DeLisi LE, Hooker CI:  The relationship between default mode network connectivity and social functioning in individuals at familial high-risk for schizophrenia. Schizophrenia Research, 156, 87-95, 2014
  • Dodell-Feder D, DeLisi LE, Hooker CI:  Neural disruption to theory of mind predicts daily social functioning in individuals at familial high-risk for schizophrenia. Social Cognitive and Affective Neuroscience, 9, 1914-1925, 2014.
  • Dodell-Feder D, Tully LM, Lincoln SH, Hooker CI:  The neural basis of theory of mind and its relationship to social functioning and social anhedonia in individuals with schizophrenia. NeuroImage: Clinical, 4, 154-163, 2014.
  • Dodell-Feder D, Koster-Hale J, Bedny M, et al:  fMRI item analysis in a theory of mind task. NeuroImage, 55, 705-712, 2011.

Diabetes Prevalence and Associated Risk Factors in Patients with Schizophrenia or Schizoaffective Disorder on Olanzapine or Clozapine

Funded by SMH Pilot Grant.  PI, Susanne Miedlich, MD.  Co-Investigators, Diana Fernandez, MD, PhD, MPH, J. Telva Olivares, MD, J. Steven Lamberti, MD.  

Rates of type 2 diabetes are considerably higher in patients with schizophrenia compared to the general population. This risk is further increased by antipsychotic medications, especially olanzapine and clozapine which are most strongly associated with metabolic side effects.  Current recommendations for antipsychotic drug monitoring include a fasting plasma glucose and/or HbA1c but not an oral glucose tolerance test (oGGT).  However, both fasting plasma glucose and HbA1c have rather poor sensitivities in diagnosing diabetes, and close to 50% of cases may be missed using these tests when compared to oGGT. The aim of this study is to assess patients with schizophrenia or schizoaffective disorder who are on stable treatment with olanzapine or clozapine for prediabetes and Type 2 Diabetes.

Project Publications

  • Forrestel AC, Miedlich SU, Yurcheshen M, Wittlin SD, Sellix MT. Chronomedicine and type 2 diabetes: shining some light on melatonin. Diabetologia, 60:808-822, 2017
  • Lamberti JS, Olson D, Olivares T, et al:  Prevalence of the metabolic syndrome among patients receiving clozapine. American Journal of Psychiatry, 163:1273-1276, 2006
  • Goff DC, Sullivan LM, McEvoy JP, et al:  A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophrenia Research; 80:45-53, 2005
  • Lamberti JS, Costea GO, Olson D, et al: Diabetes mellitus among outpatients receiving clozapine: prevalence and clinical-demographic correlates. Journal of Clinical Psychiatry, 66:900-906, 2005

Contour Integration Deficits in Schizophrenia

Funded by NIH.  PI, Brian P. Keane, PhD. 

Contour integration is a well-studied visual process in which observers rapidly construct global contours and shapes on the basis of how spatially segregated edge elements are relatively aligned and oriented.  Prior to 2014, various studies documented contour integration deficits in schizophrenia, but the effects were modest in size and could potentially be explained by patients’ poor motivation or attention. We have since developed a novel task variant that controls for attentional/motivational confounds and that requires no more than 8 minutes of testing.  Results show large deficits among chronic patients (d=1.7) and intermediate deficits among those who recently experienced their first psychotic episode. Thus, an appropriately designed contour integration task may efficiently and inexpensively provide a window into how the visual brain is altered by the first psychotic episode.

Project Publications

  • Keane, B. P., Paterno, D., Kastner, S., & Silverstein, S. M. (2016). Visual integration dysfunction in schizophrenia arises by the first psychotic episode and worsens with illness duration. Journal of Abnormal Psychology, 125(4), 543–549. PMID: 27030995.
  • Keane, B. P., Erlikhman, G., Kastner, S, Paterno, D., & Silverstein, S. M. (2014). Multiple forms of contour grouping deficits in schizophrenia: What is the role of spatial frequency? Neuropsychologia. 65, 221-233. PMID: 25446968.
  • Keane, B.P., Silverstein, S. M., Barch, D. M., Carter, C. S., Gold, J. M., Kovács, I., MacDonald, A. W. III, & Strauss, M. E. (2012). The spatial range of contour integration deficits in schizophrenia. Experimental Brain Research, 220, 251–259. PMID: 22710617.

Visual Shape Completion Deficits in Schizophrenia  

Funded by NIH. PI, Brian P. Keane.

Previous investigations demonstrated abnormal electrophysiological signatures during visual shape completion in schizophrenia.  However, these studies did not yield a consensus on when the differences arise during processing or whether behavioral deficits were a byproduct of attentional or motivational deficits.  My colleagues and I addressed these issues with a psychophysical paradigm in which subjects discriminated the orientations of four individually rotated contour elements.  A major finding was that patients normally discriminated configurations that were disconnected but poorly discriminated those that jointly formed a completed shape. The impairment was found to a similar extent in first- and later-episode patients, and was most pronounced among patients with cognitive disorganization and early adolescent premorbid dysfunction.  Intriguingly, both patient and healthy control performance was highly dependent on the salience of the completed contours, indicating that patients were interpolating contours appropriately. Taken as a whole, these results extend earlier electrophysiological studies and suggest that patients normally complete visual contours at initial stages of processing but are less able to use such contours to distinguish shapes at later global integration stages.

Project Publications   

  • Keane, B. P., Erlikhman, G., Kastner, S, Paterno, D., & Silverstein, S. M. (2014). Multiple forms of contour grouping deficits in schizophrenia: What is the role of spatial frequency? Neuropsychologia, 65, 221-233. PMID: 25446968.
  • Keane, B. P., Joseph, J., & Silverstein, S. M. (2014). Late, not early, stages of Kanizsa shape perception are compromised in schizophrenia. Neuropsychologia, 56, 302-311 (*equal contributions). PMID: 24513023.
  • Keane, B. P., Paterno, D., Kastner, S., Krekelberg, B., & Silverstein, S. M. (2019). Intact illusory contour formation but equivalently impaired visual shape completion in first- and later-episode schizophrenia. Journal of Abnormal Psychology, 128(1), 57–68. PMID: 30346202.

Visual Remediation in Schizophrenia

Funded by the National Institute of Mental Health (NIMH). Co-PIs Steven Silverstein, Ph.D., and Pamela Butler, Ph.D. (Nathan Kline Institute and New York University). Co-investigators Judy Thompson, Ph.D., Anthony Ahmed, Ph.D. (Weill Medical College of Cornell University) and Aaron Seitz, Ph.D. (University of California at Riverside).

The purpose of this project is to evaluate the effectiveness of an intervention to address two of the well-documented problems in visual processing experienced by people with schizophrenia and related conditions: problems in contrast sensitivity and in perceptual organization. The intervention consists of up to 40 outpatient sessions of computerized (or tablet-based) practice on vision improvement exercises that have been created to be experienced as simple video games and that have shown effectiveness in other groups. Study outcomes include visual acuity as well as functions based on vision (e.g., visual memory and aspects of everyday living).

Project Publications

  • Butler, P.D., Thompson, J.L., Seitz, A.R., Deveau, J., & Silverstein, S.M. (2017). Visual perceptual remediation for schizophrenia: Rationale, method, and three case studies. Psychiatric Rehabilitation Journal, 40, 43-52.
  • Demmin, D., Fradkin, S., & Silverstein, S.M. (2019). Remediation of visual processing impairments in schizophrenia: Where we are and where we need to be. Current Behavioral Neuroscience Reports, 6,13-20.
  • Silverstein, S.M., Seitz, A.R., Ahmed, A.O., Thompson, J.L., Zemon, V., Gara, M., & Butler, P.D. (2020). Development and evaluation of a visual remediation intervention for people with schizophrenia. Journal of Psychiatry and Brain Science, 5, e200017. 

Feasibility study of the ability of ERG components to distinguish schizophrenia and bipolar disorder type I

Funded by diaMentis, Inc. PI Steven Silverstein, Ph.D. Co-investigator Judy Thompson, Ph.D.

The purpose of this project is to determine if patterns of retinal functioning (reflecting sensitivity of cells at the back of the eye to light) are different in schizophrenia and bipolar disorder, both from each other and from samples of people without either condition. This study is based on a growing body of work indicating that changes in brain function in schizophrenia and bipolar disorder have parallels in changes in the functioning of certain retinal cells, which, like brain cells, are neurons. The study involves four visits: one is for gathering information about psychiatric history and current symptoms, and the other three visits involve testing using electroretinography (ERG).

Related Publications

  • Demmin, D., Davis, Q., Roché, M., & Silverstein, S.M. (2018). Electroretinographic anomalies in schizophrenia. Journal of Abnormal Psychology, 127, 417-428.
  • Demmin, D.L., Netser, R., Roché, M.W., Thompson, J.L., & Silverstein, S.M. (2020). People with current major depression resemble healthy controls on flash electroretinogram indices associated with impairment in people with stabilized schizophrenia. Schizophrenia Research, 219, 69-76.
  • Silverstein, S.M., Fradkin, S.I., & Demmin, D.L. (2020). Schizophrenia and the retina: Towards a 2020 perspective. Schizophrenia Research, 219, 84-94.
  • Silverstein, S.M., & Thompson, J.L. (2020). Progress, possibilities, and pitfalls in electroretinography research in schizophrenia. Biological Psychiatry, 87(3), 202-203.

Implementation of Academic-Community Early Psychosis Intervention Network (AC-EPINET) into URMC First Episode Psychosis (FEP) Care and a Randomized Controlled Trial of FEP Care Delivered Through Telehealth

Funded by NIMH. PI, Steven M. Silverstein, PhD.

Research has found that coordinated specialty care (CSC) programs for FEP patients may be superior to traditional care, however high psychiatric hospitalization rates and low treatment engagement still remain a challenge among this population. In an effort to address these challenges, EPINET, a learning health system (LHS), was created to connect FEP clinics through eight regional hubs across the nation through standardized clinical measures, uniform data collection methods, and the integration of client-level data. URMC is part of AC-EPINET, one of EPINET’s regional hubs and is implementing this LHS into Strong Ties’ Young Adult Program in hopes that it will improve patient care, which in turn will increase treatment engagement and lower hospitalization rates. The AC-EPINET project also involves a large-scale randomized controlled trial examining the efficacy of CSC delivered in person versus CSC delivered via telehealth among FEP patients enrolled in the Young Adult Program with the idea that telehealth may improve outcomes.

Transitions Clinical Network Post Incarceration Addiction Treatment, Healthcare, & Social Supports (TCN PATHS)

Funded by NIDA Justice Community Opioid Innovations Network  (JCOIN).
University of Rochester Sub-Award PI, Diane Morse, MD

In collaboration with University of Rochester, Yale University, University of North Carolina-Chapel Hill, University of Puerto Rico, Hennepin Research Institute, University of Connecticut, Albert Einstein College of Medicine, and the University of Miami which aims to improve health outcomes for formerly incarcerated persons with Opioid Use Disorder (OUD) .

The long-term goal of the study is to reduce morbidity and mortality from OUD among justice-involved individuals. The overall objective is to assess whether the Transitions Clinic Network (TCN), which provides enhanced primary care for people released from incarceration in 30 community health centers in the United States, improves the opioid cascade. The women’s initiative supporting health (WISH) transitions clinic is a Rochester program which Dr. Morse has directed since 2012 and measures clinical and process outcomes for women involved in the justice system, with mental health conditions (including schizophrenia), substance use disorders, and/or trauma histories.

Related publications:

  • Morse DS, Cerulli C, Hordes M, El-Bassel N, Bleasdale J, Wilson K, Henry O, Przybyla SM. “I was 15 when I started doing drugs with my dad:” victimization, social determinants of health, and criminogenic risk among women Opioid Intervention Court participants. Journal of Interpersonal Violence, in press
  • Howell BA; Puglisi L; Clark K; Albizu-Garcia C; Ashkin E; Booth T; Brinkley-Rubinstein L; Fiellin DA; Fox AD; Maurer KF; Lin HJ; McCollister K; Murphy S; Morse DS; Shavit S; Wang K; Winkelman T; Wang EA "The Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A hybrid type-1 effectiveness trial of enhanced primary care to improve opioid use disorder treatment outcomes following release from jail." Journal of substance abuse treatment. 2021; Epub 2021 Jan 29.
  • Morse DS, Wilson JL, Driffill NJ, Lauture J, Khan A, King-Turner SO. Outcomes Among Pregnant Recently Incarcerated Women Attending a Re-entry Transitions Clinic. J Community Psychol. 2018 Dec 17.  [Epub ahead of print] PubMed PMID: 30556132
  • Thomas K, Wilson JL, Bedell P, Morse DS.  “They didn’t give up on me”: Women’s Transitions Clinic from the Perspective of Re-entering Women. Addiction Science & Clinical Practice, (2019) 14:12 

Reaching Our Community (ROC) with WISH

Funded by the Greater Rochester Health Foundation. PI, Diane Morse, MD 

The Greater Rochester Health Foundation synergistically partners WISH and Exercise Express, to strengthen community and healthcare connections with the aim of addressing social determinants of health. ROC with WISH is a co-located model at two sites, downtown Rochester and Henrietta. We combine and expand services to our population of underserved Medicaid/Medicare recipients, and will measure linkage to: 1) integrated mental health and primary care services with WISH; 2) peer community health workers who regularly provide support and linkage to medical and social services; 3) the diabetes prevention program; 4) peer recovery coaches for mental health conditions (including schizophrenia) and substance use disorder recovering clients; 5) wellness programming (i.e., mindfulness, exercise classes, dancing, and nutrition); and 6) exercise bikes/equipment, internet hot spots, and computer tablets as needed for remote classes.

Related publications:

  • Morse DS, Wilson JL, McMahon J, Dozier AM, Quiroz, A, Cerulli C. Does A Primary Health Clinic for Formerly Incarcerated Women Increase Linkage To Care? Women’s Health Issues. 2017, 27-4: 499–508.
  • Bedell P, Wilson JL, White, AM, Morse DS “Our Commonality is our Past:” Meaningful Experiences of Former Justice-Involved Community Health Workers Engaging with Recently Released Individuals, Health and Justice. 2015, Dec 15, 3:19.