Author Archive | Erin Olinger

Matcheri Keshavan, Harvard University

Matcheri Keshavan, Harvard University

I have always been interested in the nature of the self- questions such as who we are, and how an optimum knowledge of the self is critical for defining our health and happiness.  As I began learning to learn about the brain in medical school, I began asking- what in our brain determines our ability to distinguish the self from others. The young woman in my psychiatry rotation, diagnosed with schizophrenia, who was troubled by thoughts being stolen by, and feelings of her actions being controlled by an alien power, reflecting a blurred boundary between the self and other. This brilliant engineering student also had a substantive decline in her cognitive functions. She had been examined by neurologists, who felt there was no brain dysfunction they could identify; she was diagnosed with a “functional” psychosis. She questioned the diagnosis of schizophrenia, and I had no answer to her question as to how I can confirm her diagnosis. Her psychosis got better with medications, though she remained functionally impaired. Working with her crystallized my passion to study this illness. The fact that psychiatry was a field in which we could help change lives but still knew so little (which is true even now) drew me to pursue research.

It is hard to pinpoint a single mentor, but many remarkable individuals with illness, teachers and institutions were formative for my subsequent development as a clinician, teacher and researcher. Successive training experiences led me to learn about the various tools of understanding the brain, including imaging, EEG, neuroendocrine, genetic and cognitive neuroscience approaches. In parallel, as I began working with patients with a first psychotic episode, it became clear to me that studies in the early course is the best way to understanding these illnesses. It was also clear that treating psychosis was only part of the solution, and that addressing cognitive, and functional impairments early in the illness is critical. A series of controlled trials of cognitive enhancement therapy led to promising results for individuals in the early course of schizophrenia, and represents one of the most gratifying aspects of my work thus far.

As I continued to work with people with serious mental illnesses, it also became clear that no two individuals the same type of illness. Our symptom-based diagnostic labels were not neatly mapping on to what we saw in the clinic, with substantive overlaps in clinical presentation, treatment response and biomarkers across several psychotic illnesses, including bipolar disorders and schizophrenia. On the other hand, there appeared to be distinct groups of psychosis patients that appeared to differ in regard to the severity of cognitive impairments. This led us, as part of the bipolar-schizophrenia network for intermediate phenotypes (BSNIP) consortium, to propose a novel approach classification of psychotic disorders using cognition and electrophysiological biomarkers agnostic to DSM diagnoses.   This suggests that we may be in a position to predict outcomes in individuals in the early course of psychosis disorders, and also to identify which patients might respond best to specific psychosocial, or pharmacological interventions.  These questions shape my ongoing research which seek to translate research insights into clinical practice.

Looking back, it appears that understanding cognition and its impairments in psychoses, as well as improving these deficits is a theme that “connects the dots” in my career. It has also become clear that cognition may be the royal road to understanding this brain disease. More work needs to be done, that will hopefully steer our field toward a more precise way to understand, diagnose, and treat these highly enigmatic, and disabling illnesses.

Each year, the Society recognizes a SIRS member for an outstanding clinical/community contribution to schizophrenia research.  The contribution may be based on a single discovery or a cumulative body of work. The selection of the award recipient is based on the quality of the contribution(s) and its impact in advancing schizophrenia research. recognizes individuals in the field of schizophrenia research. Matcheri Keshavan was named the SIRS 2022 Outstanding Clinical and Community Research Awardee.

You can find more about Matcheri Keshavan's research and accomplishments by clicking here.

Robin Emsley, Faculty of Medicine and Health Sciences, Stellenbosch University

Robin Emsley, Faculty of Medicine and Health Sciences, Stellenbosch University

I have had the privilege of spending the major part of my professional career involved in researching the illness called schizophrenia. After qualifying as I psychiatrist and opting for an academic career in the early 1980’s I needed to choose a research area to focus on. This wasn’t a difficult choice because at the time I was working in a State psychiatric hospital and most of the hospital admissions were suffering from schizophrenia. Hospital beds were filled with acutely ill people requiring urgent attention. The impact of the illness on the afflicted individuals and their families was huge. Patients were being re-admitted over and over again – improving with treatment, being discharged and having to be readmitted a few weeks or months later. Together with a great team of research colleagues, we therefore focussed our research on identifying which factors are important in determining the outcome of illness. The most important issue that we identified was that patients were stopping their treatment soon after discharge. While various reasons are given for why they stopped taking the medication, the common denominator was that they were not convinced of the need for treatment. Illness unawareness and failure to recognise the need the treatment are core features of the illness and need to be kept in mind when discussing treatment options with patients and their families. The second most important factor that we identified was use of illicit drugs. In our setting here in Cape Town cannabis and crystal methamphetamine are the two most commonly used drugs, and both seem to be particularly important in increasing the risk of developing schizophrenia and worsening the outcome of the illness. Our work has highlighted the potentially grave consequences of illness relapse and consequently we have focussed on relapse prevention as a treatment priority.

Over the past years we have been pioneering the use of long-acting injectable antipsychotics as an early treatment option, as a way of providing assured, uninterrupted treatment during the critical period when the illness is at its most aggressive and relapses are most likely to occur.  We use a patient-centred, shared decision-making approach and involve family and carers as much as possible in the process. Using this approach, in which the advantages of continuous treatment and the risks of relapse are highlighted, patient acceptance is very good and overall outcomes are generally favourable.   Most patients achieve remission of the acute psychosis symptoms together with improvements in overall social and occupational functioning and better quality of life. While there are still many challenges that remain in our understanding and management of schizophrenia, impressive progress has been made, and the best use of available treatments can make a huge difference to the overall outcome. In keeping with modern public health principles, providing appropriate and continuous treatment as early as possible in the illness to prevent accruing morbidity, offers individuals the best chance of a favourable outcome.


Each year, the Society recognizes individuals in the field of schizophrenia research. Robin Emsley was named the SIRS 2022 Distinguished Service Awardee. SIRS recognizes a member who has provided extraordinary service to the Schizophrenia International Research Society. Their service has been a significant contribution to the society.

You can find more about Robin Emsley's research and accomplishments by clicking on the button.

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