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SIRS Research Stories

Bobana Samardžija, University of Rijeka

Bobana Samardžija, University of Rijeka

My interest in mental health research spawned from my surroundings - many of my friends and family are living with various mental illnesses, so I became very sensible to these issues from a young age. Every day we are making progress in researching major mental illnesses, but we still do not know how they start or what can be done from early stages to delay its progress. To provide some insight, our lab starts from the very beginning - from cells itself and its proteins. We rely on previous genetic research to identify possible gene candidates and investigate proteins for which they encode and their possible disruption like protein aggregation. Our aims include dissecting proteins to their smallest bits to find which parts could be tipping the scale towards illness progression. Also, we are incorporating environmental factors like stress in our research to provide a bigger picture. My work mostly focuses on depression, which is highly prevalent in patients with schizophrenia, but still not talked about enough. In the future, I hope my work will bring awareness to the connection between schizophrenia (and other psychosis) and depression and how important it is to address both from early stages. On the bigger scale, I also hope research from our lab will provide more insight of specific proteins involved in major mental illnesses, thus leading towards more personalized treatment, but also more sensitive (and earlier) diagnostics. In spirit of this, I would like to emphasize how important conferences like SIRS are to the lives of people with psychosis. As an early career researcher, having an opportunity to learn from leading experts in different fields from across the globe, at one place, means a lot. Attending SIRS 2022 allowed me to meet many senior scientists, even people whose work I have read and relied on heavily in my research. But more importantly, being one of the Early Career Awardee allowed me to talk to my peers about challenges of working in academia and learn about new oportunities to learn outside of the lab.

The Early Career Award program is intended to sponsor individuals who have, through their research, teaching or clinical activities, demonstrated a professional and scientific interest in the field of schizophrenia research. You can find out more by clicking here.

Luciana Diaz-Cutraro, Parc Sanitari Sant Joan de Déu

Luciana Diaz-Cutraro, Parc Sanitari Sant Joan de Déu

Research on schizophrenia: an adventure not to be missed.

After finishing my residency in clinical psychology and training in psychological treatments for severe mental disorders, I decided to go behind the scenes of psychological treatment through research on schizophrenia, and that was the beginning of an incredible adventure!

It was not easy for me to move from clinical psychology to research, it required me to learn new skills from almost zero, until in my last year I started to integrate these two professional profiles. My main motivation for entering the world of psychosis research was to contribute to improving treatments so that as many people with psychosis as possible can have access to them as soon as possible. In addition to this, I discovered that new technologies will be my main interest for the following years of my career.

Undoubtedly, networking, meeting colleagues and references in the field of schizophrenia research is an important part of doing research. In that direction, being able to participate in the 2022 Annual SIRS Congress in Florence, exhibiting my poster in Florence was a unique opportunity to exchange contacts and get invaluable feedback from colleagues. Specifically, this year I presented part of my thesis work at the SIRS 2022 Congress, and it was one of the most enriching experiences of my career! This work explores how jumping to conclusions is related to and can influence how we interpret social information. We found that people with first episodes of psychosis who jump to conclusions are more likely to be impaired in their facial recognition of others' emotions, as well as to attribute the cause of negative events to themselves. However, these same people would not be impaired in decoding what others might be thinking. This new knowledge will allow us to refine psychological treatments that work with information processing biases and shape the topics of therapies toward those directions specifically.

For this work, I had the pleasure of receiving the Early Career Award, which was a unique impulse and a great motivation to continue exploring how to ameliorate the problems that living with psychosis can bring. Thanks to that possibility I was able to share time, exchange ideas and learn with my mentor, Dr. Matcheri Ketshavan. SIRS offers us a unique possibility to meet, exchange and learn from other researchers, both early career and long-time researchers.

How does this adventure continue? Considering the present and, above all, the future of research, I would like to highlight two points of particular interest to me. First, the possibility of developing treatments based on new technologies is a possibility to make them attractive, less expensive and simpler, which is why I am very motivated to continue in this direction after my doctorate. On the other hand, these years I learned that the wonderful thing about working in research lies in the need to generate collaborative work that includes people with psychosis and their families. I consider that first-person knowledge of the problems, as well as the need to generate solutions together, is the most appropriate way to build a research project. I have a lot to learn in this direction and it is very motivating for me. I recommend to colleagues clinical psychologists to enter into the world of schizophrenia research and above all to make community with colleagues through the SIRS. You will not come out the same as you went in!

The Early Career Award program is intended to sponsor individuals who have, through their research, teaching or clinical activities, demonstrated a professional and scientific interest in the field of schizophrenia research. You can find out more by clicking here.

Vincent Paquin, McGill University

Vincent Paquin, McGill University

People have diverse experiences of psychosis. As a physician training in psychiatry, I am taught to consider multiple factors to tailor my clinical approach and the choice of treatment: the personal history and values of patients, their culture, their social and physical environments, their family background, etc. But despite these considerations, one challenge that remains is to predict how a person’s psychotic disorder will evolve over time and during treatment. I believe this question, and its implications for personalizing our interventions, are important areas in psychosis research right now.

At the 2022 SIRS Congress, I presented research that aims to explore the diversity of symptom trajectories before and during psychosis. My research is based on data from PEPP-Montréal, an early intervention service for people with a first episode of psychosis. Under the mentorship of Dr Jai Shah and colleagues, I examined patterns of symptoms, including psychotic and non-psychotic symptoms, experienced by patients of PEPP-Montréal at different stages of their psychotic disorder. We found that some of the symptoms that preceded patients’ psychotic episodes were associated with the severity of their mental health problems later during treatment. My hope is that this type of research can help us better anticipate clinical needs and personalize services according to the unique symptom profiles of people with a first episode of psychosis.

After I complete my psychiatry training at McGill University, I hope to pursue a career in psychosis research as a clinician-scientist. Attending the SIRS Congress and receiving an Early Career Award have been incredible for my career journey. I was inspired by the research, clinical, and peer support initiatives that were presented. In addition to the opportunity of sharing my work, I had the chance to meet with mentors, to network, and to get new insights into the types of research questions I want to explore next.

I think a critical direction for future research is to understand how large-scale changes, at the societal and environmental levels, are influencing mental health across the spectrum of schizophrenia and psychosis. For example, climate change will impact several determinants of mental health relevant to psychosis, and it may exacerbate health inequalities related to people’s socioeconomic status, livelihoods, and geographical location. Another development to consider is the rise of immersive technologies like virtual reality and the metaverse: because these media can foster new forms of connections (and disconnections) between individuals, they seem to hold unique opportunities and risks for people with psychosis. As immersive digital media become more disseminated and accessible, I anticipate that there will be a need for clinical counselling and policymaking around their use, and to do so, we will need to study how they affect people with and without psychosis. I hope that we can harness some of that emerging knowledge to develop new treatment options. I am thinking for example of therapies delivered via virtual reality, which have the potential to address important therapeutic needs while tapping into people’s technological preferences. At the 2022 SIRS Congress, many scientific presentations illustrated the possibilities of digital treatment options, as well as the need to be mindful of technology-related addictions and distress.

I am excited to tackle these research areas and more as I move forward in my career, and I see multidisciplinary dialogues as central to my project. Importantly for the lives of people with psychosis, knowledge should be produced and shared in collaboration with people with lived experience, their families, health professionals, and researchers from various backgrounds. SIRS provides a space that facilitates these connections, and therefore I see SIRS as playing an important role in my future research endeavors.

The Early Career Award program is intended to sponsor individuals who have, through their research, teaching or clinical activities, demonstrated a professional and scientific interest in the field of schizophrenia research. You can find out more by clicking here.

Sandra Bucci, Cara Richardson, & Stephanie Allan (iCHARTS)

Sandra Bucci, Cara Richardson, & Stephanie Allan (iCHARTS)

A recent review by Torous and colleagues (2021) highlighted that detailed adverse events reporting is rare within the area of digital mental health, and as such, it is currently difficult to draw inferences about the safety of digital interventions. Evidence suggests that people with psychosis are willing and able to use or test digital health technologies (DHTs) to support their mental healthcare and recovery. DHTs present the unique opportunity for increased adverse events reporting and assessment of user experience due to the flexibility and adaptability of these technologies. For example, an app could have an in-built adverse event reporting function to allow users to self-report in real-time adverse events they might experience while taking part in a DHT research study. By providing participants with a range of options to report adverse events, we can record and report potential negative effects of DHTs and ensure these technologies are as safe as possible.

There is currently no consistent approach for reporting adverse events associated with digital health platforms for schizophrenia (DHPS). Convened by Professor Bucci and supported by the Schizophrenia International Research Society Research Harmonisation Award, our network is called the International Collaboration for Harmonising Adverse Events Reporting in Technology for Schizophrenia (iCHARTS). Our aim is to examine the full range of adverse events recorded and reported in DHPS trials, with a view to improving and standardising, where possible, adverse events and training procedures.

Over the past 12 months, we have successfully brought together 10 senior researchers, 14 Early Career Researchers, and three experts by experience across eight countries. During our proposed 2-year programme of work, we aim to produce a comprehensive adverse events reporting procedure, tool, and training resource to facilitate systematic reporting of adverse events in future DHPS studies. Our RHA draws on existing datasets, and members’ international expertise, to catalogue adverse events within DHPS internationally. This shared empirical data, along with an analysis of collated standard operating procedures (SOPs), will provide the basis for a harmonised reporting framework and procedure for reporting adverse events in DHPS.

The format of our iCHARTS Network has comprised wider network meetings as well as smaller Writing Group meetings (led by early career researcher members of our Network), to progress our planned programme of work. We recognise that any outputs from this Network are limited by the countries of members involved in the Network, but we look forward to producing an open-source document that can be updated and made globally relevant in due course. We also hope that the outputs from Writing Groups are “live” documents, open to feedback and additional content from experts, including experts by experience, around the world, to ensure the outputs from this Network reflect the most up-to-date global evidence.

A year into our SIRS RHA, we have collated how adverse event definitions and procedures differ across countries. We have analysed adverse events data from a wide range of DHPS studies to produce a comprehensive list of adverse events reported in 33 (so far) DHPS trials. We have also analysed over 36 Standard Operating Procedures used in DHPS trials and utilised our international collaboration Network to understand and harmonise these procedures.

We have been struck by how open many psychosis researchers have been for sharing data about adverse events that they have collected while trialling a whole range of digital interventions. We are deeply grateful for everyone’s efforts and especially Aansha (a research assistant who is assisting with the project) for making sure that they are fully anonymised. We are still welcoming datasets and hope more will come soon. Our writing group features psychiatrists, clinical psychologists, and service user researchers from across the world and we are conducting an inductive content analysis that includes all that diverse expertise. So far, we are noticing that adverse events reports vary in the amount of detail reported.

Collating the Standard Operating Procedures has brought to light how adverse events reporting differs across trials, study designs (particularly whether the study is investigating a medical device), and countries. Whilst anecdotally researchers clearly train research workers to record and report adverse events, these training procedures do not seem to be documented consistently in trials – one of our aims is to produce a training procedure that researchers can use to train research workers in sensitively asking service users about harm, and methods to record and report adverse events in the context of DHPS trials. This is where the group benefits from international collaboration to draw on the expertise of members, to understand more about these procedures.

As we move into Year 2 of the RHA Network, we will continue to harmonise our reporting procedures and would like to draw on the SIRS member community for input in how we can further develop adverse events procedures. The Network recognises and value the perspectives of our expert by experience members. Encouragement of mentor/mentee meetings between senior and early career researchers has also highlighted the value of mentorship and provided the opportunity to further collaborations between digital mental health researchers both nationally and internationally.

The Research Harmonisation Award allows sharing and/or comparing data across countries to accelerate schizophrenia research internationally. You can find out more by clicking here.

Lynn DeLisi, Cambridge Health Alliance

Lynn DeLisi, Cambridge Health Alliance

Psychiatry was the field of Medicine I chose after graduating medical school and performing field work in rural Northern New Mexico as a general practitioner for 3 years. Most of my patients would come into the clinic because of anxiety or depression and various kinds of emotional distress. So I chose to go back into training to be a psychiatrist. My interest in schizophrenia specifically goes back to the days of two movies —One Flew Over the Cuckoo’s Nest (1975) and I Never Promised you a Rose Garden (1977). The latter initiated my curiosity about the experiences people with schizophrenia have and their underlying basis. I then proceeded to read every book ever written by Frieda Fromm-Reichmann (the psychiatrist in the 1977 film) about the psychoanalysis of her patients. The former movie initiated my innate desire to change society for the better and certainly improve the quality of care in psychiatric inpatient units.  I chose a career in research, because it was clear to me that psychiatrists had no evidence-based knowledge for effectively, objectively and consistently treating their patients. The field seemed so primitive to me in the 1970’s that it was a welcomed challenge to think of being able to make some important contributions to our understanding of psychotic symptoms. There was so much yet to be done. When as a resident, I attended a lecture by Seymour Kety explaining how his adoption studies in Denmark had shown that biology and likely inheritance had far more influence on the development of schizophrenia than the environment, it was then that I decided to focus on biologic mechanisms for schizophrenia, and particularly genetic ones.

As I look back on these past 40+ years, I see that many biological findings came and then disappeared over and over again. Most depended heavily on the availability of (or lack of) advanced technology that allowed us to view them in debth. I followed many patients over the years by brain imaging to understand the progression of the schizophrenia process over time and I spent many years gathering data from large families with several members afflicted with the disorder. I hope that my research has contributed substantially to understanding the underlying progressive brain changes in schizophrenia and the heterogeneity of the possible genetic causes. Today I see those so called “multiplex families” I meticulously evaluated from all over the USA and other countries as a gold mine for further understanding of the disorder. I hope others will take off from where I left off in the quest for knowledge about schizophrenia. Currently I focus most of my time developing and expanding treatment programs for new onset cases of schizophrenia and their families. Each individual who comes to me for treatment is unique and gives me further insight into how we may improve the quality of all of their lives. I am now approaching an understanding of schizophrenia through them.

The Lifetime Achievement Award is SIRS most prestigious award, given to a scientist who has made a significant contribution to the advancement of the field of schizophrenia research. You can find out more by clicking here.

Sunny Tang, Feinstein Institutes for Medical Research

Sunny Tang, Feinstein for Medical Research

As a psychiatrist and scientist, I see the devastating toll taken by psychotic illnesses and the almost overwhelming gap between available and needed remedies. In my view, we can only achieve major leaps forward as a field by approaching problems with fresh perspectives and novel solutions. That is why I have dedicated my career to leveraging innovations in technology to better understand psychotic disorders and optimize treatment outcomes.

My presentations at the 2022 SIRS Annual Congress addressed this issue through three approaches.

While schizophrenia is related to significant functional impairment for some individuals, others are able to thrive socially and occupationally. In our talk on “Biopsychosocial Contributions to Functional Outcomes in Schizophrenia: A Data-Driven Machine Learning Approach,” we used machine learning methods to identify different patterns of functional outcomes in schizophrenia, and to relate these in reliable ways to biopsychosocial characteristics. We found that, in addition to a group of individuals who are resilient across the board, and a group who are more impaired, there is a cluster of people with schizophrenia who function well socially and with regards to independent living, but are impaired in occupational functioning. We would not have found this pattern without the machine learning approach, because we would not have known to look for it. We also found that the functioning pattern for each person was highly related to their internal sense of motivation and enjoyment, as well as the volume of some brain structures and cognitive ability. Importantly, race, sex, and socioeconomic status were not strong contributors to the functioning pattern of individuals with schizophrenia.

We know that social cognition – or the ability to process social information – is very important to functioning for people with schizophrenia. In our talk, “Speech and Language Disturbance in Schizophrenia are Related to Social Processing,” we showed that social cognitive is also related to how people with schizophrenia communicate. In particular, the ability of individuals to correctly identify emotions was closely related to how their speech was organized. This was found using traditional clinical ratings for speech, as well as with automated speech analysis – computerized methods for objectively quantifying speech characteristics.

One major roadblock in psychiatry is that treatment is often a guessing game. We have a variety of effective treatments available, but we do not yet know who will respond to standard care, and who will not. In our poster presentation on “Predicting Treatment Outcomes with Computational Speech Features in Hospitalized Patients with Schizophrenia,” we used an app developed by Winterlight Labs to record speech from hospitalized patients with schizophrenia just after they were admitted to the inpatient facility. The speech samples underwent automated processing. We found that speech features soon after admission significantly contributed to predicting how symptomatic people were when they were discharged (2 weeks later, on average).

We still have much to do before our research can tangibly benefit people with schizophrenia and their loved ones. However, I believe that taking advantage of advances in technology and machine learning has enormous potential for understanding what goes wrong in schizophrenia and for guiding personalized medical treatment to improve outcomes.

The Early Career Award program is intended to sponsor individuals who have, through their research, teaching or clinical activities, demonstrated a professional and scientific interest in the field of schizophrenia research. You can find out more by clicking here.

Sachin Nagendrappa, St. John’s Medical College Hospital

Sachin Nagendrappa, St. John's Medical College Hospital

My interest in psychiatry started in medical school. I was fortunate to get a teacher Dr. Sanjay, a Psychiatrist who sparked my interest in the field of psychosis. As Dr. Sanjay knew my interest in psychiatry, he would take me to government-run mental health rehabilitation centers where most people with untreated psychosis were admitted. During the visits, he taught me about Schizophrenia in detail and I saw the majority of patients with severe symptoms whom he treated were getting better and also realized the stigma they face and several other social factors associated with the illness. I decided to pursue my passion in the field of psychiatry to learn more. I joined as a resident to pursue my post-graduation in Psychiatry at the National Institute of Mental Health and Neurosciences(NIMHANS), where I began my research in Schizophrenia. I was privileged to get mentors at NIMHANS who are stalwarts in the field of Schizophrenia who taught me the basics of research and continue to help me grow as a researcher in the field of Schizophrenia. My initial research began with treatment-resistant Schizophrenia and the factors leading to ultra-resistance. This led me to work on the Clinical, cognitive and neurobiological effects of clozapine in treatment-resistant Schizophrenia. I used a functional near-infrared spectroscopic study to evaluate the pre-post effects of clozapine in patients with treatment-resistant Schizophrenia. Later worked briefly on the tele consultation model for improving outcomes in Schizophrenia, in people who lack access to treatment in India. Currently, I am working as an Assistant Professor of Psychiatry at St Johns Medical College Hospital, Bengaluru, India, and will be beginning my journey as a Ph. D Scholar this month and continue to work in the field of Schizophrenia.

The journey as a researcher in the field of Schizophrenia is personally satisfying and made me more curious to learn and understand various aspects of treatment resistance in Schizophrenia. I am also involved in several other research collaborations including collaborations with UNICEF, ETH Switzerland, the University of Pittsburgh, Global mental health International, and several other national collaborations. The major studies in which I’m involved currently are RCT evaluating the efficacy of a repurposed drug in Schizophrenia, a study on neurophysiological correlates of self-other distinction in Schizophrenia, etc.

After I joined St Johns Medical College hospital, a general hospital,  I’m seeing numerous patients with chronic medical illnesses with comorbid psychiatric illnesses who are not taking adequate care of themselves. They come with varying knowledge of their illnesses and vary in their ability to monitor internal sensations and thoughts that can serve to improve self-care. This has intrigued me. I found it interesting to know the factors, and I have chosen to explore if low awareness of bodily sensation in chronic medical illnesses is similar to a lack of awareness of chronic psychotic illnesses. I believe this will potentially help broaden the concept of awareness of the illness and support cognitively informed interventions on the one hand, and radically alter the concept of awareness of illness on the other. I will use my research in understanding the treatment resistance in Schizophrenia, looking forward to developing cognitively informed intervention models to gain better insight in patients with Schizophrenia and thus improve the outcomes

I am ever grateful for the guidance of excellent mentors throughout my career and especially SIRS. SIRS has always motivated early-career researchers like me. SIRS stands at the forefront in providing support and the opportunity to interact with and gain knowledge from the esteemed and eminent faculty who are much more experienced in Schizophrenia research. I always look forward to attending SIRS annual conferences. The experience to gain as an early career researcher will be enormous and this will give a great fillip to early-career researchers' desire to set up an independent career in research.

Yours Sincerely,

Sachin Nagendrappa

The Global Schizophrenia Award is to support a SIRS member in a low and middle income country to attend the annual SIRS congress. The intent of the award is to widen diversity and to bring a member from under-represented countries to a state-of-the-art meeting to establish collaborations with other SIRS members. Sachin Nagendrappa was named the SIRS 2022 Global Schizophrenia Awardee.

You can find more about Sachin Nagendrappa's research and accomplishments by clicking here.

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.

About

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.

E. Fuller Torrey, Stanley Medical Research Institute, Uniformed Services University of the Health Sciences, USA

E. Fuller Torrey

When I was in college I was introduced to schizophrenia by my younger sister, Rhoda, who was so diagnosed at age 17. As a young psychiatrist I was introduced to infectious agents as a possible cause of schizophrenia by Dr. Carlton Gajdusek, who was subsequently awarded a Nobel Prize for his work on prion diseases of the brain. From the 1890s until the 1920s there had been some interest in infectious agents as a possible cause of schizophrenia, especially after the 1918-1919 influenza pandemic which was followed by many cases of a schizophrenia-like psychosis. However, for the next half-century interest in infectious agents in psychiatry virtually disappeared. Perhaps my major contribution to the schizophrenia research field has been to revive interest in an infectious hypothesis, beginning in 1973 with my paper in Lancet on “Slow and Latent Viruses in Schizophrenia”.

Since that time I have been continuously involved in research on infectious agents as possible causes for schizophrenia and bipolar disorder. The vast majority of this research has been done in collaboration with my friend and colleague, Dr. Robert Yolken, a specialist in pediatric infectious diseases at Johns Hopkins University Medical Center. Our research was enormously facilitated in 1989 when the late Ted and Vada Stanley generously offered to fund it. We therefore set up the Stanley Laboratory for Developmental Neurovirology under Dr. Yolken's direction, and it has become the world's leading laboratory for such research. Serological and CSF specimens for study have been obtained from St. Elizabeth’s hospital; the Stanley Research Unit under the direction of Dr. Faith Dickerson at Sheppard Pratt Hospital; and from a study of identical twins. Using the Stanley funds we also created The Stanley Brain Bank under the direction of Dr. Maree Webster, both to provide tissue for our own research as well as for researchers throughout the world.

In the intervening years we have examined a large number of infectious agents to see whether they might cause some cases of schizophrenia. Among the more interesting findings have been our studies on the endogenous retroviruses, especially HERV- W; the herpes family of viruses, especially cytomegalovirus; and the parasite Toxoplasma gondii. The latter is carried by cats and infects approximately 30% of Americans, most asymptomatically. Recent research has suggested that this parasite may be linked to approximate 20% of cases of schizophrenia; the evidence for this is summarized in my current book, Parasites, Pussycats and Psychosis: The Unknown Dangers of Human Toxoplasmosis (2021).

During the same years I have examined epidemiological aspects of schizophrenia to ascertain their compatibility with an infectious hypothesis. Schizophrenia has a clearly defined 6 to 8% birth excess in the winter and spring months, consistent with an infectious agent. Being born in, or raised in, an urban area compared to a rural area doubles your chances of later being diagnosed with the disease. Contrary to what is claimed in most textbooks, the incidence and prevalence of schizophrenia varies widely across the world, as summarized in my book Schizophrenia and Civilization (1980). Finally, there is good evidence that schizophrenia is a comparatively new disease and only became common within the past 300 years; this is summarized in my book The Invisible Plague: The Rise of Mental Illness from 1750 to the Present (2002). These epidemiological aspects are consistent with an infectious agent.

Finally, has research on infectious aspects of schizophrenia produced any new or improved treatments? Although it has opened up possibilities for new treatments using anti-infective and anti-inflammatory agents, the research has not yet led to any significant breakthroughs. Dr. Yolken's laboratory has shown that many standard antipsychotic drugs also suppress viruses. For example, some metabolites of clozapine suppress the growth of HIV in laboratory cultures. We have also supported research to identify drugs which are effective against brain cysts formed by Toxoplasma gondii; currently no effective drug exists. Perhaps most importantly, the infectious hypothesis raises the possibility of true prevention of schizophrenia if a vaccine could be developed against the causative infectious agent or agents.

 

About

Each year, the Society recognizes individuals in the field of schizophrenia research. E. Fuller Torrey was named the SIRS 2021 Lifetime Achievement Awardee. The Lifetime Achievement Award is SIRS most prestigious award, given to a scientist who has made a significant contribution to the advancement of the field of schizophrenia research. These individuals have:

– an established history in schizophrenia research
– exhibited leadership and provided mentoring to young investigators
– positively impacted the field of schizophrenia research

You can find more about E. Fuller Torrey's research and accomplishments by clicking on the button.

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