Exercise is great for your body—and your mind. When you engage in any physical activity, your brain releases “feel-good” chemicals (dopamine, serotonin, oxytocin, and endorphins) that boost your mood. In addition, forming long-term exercise habits can reduce your risk for neurological diseases, such as dementia.
Anna Hickner, PsyD
In this Q&A, Anna Hickner, PsyD, Supervising Psychologist and Assistant Professor, Icahn School of Medicine at Mount Sinai, and a trained yoga and meditation instructor, explains how increasing your activity can lead to a healthier, happier mind.
How does not getting enough exercise affect my mental health?
Leading a sedentary lifestyle can have many adverse effects on your physical, emotional, and mental well-being. Additionally, if you are not sleeping well and don’t move much during the day, this can have a compounding effect of worsening sleep and mood without inducing the benefits of the “feel-good” chemicals that exercise offers. As a result, you may find it harder to function or interact effectively with others.
Quick tips:
Creating an exercise routine can help you feel grounded and regulate stress
Achieving exercise goals boosts the brain’s reward center and builds self-esteem
Even small activities, such as walking during your lunch break, can make a big difference
How does exercise affect my mood?
There has been a lot written on the association between exercise and mental health, including how exercise induces the production of our natural “feel-good” chemicals. But exercise has additional benefits—for example, certain activities, like sports, are great outlets for socializing, and exercise, in moderation and well before bedtime, in general helps regulate sleep. Becoming more active may also motivate you to eat well in order to fuel your body, which can have a positive impact on mood. Some studies indicate people might demonstrate better memory and attention after a workout, which is most noticeable when exercise is consistent and the effects are studied over a longer period.
How can exercise improve my mental health in the long term?
Turning exercise into a routine that helps you achieve goals, such as losing weight or becoming fitter, can be gratifying and help build self-esteem, as long as you have reasonable expectations and stick to your goals. When you complete an activity, such as a race, or compete in a team sport, there can be an extra boost in your neurochemical rewards center, which offers a feedback loop for motivation to continue to engage in the activity. When you do this in moderation, exercise transforms into a habit that provides physical, emotional, and psychological benefits. It is important to find an activity that is enjoyable so you can easily stick with it. Another long-term benefit of exercise is that it is shown to reduce the risk of neurodegenerative diseases, such as Alzheimer’s disease and dementia, due to the stimulation of blood flow in the brain.
How much exercise do I need to get these benefits, and at what intensity?
It is usually better to be active than not. That said, some studies show walking is just as beneficial as running, whereas others find intensity matters. Regardless, a minimum of 150 minutes of moderate to vigorous movement each week is often cited as ideal, as well as the importance of elevating your heart rate.
While intensity can be beneficial, too much may stress your body or lead to injury, so consistency and moderation are important. Having a routine can keep you grounded and helps regulate stress. If intense exercise feels daunting, find an activity you enjoy that gets you moving, and that you can do regularly. You can also combine exercises, such as swimming, dancing, walking, or kick-boxing classes, mixing exercises that are leisurely on some days with more intense ones on others.
What are some simple ways to increase my activity to improve my mood?
Small activities can add up. If you have a desk job, get up and stretch or go for a mini walk every hour or so. Take the stairs instead of the elevator, bike instead of taking the bus or driving, park far away so you have to walk further. These are all examples of small, daily changes that can bring big benefits. You can also try fitness trends, such as “exercise snacks,” in which you do a vigorous activity for as little as two minutes. Whether you lack the time or a place to work out, finding small ways to increase exercise can improve both your health and mental well-being. Exercising outside on a regular basis can also improve your mood.
How does my gut health contribute to my mental well-being?
Gut health is also important for mental health—some research indicates that microbiome and inflammation can affect mood. Consuming food that offers adequate macronutrients (carbs, fats, proteins, water, and fiber) as well as micronutrients (vitamins and minerals) is imperative to feeling energized, meeting the day’s demands, and staying motivated. Increase your consumption of whole foods, limit processed foods, caffeine, alcohol, and sugar, and consult a dietician if you feel you need help.
Autumn brings about many things: leaves on the ground, cooler temperatures, and of course, Halloween. But while many look forward to a reprieve from the summer months, the start of the season can introduce new challenges. Seasonal depression—commonly known as seasonal affective disorder (SAD)—is a temporary condition estimated to affect 10 million Americans each year.
Mariana Figueiro, PhD, Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and Director of the Light and Health Research Center at Mount Sinai, explains the effects of SAD and how those who experience it can manage the disorder.
What are the symptoms of seasonal affective disorder, and what causes it?
Symptoms of seasonal affective disorder vary, but in general, it includes feeling down or depressed as well as experiencing a lack of interest and energy. People tend to be sleepier and tend to overeat, especially carbohydrates. And, as with any depressive episode, there could be suicidal thoughts. These depressive symptoms occur at specific times of the year, typically the fall and winter, and there is a full remission at other times of the year, such as the spring and summer.
Unfortunately, the cause of the disorder is still unclear, but there are some competing theories. One is that the start of autumn causes circadian rhythm disruption. Another is that the photoreceptors in the eye are not as sensitive to light, and another is serotonin reuptake dysfunction, which is an imbalance in serotonin levels. But the most prominent theory is that, due to the lack of or delay in getting morning light, the biological clock in the brain is out of phase with your natural light-dark patterns, affecting the timing of the sleep cycle. As such, your biological clock is telling you that it is 6:30 in the morning, but your watch is telling you differently. That mismatch can be the cause of seasonal depression.
Does the disorder only affect people who live in cities with long winters, or are people in warmer climates affected as well?
It tends to mostly affect people who live at higher latitudes, as these areas have less daylight availability in the winter months.
In the United States, higher latitude areas will be the northernmost states such as Alaska, Washington, Michigan, New York, and Maine. In the New York metropolitan area, we have about 15 hours of daylight at the height of summer but only about nine hours in the dead of winter. This contrast is starker in areas that are farther north. Barrow, Alaska—the northernmost city in our northernmost state—has 67 straight days of darkness in the winter.
Within high latitude populations, the prevalence of SAD varies between one and 10 percent. But it can happen at lower latitudes, it’s just less prevalent.
How can I recognize and manage SAD?
If you go to a physician, there are standardized questionnaires—such as the seasonal pattern assessment questionnaire—that you can take. But, in general, if year after year you begin to crave carbohydrates, lose energy, lose interest in things, overeat, and oversleep around October, that’s a good sign that you should seek a formal SAD diagnosis.
Once you consult a physician, they will discuss how you can manage the disorder. There are two common ways to treat SAD. One would be medication—typically an antidepressant or a selective serotonin reuptake inhibitor—that would be prescribed by a physician. The other is non-pharmacological: light therapy. Exposing yourself to light—be it morning, natural, or electric indoor light—will help resynchronize your biological clock so that it matches your local time. You can do this by adding more lights in the home, opening up your windows, and trying to be outside during daybreak. And if you work from home, try to sit facing a window. Making your environment brighter during the day will help get more light to the back of the eye, which is what you want in order to be an effective treatment for seasonal depression.
Has light therapy been used to treat other illnesses?
Yes, it has. The Light and Health Research Center at Mount Sinai has done a number of studies showing that—outside of treating seasonal depression—there is a definite benefit to exposing people to bright days and dim nights. For instance, in a study with Alzheimer’s disease patients, the lighting was changed in their nursing homes and assisted living facilities to simulate bright days and dim nights. The results were a very robust, positive impact on their sleep, mood, and behavior. In other applications, we worked with persons with mild cognitive impairment and sleep disturbance from mild traumatic brain injury to see how light therapy can help. And we have been working with breast cancer and myeloma transplant patients to see if delivering light therapy during a transplant or during chemotherapy will help to minimize fatigue and improve their sleep.
There are various applications. You can even use it to try to get your teenager to go to bed and wake up earlier. The addition of light can have many positive effects on life.
“We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
By the time students reach New York City’s Judith S. Kaye High School (JSK), multiple systems have failed them. As a public transfer school for students with significant barriers to their education, many of JSK’s students have faced significant adversity.
“All of our students have been disconnected from school at some point and many have experienced some trauma,” says school principal Andrew Brown. Mental health disorders and substance use problems are common, but linking students to traditional mental health services is nearly impossible. “Even for students who are ready to meet with someone, once they leave the building, the obstacles are frequently insurmountable,” Brown says.
Thanks to Mount Sinai’s UPRISE (Use Prevention Recovery Intervention Services & Education) program, students no longer have to leave school to get the care they need. “Rather than trying to get students to come to us, we provide services on-site,” says Rachel Weller, PsyD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and project manager and clinical supervisor for UPRISE.
The partnership, launched just before the COVID-19 pandemic, is helping students address their mental health problems and substance use, often for the first time. “Having access to this high-quality care, within the school building, is a game changer,” Brown says.
Youth Mental Health: An Unmet Need JSK, which serves about 145 students at their Manhattan site, is co-located within the School of Cooperative Technical Education (Coop Tech), a career and technical school that serves about 1,500 students. Students from both schools are offered access to mental health and substance use treatment through the UPRISE program.
UPRISE is an offshoot of the Comprehensive Adolescent Rehabilitation and Education Service (CARES), a program of the Addiction Institute of Mount Sinai that has served adolescents and young adults for more than 20 years. CARES provides a therapeutic high school environment that includes a range of targeted services for youth with complex mental health, substance use, and educational problems. While CARES has seen great success, the need for services among New York City youth remains significant. UPRISE is a new model that shows how mental health services can be integrated into a public school setting.
Both Coop Tech and JSK serve historically marginalized populations who have long been subject to systemic racism and discrimination, says Shilpa R. Taufique, PhD, director of the psychology division for the Mount Sinai Health System and director of CARES. “These students and their families have all had the experience of not being seen or heard, and of having institutions impose what they think is best for them,” she says. “There’s such a deep mistrust of the systems that are supposed to be helping them.”
As a result, students have often struggled for years with mental health problems — even before the COVID-19 pandemic made youth mental health a national crisis. “We see many kids present with PTSD, complex trauma, major depression, anxiety, and difficulty with substance use,” Dr. Weller says. “What’s most striking is the number of students who have a longstanding history of mental health difficulties, yet have never received any type of treatment.”
A New Model of School Mental Health UPRISE aims to give adolescents the tools to help them develop into healthy, functioning young adults. The clinical team is small but mighty: Dr. Weller is on-site in the school most days, along with part-time clinical staff including two postdoctoral fellows and a graduate student extern. They currently provide services for about 30 students, but Weller and her colleagues hope to double that number in early 2023.
UPRISE offers a range of services, including:
Psychoeducation
Individual therapy
Group therapy
Family therapy
Milieu therapy
Substance use treatment
Medication management
In addition to counseling and therapy services, the team helps students connect with prescribing providers via telehealth for medication management. All of these services are billed to students’ insurance companies, making it a model that is both sustainable and replicable, Dr. Taufique says.
Flexible Approaches to Teen Mental Health Plenty of schools have experimented with embedding social workers or mental health providers in school settings. But UPRISE goes further. Before launching the program, the team spent a year learning about the schools and their students’ unique needs. “People make a lot of assumptions about teenagers, especially young people who have been disconnected from school or who are in treatment,” Brown says. “[The UPRISE team] didn’t come in with any expectations about who these kids are.”
That open-minded attitude has led to several innovations. URPISE takes a novel approach to family therapy, incorporating school staff into students’ treatment plans much like parents or other family members might be included. “The school setting is a surrogate family for most of these students. The teachers, guidance counselors, and social workers are very involved in their students’ lives — these are the people students call in the middle of the night if they’re in crisis,” Dr. Taufique says. “We want to highlight the roles they play in students’ lives and also give school staff some therapeutic framework to draw on so they don’t get burned out.”
Clinicians provide services to students in school during the school day, but they also reach out to them in the community. If a student has a phobia of the subway or anxiety about coming to school, for instance, providers might arrange to travel to school with them to provide a form of exposure therapy. “We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
Services Without Stigma In addition to services for patients, UPRISE offers psychoeducation and outreach to the entire school community, such as school-wide presentations on topics related to substance use and mental health. The program is also open for a drop-in hour five days a week, so any student in either school can come in to talk whenever they need. “With the drop-in hour, we discuss things that are going on in students’ lives, provide some psychoeducation, and sometimes link students to services or provide referrals,” Weller says. “We want to make this accessible, even to kids we’re not directly serving.”
At a time when most of the news about teen mental health is bleak, UPRISE is making a positive difference in his students’ lives, Brown says. “We have students who are seeing counselors for the first time. They’re showing up to appointments, connecting with counselors. They’re more connected to school.”
“Students look at this as a tool to help them get better and help them transition into adulthood. There’s no stigma attached to it,” he adds. “It’s just become a part of our community.”
“Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
Stigma remains a big problem for psychiatry. Inpatient psychiatric care, in particular, has long suffered from unfair portrayal. The mere mention of an inpatient psychiatric unit conjures up images of Jack Nicholson in One Flew Over the Cuckoo’s Nest. This stigma is present not only among the public, but also among many doctors and medical providers. “There’s a certain amount of stigma and fear around the idea of being hospitalized in a psychiatric unit, but it’s a very different quality of care and treatment than what is typically portrayed in the media,” says Rajvee Vora, MD, MS, Associate Professor and Vice Chair of Clinical Affairs for the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
Forget the stereotypes, Dr. Vora says. The inpatient psychiatric facilities at The Mount Sinai Hospital are bright, welcoming, and beautifully designed, and patients receive high-quality care. “Patients are up and walking around, encouraged to be up and about, attend groups and sessions, and play basketball in our indoor court.”
Above all, hospitalized patients receive a range of evidence-based treatments to help them manage their mental illnesses. “Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
An Interdisciplinary Approach to Inpatient Mental Health In recent years, the field of psychiatry has moved most treatments to outpatient settings. Yet for some patients with severe mental illness and acute psychiatric needs, inpatient care remains critical. In fact, the need for such care has increased recently. “During COVID, many outpatient providers switched to remote services, which aren’t always accessible to people with serious mental illness,” says Danielle Campisi, LCSW, director of social work for the inpatient psychiatry service. “Now we’re seeing a big uptick in the number of patients that had been chronically well-managed, but lost access to care during the pandemic.”
The team at Mount Sinai’s inpatient behavioral health unit treats a variety of psychiatric illnesses, including:
Mood and anxiety disorders
Personality disorders
Psychotic illness
“Treatment isn’t something that happens to the patient. It happens with the patient,” says Dr. Rosenthal.
Patients don’t need to be severely incapacitated to benefit from hospitalization, says Blake Rosenthal, MD, Assistant Professor of Psychiatry and Inpatient Unit Chief at The Mount Sinai Hospital. “Sometimes our patients have developed psychotic symptoms for the first time. They may have a change in their ability to perceive reality or are developing hallucinations,” Dr. Rosenthal says. “They can come in without having a complete decompensation and loss of function, and we’re able to meet those needs really well.”
Cutting-Edge Psychiatric Treatments Inpatient treatments typically include medications and intense psychotherapy, including individual, group, and milieu therapy. As a cutting-edge research institution, Mount Sinai offers access to new and emerging treatments, including interventions such as electroconvulsive therapy (ECT) and esketamine for treatment-resistant depression. Patients also receive additional services such as art therapy, music therapy, dance/movement therapy, and substance abuse counseling. “Inpatient treatment is so much more than medication management,” Dr. Vora says. “The core of the work we do is ‘milieu therapy’ — what being in this environment does for patients.”
Patients are treated by an interdisciplinary team that includes an attending psychiatrist, psychiatric residents, nursing staff, creative arts therapists, assistive staff, and social workers. The team develops a comprehensive treatment plan for each patient, which describes the interventions and services they will receive as well as the plan for transitioning to outpatient care. That transition is important, since patients typically stay in the hospital just a week or two before being discharged to outpatient services or to higher levels of care, such as assertive community treatment (ACT).
Social workers work closely with patients to understand their psychosocial needs, connect them with appropriate services, and teach them about their illnesses. “When patients come in, they’re sometimes resistant to being treated. We do a lot of psychoeducation to improve patients’ understanding of their illness, the potential need for medications, and the importance of outpatient follow-up,” she says.
It’s a collaborative effort, Rosenthal adds. “Treatment isn’t something that happens to the patient. It happens with the patient,” he says.
Inpatient Mental Health at Mount Sinai While Mount Sinai provides access to the latest evidence-based treatments, its biggest asset is the people delivering those therapies, Dr. Rosenthal says. “What really distinguishes Mount Sinai’s inpatient program is our team. Our treatment team almost functions as a single provider,” he says. “It sounds cliché, but everyone on the unit cares deeply about how patients are doing.”
Mount Sinai has leading experts in schizophrenia, depression, and other psychiatric illnesses, who often consult on treatment. The team mentality extends to treating a patient’s non-psychiatric medical conditions as well. The inpatient psychiatry team collaborates closely with other service lines such as OBGYN and neurology to ensure all of a patient’s healthcare needs are met during their inpatient stay.
Most psychiatric inpatients are transferred from the emergency department, but individual cases are considered. Learn more about Mount Sinai’s Inpatient Behavioral Health Services, or contact the inpatient behavioral health admissions coordinator at 212-241-5675.
From left, Honoree David Sanborn, Shantelena Mouzon, administrative coordinator at the Louis Armstrong Center for Music and Medicine, and musician Paul Shaffer
The 17th annual “What a Wonderful World” gala benefiting the Louis Armstrong Center for Music and Medicine, was a festive evening of jazz and expressions of gratitude to three honorees for making the world more wonderful through their contributions to music and music therapy.
The event, held Monday, October 24, at the Angel Orensanz Foundation and hosted by the Wonderful World Friends of Music Therapy Inc., honors the legacy of the Louis Armstrong Department of Music Therapy and their commitment to music therapy at Mount Sinai hospitals.
The event recognizes a dynamic group of individuals chosen from a variety of fields including music, medicine, and patients who have benefitted from receiving music therapy at Mount Sinai hospitals.
This year’s honorees were Grant Mitchell, MD, Chair, Department of Psychiatry, Mount Sinai Beth Israel; David Sanborn, the multi-Grammy Award-winning saxophonist, who was presented the Phoebe Jacobs Award by Paul Shaffer (pianist of the former Late Night with David Letterman); and patient Rosemarie Greene.
From left, Honoree Grant Mitchell, MD, Joanne V. Loewy, DA, LCAT, MT-BC, Prameet Singh, MD, and Daniel S Safin, MD
The gala was hosted by Mercedes Ellington, dancer, choreographer, and granddaughter of Duke Ellington, and Bill Daughtry, the retired radio and TV host. The co-chairs were Karen and Doug Seidman from the Louis Armstrong Center for Music and Medicine’s Steering Committee. The event featured performances by Rema Webb from the Broadway production of The Music Man; Antoine Smith from the Broadway production of MJ: The Musical; saxophonist Erik Lawrence, Lou Marini, a saxophonist and an original member of The Blues Brother, and jazz pianist Garry Dial. Mr. Shaffer and Mr. Sanborn, along with Will Lee (bass), performed jazz and Louis Armstrong’s ‘Wonderful World’.
“We are proud to bring together members of the music, medicine, and patient community who through the gala learn of the breadth and scope of patients we serve and our research projects with doctors and nurses, from neonatal care to oncology, Alzheimer’s disease and psychiatry,” said Joanne V. Loewy, DA, LCAT, MT-BC, Founder and Director of the Louis Armstrong Center for Music and Medicine, which provides music therapy services throughout the Mount Sinai Health System.
The Department of Music Therapy, with support from the Louis Armstrong Educational Foundation and other grants, provides a range of clinical services for infants, children, and adults, and day treatment at the Mount Sinai-Union Square clinic and within the community. Its music therapists are licensed and board certified to provide care that complements medical treatment, assisting with sedation, pain management, and neurologic and respiratory function.
“We can’t always prevent psychosis. But the earlier someone gets treatment, the greater the likelihood that they’ll recover and do better in the long term.”
A college student often hears her name in the wind. A teenager starts to believe they have a special relationship with God. Another is worried that strangers are watching him. Yet they all retain insight and skepticism about the strange beliefs and perceptions they’re experiencing. They wonder: Is it just a trick of my mind?
These symptoms may indicate clinical high risk for psychosis (attenuated psychosis syndrome). In addition to suspiciousness, grandiose thoughts, and perceptual disturbances in what they see and hear, people at clinical high risk often experience social withdrawal, worsening performance in school, anxiety, and suicidal ideation. About 20% will develop psychosis within two years.
The symptoms of clinical high risk often develop in adolescence or early adulthood, and they are, unsurprisingly, alarming. “We see a lot of functional impairment and suffering in these individuals. They’re often afraid, and their families are often afraid,” says Cheryl Corcoran, MD, associate professor of psychiatry at Icahn School of Medicine at Mount Sinai and co-director of Mount Sinai’s Psychosis Risk Program. She and her colleagues are there to help.
“The goal is to catch people early to provide treatment,” says Shaynna Herrera, PhD, a clinical psychologist and instructor of psychiatry and project director at the Psychosis Risk Program. “Through education and cognitive behavioral therapy, we help them learn about the symptoms and how to manage them. We can’t always prevent psychosis. But the earlier someone gets treatment, the greater the likelihood that they’ll recover and do better in the long term.”
Interventions for Attenuated Psychosis Syndrome The Psychosis Risk Program works with teenagers and young adults at clinical high risk for psychosis, providing evaluation, treatment, and psychoeducation to reduce the risk of psychosis and help patients manage symptoms.
For patients with high clinical risk, anti-psychotic medications aren’t recommended as a first-line therapy (though patients may take medications to address comorbid anxiety or depression). The Psychosis Risk Program offers a variety of interventions to help patients and their families. These include a structured five-session psychoeducation program that educates patients and family members about psychosis risk, called BEGIN: Brief Educational Guide for Individuals in Need. The program also offers cognitive-behavioral therapy for psychosis (CBT), which aims to decrease symptoms, provide coping skills, and prevent the development of full psychosis.
This type of CBT is adapted for people with clinical high risk, and research has shown that it can delay the progression to psychosis for at least four years, says clinical psychologist Yulia Landa, PsyD, MS, assistant professor of psychiatry, Director of Cognitive Behavioral Therapy for the Treatment and Prevention of Psychosis research and clinical program, and co-director of the Psychosis Risk Program. “We will need much longer longitudinal studies to know if CBT can really prevent psychosis, but we can delay it, and maybe prevent it,” she says.
Because most patients are adolescents and young adults who still live at home with parents, the Psychosis Risk Program also provides family-based programs. “Our group- and family-based CBT teaches family members how to interact with their loved ones who are beginning to experience psychotic-like symptoms and learn how to support them in using CBT skills at home,” Dr. Landa says.
Schizophrenia and Psychosis Research In addition to clinical work, the Psychosis Risk Program is active in research, from mechanistic studies of biomarkers to research that evaluates diagnostic and clinical services. One recent project aims to improve early identification of patients at clinical high risk. “[Attenuated psychosis syndrome] is a newer concept, and not all clinicians recognize there is this population of people at clinical high risk who don’t meet the criteria for a psychotic disorder,” says Rachel Jespersen, LMSW, a clinical social worker and coordinator of the CBT for the Treatment and Prevention of Psychosis research and clinical program. “What’s more, these are types of symptoms people don’t spontaneously disclose, so it can be difficult to identify patients at clinical high risk.”
To improve identification, she and her colleagues recently conducted a pilot screening program in Mount Sinai’s outpatient clinics. They asked providers to use a brief screening tool for all patients between 12 and 30. Those who screened positive received further evaluation, and patients identified as clinical high risk were referred to the program for symptom monitoring and adjunctive treatment. The screening pilot identified 3.5 times as many patients at clinical high risk of psychosis compared to the standard referral model, Dr. Landa says.
She and her colleagues are also evaluating interventions such as CBT-based programs for individuals, groups, and families. “Eventually we want to establish solid interventions that could be disseminated across Mount Sinai and integrated into community practice,” Dr. Landa says.
Meanwhile, Dr. Corcoran and colleagues are actively involved in research to better understand biomarkers for schizophrenia. The Accelerating Medicines Partnership: Schizophrenia, spearheaded by the National Institutes of Mental Health, is collecting information on biomarkers such as MRI and EEG data, cognition, fluid biomarkers such as inflammatory and genetic markers, daily diary studies and biosensors that may predict behavioral patterns, even subtle patterns of language and facial expression that could predict the transition to psychosis. Mount Sinai is one of the study’s data processing centers, responsible for collecting and analyzing data from across the consortium. “We’ve identified a number of biomarkers that are predictive of psychosis,” Dr. Corcoran says. “We want to understand how they relate to each other, to better understand the causes of psychosis and ultimately to develop new pharmacological treatments.”
In addition, one of Dr. Corcoran’s abiding research interests involves collaborating with physicists, engineers, and computer scientists to use artificial intelligence to analyze speech, language, and face expression. Language disturbance (particularly complexity and coherence) is common in psychotic disorders, and often appears at the initial onset of symptoms. Using natural language processing, Dr. Corcoran and her collaborators were able to predict psychosis onset in clinically high risk patients with an 83% accuracy rate—that is, more accurate that clinician predictions. The implications of this field of study can potentially help prevent psychosis by initiating the development of treatments that address the problems with cognition that are at the root of language disturbance. Her team has focused on this as a biomarker for mechanistic studies (several currently in recruitment), and are working to include this “natural language processing” approach for services as well.
Patient Care at the Psychosis Risk Program Running throughout all clinical and research efforts at the Psychosis Risk Program is a commitment to the well-being of patients, whose symptoms are often misunderstood and stigmatized. “We have been contributing to research on stigma and interventions to reduce stigma,” Dr. Herrera says. “And we’re committed to involving patients and their families in our work. We conduct qualitative interviews and get their feedback so that we adjust our practices and make sure that they are meeting peoples’ needs.”
The program staff also takes time in caring for patients with a challenging and frightening diagnosis. “In mental health care, there’s often not enough time to provide psychoeducation and do lengthy feedback sessions” where the evaluating therapist sits down with the patient and their family members to discuss the diagnosis, Dr. Herrera says. “One thing that makes Mount Sinai stand out is that we take our time to do thorough assessments, give feedback and write detailed reports so that families and clinicians have the information they need to seek care.”
Schizophrenia and psychosis remain challenging conditions, for the people affected and for their clinicians. But Mount Sinai’s Psychosis Risk Program is providing hope and health to the young people at clinical high risk. Learn more about their services and research, including language-based studies, at www.mountsinai.org/psychosis-risk.
