American Psychological Foundation

Some people with schizophrenia have particular difficulty seeing a collection of object parts as a group. If they’re looking at a watch face, for instance, they’ll perceive the hands, the dial and the numbers as separate forms, but it’s hard for them to process the watch face as a whole.

Psychologist Steven M. Silverstein, PhD, of the University of Medicine and Dentistry of New Jersey, has spent much of his more than 20-year career studying this phenomenon, which he calls a “perceptual organizational deficit.” Through studies using cognitive psychological tasks, recordings of the brain’s electrical activity and functional magnetic resonance imaging, he and others have shown that a subset of schizophrenia patients is more likely than other schizophrenia patients, other psychiatric patients or healthy controls to have this visual-integration problem.

In addition, patients with these deficits are more prone to have problems with social functioning before the illness presents — that is, “premorbidly” — than those without these difficulties. As children, for instance, they’re more likely to have trouble interacting with others, resulting in few friends and intimate relationships, says Silverstein, who also has treated these patients clinically.

As recipient of the 2010 Alexander Gralnick Research Investigator Prize, a $20,000 prize given every two years to support research, mentoring and service in the area of serious mental illness, Silverstein will be able to take his research a step further. He’s conducting a study that compares the visual-task performances of people with both subtypes of schizophrenia with their genetic profiles. Findings could lead to better understanding of differences among people with the condition and eventually to treatments chosen on the basis of a person’s cognitive and genetic profile — a means to more effectively address specific, personally relevant neurobiological mechanisms associated with different manifestations of the disorder.

“The dream of personalized medicine is to use a person’s behavioral and genetic profile to get it right the first time,” he says. “While it will take us awhile to get there, I see this study as one part of that growing movement.”

In the study, Silverstein will administer a battery of perceptual organization tasks to schizophrenia patients with and without poor premorbid social functioning. At the same time, he’ll collect DNA samples that will allow an analysis of 384 minor genetic variations known as single nucleotide polymorphisms, or SNPs. That analysis could determine which genetic alterations are related to which subset of schizophrenia patient, says Silverstein.

If the findings are robust, they’ll also represent a solid step toward integrating some of the puzzle pieces of schizophrenia — a needed direction in a field marked by increasingly fine-grained but fragmented data, Silverstein adds.

“Combining this information will help to give us a better global understanding of the illness, from its genetic basis to how that shows up in the brain’s neurobiology to how a particular pattern of brain signals translates into the person’s subjective experience of the world,” he says.

Silverstein’s work promises to fulfill the mission of the award: to shed further light on the disorder and therefore provide meaningful help to those who live with and treat it, says APF President Dorothy W. Cantor, PsyD.

“Dr. Silverstein’s studies of perceptual abnormalities and of creative interventions related to those findings are a boon to people suffering from this disorder and to their families,” she says.

Tori DeAngelis is a writer in Syracuse, N.Y.