Psychotic disorders (e.g., schizophrenia, schizoaffective disorder, depression and bipolar disorder with psychotic features) are devastating for patients and their families as they involve the onset of symptoms and significant impairment during late adolescence- a critical developmental period when youth are only just starting to make a transition into independence. These disorders are highly prevalent, and once diagnosed, involve a chronic course and bleak prognosis. However, an emerging research field suggests that we can now effectively identify those who are at imminently high-risk for psychosis, several years before onset. These ultra high-risk (UHR) adolescents exhibit attenuated psychosis symptoms (e.g., experiencing unusual thoughts, seeing brief shadows, hearing strange sounds). Those who meet criteria for a UHR syndrome have a significant chance of developing schizophrenia or an affective disorder with psychotic features within a two-year period. This serves as a foundation for a line of research that suggests that if we can identify high-risk adolescents and provide early intervention, the course of illness will be improved or perhaps prevented entirely. In a neural diathesis-stress conceptualization of psychosis, individuals with an early biological susceptibility exhibit subtle signs of impairment in childhood. Later in development these vulnerabilities interact with maturational factors and environmental stressors, ultimately contributing to the onset of psychosis. My research involves developing and applying this model to work with adolescents and young adults exhibiting high-risk syndromes as well as those who have recently developed psychotic disorders. Specifically, I conduct prospective studies that follow a range of characteristics that may be used to enhance identification of these individuals, predict who among them may eventually transition to psychosis, and concurrently, refine understanding of pathophysiology. Additionally, I utilize the information from these longitudinal studies to develop novel targeted treatments and remediations. The website below describes one such recent treatment focusing on aerobic exercise and neurogenesis that I am currently in the process of testing in the context of a randomized clinical trial.
Note: * indicates the first author conducted the study while working as a graduate student or postdoctoral student in my lab.
*Dean, D., Orr, J.M, Bernard, J., Gupta, T., Pelletier-Baldelli, A., Carol, E., Mittal, V.A. (in press) Hippocampal shape abnormalities predict symptom progression and impaired tolerance to stress in youth at ultrahigh risk for psychosis, Schizophrenia Bulletin
Mittal, VA, Gupta, T., Keane, B., Silverstein, S., (in press) Visual context processing dysfunctions in youth at high-risk for psychosis: Resistance to the Ebbinghaus illusion and its symptom and social and role functioning correlates. Journal of Abnormal Psychology
*Earls, H., Curran, T., Mittal, V.A. (in press). Social deficits in early perceptual stages in schizophrenia: A systematic review of the P100 during face processing. Schizophrenia Bulletin
*Bernard, J., Millman, Z., Mittal, V.A. (in press) Metaphoric and beat gestures are differentially associated with cortical and regional cerebellar volumes. Human Brain Mapping
Mittal, V.A., Dean, D., Mittal, J., Saks, E. (in press). Ethical, legal, and clinical considerations when disclosing a high-risk syndrome for psychosis. Bioethics.
*Bernard, J., & Mittal, V.A. (in press). Dysfunctional activation of the cerebellum in schizophrenia: A functional neuroimaging meta-analysis. Clinical Psychological Science, doi: 10.1177/2167702614542463
*Bernard, J., Mittal, V.A. (in press) Updating the research domain criteria: the utility of motor dimension. Psychological Medicine.
*Carol, E., Mittal, V. (2015). Negative self-concept is associated with elevated resting cortisol and putative familial environment in youth at ultra high-risk for psychosis. Psychoneuroendocrinology, 57, 26-36.
*Bernard, J. Dean, D., Kent, J., Pelletier, A.L., Gupta, T Mittal, V.A. (2014). Cerebellar Networks in Individuals at Ultra High-Risk of Psychosis: Impact on Postural Sway and Symptom Severity. Human Brain Mapping. 35(8), 4064-4078. DOI; 10.1002/hbm.22458
Mittal, V.A., Dean, D.J., Bernard, J.A., Orr, JM., Pelletier, A., Carol, E., Gupta, T., Turner, J., Leopold, D., Robustelli, B., Millman, Z. (2014) Neurological Signs predict cerebellar-thalamic tract development and negative symptoms in adolescents at high risk for psychosis: a longitudinal perspective. Schizophrenia Bulletin, 40(6) 1204-1215 doi:10.1093/schbul/sbt199
Mittal, V.A., Gupta, T., Orr, J.M. Pelletier, A.L., Dean, D.J., Lunsford-Avery, J. Smith, A., Robustelli, B.R., Leopold, D.R., Millman, Z. (2013). Physical activity level and medial temporal health in youth at ultra high-risk for psychosis. Journal of Abnormal Psychology, 122(4), 1101-1110.
Mittal, V. A., Karlsgodt, K. H., Zinberg, J., Cannon, T. D. & Bearden, C. E., (2010). Identification and Treatment of a Pineal Gland Tumor in an Adolescent with Prodromal Psychotic Symptoms. American Journal of Psychiatry, 167(9), 1033-1037.
Mittal, V. A. Walker, E. F., Walder, D., Trottman, H., Bearden, C. E., Daley, M. Simone, A. & Cannon, T. D. (2010). Markers of basal ganglia dysfunction and conversion to psychosis: Neurocognitive deficits and dyskinesias in the prodromal period. Biological Psychiatry, 68, 93-99.
Mittal, V. A., Ellman, L. M. & Cannon, T. D. (2008). Gene-environment interaction and covariation in schizophrenia: The role of obstetric complications. Schizophrenia Bulletin 34, 1083-1094.
Mittal, V. A., Neumann, C., Saczawa, M., & Walker, E. F. (2008). The longitudinal progression of movement abnormalities and psychotic symptoms in adolescents at high-risk for psychosis. Archives of General Psychiatry, 65(2), 165-170.
Walker, E. F., Mittal, V. A., & Tessner, K. D. (2008). HPA activity and the developmental course of schizophrenia. Annual Review of Clinical Psychology, 4, 5.1-5.28.
Mittal, V. A., & Walker, E. F. (2007). Movement abnormalities predict conversion to Axis I psychosis among prodromal adolescents. Journal of Abnormal Psychology, 116(4), 796-803.
Mittal, V. A., Dhruv, S., Tessner, K. D. Walder, D. J., & Walker, E. F. (2007). The relations among putative bio risk markers in schizotypal adolescents: minor physical anomalies, movement abnormalities and salivary cortisol. Biological Psychiatry, 61(10), 1179-1186.