Dr. Gregory Strauss (Psychology)
Interviewed by Andrea Horsman
OIBR Fellow Dr. Gregory P. Strauss, is an Assistant Professor of Psychology and Neuroscience at UGA. He directs the Clinical Affective Neuroscience Lab (CAN) and Georgia Psychiatric Risk Evaluation Program (G-PREP). Dr. Strauss received his B.S. in Psychology from UGA (2002) and PhD in clinical psychology from UNLV after completing his clinical internship at the University of Illinois-Chicago (UIC), Department of Psychiatry (2008). He then completed a two year National Institute of Mental Health (NIMH) funded postdoctoral fellowship at the Maryland Psychiatric Research Center.
Dr. Strauss’ interest in psychology and neuroscience began when he was an undergraduate at UGA. He felt very fortunate to work in the laboratory of Dr. Paula Schwanenflugel a professor of Educational Psychology, who supervised his undergraduate honors thesis and made him believe he could pursue a career in research. He was also very fortunate to have worked in the laboratory of Dr. L. Stephen Miller who helped him develop an interest in what has become his passion and the focus of his research: examining the neural basis of schizophrenia using neuroscience based methods.
He was fortunate to have some very supportive mentors in his career in Drs. Daniel Allen, Martin Harrow, Jim Gold, and Will Carpenter. They helped him to see the importance of clinically oriented research and taught him to develop skills in neuroscience that are needed to answer questions about the mechanisms underlying schizophrenia. Most importantly, they imparted a scientific philosophy of doing careful research, taking the extra time to get the details right, making his research translational in nature, and caring deeply about helping the participants in his studies. Collaborators from a number of disciplines have also been integral in allowing him to adopt new methods and theoretical approaches, which has been critical for addressing a number of scientific questions that he could not have pursued alone.
His current research primarily examines the etiology, assessment, and treatment of negative symptoms in individuals diagnosed with schizophrenia and youth at clinical high-risk for psychosis. Negative symptoms are reductions in behavior, emotion, and motivation that are common to many psychiatric and neurological disorders. There are five core negative symptom domains: avolition (reductions in the desire for and engagement in goal-directed activities), asociality (reductions in the engagement in and desire for social activity), anhedonia (reductions in the intensity and frequency of pleasurable activity), alogia (reductions in the quantity of speech), and blunted affect (reductions in the expression of emotion in face, voice, and body gestures). Once present, the five negative symptoms tend to be persistent and predict poor vocational and social outcomes, as well as low rates of recovery. Unfortunately, currently available pharmacological and psychosocial treatments have not proven efficacious for remediating negative symptoms. This is due in part to: 1) limited understanding of the mechanisms underlying negative symptoms and the fact that few clinical investigators are trained to take a cognitive or affective neuroscience approach to exploring pathophysiological mechanisms of negative symptom and 2) lack of conceptually up-to-date assessments of negative symptoms.
Much of Dr. Strauss’ work has focused on resolving these two issues. New tools were needed to enhance reliable and valid negative symptom assessment and he co-developed and validated a next-generation negative symptom rating scale for adults with schizophrenia in response to this initiative. The measure has now been translated into >20 languages and is becoming the gold-standard for use in clinical trials of negative symptoms in schizophrenia.
Dr. Strauss was recently awarded a $3 million grant from NIMH for his project entitled “Prodromal Inventory for Negative Symptoms (PINS): A Development and Validation Study.” This research will extend the measurement development efforts to youth who are at clinical high-risk for developing a psychotic disorder.
Psychotic disorders are serious and debilitating mental illnesses that incur substantial suffering for patients and present major challenges to our health care system. Given that few individuals achieve recovery after the onset of a psychotic disorder, there is increasing interest in the early identification and prevention of psychosis. Psychotic disorders are typically preceded by a prodromal (i.e., pre-illness) phase characterized by functional decline and subtle attenuated symptoms that progressively worsen over the course of several months to years. This period is of interest both as a window for investigating processes involved in disease onset and as a potential point of intervention and prevention. State of the art clinical assessments are now available to identify a group of youth at “clinical high risk” (CHR) for developing a psychotic disorder based on attenuated positive symptom criteria. However, more than 75% of youth identified as CHR do not convert to full psychotic illness within two years and currently available risk prediction algorithms are thus not optimized for sensitivity and specificity. This application takes a novel approach to enhancing psychosis risk prediction by investigating negative symptoms. In the prodromal phase, negative symptoms (e.g., anhedonia, avolition, asociality) are highly prevalent (e.g., occurring in 82% of cases) and one of the earliest indicators of risk, typically appearing years before the emergence of attenuated positive symptoms. They are often the reason why CHR youth and their families seek initial contact with the treatment system, and one of the strongest predictors of conversion to psychosis. However, currently available risk calculators do not take negative symptoms into account. This study is a three site investigation, led by Dr. Strauss, which collects data at UGA, Northwestern University (Dr. Vijay Mittal), and Emory University (Dr. Elaine Walker). Several novel risk identification methods will be evaluated, including digital phenotyping (i.e., collecting data passively via the internal sensors of the phone such as geolocation, accelerometry, and speech), social media data, and a new negative symptom clinical rating scale. The goal is to derive a new set of risk prediction measures and algorithms that can detect risk for developing schizophrenia with a high degree of sensitivity and specificity. Dr. Strauss’ hope is that these measures can be widely available for use by the general public and clinicians to enhance the detection of psychosis, leading to an enhanced ability to prevent illness onset.
Since starting his work approximately 10 years ago, Dr. Strauss has been continually surprised by the need for mental health services throughout our country, as well as the pervasive lack of knowledge about the psychosis prodrome among mental health and educational professionals. Approximately 15% of the world’s population has occasional psychotic like experiences. Often these are transitory and do not cause distress, but occasionally they warrant clinical attention. The medical and educational fields have not focused on screening for these forms of mental illness, like they have others such as autism, ADHD, or suicidal ideation. Dr. Strauss feels that screening is necessary to enhance prevention efforts, and his hope is that his research is an important step in this direction. He adds that additional efforts are needed to disseminate this information to clinicians and educators who see young people on a daily basis and can help them to receive early monitoring and intervention services that could prevent the onset of psychotic disorders.
Dr. Strauss thinks turning neuroscience-based research results into clinically meaningful products is the biggest challenge facing his field. “We have been able to develop eloquent mathematical and neuroscience models of psychiatric symptoms in our research. But, translating these models to assessments and treatments that clinicians can meaningfully use is an important challenge. Our new R01 is a step in this direction,” he stated.
Helping young people at risk for developing psychosis and becoming part of their clinical care team has been highly rewarding for Dr. Strauss and the team of graduate students and employees that he supervises. “If we can help with the process of early identification, monitoring, and prevention for even a small number of people at risk for developing a psychotic disorder, we will have made a meaningful impact on the lives of people at a time when they need it most.”
“Our research relies on rapid translation of research done in basic neuroscience (i.e., animal models) to humans. This requires a team-based approach to science, and collaborators with expertise in multiple methods. Thus, my approach to science is one that is team-based and I strive to collaborate with others who have expertise in methods and conceptual frameworks that extend my own expertise, to allow more complex questions to be answered. This has included collaborating with other psychologists, neuroscientists, computer scientists, mathematicians, and engineers,” said Dr. Strauss.
In addition to the newly funded NIMH grant, Dr. Strauss has several other ongoing grants that focus on negative symptoms.
In an ongoing R21 from NIMH (R21 MH112925), Dr. Strauss is exploring mechanisms underlying anhedonia in adults with schizophrenia using novel mathematical approaches. This study uses the ecological momentary assessment method, which involves obtaining self-reports of emotion, symptoms, context etc., as well as ambulatory psychophysiology, in the context of everyday life. This data is submitted to computational models (e.g., network analysis, Markov chain analysis, Machine Learning) that evaluate whether anhedonia reflects an abnormality in the temporal dynamics of positive emotion (e.g., the trajectory leading up to or following a planned pleasurable activity). Results have potential to lead to an updated perspective on the nature of anhedonia, as well as its underlying mechanisms. This information will be useful for developing novel psychosocial treatments of negative symptoms that utilize cognitive therapy approaches to normalize the temporal dynamics of emotion in the context of everyday life using mobile cellular phone based interventions.
In a NARSAD Young Investigator grant funded by the Brain & Behavior Research Foundation, Dr. Strauss is exploring pathophysiological mechanisms underlying negative symptoms in youth at clinical high risk for a psychotic disorder. The study aims to determine whether abnormalities in cortico-striatal function lead to disruptions in a range of reward processes that contribute to avolition and anhedonia. Studies by Dr. Strauss and collaborators have found support for such a model in adults with schizophrenia, and this will reflect the first attempt to determine whether the model extends to youth at clinical high risk for schizophrenia. To evaluate this model, a range of behavioral, EEG, and computational modeling approaches will be used in a 2 year longitudinal study of youth at clinical high-risk for psychosis. Results have potential to inform new pharmacological targets for drug development by identifying neural mechanisms underlying negative symptoms in the prodromal period.
Over the next five years Dr. Strauss said his research will continue to explore novel mechanisms underlying negative symptoms in those diagnosed with schizophrenia and youth at clinical high-risk for developing psychosis. They have recently started adopting fMRI as a new method and plan to conduct a series of studies where they examine neural mechanisms that lead at-risk youth to develop a psychotic disorder versus other psychiatric diagnoses, such as mood and anxiety disorders.
The ultimate aim of Dr. Strauss’ research is to translate results obtained in the laboratory into enhanced risk monitoring and novel treatments of negative symptoms. Focusing on negative symptoms in the prodromal phase may reflect a novel means of tracking illness progression and even preventing the onset of psychotic disorders, which are the leading medical cause of functional disability in the United States.
If you would like to read more about Dr. Strauss and his research, you can go to his lab website found here: https://ugacanlab.com/.