“One of the things we now understand about psychiatric disorders, is they don’t just suddenly come on out of the blue when someone is an adult,” explains Sophia Vinogradov, MD, who is the Donald W. Hastings Endowed Chair in Psychiatry and Department Head of Psychiatry at the University of Minnesota Medical School. “Many psychiatric disorders actually emerge during adolescence.

This understanding has opened the doors for researchers and physicians like Dr. Vinogradov to better identify vulnerabilities in adolescence and work with teens before their symptoms get too serious. It has also led to new treatment approaches.

Dr. Vinogradov focuses on psychotic disorders where individuals experience abnormal thinking and perceptions. People with psychosis have generally lost touch with reality and display symptoms like delusions and hallucinations. Typical treatment for psychosis is medication, often accompanied by hospitalization if the symptoms are very severe. However, Dr. Vinogradov is focusing on non-drug treatments, called cognitive training or brain training exercises.

“My research has focused on the brain’s information processing systems that are not functioning right when people have psychosis. We focus on what specifically in the brain has broken down, in terms of its ability to process information accurately and appropriately, and then we come up with exercises to strengthen that part of the brain,” Dr. Vinogradov said.

Dr. Vinogradov explained that when a person has a psychotic episode, which can occur in schizophrenia, for example, the brain's ability to process information accurately is impaired. For instance, the brain may no longer process auditory information very well or be able to accurately process the information on people’s faces. “We know there are certain exercises we can ask the brain to engage in that can strengthen those functions,” she said.

Those exercises are computerized and kind of look like games. Researchers can devise specific exercises which can, for example, get the brain to more accurately process sounds or to become more exact in their ability to read a person’s face or facial expressions.

This is extremely important for someone with schizophrenia, where the brain can often lose its ability to process social information. When those patients look at a person’s face, their brains automatically scan the person’s eyes and facial features, putting it all together, creating a representation of a face and the emotion on that face. When people have schizophrenia, the brain is not picking up the information in the correct order and has difficulty correctly recognizing the emotions on the face. This can lead the person to misinterpret many things happening around them.

“We are focusing our work with young people in the very early phases of the illness because evidence, including our own, suggests that if you can improve these functions early, then people don’t end up having the more serious heartbreaking illness that they can have if these symptoms go on uninterrupted for many years,” Dr. Vinogradov said.

Some of the ways Dr. Vinogradov and her team have researched and studied this have been done remotely, so people don’t have to come into a clinic. Patients can do the brain training exercises online. In collaboration with colleagues in California, they have also developed a smartphone app, which serves as a social networking and motivational coaching site for young people to connect with others who have experienced the same symptoms.

“When a teen has these devastating symptoms, they start to become scared, ashamed and isolated. They don’t tell people about what they are going through, and they think they can't share it. It’s very important not to withdraw during the teen years and very important to have healthy relationships with others,” Dr. Vinogradov said.

When someone joins the community on the app, they are assigned a coach who is a therapist at the Medical School. The coach works with them to choose some goals for a healthy lifestyle and behavior. The app includes a social feed for members to share their achievements and to participate in a community of support.

In the past 15 years, there have been huge advances in the understanding of how important adolescence is for the brain and for healthy mental functioning and development. It has become a focus of research in the Department of Psychiatry, and one that Dr. Vinogradov personally is devoted to. A newly awarded grant from the National Institute of Mental Health continues to help the department pursue its goals. It was one of five grants given around the country.

Dr. Vinogradov spoke about the federally funded study in a Star Tribune article published Oct. 14, 2019. The goal is to create an Early Psychosis Intervention Network that will speed up the process of identifying and treating psychosis. Her partner in this study is Dr. Piper Meyer-Kalos, a psychologist in the Department of Social Work.

“The more you let your brain be dysfunctional, the more you hear voices and believe delusional things … the harder it is to bring it back,” Dr. Vinogradov said in the article. “This is why early intervention is so critical.”