Monica E Calkins
VerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 1868–2026
About
Monica E Calkins, Ph.D., is a Professor of Psychiatry at the Hospital of the University of Pennsylvania. She serves as the Director of Clinical Research Assessment in the Department of Psychiatry, Neurodevelopment and Psychosis Section, and is also the Associate Director of the Penn Psychosis Evaluation and Recovery Center. Additionally, she co-directs the Pennsylvania Early Intervention Center (HeadsUp) within the same department. Her research focuses on psychosis spectrum symptoms, early intervention, and neurodevelopmental trajectories related to psychosis. Dr. Calkins has contributed to the development and validation of screening tools for subthreshold psychosis symptoms in youth and has conducted longitudinal studies on clinical features in community youth with recurrent psychosis spectrum symptoms. Her work emphasizes understanding illness phases as key windows for assessment and intervention in psychosis, and she has been involved in constructing deep phenotyping collaborations to advance research in this field.
Research topics
- Computer Science
- Genetics
- Machine Learning
- Psychology
- Psychiatry
- Biology
- Statistics
- Computational biology
- Neuroscience
- Demography
- Clinical psychology
- Mathematics
- Medicine
- Evolutionary biology
Selected publications
Schizophrenia Research · 2026-04-16
articleOpen accessBACKGROUND: Youth at risk for psychosis based on subthreshold positive symptoms (PS) show elevated negative symptoms such as amotivation, associated with disability and increased risk of psychotic transition. Intrinsic motivation (IM), the desire to obtain internal satisfactions such as mastery or curiosity, is more impaired in psychosis than extrinsic motivation (EM), the desire to obtain external rewards. However, the neural mechanisms underlying IM impairment in PS have scarcely been studied, and never with measures designed for this purpose. METHODS: We applied a novel fMRI fractal memory task that leveraged distinct feedback conditions designed to engage IM and EM processes, along with self-reported IM and EM, in adolescents and young adults with PS (n = 95) and healthy controls (CT, n = 31). RESULTS: We hypothesized that IM would generate reinforcement signals in the ventral striatum (VS), a core motivation region, as individuals internally evaluated their performance relative to their expectations. We further hypothesized that reduced VS activation would relate dimensionally to lower self-reported IM across both PS and CT groups. Consistent with these hypotheses, VS and related motivation circuitry preferentially activated to higher confidence task choices and to reward prediction error during performance feedback. VS activation during task choices related selectively to IM but not EM. CONCLUSIONS: Our findings highlight the role of VS in encoding self-generated reinforcement signals, and demonstrate a selective relationship between VS activation and IM. Understanding the link between VS dysfunction and impaired IM will facilitate therapeutic advances to remediate IM deficits in those at risk for psychosis.
Archives of Sexual Behavior · 2026-04-24
articleOpen accessPsychosis spectrum symptoms, including a range of unusual thoughts and perceptual abnormalities, are markers of increased vulnerability to psychotic disorders. Sexual and gender diverse (SGD) populations experience higher rates of psychotic disorders than the general population, raising the possibility that emerging adult SGD individuals may also report elevated psychosis spectrum experiences. We hypothesized that SGD emerging adults would report higher rates of psychosis spectrum symptoms than the general population. In line with intersectional frameworks, we further hypothesized that rates would be higher among individuals with multiple marginalized identities. We screened SGD emerging adults (ages 18-24; N = 376) for a clinical trial of a mobile health intervention to decrease suicide risk. A brief eligibility screening questionnaire assessed racial, ethnic, sexual, and gender identities. The Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND) psychosis screener questions were used to assess self-reported unusual thoughts and perceptual abnormalities. Psychosis spectrum symptoms were reported by 40% of the screened sample versus 23% in the general population. The probability of endorsing symptoms (OR = 1.528, 95% CI = 1.16-1.99, p = 0.002) increased with each additional minority status identification (i.e., race, ethnicity, sexual identity, gender identity). Future research should explore unique factors contributing to the heightened rates of self-reported psychosis spectrum symptoms among these minority populations and attempt to test the replicability of these findings.
Machine learning enables efficient neurocognitive profiling in patients with schizophrenia
Nature Mental Health · 2026-01-07 · 1 citations
articleSchizophrenia Bulletin · 2026-04-03
articleOpen accessBACKGROUND AND HYPOTHESIS: Persistent negative symptoms (PNS) often emerge early in the course of schizophrenia spectrum disorders, significantly impair long-term functional outcomes, and remain difficult to treat, with no consistently effective interventions available. The manifestation of PNS in individuals with first-episode psychosis (FEP) engaged in coordinated specialty care (CSC) in the United States remains largely unknown. This study characterizes negative symptoms in routine clinical care using data from the Early Psychosis Intervention Network's Connection Learning Healthcare System, with a focus on a subcohort of individuals with PNS. STUDY DESIGN: Practice-based data were collected every 6 months over a 2-year period from 1289 participants across 23 CSC programs using a Core Assessment Battery (CAB) comprised of clinician-rated and self-report measures. Negative symptoms were quantified across CAB items, allowing for categorization of participants into PNS (n = 79) and non-PNS groups (n = 455). Group comparisons examined outcomes across CAB items, and exploratory mediation analyses focused on the role of engagement in outcomes relative to PNS. STUDY RESULTS: Individuals with PNS had higher rates of schizophrenia and lower social and role functioning compared to those in the non-PNS group. Exploratory analyses indicated that service engagement at 6 months mediated the negative relationship between PNS and 12-month social and role functioning. CONCLUSIONS: These findings highlight the challenge of PNS in individuals with FEP receiving CSC, the importance of early service engagement, and an opportunity to develop targeted interventions and refine treatment approaches to improve outcomes in this unique subgroup.
bioRxiv (Cold Spring Harbor Laboratory) · 2026-04-14
articleOpen accessAbstract Background Perinatal mood and anxiety disorders (PMADs) are among the most common and consequential complications of pregnancy. The perinatal period is also characterized by profound hormonal fluctuations and large-scale brain plasticity. However, the mechanisms linking these neurobiological changes to psychiatric risk are poorly understood. Prospective, clinically informed studies are needed to identify quantitative biomarkers and clarify pathways linking perinatal neurobiology to PMADs risk. Methods This report describes the design of a prospective, longitudinal cohort study integrating multimodal neuroimaging, biofluid sampling, and deep clinical phenotyping to enable precision characterization of neurobiological trajectories of PMADs risk. Twenty-five individuals at elevated risk for PMADs will be recruited prior to conception and followed across six in-person timepoints spanning the menstrual cycle, pregnancy, and early postpartum, with additional remote follow-ups through the first postpartum year. Data collection includes high-resolution structural MRI, functional brain mapping using multi-echo resting-state fMRI, diffusion MRI, arterial spin labeling, ultra-high field MR-based techniques for measuring glutamate (GluCEST and 1 HMRS), biofluid sampling, and comprehensive clinical, behavioral, and cognitive assessments. Structured clinical interviews assess categorical diagnoses while dimensional symptom measures capture heterogeneity and transdiagnostic features of perinatal psychopathology. Longitudinal analyses will model nonlinear trajectories of brain and symptom change across the perinatal period as well as evaluate whether preconception network features and menstrual cycle-related brain changes are associated with subsequent perinatal symptom emergence. Discussion This cohort study establishes a longitudinal, multimodal framework for investigating neurobiological changes across the transition to pregnancy in individuals at elevated risk for PMADs. By anchoring pregnancy-related brain changes to preconception and menstrual cycle-related variability within the same individuals, this study is designed to evaluate associations between preconception hormone sensitivity, pregnancy-induced neuroplasticity, and PMADs risk. The resulting dataset will provide a deeply phenotyped longitudinal resource for investigating brain-behavior relationships across the perinatal period. Findings are expected to inform future larger-scale studies aimed at advancing mechanistic understanding of PMADs, improving individualized risk stratification, and supporting development of personalized preventive and neuromodulatory interventions.
Schizophrenia Bulletin · 2025-11-07 · 1 citations
articleSenior authorCategorical models of mental illness have come under increasing scrutiny in recent years, but there is no uniformly accepted alternative. One option that has gained attention in psychiatry is clinical staging, which frequently refers to staging models in other areas of healthcare, most prominently that of oncology/cancer. Yet, such comparisons are often inadvertently broad and leave unanswered questions about the applicability of cancer staging models to mental health. To address this gap, we convene expertise in oncology and psychiatry to better understand features of the clinical staging model in theory and practice as applied to cancer, and its potential translation to psychosis as an example of a mental illness. We compare and contrast features of the staging model in the context of illness development in cancer, consider how these features might port over to psychosis, and finally, the ways in which staging might need to be adapted if it is to have validity and clinical utility for psychosis.
UNC Libraries · 2025-12-06
articleOpen accessAIM: To harmonize two ascertainment and severity rating instruments commonly used for the clinical high risk syndrome for psychosis (CHR-P): the Structured Interview for Psychosis-risk Syndromes (SIPS) and the Comprehensive Assessment of At-Risk Mental States (CAARMS). METHODS: The initial workshop is described in the companion report from Addington et al. After the workshop, lead experts for each instrument continued harmonizing attenuated positive symptoms and criteria for psychosis and CHR-P through an intensive series of joint videoconferences. RESULTS: Full harmonization was achieved for attenuated positive symptom ratings and psychosis criteria, and modest harmonization for CHR-P criteria. The semi-structured interview, named Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS (PSYCHS), generates CHR-P criteria and severity scores for both CAARMS and SIPS. CONCLUSIONS: Using the PSYCHS for CHR-P ascertainment, conversion determination, and attenuated positive symptom severity rating will help in comparing findings across studies and in meta-analyses.
UNC Libraries · 2025-12-05
articleOpen accessUNC Libraries · 2025-12-05
articleOpen accessUNC Libraries · 2025-12-05
articleOpen accessIndividuals at clinical high risk for psychosis (CHR) have variable clinical outcomes and low conversion rates, limiting development of novel and personalized treatments. Moreover, given risks of antipsychotic drugs, safer effective medications for CHR individuals are needed. The Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ) Program was launched to address this need. Based on past CHR and schizophrenia studies, AMP SCZ assessed electroencephalography (EEG)-based event-related potential (ERP), event-related oscillation (ERO), and resting EEG power spectral density (PSD) measures, including mismatch negativity (MMN), auditory and visual P300 to target (P3b) and novel (P3a) stimuli, 40-Hz auditory steady state response, and resting EEG PSD for traditional frequency bands (eyes open/closed). Here, in an interim analysis of AMP SCZ EEG measures, we assess test-retest reliability and stability over sessions (baseline, month-2 follow-up) in CHR (n = 654) and community control (CON; n = 87) participants. Reliability was calculated as Generalizability (G)-coefficients, and changes over session were assessed with paired t-tests. G-coefficients were generally good to excellent in both groups (CHR: mean = 0.72, range = 0.49–0.85; CON: mean = 0.71, range = 0.44–0.89). Measure magnitudes significantly (p < 0.001) decreased over session (MMN, auditory and visual target P3b, visual novel P3a, 40-Hz ASSR) and/or over runs within sessions (MMN, auditory/visual novel P3a and target P3b), consistent with habituation effects. Despite these small systematic habituation effects, test-retest reliabilities of the AMP SCZ EEG-based measures are sufficiently strong to support their use in CHR studies as potential predictors of clinical outcomes, markers of illness progression, and/or target engagement or secondary outcome measures in controlled clinical trials.
Recent grants
NIH · $750k · 2012
Frequent coauthors
- 727 shared
Raquel E. Gur
Children's Hospital of Philadelphia
- 681 shared
Ruben C. Gur
Children's Hospital of Philadelphia
- 507 shared
Tyler M. Moore
California University of Pennsylvania
- 324 shared
Theodore D. Satterthwaite
Children's Hospital of Philadelphia
- 263 shared
Daniel H. Wolf
University of Pennsylvania
- 219 shared
David R. Roalf
- 218 shared
Kosha Ruparel
- 204 shared
Ran Barzilay
University of Pennsylvania
Education
- 2002
Ph.D., Psychology - Clinical Science and Psychopathology Research
University of Minnesota
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