Primarily on the basis of epidemiological studies, recent research in psychiatry has established a robust link between urban living and psychosis. This paper argues first, that an experienced-based approach, moving beyond epidemiology, is needed in order to enable more fine-grained understandings of the city/psychosis nexus. The second part of the paper presents preliminary fieldwork results based on video-elicitation sessions with first-episode patients with psychotic disorders. These results lead to the generation of a series of hypotheses for further research on the role of density, sensory overload and social interaction as factors in the onset of non-affective psychoses. The conclusion discusses the insights gained from viewing the city as an experiential milieu rather than as a set of substances. We argue that such insights enable, on the one hand, observation of the role of specific places and situations - and thus to unpack 'the city'; and, on the other, to envisage the urban milieu as a nexus of possible sites of recovery.

The background of this study is recent work on the correlation between urban living and psychosis. It is part of a larger interdisciplinary research project using an experience-based approach to the citypsychosis nexus. The aim of this paper is to investigate how, soon after a first episode of psychosis, patients manage urban factors of stress. Methodologically, it is based on video-elicitation interviews of urban walks and ethnographic observations in a community care centre in the city of Lausanne, Switzerland. It shows that patients use three tactics: creating sensory bubbles; programming mobility; and creating places of comfort. On the basis of these findings, the paper discusses how the approach and results of our study can inform strategies of recovery that are both user-driven and take into consideration the importance of places and situations in the city in the phase following a first episode.

Background: A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies. Method:A comprehensive literature survey on the main computerised medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted. Results:The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress". The latter may link urban upbringing to the development of psychosis through overlapping neuro-and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce. Conclusions: Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, This article is protected by copyright. All rights reserved.bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental wellbeing.

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Background: A considerable amount of research has explored the link between living in an urban environment during childhood and the increased risk to develop psychosis. However, the urban milieu is more than a risk factor as it is also a place for socialization and enrichment. The aims of the current study were to explore, in a large sample of early psychosis (EP) patients, their pattern of use of the city, their perception when exposed to various critical stressors, and their sensitivity to diverse forms of stimuli. Methods: We sent a questionnaire (based on previous work conducted in a group of patients, including video-recorded walk-along in the city and a literature review) to 305 EP patients and to 220 medical students. Results: Response rate in patients was low (38%). City avoidance and negative perceptions towards the urban environment increased in patients after onset of psychosis. Patients’ tendency to avoid city center correlates with both problematic social interactions and stimuli perceived as unpleasant. Patients seemed less likely to enjoy urban spaces considered as relaxing, suggesting a lower capacity to benefit from positive aspects of this environment. Conclusions: The development of psychosis influences the way EP patients perceive the city and their capacity to feel at ease in the urban environment, leading to a high rate of city avoidance. Considering the possible influence of city avoidance on social relations and the recovery process, the development of strategies to help patients in this regard may have a significant effect on their recovery process.