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.

Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.

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.

No abstract

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.

Background Frequently associated with early psychosis, depressive and manic dimensions may play an important role in its course and outcome. While manic and depressive symptoms can alternate and co-occur, most of the studies in early intervention investigated these symptoms independently. The aim of this study was therefore to explore the co-occurrence of manic and depressive dimensions, their evolution and impact on outcomes. Methods We prospectively studied first-episode psychosis patients (N = 313) within an early intervention program over 3 years. Based on latent transition analysis, we identified sub-groups of patients with different mood profiles considering both manic and depressive dimensions, and studied their outcomes. Results Our results revealed six different mood profiles at program entry and after 1.5 years follow-up (absence of mood disturbance, co-occurrence, mild depressive, severe depressive, manic and hypomanic), and four after 3 years (absence of mood disturbance, co-occurrence, mild depressive and hypomanic). Patients with absence of mood disturbance at discharge had better outcomes. All patients with co-occurring symptoms at program entry remained symptomatic at discharge. Patients with mild depressive symptoms were less likely to return to premorbid functional level at discharge than the other subgroups. Patients displaying a depressive component had poorer quality of physical and psychological health at discharge. Conclusions Our results confirm the major role played by mood dimensions in early psychosis, and show that profiles with co-occurring manic and depressive dimensions are at risk of poorer outcome. An accurate assessment and treatment of these dimensions in people with early psychosis is crucial.

Aim: Reduction of duration of untreated psychosis (DUP) remains a key goal of early intervention programs. While a significant body of literature suggests that a short DUP has a positive impact on outcome, little is known regarding the threshold above which various dimensions of outcome are impaired. In this study, we explore the DUP threshold that best discriminates subgroups with poorer outcome regarding global functioning and quality of life after 3 years of treatment.Method: A total of 432 patients were followed-up prospectively over 3 years. Several hypothetical cut-off points for DUP were tested in order to maximize differences in effect size for quality of life and general functioning.Results: While a DUP cut-off of 86 weeks defined two subpopulations with a difference of greatest effect size in quality of life after 3 years, it is already at a cut-off of 3 weeks of DUP that two subpopulations with a difference in global functioning of the greatest effect size was reached. Conclusion:DUP seems to have a differential impact on the various components of outcome, and in particular on quality of life and global functioning. Our data suggest that aiming at very short DUP is justified, but that DUP over 3 weeks are still compatible with good quality of life after 3 years of treatment.duration of untreated psychosis, early intervention, functioning, quality of life | INTRODUCTIONDelay between psychosis onset and exposure to appropriate treatment or 'duration of untreated psychosis' (DUP), has been identified as a key target in specialized early intervention programs in the early phase of psychotic disorders (Joa et al., 2007;Melle et al., 2008;NHS, 2015). This is based on the assumption that its reduction may have a positive impact on the course of symptoms and functioning (Melle et al., 2008).Several papers have shown DUP to be significantly associated with outcomes: these studies reported lower severity of symptoms, better functioning and quality of life, as well as higher remission rates in patients with shorter DUP (