Psychosis is the most ineffable experience of mental disorder. We provide here the first co‐written bottom‐up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically‐informed perspectives. First‐person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud‐based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self‐referentiality and permeated self‐world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re‐establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.

Phenomenological psychopathology is a body of scientific knowledge on which the clinical practice of psychiatry is based since the first decades of the twentieth century, a method to assess the patient's abnormal experiences from their own perspective, and more importantly, a science responsible for delimiting the object of psychiatry. Recently, the frontiers of phenomenological psychopathology have expanded to the productive development of therapeutic strategies that target the whole of existence in their actions. In this article, we present an overview of the current state of this discipline, summing up some of its key concepts, and highlighting its importance to clinical psychiatry today. Phenomenological psychopathology understands mental disorders as modifications of the main dimensions of the life-world: lived time, lived space, lived body, intersubjectivity, and selfhood. Psychopathological symptoms are the expression of a dialectical modification of the proportions of certain domains of the life-world or of the lived experience. The far-reaching relevance of the concepts of proportion and dialectics for the clinical agenda is explored. The article presents two contemporary models for clinical practice based on phenomenological psychopathology: Dialectical-proportional oriented approach and Person-centered dialectic approach (P.H.D. method). The main characteristics of these approaches are considered, as well as the new perspectives they bring to the challenges of psychiatric care in the twentieth-first century.

ResumoAs síndromes demenciais são caracterizadas pela presença de déficit progressivo na função cognitiva, com maior ênfase na perda de memória, e interferência nas atividades sociais e ocupacionais. O diagnóstico diferencial deve, primeiramente, identificar os quadros potencialmente reversíveis, de etiologias diversas, tais como alterações metabólicas, intoxicações, infecções, deficiências nutricionais etc. Nas demências degenerativas primárias e nas formas seqüelares, o diagnóstico etiológico carrega implicações terapêuticas e prognósticas. Sabe-se que o diagnóstico definitivo da maioria das síndromes demenciais depende do exame neuropatológico. Entretanto, uma avaliação clínica cuidadosa incluindo anamnese detalhada, exames físico e neurológico, associado a determinações bioquímicas e de neuroimagem, podem possibilitar maior acurácia no diagnóstico diferencial. Inovações tecnológicas servindo-se de métodos de neuroimagem estrutural e funcional, bem como de técnicas de biologia e genética molecular, têm apresentado perspectivas para o diagnóstico precoce das demências, particularmente da doença de Alzheimer. As diversas etiologias implicadas no desenvolvimento de síndromes demenciais, bem como as respectivas condutas diagnósticas, serão revistas neste artigo.Palavras-chave: Demência, diagnóstico diferencial, doença de Alzheimer, demência vascular, demência não-Alzheimer. AbstractDementia is a syndrome characterized by progressive impairment of cognitive functions, particularly in memory, which affects social and occupational activities. The differential diagnosis must, firstly, identify potentially treatable causes of cognitive impairment, addressing the different etiologies of reversible dementia such as metabolic alterations, intoxications, CNS infections, and nutritional deficiencies. The correct and early diagnosis of primary degenerative dementia carries therapeutic and prognostic implications, which may attenuate the inevitable cognitive and behavioral deficits.

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