Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Early Interv Psychiatry. 2020 Aug;14(4):398-409. doi: 10.1111/eip.12861. Epub 2019 Aug 6.
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.
A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted.
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.
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, 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 well-being.
越来越多的证据表明，城市生活有助于精神分裂症的发展。然而，这一现象背后的机制尚不清楚。本文旨在探讨这方面的现有最佳知识，确定研究空白，并概述未来的研究策略。
对主要计算机医学研究数据库进行了全面的文献调查，时间限制为 2017 年 8 月，主题为城市环境与精神分裂症。
城市环境的影响可能源于广泛的因素（从城市物质特征到社会生活的压力影响），导致“城市压力”。后者可能通过重叠的神经和社会发展途径将城市教养与精神分裂症的发展联系起来，可能通过中脑边缘多巴胺能系统的过度活跃来统一。然而，“城市压力”的定义很差，基于患者对城市环境的体验的研究很少。
尽管积累了数据，但到目前为止，大多数研究都未能解释城市环境的具体因素如何在患者的日常生活中结合起来，形成保护或破坏环境。这破坏了将大量流行病学知识转化为有效治疗和城市发展的能力。因此，关于城市环境的新研究应该更加跨学科，弥合不同学科（精神病学、流行病学、人文地理学、城市规划等）的知识，以丰富研究方法，确保有效治疗和预防策略的发展，并创造有助于心理健康的城市环境。
