Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland.
Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Soc Psychiatry Psychiatr Epidemiol. 2020 Mar;55(3):273-283. doi: 10.1007/s00127-019-01795-7. Epub 2019 Oct 30.
Urban living is a major risk factor for psychosis. Considering worldwide increasing rates of urbanization, new approaches are needed to enhance patients' wellbeing in cities. Recent data suggest that once psychosis has emerged, patients struggle to adapt to urban milieu and that they lose access to city centers, which contributes to isolation and reduced social contacts. While it is acknowledged that there are promising initiatives to improve mental health in cities, concrete therapeutic strategies to help patients with psychosis to better handle urban stress are lacking. We believe that we should no longer wait to develop and test new therapeutic approaches.
In this review, we first focus on the role of urban planning, policies, and design, and second on possible novel therapeutic strategies at the individual level. We review how patients with psychosis may experience stress in the urban environment. We then review and describe a set of possible strategies, which could be proposed to patients with the first-episode psychosis.
We propose to group these strategies under the umbrella term of 'urban remediation' and discuss how this novel approach could help patients to recover from their first psychotic episode.
The concepts developed in this paper are speculative and a lot of work remains to be done before it can be usefully proposed to patients. However, considering the high prevalence of social withdrawal and its detrimental impact on the recovery process, we strongly believe that researchers should invest this new domain to help patients regain access to city centers.
城市生活是精神分裂症的一个主要危险因素。考虑到全球城市化率不断上升，需要新的方法来提高城市中患者的幸福感。最近的数据表明，一旦出现精神分裂症，患者就难以适应城市环境，他们失去了进入市中心的机会，这导致了孤立和社交接触减少。虽然人们承认有一些有前途的举措可以改善城市的心理健康状况，但缺乏具体的治疗策略来帮助精神分裂症患者更好地应对城市压力。我们认为，我们不应该再等待，而应该开发和测试新的治疗方法。
在这篇综述中，我们首先关注城市规划、政策和设计的作用，其次关注个体层面可能的新治疗策略。我们回顾了精神分裂症患者在城市环境中可能经历的压力。然后，我们回顾并描述了一系列可能的策略，这些策略可以被提议给首次出现精神分裂症的患者。
我们将这些策略归为“城市修复”这一总括术语，并讨论了这种新方法如何帮助患者从首次精神病发作中康复。
本文提出的概念是推测性的，在将其有用地应用于患者之前，还有很多工作要做。然而，考虑到社交退缩的高患病率及其对康复过程的不利影响，我们强烈认为研究人员应该投资这一新领域，帮助患者重新获得进入市中心的机会。
