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.
Highlights
An important body of literature suggests that growing up in an urban environment during childhood is a risk factor for the later development of psychosis (1–4)
In a first paper (5), we studied the way early psychosis (EP) patients experience being in the city, with the aim to identify places of stress
In a second paper (6), we identified some of the strategies EP patients adopt in order to face these stressful elements, such as establishing sensory bubbles, creating niches and breaks in the city, or carefully programming trajectories in the city
Summary
An important body of literature suggests that growing up in an urban environment during childhood is a risk factor for the later development of psychosis (1–4). Within the city and psychosis nexus, researchers in psychiatry have so far neglected to study the way patients experience the urban environment, how they use it, and to what degree they manage to gain access to it. This failure to address this aspect of the problem and the absence of studies doing so through the eyes of patients are limitations that need to be overcome. The exploration of patients’ experience of the city environment may contribute to generate hypotheses to explain why growing up in an environment is a risk factor for later development of psychosis; it could increase our understanding of the phenomenon of social withdrawal often described in psychosis patients. 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
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