Refining targets for urban remediation in early psychosis

The emergence of psychosis generates city avoidance-a drastic decrease in city attendance and a lack of capacity to benefit from city's restorative resources among early psychosis patients (EP). Patients with low and moderate city attendance (self-reported duration and frequency of city outings before and after first episode of psychosis) have reduced access to important city resources and may benefit from a city-specific recovery-oriented program. This paper aims to refine the targets for such an intervention aimed at reducing city avoidance.

Sociodemographic characteristics, urban practices, and psychological reactions in the city of 117 EP patients were collected via a tailor-made questionnaire. Survey-based data and medical record-based data were compared through Bayesian modelling based on the degree of city attendance.

19 % of EP patients reported low city attendance (<1 h/day), 47.4 % reported moderate city attendance (1-4 h/day) and 33.6 % reported high city attendance (>4 h/day). Variables discriminating between patients with low, moderate, and high city attendance were sex, low level of premorbid adjustment, low level of functioning at the end of the treatment phase, global negative perception of the city, higher levels of anxiety and persecutory feelings, and elements related to social defeat.

A significant proportion of EP patients avoids the city and has potentially restricted access to city resources. We identified various patients' and environment characteristics of interest when designing a strategy aimed at reducing city avoidance and promoting a better integration in the community for early psychosis patients.