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The Designed Environment and How it Affects Brain Morphology and Mental Health
Abstract
Background:
The environment is inextricably related to mental health. Recent research replicates findings of a significant, linear correlation between a childhood exposure to the urban environment and psychosis. Related studies also correlate the urban environment and aberrant brain morphologies. These findings challenge common beliefs that the mind and brain remain neutral in the face of worldly experience.
Aim:
There is a signature within these neurological findings that suggests that specific features of design cause and trigger mental illness. The objective in this article is to work backward from the molecular dynamics to identify features of the designed environment that may either trigger mental illness or protect against it.
Method:
This review analyzes the discrete functions putatively assigned to the affected brain areas and a neurotransmitter called dopamine, which is the primary target of most antipsychotic medications. The intention is to establish what the correlations mean in functional terms, and more specifically, how this relates to the phenomenology of urban experience. In doing so, environmental mental illness risk factors are identified.
Conclusions:
Having established these relationships, the review makes practical recommendations for those in public health who wish to use the environment itself as a tool to improve the mental health of a community through design.
... A psiquiatra Lilith Abrahamyan Empson e colaboradores (2019) confirmam a consistência de diversos estudos que apontam como o ambiente urbano pode desempenhar papel significativo no funcionamento de nossos corpos e mentes, desde a insuficiência de vitamina D até profundas diferenças subjetivas, assim como a possibilidade de facilitar o disparo de variados sofrimentos psíquicos (Golembiewski, 2016). Segundo as autoras, não "há nenhum outro lugar onde o design seja mais onipresente do que na cidade, onde literalmente cada pedaço de lixo carrega significado e potencialmente pode tornar-se um gatilho para o desencadeamento de outras ações" (Abrahamyan Empson et al., 2019, p.4, tradução minha). ...
... A perspectiva biologicista alia-se à dualidade entre corpo e mente amplamente valorizada desde o século XVII. A atenção sobre o contexto é subestimada pela reprodução do jargão popular "mente sã, corpo são", mas em realidade, nosso funcionamento psíquico é também produção de como nossos corpos reagem aos entornos em que estamos presentes e sempre suscetíveis (Golembiewski, 2016). Imprudentemente, a questão ambiental na produção de saúde foi colocada praticamente à parte da discussão até o final da década de 1990, quando estudos começaram a olhar para ambas as variáveis, biológica e social (Goldsmith;Holzer;Manderscheid, 1998). ...
... É fundamental uma mudança nos ângulos de visão para avançarmos no preenchimento das diversas lacunas existentes nas indagações sobre a influência do ambiente urbano em nossa subjetividade. Atualmente, em nosso mundo contemporâneo, os sofrimentos psíquicos se apresentam como grandes custos sociais e financeiros para as cidades, e vale destacar que a população urbana no planeta apresenta crescimento exponencial (Golembiewski, 2016). ...
Este livro percorre uma série de pontos que se interligam e pendulam entre teorias e narrativas na interface entre o neoliberalismo, as drogas e a produção das cidades na América Latina. Para Hilderman Cardona Rodas, professor da Universidad de Medellín (Colômbia), trata-se de um “excelente trabalho em termos de revisão documental, trabalho de campo e compromisso intersubjetivo do autor em sua argumentação. Um magnífico arcabouço epistemológico para rastrear os cenários públicos de uso de drogas e a produção social de risco nas cidades pesquisadas. Os desenhos enriquecem o conteúdo e a expressão da obra, oferecendo suporte de valor estético às experiências do autor”. Segundo Gabriela Marques Di Giulio, professora da Faculdade de Saúde Pública da Universidade de São Paulo (USP), o livro “expõe panoramas robustos sobre os contextos estudados e suas especificidades, com provocações e reflexões sobre a urgência de uma mudança nos paradigmas de produção de nossas cidades, trazendo a dimensão do cuidado, e reforçando a relevância do processo de escuta da população local e de sua participação mais ativa no desenho urbano e na implantação de políticas”.
... The story further influences neural and endocrine systems through the biochemical correlates of these emotions (Sapolsky, 2017). It is evident then that architecture can directly influence health (Golembiewski, 2016), but how can architects plan for these effects? Antonovsky's salutogenic theory provides an accessible overarching logic for determining the health and well-being benefits of design (Golembiewski, 2012b), beyond the basics covered by Environmental Medicine 1,2 and without the need to understand any illnesses suffered by the environment's users. ...
... Perhaps because of these ancient origins, the correlation of aesthetics and health (and even on mortality) appears to be superstitious and occult and is thus not nearly as widely accepted as evidence suggests it should (Golembiewski, 2016). But the impact of aesthetics (such things as views and presence of potted plants) on health has been scientifically tested thousands of times, including dozens of studies against a null hypothesis (a statistical method used to demonstrate causality). ...
... Some are insignificant -for example, there is little phenomenological difference between a left or right turn, even though they are opposites. But many physical restrictions and opportunities are deliberately there to moderate our behaviour (Golembiewski, 2016). Consider the design of shops, for instance, where every detail is assessed on its capacity to improve sales (Turley & Milliman, 2000). ...
In this chapter, the author suggests adding another domain in our life to be viewed through the salutogenic lens: architectural design. In a creative and explorative discussion, the author analyses detailed and concrete examples and offers ideas on how architecture can advance comprehensibility, manageability and meaningfulness in our lives.
... It is unfortunate that the separation between mental health and urban design has been so longstanding (Drummond 2013) considering the high degree of interconnectivity between both fields. There is now a growing interest in how mental health promotion requires amenable environments to support wellbeing and to allow people to adopt and maintain healthy lifestyles (Mental health: strengthening our response 2016; Golembiewski 2016). This goes in line with the goal of urban design that is making urban areas functional, attractive, and sustainable (Boeing et al. 2014). ...
... They have made extraordinary associations between the mental illness sector of mental health, and urban development, including replicating epidemiological data (Kelly et al. 2010;van Os et al. 2010), and even tied these findings to specific neurological morphologies (Haddad et al. 2014;Lederbogen et al. 2011;Lederbogen et al. 2013). Attempts to draw the science of public/mental health and urban design is still rare according to the found literature, although it has been done, leading in some cases to practical recommendations for architects and urban designers to put mental health factors into consideration during the design process (Golembiewski 2012(Golembiewski , 2013(Golembiewski , 2016. ...
... While many studies have confirmed that exposure of individuals to natural environmentsincluding blue and green spacescan boost stress reduction and assist in mental recovery (Golembiewski 2012(Golembiewski , 2013(Golembiewski , 2016Depledge et al. 2011), there are still very few studies that address features of the designed environment that may either trigger mental illness or protect against it (Golembiewski 2016). This area of the urban design/mental health relationship can be particularly important in the post-war urban design, as a high percentage of people most probably suffer from various mental illnesses. ...
The review firstly explores the relationship between mental health and urban design, pursuing the role of urban design in both health promotion and illness prevention against the mental illness epidemics, by conducting a comprehensive literature search; secondly, a systematic literature search is conducted to explore the relationship between urban design and post-traumatic stress disorder (PTSD) specifically. Apparently, health in general and urban design do share a solid history, however, even though mental health/urban design relationship has been increasing over the past 20, they seem to share a weak historical relationship, and even recent research that tries to define links between the two is still preliminary. On the other hand, a gab in knowledge can be addressed regarding the relationship between PTSD and urban design.
... While these theories are all important to hospital design, they ignore the elephant in the room-that architecture can be psychologically manipulative, for better or for worse. Architecture does this by providing a narrative context that affects a person's behaviour, neural and endocrine systems, and through its influence on the brain and the body, architecture can directly influence health (Golembiewski 2016). Antonovsky's salutogenic theory provides an accessible overarching logic for determining these effects in design (Golembiewski 2012b). ...
... These emotions are not superficial but have real and long-lasting implications (Rudd, Vohs, & Aaker 2012). The science is relatively new, and requires far more research, but it appears that a number (if not all) of the neurotransmitters react to environmental stimuli, and therefore react to design (Golembiewski 2016). Acetylcholine, for instance, moderates balance, homeostasis, muscular tone and most of the things we associate with comfort-body warmth, the senses of touch and hunger (Changeux & Edelstein 2005). ...
... The idea that aesthetics have any impact on health (and even on mortality) appears to be superstitious and occult and is thus not nearly as widely accepted as it should be (Golembiewski 2016). The concept of aesthetic impact on health has been scientifically tested thousands of times, including dozens of studies against a null hypothesis-a statistical method used to demonstrate causality. ...
The term ‘salutogenic’ is widely used in healthcare architecture, even though very few healthcare architects have much of a handle on what the term means. Here, we clarify the key concepts of salutogenesis, demonstrate how they work and show how they have been designed into healthcare facilities to yield exemplary results.
The central idea is that there are three resources that combine to provide a Sense of Coherence—a forward thrust that resists the entropic forces of illness and infirmity. The sense of coherence is made up of resources that improve manageability—the capacity to maintain homeostasis and physical function; resources that improve comprehensibility—an ability to negotiate circumstances in order to maximise their benefit; and resources that enrich a sense of meaningfulness—the desires, causes and concerns that give us the need to resist illness in the first place.
... However, the intangible qualities of a home environment that address emotional, psychological, and/or social needs are rarely addressed. The building itself was generally considered as a 'disembodied commodity' [19], with no recognition that it is in fact "at the helm of a major force of neural functional dynamics" [20]. ...
... This relates to a person feeling that their abilities are accepted, they are supported to participate in their community and can get involved. We refer to this as emotional affordance: a concept that complements the work of others [20,25]. Collectively these four aspects of support in this chapter are referred to as enabling a sense of coherence (SoC). ...
For people with schizophrenia, home environments that are readily understandable, easily managed, provide opportunities for self-expression and support psycho-social needs can enhance their wellbeing. Importantly, symptoms of schizophrenia (including agitation, anxiety, helplessness, perceptual distortion) can potentially be reduced through responsive accommodation design. The embedded potential of design of homes to offer support or create hindrances for people with schizophrenia has been poorly explored. Cues as to what things are and how to function in a space can be designed to provide support. This chapter records a multi-prong action research approach to develop a resource to assist designers and service providers create responsive residential environments for people with impeded cognitive functioning. Research from such fields as environmental psychology, sociology and design, together with discussions with people with schizophrenia, indicates that quality of life for people with schizophrenia can be enhanced through design. A key outcome is a Framework that enables the user to both understand the reason why a person with schizophrenia may respond to the environment in a particular way and how to design to acknowledge that potential response.
... To date, the junction of neuroscience and architecture has validated many of the disciplinary tenets of good urban design, such as the value of inhabitable edges and the importance of landmarks and patterns for orientation and navigation, as well as reinforcing the importance of direct and indirect connections with nature [39][40][41]. Further, this collaboration has provided insights into the relationships between the design of the built environment and health and wellbeing for specific populations with diverse needs and abilities; populations that are often not captured under a generic umbrella of 'good' design [42]. ...
... While understanding what is known and being discovered about how specific stimuli and environments become associated with trauma and trigger fear responses will be valuable in 'reducing or removing' adverse stimuli and environmental stressors, arguably, even greater emphasis needs to be placed on creating defensible environments, not only in crisis shelters and accommodation, but also within permanent supported housing. Golembiewski [42], in a study exploring the neuroscientific basis of mental illness in relation to the design of the built environment, similarly identifies safety as the most essential aspect of environmental design. While certain common built environment features were identified, such as those promoting situational awareness, control over social interactions, pathways for escape, and avoidance of particular environmental triggers such as noise, they also contend that environments need to promote a 'compelling and positive story' that suggests safety and comfort [109] (p. ...
There is growing recognition of the importance of the design of the built environment in supporting mental health. In this context, trauma-informed design has emerged as a new field of practice targeting the design of the built environment to support wellbeing and ameliorate the physical, psychological and emotional impacts of trauma and related pathologies such as Post Traumatic Stress Disorder (PTSD). With high levels of prevalence of PTSD among people escaping homelessness and domestic violence, a priority area is the identification and application of evidence-based design solutions for trauma-informed supported housing. This study sought to examine the scope of existing evidence on the relationship between trauma, housing and design and the correlation of this evidence with trauma-informed design principles, and to identify gaps and opportunities for future research. In response to the commonly articulated limitations of the evidence-base in built environment design research, we combined a scoping review of literature on trauma, housing and design with insights from neuroscience to focus and extend understanding of the opportunities of trauma-informed design. We found that while limited in scope, there is strong alignment between existing evidence and the principles of trauma-informed design. We also identify three areas of future research related to the key domains of safety and security; control; and enriched environments.
... Moreover, neurobiological findings indicate that specific features of urban environment directly influence a range of psychosocial processes known to be associated with negative mental health outcomes and impact on relevant brain structures and functions (Giles-Corti et al., 2012;Golembiewski, 2016;Andreas Heinz et al., 2013;Lederbogen et al., 2011). ...
... On the above-mentioned grounds, living in cities and mental health should be taken as interdependent factors, which can impact one another. Hence, their relation should be taken into consideration when making further policies for development of healthy urban environments (Dye, 2008;Golembiewski, 2016;van Os et al., 2010;Vassos et al., 2012). ...
Die wachsende Zahl an Menschen, die aus ihren Herkunftsländern fliehen musste und nach 2015 in Berlin ankam, stellte städtische Einrichtungen und die Bereitstellung sozioökonomischer Dienstleistungen für Personen mit diversen soziokulturellem und politischen Hintergründen vor eine große Herausforderung. Es gilt anzunehmen, dass zusätzlich zu früheren traumatischen Erfahrungen, der mehrdimensionale und komplizierte Prozess der Verteilung von Geflüchteten in städtischen Räumen zu Belastungen führen und die Prävalenz psychischer Störungen erhöhen kann. Angesichts der Tatsache, dass geflüchtete Frauen verstärkt unter verschiedenen Formen stressbedingter Störungen leiden, zielt die Dissertation darauf ab, jene sozialen Stressoren in drei verschiedenen sozio-räumlichen Settings zu untersuchen, welchen sich geflüchtete Frauen bei ihrer Ankunft in Berlin ausgesetzt wahrnahmen.
... Increasing urban population can have side effects, which are systematic and mental health related (Srivastava, 2009, Gruebner et al., 2017, Anakwenze and Zuberi, 2013. Some studies have begun to establish a link between built form and mental health (Golembiewski, 2017, Golembiewski, 2016, Gharib et al., 2017 and that design features in urban environments can impact happiness (Pringle and Guaralda, 2018, Samavati and Ranjbar, 2017. Urban problems, such as crime or poverty, are not solely responsible for urban unhappiness. ...
... The review of literature which discusses mental health and urban environments highlights that there is empirical evidence which supports the argument that mental health is affected by urban living. Studies have found that urban environment factors and urban living can increase the occurrence of serious mental health illness such as schizophrenia (Lederbogen et al., 2013, Gruebner et al., 2017, Haddad et al., 2015, Lederbogen et al., 2011, van Os et al., 2010, psychiatric morbidity (Lewis andBooth, 1994, Peen et al., 2010), psychosis (Golembiewski, 2016, Golembiewski, 2017, as well as stress from population density (Yates, 2011, Okulicz-Kozaryn andMazelis, 2016). This reaffirms that there are particular environmental factors within urban areas that can increase the chance of developing a serious mental health condition. ...
Cities, towns, streets and urban places are comprised of urban features arranged according to an array of planning rules, economic, political, social and community needs. From a macro scale, they are a patchwork of land uses, roads, and infrastructure integrated, in some ways flawlessly, but at a finer scale the very fabric of this intricate patchwork has a profound impact and influences the lives of people on a daily basis. Often, unbeknownst to the user. Urban places can have positive effects, such as boosting individual happiness, when they are comprised of visually pleasing aesthetic qualities (Seresinhe et al., 2019). Or, they can also have negative effects, such as increasing the likelihood of developing mental illnesses (Kelly et al., 2010, van Os et al., 2010). Since the new millennium studies have increasingly investigated the relationship between environment factors and mental health, well-being and happiness (Seresinhe et al., 2019, Bratman et al., 2015, Hartig et al., 2003, MacKerron and Mourato, 2013, Van den berg et al., 2010, White et al., 2013, Okulicz-Kozaryn and Mazelis, 2016, Abdullah and Zulkifli, 2016). Some of these studies have found that urban dwelling (Srivastava, 2009, Gruebner et al., 2017) and the actual physical fabric of the environment (urban design) impacts upon mental health (Golembiewski, 2017, Golembiewski, 2016, Gharib et al., 2017). Happiness can also be adversely impacted by urban environments (Pringle and Guaralda, 2018, Samavati and Ranjbar, 2017, Abdullah and Zulkifli, 2016).
It is important to understand how these notions of happiness and well-being are impacted by environmental factors, such as the designed environment, because they are components of mental health (World Health Organization, 2004, Galderisi et al., 2015, Lamers et al., 2011). The designed environment is where a vast majority of the population, currently, and will continue to live. The rapid increase in urban population is amongst the most important global health issues this century (Srivastava, 2009). Therefore, maintaining public health is increasingly important for developed nations, that are experiencing high rates of population growth within urban areas, because they are exposing more people to urban dwelling, which can adversely impact upon the various components of mental health. Thus, investigating ways in which planning and design could mitigate or reduce such impacts is essential.
Whilst that is an aim for future research, within this article, the authors explore an overview of literature on mental health and environmental factors, the concepts of happiness and well-being, in relation to the environment, including the theories which are referenced in literature from a variety of medical, planning, architecture and design fields, to arrive at an understanding of how these concepts may be applied to the urban context. This is proposed through the development of the theoretical and conceptual framework which is formed as a result of reviewing a range of literature and theories that discuss mental health, happiness, well-being, and the physical environment (both nature and urban). The aim of this paper is to present the theoretical and conceptual framework used to guide the research process, so that reliable, empirical evidence can be developed in subsequent studies.
Keywords: Affective state, happiness, positive emotion, urban design, urban planning, well-being, health
... But before we head for conclusions, it is critical to understand the Ecological Hypothesis for Schizophrenia, and where it stands alongside current epidemiological thinking in this space. As we shall see shortly, the theory is tenable but even so, any relationships that draw together the built environment and mental illness will be regarded with suspicion because the idea contradicts an engrained axiom of modern medicine: the assumption that the brain is a cognition machine and mental illness is a fault in the machinery, not the input (the phenomenological environment) (Golembiewski, 2016). As Kelly and O'Callaghan report, the epidemiology of severe psychotic illness is strikingly prevalent in urban areas – to the extent that this may be the single largest and most robust finding about the spectrum of psychotic conditions (Kelly et al., 2010) There are a few hypotheses that attempt to grapple with this data, but none have especially robust correlations between the proposed active agents and the outcomes – that is the symptomatology of psychosis. ...
... Also, design is ubiquitous in the urban environment (in contrast to rural environments). In the city, virtually every piece of litter has design intention; every building, billboard, shop window and flashing light contains instructions and meanings (Golembiewski, 2016). Even social exchanges cannot be meaningfully separated from the designed context. ...
The finding that schizophrenia and other severe psychoses are largely urban phenomena raises questions about why this is the case and how the physical environment affects the brain. This article outlines the background for the Ecological Hypothesis for Schizophrenia, proposing that any environment makes demands on people, and that these can be naturally inhibited, especially if the nature of the demands are unsavoury or unwanted. But a person’s inhibition reflex decreases in the face of a continual onslaught of demands to the point where the person just can’t cope; the result is a series of unwanted and often undesirable reactions to the demands of the phenomenological environment.
Both social and physical environments trigger demands, but the latter is usually more insidious. This is especially true in the urban environment because every part of it is deliberately designed to assert meanings and messages. These demands trigger action and thought on a latent level of awareness, and become more potent as an inability to ‘cope’ sets in. This is because dopamine, the neurotransmitter that’s thought to moderate the saliency of phenomena is also what gives perceptions more compulsive power. As phenomenological experience spirals further out of control with on-going environmental stimulation, so too will dopamine. The automatic behaviours that the environment triggers are the major symptoms that we recognise as psychosis.
This article is Part 1 of a pair of articles describing the complex relationship between severe psychosis and the environment.
... A review published in 1974 revealed higher rates of psychiatric disorders in urban areas [7], especially for mood disorders and anxiety disorders [8]. Further studies showed that living in a city is one of the most predictable factors for developing major psychiatric disorders like schizophrenia [9,10]. A Danish study on patients with schizophrenia uncovered a dose-dependent effect: individuals who lived in a highly urbanized area during the first 15 years of their life show a 2.75 times higher prevalence to develop schizophrenia [11]. ...
Background: Living in the city is associated with a higher risk of suffering from stress, anxiety, and depression. Due to an increase of migration to the city, the association between mental health and city life is highly relevant to society. Methods: We analyzed data of 9573 participants (Ø 55.3 years, SD = 7.4) of the Paracelsus 10,000 study (Salzburg, Austria) who were classified into having or not having depressive symptoms. Population density, green space, and noise around the home address of the participants were collected and tested for correlations with mental health defined by depressive symptoms. We additionally tested whether migration status influenced the effect of urbanization on mental health. Results: There is a positive correlation between degree of urbanization and the probability of suffering from depressive symptoms (p = 0.011), yet this effect is independent of the migration background (p = 0.581). Participants in areas with high residential density were significantly more likely to suffer from poor mental health (p = 0.006 unadjusted). No significant association could be found between mental health and noise (p = 0.126 unadjusted) or green space neither regarding distance to closest green space (p = 0.549 unadjusted), nor size of green space (p = 0.549 unadjusted). Conclusions: In the Paracelsus 10,000 cohort, living in the city is associated with lower mental health, especially in participants with a high population density in the direct neighborhood. This might be due to social stress yet does not reflect minority stress in migrants. However, the influence of noise pollution and green space on mental health is limited in this cohort.
... All of these ideas confirmed the fact that the design of the environment had a direct effect on people with dementia, and they showed no reduced ability to engage in their daily behaviours, in contrast to what is normally associated with the deterioration and progression of the disease. Since then, there has been growing interest in understanding and knowing how and why mental health requires responsible and sustainable environments, providing wellbeing and allowing people to adopt and maintain healthy lifestyles [31]. ...
The recent COVID-19 pandemic has catalysed a new awareness of what living and working spaces should look like from a different perspective, and healthier cities and architecture have arisen because of inescapable public demand. Society has become clearly aware that there are still unhealthy concentrations within its environment. Spaces in cities are still being built that can favour the spread of diseases, in addition to using harmful construction materials. Living spaces must not only be sustainable, functional, and aesthetically beautiful but also comfortable, safe, and accessible, and, above all, they must be healthy. Healthy architecture has emerged as a new paradigm. This is the subject area of this work. This paper describes and develops the nature of this concept and proposes a novel definition of healthy architecture, aiming to compile state-of-the-art knowledge with a qualitative empirical and multi-method process, using case studies. This article provides a global perspective on new approaches and proposes a Decalogue with the basic principles that an environment or building must comply with in order to be healthy. The main contribution is to establish the basis for the creation of a new healthy architecture epistemology, focussing on cognitive, emotional, and physiological stimuli. This paper can help health professionals, designers, and architects, as well as companies and public administrations, to follow an innovative path in the planning of healthier cities and buildings.
... Medical practitioners are belatedly realizing that architectural culture's dominant, ingrained aesthetic is not compatible with laboratory measurements indicating salutogenic environments [31][32][33][34][35][36][37][38]. The established approach to design undermines recent trends in using the environment to significantly aid in healing. ...
After decades of being ignored, the concept of beauty, as understood by the non-architect, has recently been making a comeback in architecture, not so much in the practice itself, as in appeals for design solutions that are more human-centered and not dictated by abstract principles. Architectural beauty needs to be evaluated from its effects on human health. This study discusses two diagnostic tools for measuring the degree of architectural “beauty” and presents the results of the pilot application of one of them. The goal is to use diagnostic imaging for evaluations. Analytical elements are introduced from disciplines with which practitioners are normally not familiar, such as artificial intelligence, medicine, neuroscience, visual attention and image-processing software, etc. In addition to the diagnostic tools, this paper ties related ideas on objective beauty into a novel synthesis. These results support the idea of a feasible, “objective” way to evaluate what the users will consider as beautiful, and set the stage for an upcoming larger study that will quantitatively correlate the two methods.
... These risk attributes could illuminate the relationship between urban exposure and schizophrenia. First, design meanings, triggers, symbols, etc., (high-rise buildings, narrow streets with no escape ways, less street planting and gardens, and billboards and flashing lights) of the built urban environment were associated with aberrant brain morphologies and reactivity patterns 46 . Furthermore, exposure to less green space in urban design was associated with a high incidence of psychological stress and schizophrenia 47,48 . ...
Exposure to urban birth, childhood trauma, and lower Intelligence Quotient (IQ) were the most well-established risk factors for schizophrenia in developed countries. In developing countries, whether urban birth is a risk factor for schizophrenia and how these factors are related to one another remain unclear. This study aimed to investigate whether IQ mediates the relationship between urban birth or childhood trauma and first-episode schizophrenia (FES) in China. Birthplace, childhood trauma questionnaire (CTQ), and IQ were collected from 144 patients with FES and 256 healthy controls (HCs). Hierarchical logistic regression analysis was conducted to investigate the associations between birthplace, childhood trauma, IQ, and FES. Furthermore, mediation analysis was used to explore the mediation of IQ in the relationship between birthplace or childhood trauma and FES. After adjusting for age, sex and educational attainment, the final model identified urban birth (odds ratio (OR) = 3.15, 95% CI = 1.54, 6.44) and childhood trauma (OR = 2.79, 95% CI = 1.92, 4.06) were associated an elevated risk for FES. The 52.94% total effect of birthplace on the risk of FES could be offset by IQ (indirect effect/direct effect). The association between childhood trauma and FES could be partly explained by IQ (22.5%). In total, the mediation model explained 70.5% of the total variance in FES. Our study provides evidence that urban birth and childhood trauma are associated with an increased risk of FES. Furthermore, IQ mediates the relationship between urban birth or childhood trauma and FES.
... This indicates that our neighbourhood parks are highly adaptive, where the design emphasized the importance of wayfinding and legibility to make people aware of their surroundings. These findings support the study of Golembiewski [20], where it was observed that readable space and a clear sense of direction aid the capacity of mental process to screen out distractions, hence promote fascination to cognitive memory. ...
Salutogenesis works on a prospective basis by considering creating, enhancing, and improving physical, mental, and social well-being. This research aims to identify the best landscape stimuli that comply with the criteria of both cognitive and salutogenic aspects for reducing stress. This research was conducted by first developing the theory-based model and assessment checklist, followed by preliminary studies that assessed18 parks in Klang Valley based on a neuro-salutogenic landscape checklist. The results indicated that Taman Aman, Petaling Jaya recorded the best neuro-salutogenic landscape stimuli with the highest score for all three aspects of adaptive, restorative, and assertive elements. This research concludes an interesting theory for design professionals about how neural potentials could explains the specific human response to different design settings.KeywordsSalutogenicCognitiveStress mitigationLandscape stimuli
... (Fish looking upwards) According to ETP, we live in a material world surrounded by objects and we're utterly unaware of how those objects command our behavioural responses (Gibson, 2014). Imagine this… our objects, that we take for granted as inanimate and powerless, are not just designed by us-deliberately to solicit such effects, but they also end up designing us (Golembiewski, 2015). Preposterous, you might say! ...
This chapter examines the notion of the ‘prepared mind’, popular in serendipity and creativity studies, in ways that defend and advance the ontological position that mind and context are co-constitutive or interdependent. From this standpoint, it makes little sense to ask what is ‘inside’ the mind but, rather, what happens in-between mind and world in moments of creative serendipity. Three forms of relating to the world are proposed as essential for serendipity and, more broadly, for creativity: surprise, curiosity and wonder. The ways in which surprise, curiosity and wonder shape our experience of serendipity are discussed with a view towards expanding the prepared mind into a system of open and dynamic relations between self and other, mind and culture, person and world.
... One of the brain's principal tasks is to make sense of the world and situations we find ourselves in; that is, to perceive (de Wit et al., 2017). When we look around, however, there usually is not much that is natural to be perceived; what we largely are faced with is artificial -the 'designed' environment (Golembiewski, 2016). Perception, as it is moderated by language and visual culture, leads us to perceive according to implied meanings with powerful psychological implications (Moen et al.,1995). ...
In this chapter, the authors address salutogenic approaches in dementia care support, using a resident-centred model of care. Securing residents’ sense of coherence in care settings requires shifting the locus of decision-making power from only staff, to include residents. In this approach, residents manage more tasks themselves, they get not only what they need but also what they want and they engage meaningfully with others and with life in general. The authors explain that implementing salutogenic models of dementia care is not a simple task. It involves reimagining approaches to interpersonal communication, the thoughtful development of meaningful and enjoyable activities, and creative inclusion and engagement of friends and family. Supportive design of facilities includes spaces that provide choice, opportunities for social interaction, and memory-triggering cues that inform persons living with dementia about where they are, who they are, what there is to do to keep occupied, who other people are – in sum, environments that remind them that they are meaningfully engaged, safe and happy. The authors contend that replacing old-fashioned approaches to care with life-affirming environments is richly rewarding. They explain that success in making this switch requires professionals to pivot away from models that see dementia primarily as a disease to be cured, towards seeing living with dementia in terms of maximum health and well-being. They conclude that salutogenesis is a useful theory to guide this transition.
... Recovery entails having dreams, aspirations and positive thoughts for the future. Access to nature and natural light have been widely reported as beneficial [29] Warmth and sunshine in a facility balanced and harmonised with both calming and stimulating spaces can help to reduce distress and relieve pain. Attention to all aspects of the qualities of the indoor environment have shown to produce beneficial outcomes [30]. ...
Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.
... Chrysikou 2013); new theoretical approaches to establish the best way to integrate extant knowledge about mental illness and design theory (Golembiewski 2010(Golembiewski , 2012; and explorations of psycho-aetiological mechanisms embedded within the physical environment (e.g. Ellett, Freeman, and Garety 2008;Golembiewski 2013Golembiewski , 2016. Most of this research follows significant changes in models of care following the influential philosophy of Foucault (1965) and the highly polemic action-oriented ethnographies of Goffman (1961) and Rosenhan (1973). ...
There is strong evidence that people with psychosis are highly responsive to environmental changes. The institutional tradition has been blamed for chronic psychotic illness in the past, but there has been little evidence to identify the negative influences that it has perpetrated. This study attempts to identify hitherto unknown factors embedded in the physical design of psychiatric environments. A grounded theory method was chosen for this study. The study was undertaken from April 2013 until May 2015 in a mental health facility with 110 male patients with psychosis mostly diagnosed with chronic schizophrenia. Data were collected by covert non-participant observation and unstructured interviews with nine centre staff. The study found that there are standing patterns of behaviour around affordances – that is, around opportunities for action. When these encourage self-expression, better sensory, and bodily engagement and form meaningful experiences, they are positive and recovery-oriented. However, when they involve competition for territory and relative comfort, they are deleterious to mental health. Standing patterns of behaviour are predictable – be they good or bad. An understanding of these patterns will enable better mental health facility design in the future.
... Mental health-related issues are on the rise in America, where one in every five adults in the U.S. are experiencing some kind of mental health-related disorder (Center for Behavioral Health Statistics and Quality, 2017). Our mental health is not immune to the negative aspects of environmental factors (Alexander, 2008;Ellard, 2015;Goldhagen, 2017;Golembiewski, 2016;Menatti & Casado da Rocha, 2016;Schmidt, 2007). Public health professionals understand the many ways in which the environment affects health and mental well-being (DiClemente, Salazar & Crosby, 2013), yet there is much more to understand and much more that practitioners can do. ...
Human narratives are intertwined with the environments they inhabit. Building and designing environments has been part of human history for thousands of years. Over time, humans have become removed from nature, which has meant building places that are not considered beneficial for our mental health. Rates of mental health disorders have been steadily increasing. The urban built environment is a unique environment with many types of spaces. This study looks at an urban neighborhood in Salt Lake City, Utah and explores residents’ experiences of living in the neighborhood. I then explore how those experiences correspond to emotions and feelings. The main findings for the participants’ experiences are centrality, crime, social places, and neighborhood neglect. Correspondingly, the feelings attached to those experiences were belonging and urgency for civic engagement, empathy and stress, neighborly affinity, and anticipation and resilience. Lastly, I found that designed nature was the most important aspect for improving mental health and well-being. I assert that nature itself is not enough, it is the human alteration on nature that gives the most comfort.
... 2 In particular, it has been argued that the city is one of the most predictable factors of developing schizophrenia or major psychiatric disorders. 90,91 In fact, The Ecological Hypothesis for Schizophrenia is based on the concept of "direct perception" which links external stimuli from the environment to brain neural mechanisms: designed environments might impact on the attentional neural system. [92][93][94] In addition, Mirror Neuron Theory has identified neural regions involved in the reaction to external actions such as premotor cortex and perigenual anterior caudal cortex (pACC). ...
Rapid urbanization worldwide is associated to an increase of population in the urban settings and this is leading to new emerging mental health issues. This narrative mini-review is based on a literature search conducted through PubMed and EMBASE. A total of 113 articles published on the issue of urban mental health have been selected, cited, reviewed, and summarized. There are emerging evidences about the association between urbanization and mental health issues. Urbanization affects mental health through social, economic, and environmental factors. It has been shown that common mental syndromes report higher prevalence in the cities. Social disparities, social insecurity, pollution, and the lack of contact with nature are some of recognized factors affecting urban mental health. Further reserach studies and specific guidelines should be encouraged to help policy makers and urban designers to improve mental health and mental health care facilities in the cities; additional strategies to prevent and reduce mental illness in the urban settings should be also adopted globally.
... Indeed, urban design (tall and impressive buildings, narrow streets with no escape ways, billboards and flashing light containing instructions and meanings) may shape and alter individual behaviour and social exchanges. This could be linked, as proposed by Golembievski, to the fact that "… there is nowhere else where design is more ubiquitous than in the city, where literally every piece of rubbish carries meaning and potentially triggers action" (Golembiewski, 2013(Golembiewski, , 2017Golembiewski, 2016). It is interesting to note, that recent imaging and EEG studies indicate distinct patterns of prefrontal activity when healthy subjects are exposed either to natural or urban environment, and that they report reduction of anxiety and tension when exposed to visual stimulation by nature (Chen, He, & Yu, 2016;Igarashi, Song, Ikei, & Miyazaki, 2015;Song et al., 2014). ...
Aim:
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.
Method:
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.
Results:
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.
Conclusions:
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.
... While there is emerging research and practice that explores the potential for the physical environment to be salutogenic, no examples could be found that explicitly relate to the physical school environment, and very few that deal with environments outside healthcare facilities. Of the research dealing with healthcare facilities, the most cited include Dilani (2006Dilani ( , 2008 and Golembiewski (2010Golembiewski ( , 2014Golembiewski ( , 2016Golembiewski ( , 2017. In terms of other environments, there is research to do with work environments that look promising, including that of Ruohomäki, Lahtinen, and Reijula (2015). ...
This chapter proposes a holistic
approach to designing
school spaces that envisages student
wellbeing as flourishing
. It focusses on the potential of design
and the physical school environment
to enhance student
capability enabling students to flourish by living a life they have reason to value. The first part discusses a
capabilities approach
to wellbeing and explores the role of the senses, perception and emotions in wellbeing and the existential possibility
for flourishing that they afford. Building on this conceptual foundation, the second part presents a new Salutogenic design framework for wellbeing as flourishing
which offers a theoretically based holistic
design
approach for educators
as well as designers that responds to the values
, interests and needs
of the students who experience school spaces.
... Indeed, urban design (tall and impressive buildings, narrow streets with no escape ways, billboards and flashing light containing instructions and meanings) may shape and alter individual behaviour and social exchanges. This could be linked, as proposed by Golembievski, to the fact that "… there is nowhere else where design is more ubiquitous than in the city, where literally every piece of rubbish carries meaning and potentially triggers action" (Golembiewski, 2013(Golembiewski, , 2017Golembiewski, 2016). It is interesting to note, that recent imaging and EEG studies indicate distinct patterns of prefrontal activity when healthy subjects are exposed either to natural or urban environment, and that they report reduction of anxiety and tension when exposed to visual stimulation by nature (Chen, He, & Yu, 2016;Igarashi, Song, Ikei, & Miyazaki, 2015;Song et al., 2014). ...
Review on urbanicity and psychosis
... Emerging models and techniques have demonstrated the importance of brain health microenvironment in keeping all aspects of brain function and from pathological injury [13]. A highly controlled microenvironment is a critical requirement to run proper function of neuron and neural signaling. ...
The blood-brain barrier (BBB) is involved in the pathogenesis of Alzheimer’s disease (AD). BBB is a highly selective semipermeable structural and chemical barrier which ensures a stable internal environment of the brain and prevents foreign objects invading the brain tissue. BBB dysfunction induces the failure of Aβ transport from brain to the peripheral circulation across the BBB. Especially, decreased levels of LRP-1 (low density lipoprotein receptor-related protein 1) and increased levels of RAGE (receptor for advanced glycation endproducts) at the BBB can cause the failure of Aβ transport. The pathogenesis of AD is related to the BBB structural components, including pericytes, astrocytes, vascular endothelial cells, and tight junctions. BBB dysfunction will trigger neuroinflammation and oxidative stress, then enhance the activity of β-secretase and γ-secretase, and finally promote Aβ generation. A progressive accumulation of Aβ in brain and BBB dysfunction may become a feedback loop that gives rise to cognitive impairment and the onset of dementia. The correlation between BBB dysfunction and tau pathology has been well-reported. Therefore, regulating BBB function may be a new therapeutic target for treating AD.
... More specifically, studies such as those conducted by Northoff et al. (2004) found that people with mental disorders are much more reactive to their environment. Further investigations conducted by Golembiewski (2012Golembiewski ( , 2016 based on data from Northoff et al. Suggest that the symptoms of psychiatric illnesses have arisen following intense exposure to negative factors and stimulants of the external environment. ...
Poor settings are predominantly symbolized by the old cities and present a more negative picture of mental health, as a result of working conditions, housing or family problems, which make individuals more vulnerable to the vagaries of mental health. The old town of Annaba is a good example.
Background: Despite a lot of studies that have been conducted on the effects of the built environment on the health of the elderly and environmental salutogenic factors, a limited number of studies have investigated the architectural physical factors clearly. Purpose and Aim: This paper investigated the architectural elements in the non-therapeutic built environment that can achieve salutogenic goals for the elderly. It also aimed to provide an answer to the question of how architectural design might be used to physically bring salutogenic theory to life. Method: In this review study, data were collected systematically using the PRISMA checklist. The three lists of keywords used for the initial search were “built environment” or “architecture,” “elderly,” and “health,” and were supplemented with synonyms for a second search in four databases: Scopus, Science Direct, Web of Science, and PubMed, in the period from 2000 to 2024. By applying inclusion and exclusion criteria, 26 articles were selected for review and data extraction. The data were then qualitatively analyzed, and two reviewers independently verified the analysis. Conclusions: This study found that architectural elements can be salutogenic by supporting the comprehensibility, manageability, and meaningfulness. Porches, Stoop, above-grade entrances, and balconies are key elements in the home that support the sense of coherence. In assisted living facilities, walls were recognized as the only physical factor supporting the sense of coherence due to the creation of a personal, distinct, meaningful, comprehensible, and manageable space.
This chapter reports on research conducted across Australia with clinicians during the COVID-19 pandemic in 2020–21. The researchers worked with clinicians in hospital Emergency departments, often the first point of contact at the hospital for many consumers, to investigate ways to make the layout and wayfinding easier, both for consumers and clinicians. Research suggests that a biophilic (bringing in elements of nature), salutogenic (promoting good health), and eudaimonic (supporting happiness and contentment) environment will make Emergency departments in hospitals more positive places, and clinician feedback provides specific examples of how these architectural goals could be achieved.
Temporal Urban Design: Temporality, Rhythm and Place examines an alternative design approach, focusing on the temporal aesthetics of urban places and the importance of the sense of time and rhythm in the urban environment.
The book departs from concerns on the acceleration of cities, its impact on the urban quality of life and the liveability of urban spaces, and questions on what influences the sense of time, and how it expresses itself in the urban environment. From here, it poses the questions: what time is this place and how do we design for it? It offers a new aesthetic perspective akin to music, brings forward the methodological framework of urban place-rhythmanalysis, and explores principles and modes of practice towards better temporal design quality in our cities. The book demonstrates that notions of time have long been intrinsic to planning and urban design research agendas and, whilst learning from philosophy, urban critical theory, and both the natural and social sciences debate on time, it argues for a shift in perspective towards the design of everyday urban time and place timescapes. Overall, the book explores the value of the everyday sense of time and rhythmicity in the urban environment, and discusses how urban designers can understand, analyse and ultimately play a role in the creation of temporally unique, both sensorial and affective, places in the city.
The book will be of interest to urban planners, designers, landscape architects and architects, as well as urban geographers, and all those researching within these disciplines. It will also interest students of planning, urban design, architecture, urban studies, and of urban planning and design theory.
This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.
Creative writers have boundless opportunities to explore the outer (and inner) regions of knowledge, starting with the vast unknowns of the ‘tabula rasa’, travelling down paths that lead absolutely everywhere. So how do writers rely on serendipity? From fiction that begins with the real, to the real that veers towards fiction, I argue for a practice I describe as ‘intentional serendipity’—a complex combination of trust, openness and contrivance. I explore not only the ‘prepared mind’ of Pasteur, but a decolonised perspective on knowledge and where it resides—and ways that have been used to conjure inspiration—including through encounters with muses in the cultural imaginary that figure large in guiding serendipity—from Calliope, the Greek muse of epic poetry, to Lorca’s goblin, Duende.
There is a growing field of research that indicates a significant relationship between the design of the environment and the mental health of people with impeded cognitive functioning. The research suggests that if a physical environment is experienced as having a sense-of-coherence it is a resource to help reduce negative impacts and increase supportive qualities for the resident so they can better cope under adversity. How can designers incorporate a sense-of-coherence in projects? This paper challenges some aspects of common design practice when accommodation for people with impeded cognitive functioning is being created. Also, it expands on what is known about the person–environment relationship to propose a design model that revolves around the idea that a sense-of-coherence has cognitive, behavioural, motivational and emotional dimensions. The model is used to create a tool that can be used by designers. A pilot test of the tool is carried out using two examples of supported accommodation occupied by people with schizophrenia. The tool created provides a practical way of enhancing the design of the physical home environment. The paper suggests the future potential of the tool as well as some limitations.
Research in architecture, design, sociology and environmental psychology assists us to gain insights into the interdependency between occupants and their settings. Theorists are drawn upon to identify indicators of environments that may facilitate improved wellbeing. Following a description of the theoretical position, the current study's methodology is outlined. Drawing upon the client group of a local supported-accommodation provider in Western Australia, where the majority of clients have some form of cognitive impairment, key aspects of user conditions are combined with theoretical positions to inform an accommodation design matrix. Schizophrenia, depression and/or formal thought disorder were conditions experienced by the occupants of the homes examined by the researchers. Accommodation can impact on occupants who have cognitive deficiencies or impairments. Home settings afford certain ways of perceiving, using and experiencing them, can induce a sense-of-coherence, and foster a sense-of-wellbeing. The proposal is to integrate design directives for a particular cognitive impairment or difficulty with the indicators of supportive environments for resident wellbeing to assist designers to enhance accommodation design.
Aim::
The objective of this article is to identify and analyze what is known about characteristics in and around the home that support well-being for those with cognitive impairment. This could provide direction for designers of homes in general, but specifically for designers trying to meet the needs of people with cognitive impairment.
Background::
It has been established that there is a relationship between psychological well-being and a person's environment. Research also shows that particular design aspects can reduce the impact of cognitive impairment. However, there is limited design expertise in the Australian housing market to create supportive spaces which will help to reduce the impact of the disability for those with cognitive impairment.
Method::
A literature review was carried out to determine the extent and details of what is known about the relationship of home design and its impact on emotional, psychological, or social well-being for people with cognitive impairment.
Conclusions::
The study indicates that researchers in various disciplines understand that pragmatic design inputs such as thermal comfort and adequate lighting are important for people with cognitive impairment. In addition, some researchers have shown or surmise that there are other "intangible" designer-controlled elements that have beneficial impacts on people with cognitive impairment. Details of these intangible elements are sparse, and how much they might improve the quality of life for a person with cognitive impairment is not well understood. Further research is required to meet a growing need.
Each year, thousands of victims of violence enter the Canadian criminal justice system and, by extension, justice buildings, such as police stations and courthouses. The architecture and design of these buildings communicate symbolic messages about justice and may influence the emotions, behaviors, and well-being of survivors. This qualitative study explored survivors’ emotional experiences with justice architecture. Findings reveal that survivors experience justice architecture as cold and hard; a facilitator of feelings of insignificance; lacking in privacy and; representative of their raw emotional state. The author discusses implications of these findings for victim engagement in the context of justice spaces.
This is a monthly list of new papers on key topics: Air Pollution, Bed Bugs, Biosolids, Climate Change, Drinking Water, Food Safety, Health Impact Assessment, Indoor Air, Noise Pollution, Pesticides, Plastics, Shale Gas, Urban Agriculture, WiFi, Wildfire Smoke, Zoonoses. This resource is produced through the National Collaborating Centre for Environmental Health (NCCEH.ca).
The Meaning of Things explores the meanings of household possessions for three generation families in the Chicago area, and the place of materialism in American culture. Now regarded as a keystone in material culture studies, Halton's first book is based on his dissertation and coauthored with Mihaly Csikszentmihalyi. First published by Cambridge University Press in 1981, it has been translated into German, Italian, Japanese, and Hungarian. The Meaning of Things is a study of the significance of material possessions in contemporary urban life, and of the ways people carve meaning out of their domestic environment. Drawing on a survey of eighty families in Chicago who were interviewed on the subject of their feelings about common household objects, Mihaly Csikszentmihalyi and Eugene Rochberg-Halton provide a unique perspective on materialism, American culture, and the self. They begin by reviewing what social scientists and philosophers have said about the transactions between people and things. In the model of 'personhood' that the authors develop, goal-directed action and the cultivation of meaning through signs assume central importance. They then relate theoretical issues to the results of their survey. An important finding is the distinction between objects valued for action and those valued for contemplation. The authors compare families who have warm emotional attachments to their homes with those in which a common set of positive meanings is lacking, and interpret the different patterns of involvement. They then trace the cultivation of meaning in case studies of four families. Finally, the authors address what they describe as the current crisis of environmental and material exploitation, and suggest that human capacities for the creation and redirection of meaning offer the only hope for survival. A wide range of scholars - urban and family sociologists, clinical, developmental and environmental psychologists, cultural anthropologists and philosophers, and many general readers - will find this book stimulating and compelling. Translations: Il significato degli oggetti. Italian translation. Rome: Edizione Kappa, 1986. Der Sinn der Dinge. German translation. Munich: Psychologie Verlags Union, 1989. Japanese translation 2007. Targyaink tukreben. Hungarian translation, 2011.
The cortisol rise after awakening (cortisol awakening response, CAR) is a core biomarker of hypothalamic-pituitary-adrenal (HPA) axis regulation related to psychosocial stress and stress-related psychiatric disorders. However, the neural regulation of the CAR has not been examined in humans. Here, we studied neural regulation related to the CAR in a sample of 25 healthy human participants using an established psychosocial stress paradigm together with multimodal functional and structural (voxel-based morphometry) magnetic resonance imaging. Across subjects, a smaller CAR was associated with reduced grey matter volume and increased stress-related brain activity in the perigenual ACC, a region which inhibits HPA axis activity during stress that is implicated in risk mechanisms and pathophysiology of stress-related mental diseases. Moreover, functional connectivity between the perigenual ACC and the hypothalamus, the primary controller of HPA axis activity, was associated with the CAR. Our findings provide support for a role of the perigenual ACC in regulating the CAR in humans and may aid future research on the pathophysiology of stress-related illnesses, such as depression, and environmental risk for illnesses such as schizophrenia.Neuropsychopharmacology accepted article preview online, 17 March 2015. doi:10.1038/npp.2015.77.
The neural mechanisms that produce hallucinations and other psychotic symptoms remain unclear. Previous research suggests that deficits in predictive signals for learning, such as prediction error signals, may underlie psychotic symptoms, but the mechanism by which such deficits produce psychotic symptoms remains to be established. We used model-based fMRI to study sensory prediction errors in human patients with schizophrenia who report daily auditory verbal hallucinations (AVHs) and sociodemographically matched healthy control subjects. We manipulated participants' expectations for hearing speech at different periods within a speech decision-making task. Patients activated a voice-sensitive region of the auditory cortex while they experienced AVHs in the scanner and displayed a concomitant deficit in prediction error signals in a similar portion of auditory cortex. This prediction error deficit correlated strongly with increased activity during silence and with reduced volumes of the auditory cortex, two established neural phenotypes of AVHs. Furthermore, patients with more severe AVHs had more deficient prediction error signals and greater activity during silence within the region of auditory cortex where groups differed, regardless of the severity of psychotic symptoms other than AVHs. Our findings suggest that deficient predictive coding accounts for the resting hyperactivity in sensory cortex that leads to hallucinations.
Urban upbringing has consistently been associated with schizophrenia, but which specific environmental exposures are reflected by this epidemiological observation and how they impact the developing brain to increase risk is largely unknown. On the basis of prior observations of abnormal functional brain processing of social stress in urban-born humans and preclinical evidence for enduring structural brain effects of early social stress, we investigated a possible morphological correlate of urban upbringing in human brain. In a sample of 110 healthy subjects studied with voxel-based morphometry, we detected a strong inverse correlation between early-life urbanicity and gray matter (GM) volume in the right dorsolateral prefrontal cortex (DLPFC, Brodmann area 9). Furthermore, we detected a negative correlation of early-life urbanicity and GM volumes in the perigenual anterior cingulate cortex (pACC) in men only. Previous work has linked volume reductions in the DLPFC to the exposure to psychosocial stress, including stressful experiences in early life. Besides, anatomical and functional alterations of this region have been identified in schizophrenic patients and high-risk populations. Previous data linking functional hyperactivation of pACC during social stress to urban upbringing suggest that the present interaction effect in brain structure might contribute to an increased risk for schizophrenia in males brought up in cities. Taken together, our results suggest a neural mechanism by which early-life urbanicity could impact brain architecture to increase the risk for schizophrenia.
To understand schizophrenia, a linking hypothesis is needed that shows how brain mechanisms lead to behavioral functions in normals, and also how breakdowns in these mechanisms lead to behavioral symptoms of schizophrenia. Such a linking hypothesis is now available that complements the discussion offered by Phillips & Silverstein (P&S).
Per Aage Brandt, commenting on a passage from Merlin Donald, suggests that there is ‘a narrative aesthetics built into our mind.’ In Donald, one can find an evolutionary account of this narrative aesthetics. If there is something like an innate narrative disposition, it is also surely the case that there is a process of development involved in narrative practice. In this paper I will assume something closer to the developmental account provided by Jerome Bruner in various works, and Dan Hutto's account of how we learn narrative practices, and I'll refer to this narrative aesthetics as a narrative competency that we come to have through a developmental process. I will take narrative in a wide sense, to include oral and written communications and self-reports on experience. In this regard narrative is more basic than story, and not necessarily characterized by the formal plot structure of a story. A story may be told in many different ways, but always via narrative discourse. Also, having narrative competency includes not just abilities for understanding narratives, but also for narrative understanding, which allows us to form narratives about things, events and other people. To be capable of narrative understanding means to be capable of seeing events in a narrative framework. The questions that I want to explore are these: what are the cognitive elements that contribute to the development of narrative competency? What do we gain from the deployment of this narrative competency?
Progress in urban climatology over the two decades since the first publication of the International Journal of Climatology is reviewed. It is emphasized that urban climatology during this period has benefited from conceptual advances made in microclimatology and boundary-layer climatology in general. The role of scale, heterogeneity, dynamic source areas for turbulent fluxes and the complexity introduced by the roughness sublayer over the tall, rigid roughness elements of cities is described. The diversity of urban heat islands, depending on the medium sensed and the sensing technique, is explained. The review focuses on two areas within urban climatology. First, it assesses advances in the study of selected urban climatic processes relating to urban atmospheric turbulence (including surface roughness) and exchange processes for energy and water, at scales of consideration ranging from individual facets of the urban environment, through streets and city blocks to neighbourhoods. Second, it explores the literature on the urban temperature field. The state of knowledge about urban heat islands around 1980 is described and work since then is assessed in terms of similarities to and contrasts with that situation. Finally, the main advances are summarized and recommendations for urban climate work in the future are made. Copyright © 2003 Royal Meteorological Society.
We measured the concentration of brain monoamine oxidase B (MAO B; EC 1.4.3.4) in 8 smokers and compared it with that in 8 non-smokers and in 4 former smokers using positron emission tomography (PET) and deuterium substituted [11C]L-deprenyl ([11C]L-deprenyl-D2) as a radiotracer for MAO B. Smokers had significantly lower brain MAO B than non-smokers as measured by the model term lambda k3 which is a function of MAO B activity. Reductions were observed in all brain regions. Low brain MAO B in the cigarette smoker appears to be a pharmacological rather than a genetic effect since former smokers did not differ from non-smokers. Brain MAO B inhibition by cigarette smoke is of relevance in light of the inverse association between smoking and Parkinson's disease and a high prevalence of smoking in psychiatric disorders and in substance abuse. Though nicotine is at the core of the neuropharmacological actions of tobacco smoke, MAO B inhibition may also be an important variable in understanding and treating tobacco smoke addiction.
More than half of the world's population now lives in cities, making the creation of a healthy urban environment a major policy priority. Cities have both health risks and benefits, but mental health is negatively affected: mood and anxiety disorders are more prevalent in city dwellers and the incidence of schizophrenia is strongly increased in people born and raised in cities. Although these findings have been widely attributed to the urban social environment, the neural processes that could mediate such associations are unknown. Here we show, using functional magnetic resonance imaging in three independent experiments, that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. Current city living was associated with increased amygdala activity, whereas urban upbringing affected the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect and stress. These findings were regionally and behaviourally specific, as no other brain structures were affected and no urbanicity effect was seen during control experiments invoking cognitive processing without stress. Our results identify distinct neural mechanisms for an established environmental risk factor, link the urban environment for the first time to social stress processing, suggest that brain regions differ in vulnerability to this risk factor across the lifespan, and indicate that experimental interrogation of epidemiological associations is a promising strategy in social neuroscience.
Psychotic syndromes can be understood as disorders of adaptation to social context. Although heritability is often emphasized, onset is associated with environmental factors such as early life adversity, growing up in an urban environment, minority group position and cannabis use, suggesting that exposure may have an impact on the developing 'social' brain during sensitive periods. Therefore heritability, as an index of genetic influence, may be of limited explanatory power unless viewed in the context of interaction with social effects. Longitudinal research is needed to uncover gene-environment interplay that determines how expression of vulnerability in the general population may give rise to more severe psychopathology.
Reviews of urban-rural differences in psychiatric disorders conclude that urban rates may be marginally higher and, specifically, somewhat higher for depression. However, pooled results are not available.
A meta-analysis of urban-rural differences in prevalence was conducted on data taken from 20 population survey studies published since 1985. Pooled urban-rural odds ratios (OR) were calculated for the total prevalence of psychiatric disorders, and specifically for mood, anxiety and substance use disorders.
Significant pooled urban-rural OR were found for the total prevalence of psychiatric disorders, and for mood disorders and anxiety disorders. No significant association with urbanization was found for substance use disorders. Adjustment for various confounders had a limited impact on the urban-rural OR.
Urbanization may be taken into account in the allocation of mental health services.
Advances in cognitive neuroscience offer us new ways to understand the symptoms of mental illness by uniting basic neurochemical and neurophysiological observations with the conscious experiences that characterize these symptoms. Cognitive theories about the positive symptoms of schizophrenia--hallucinations and delusions--have tended to treat perception and belief formation as distinct processes. However, recent advances in computational neuroscience have led us to consider the unusual perceptual experiences of patients and their sometimes bizarre beliefs as part of the same core abnormality--a disturbance in error-dependent updating of inferences and beliefs about the world. We suggest that it is possible to understand these symptoms in terms of a disturbed hierarchical Bayesian framework, without recourse to separate considerations of experience and belief.
Concern is building about high rates of schizophrenia in large cities, and among immigrants, cannabis users, and traumatized individuals, some of which likely reflects the causal influence of environmental exposures. This, in combination with very slow progress in the area of molecular genetics, has generated interest in more complicated models of schizophrenia etiology that explicitly posit gene-environment interactions (EU-GEI. European Network of Schizophrenia Networks for the Study of Gene Environment Interactions. Schizophrenia aetiology: do gene-environment interactions hold the key? [published online ahead of print April 25, 2008] Schizophr Res; S0920-9964(08) 00170-9). Although findings of epidemiological gene-environment interaction (G x E) studies are suggestive of widespread gene-environment interactions in the etiology of schizophrenia, numerous challenges remain. For example, attempts to identify gene-environment interactions cannot be equated with molecular genetic studies with a few putative environmental variables "thrown in": G x E is a multidisciplinary exercise involving epidemiology, psychology, psychiatry, neuroscience, neuroimaging, pharmacology, biostatistics, and genetics. Epidemiological G x E studies using indirect measures of genetic risk in genetically sensitive designs have the advantage that they are able to model the net, albeit nonspecific, genetic load. In studies using direct molecular measures of genetic variation, a hypothesis-driven approach postulating synergistic effects between genes and environment impacting on a final common pathway, such as "sensitization" of mesolimbic dopamine neurotransmission, while simplistic, may provide initial focus and protection against the numerous false-positive and false-negative results that these investigations engender. Experimental ecogenetic approaches with randomized assignment may help to overcome some of the limitations of observational studies and allow for the additional elucidation of underlying mechanisms using a combination of functional enviromics and functional genomics.
Terrorists, child abductors, muggers, delinquent teenagers, malicious colleagues . . . Who wouldnt be worried? The world can be a dangerous place, for sure. But have we lost the knack of judging risk? Are we letting paranoia get the better of us? In this entertaining and thought-provoking book, based on the most up-to-date scientific research, Daniel and Jason Freeman highlight just how prominent paranoia is today. One in four of us have regular paranoid thoughts. The authors analyse the causes of paranoia, identifying the social and cultural factors that seem to be skewing the way we think and feel about the world around us. And they explain why paranoia may be on the rise and, crucially, what we can do to tackle it. Witty, clear, and compelling, Paranoia takes us beyond the tabloid headlines to pinpoint the real menace at the heart of twenty-first century culture.
The evolutionary advantage of humans is in our unique ability to process stories – we have highly evolved ‘narrative organs.’ Through storytelling, vicarious knowledge, even guarded knowledge, is used to help our species survive. We learn, regardless of whether the story being told is ‘truth’ or ‘fiction.’ Humans place themselves in stories, as both observer and participant, to create a ‘neural balance’ or sweet spot that allows them to be immersed in a story without being entirely threatened by it – and this involvement in story leads to the formation of empathy – an empathy that is integral to forging a future humanity. It is through empathy, we argue, that stories have the power to save us. The hippocampi process narrative details. Situated alongside are the amygdalae – organs that place the reader in the story. The temporal lobes store ‘story nuggets.’ Finally there’s the frontal cortex to inhibit full participation in narrative, so that the story can be experienced vicariously.
Objective: Negative symptoms of schizophrenia are debilitating and they contribute to poor outcome in schizophrenia. Initial enthusiasm that second-generation antipsychotics would prove to be powerful agents to improve negative symptoms has given way to relative pessimism that the effects of current pharmacological treatments are at best modest. Method: A review of the current 'state-of-play' of pharmacological treatments for negative symptoms in schizophrenia. Results: Treatment results to date have been largely disappointing. The evidence for efficacy of second-generation antipsychotics is reviewed. Conclusion: The measurement and treatment trials methodology for the evaluation of negative symptoms need additional refinement before therapeutic optimism that better treatments for negative symptoms can be realized.
It’s commonly assumed that psychiatric violence is motivated by delusions, but here the concept of a reversed impetus is explored, to understand whether delusions are formed as ad-hoc or post-hoc rationalizations of behaviour or in advance of the actus reus.
The reflexive violence model proposes that perceptual stimuli has motivational power and this may trigger unwanted actions and hallucinations. The model is based on the theory of ecological perception, where opportunities enabled by an object are cues to act. As an apple triggers a desire to eat, a gun triggers a desire to shoot. These affordances (as they are called) are part of the perceptual apparatus, they allow the direct recognition of objects – and in emergencies they enable the fastest possible reactions.
Even under normal circumstances, the presence of a weapon will trigger inhibited violent impulses. The presence of a victim will also, but under normal circumstances, these affordances don’t become violent because negative action impulses are totally inhibited, whereas in psychotic illness, negative action impulses are treated as emergencies and bypass frontal inhibitory circuits. What would have been object recognition becomes a blind automatic action.
A range of mental illnesses can cause inhibition to be bypassed. At its most innocuous, this causes both simple hallucinations (where the motivational power of an object is misattributed). But ecological perception may have the power to trigger serious violence also –a kind that’s devoid of motives or planning and is often shrouded in amnesia or post-rational delusions.
Keywords: utilization behavior, automatic action, ecological perception, violence, delusions
The evolutionary advantage of humans is in our unique ability to process stories – we have highly evolved 'narrative organs.' Through storytelling, vicarious knowledge, even guarded knowledge, is used to help our species survive. We learn, regardless of whether the story being told is 'truth' or 'fiction.' Humans place themselves in stories, as both observer and participant, to create a 'neural balance' or sweet spot that allows them to be immersed in a story without being entirely threatened by it – and this involvement in story leads to the formation of empathy – an empathy that is integral to forging a future humanity. It is through empathy, we argue, that stories have the power to save us. The hippocampi process narrative details. Situated alongside are the amygdalae – organs that place the reader in the story. The temporal lobes store 'story nuggets.' Finally there's the frontal cortex to inhibit full participation in narrative, so that the story can be experienced vicariously.
In two studies, we investigated the degree to which action primes, and acting upon those primes affect agency ratings. Participants performed left or right button-presses that generated tones, and were subsequently asked to indicate the degree to which they felt that they, instead of the computer, had caused the tones. Prior to button-presses, participants were subliminally or supraliminally primed with "left" or "right". Participants were free to press either button, and thus could perform prime-compatible or prime-incompatible actions. Results showed that incompatible subliminal primes lowered sense of agency compared to the effects of subliminal compatible primes. In contrast, supraliminal compatible primes lowered agency compared to incompatible primes.
There’s abundant evidence that the dopamine system is dysfunctional in schizophrenia: specifically, the excitatory D2Low receptors (D1/D2 heteromers) of the frontal complex are depleted, while the subcortical areas that are rich in D2High (D2/D2 homomer) receptors, are over-stimulated. It is hypothesized that this imbalance may cause hallucinations because the dopamine pathways that appear to moderate selective attention - the leading edge of declarative perception become dysfunctional.
The dysfunctional distribution pattern effectively confines dopamine activity to the striatum and deeper subcortical regions. Exactly what this means is still speculative, but a tenable hypothesis is that the dopamine pathways process schemata: with the mesolimbic receptors processing well-learned and instinctive associations, and the frontal complex for processing perceptions that need declarative consideration and self-awareness.
It’s speculated that when dopamine is limited to the subcortical regions, the loss of activity in the frontal complex reduces the capacity to handle abstractions. The leap from symbols to meaning, the ability to reason and ability to critically question, will therefore be hampered. It will also reduce a capacity for self-awareness. This creates the opposite of the ‘flight of ideas,’ inflated ego, euphoria, dysphoria and other signs of expansiveness of a manic episode but still creates an event potential of sorts, although wholly within the striatum.
A surplus of striatal dopaminergic activation will stimulate automatic and the structural elements of thought: The striatum is well connected to manage the well-learned routines of lexica, grammar, schemata, and other procedural resources. Importantly for hallucinations, the striatum has bidirectional connections to the perceptual association cortex, which mediates the visuo-spatial sketchpad and phonological loop within working memory – meaning that striatal activations could reverse-trigger perceptual experience.
Introduction
The last half-century of epidemiological enquiry into schizophrenia can be characterized by the search for neurological imbalances and lesions, for genetic factors. The growing consensus that these directions have failed and there is now a growing interest in psycho-social and developmental models. Another area of recent interest is in epigenetics – the multiplication of genetic influences by environmental factors.
Methods
This integrative review comparatively maps current psychosocial, developmental and epigenetic models for schizophrenia epidemiology to identify crossover and theoretical gaps.
Results In the flood of data that is being produced around the schizophrenia epidemiology, one of the most consistent findings is that schizophrenia is an urban syndrome. Once demographic factors have been discounted, between a quarter and a third of all incidence is repeatedly traced back to urbanicity – potentially threatening more established models such as the psycho-social, genetic and developmental hypotheses.
Conclusion
Close analysis demonstrates how current models for schizophrenia epidemiology appear to miss the mark. Furthermore the built environment appears to be an inextricable factor in all current models and indeed may be a valid epidemiological factor on its own.
The reason the built environment hasn’t already become a de rigueur area of epidemiological research is possibly trivial – it just doesn’t attract enough science, and lacks a hero to promote it alongside other hypotheses.
This chapter discusses the functional relation between perception and behavior. It presents a general perspective on perception and action along with elaborating the direct relation between perception and behavior and specifically on one consequence of this relation—namely, the imitation. The chapter describes the core concepts of social perception. Furthermore, the chapter examines all three forms of social perception that lead directly to corresponding overt behavioral tendencies. The cognitive approach that has dominated psychology for over 30 years has changed psychology's perspective on perception. Certainly, perception is essential for us to comprehend our environment but that does not mean that this understanding is an end in itself. The chapter concludes with a discussion on the perception-behavior link from a functional perspective. In specific, perception provides an understanding of the world. Social perception refers to the activation of a perceptual representation, which generally has a direct effect on social behavior. Perceptual inputs are translated automatically into corresponding behavioral outputs.
The world can certainly be a dangerous place. But have we lost the knack of judging risk? Are we letting paranoia get the better of us? In this entertaining and thought-provoking book, based on the most up-to-date scientific research, Daniel and Jason Freeman highlight just how prominent paranoia is today. One in four of us have regular paranoid thoughts. The authors analyze the causes of paranoia, identifying the social and cultural factors that seem to be skewing the way we think and feel about the world around us. And they explain why paranoia may be on the rise and, crucially, what we can do to tackle it.
Paranoia takes us beyond the tabloid headlines to pinpoint the real menace at the heart of twenty-first century culture. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study of 34,864 cases of mental disorder admitted to 4 state hospitals and 8 private sanitariums in Chicago during the period 1922-1934 by means of ecological mapping reveals a close relationship between insanity and the ecological structure of the city. The rates of incidence per 100,000 of population decrease steadily from 362 in the disorganized areas near the center of the city to 55.4 in the residential sections near the outskirts. Schizophrenia alone shows a similar distribution, but manic-depressive insanity is randomly distributed. Study of the sub-types of schizophrenia shows that the catatonic states come principally from the foreign-born and negro slum areas where poverty and culture conflict are combined, while the paranoid and hebephrenic types find their highest incidence in the rooming-house areas of the city where the primary group has broken down and individuals live in social isolation. High incidence of alcoholic psychoses and drug addiction is identified with zones of transition and poverty, and of general paralysis with "hobohemia" and rooming-house areas where there is a disproportion of the sexes and low income. Senile psychoses and psychosis with arteriosclerosis do not fit the ecological structure of the city so well as do the schizophrenic rates, but relatively high rates are found in the central slum and negro communities. A similar study of the incidence of mental disorder in Providence, R. I., confirms in general the findings in Chicago. Two chapters of interpretation are given, and 96 tables. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The association between urbanicity and risk of schizophrenia is well established. The incidence of schizophrenia has been observed to increase in line with rising levels of urbanicity, as measured in terms of population size or density. This association is expressed as Incidence Rate Ratio (IRR), and the results are usually presented by comparing the most urban with the most rural environment. In this study, we undertook to express the effect of urbanicity on the risk of schizophrenia in a linear form and to perform a meta-analysis of all available evidence. We first employed a simple regression analysis of log (IRR) as given in each study on the urbanicity category, assuming a uniform distribution and a linear association. In order to obtain more accurate estimates, we developed a more sophisticated method that generates individual data points with simulation from the summary data presented in the original studies, and then fits a logistic regression model. The estimates from each study were combined with meta-analysis. Despite the challenges that arise from differences between studies as regards to the number and relative size of urbanicity levels, a linear association was observed between the logarithm of the odds of risk for schizophrenia and urbanicity. The risk for schizophrenia at the most urban environment was estimated to be 2.37 times higher than in the most rural environment. The same effect was found when studies measuring the risk for nonaffective psychosis were included.
Paradoxical performance effects (‘choking under pressure’) are defined as the occurrence of inferior performance despite striving and incentives for superior performance. Experimental demonstrations of these effects on tasks analogous to athletic performance and the theories that may explain them are reviewed. At present, attentional theories seem to offer the most complete explanation of the processes underlying paradoxical performance effects. In particular, choking may result from distraction or from the interference of self-focused attention with the execution of automatic responses. Experimental findings of paradoxical performance decrements are associated with four pressure variables: audience presence, competition, performance-contingent rewards and punishments, and ego relevance of the task. The mediating factors of task complexity, expectancies, and individual differences are discussed.
Schizophrenia is a most disabling psychiatric disorder characterized by a myriad of symptoms. While the delusions and hallucinations
are the most iconic symptoms of schizophrenia, patients also exhibit negative and cognitive symptoms. It is thought that these
symptoms arise, at least in part, through a cortical–subcortical imbalance of dopamine function and pharmacological approaches
that reduce dopaminergic neurotransmission through dopamine receptor blockade, and in particular through the D2 receptor, have antipsychotic action in humans. However, D2 antagonists are not optimally effective against the full spectrum of schizophrenia symptoms and induce side effects that
limit their use. Research to enhance the therapeutic benefits of antipsychotics while diminishing their side effects has led
to the development of atypical antipsychotics (D2 antagonists with activity at other receptors) and, more recently, a new strategy using dopamine partial agonists to reduce
dopaminergic neurotransmission has proven to be successful. This chapter reviews the pharmacological effects of typical and
atypical antipsychotics on the different dopamine receptor subtypes, as well as on non-dopaminergic receptor targets, and
on the prominent role of D2 receptor blockade as the primary site of their action in brain. In addition, we discuss current theories on the mechanisms
of antipsychotic action, including the role of combined action at the dopamine and serotonin receptors, transient dopamine
D2 blockade, preferential blockade of limbic D2 receptors, or combined blockade of D1 and D2 receptors. Some critical clinical considerations with regard to the speed of onset action and the occurrence of relapse and
supersensitivity psychosis on withdrawal are discussed with special relevance to their relationship to the dopamine system.
While the D2 receptor-based treatments seem to have dominated the field till now, drugs that reduce dopamine-mediated transmission
through action at presynaptic sites and of drugs providing D1 signaling augmentation in prefrontal cortex may provide novel therapeutic avenues for the treatment of schizophrenia.
KeywordsSchizophrenia-Antipsychotic action-Dopamine receptor blockade-D2 antagonist-D2 partial agonist-D2 inverse agonist-Relapse-Supersensitivity-Tardive dyskinesia
The symptoms of psychiatric illness are diverse, as are the causes of the conditions that cause them. Yet, regardless of the heterogeneity of cause and presentation, a great deal of symptoms can be explained by the failure of a single perceptual function--the reprocessing of ecological perception. It is a central tenet of the ecological theory of perception that we perceive opportunities to act. It has also been found that perception automatically causes actions and thoughts to occur unless this primary action pathway is inhibited. Inhibition allows perceptions to be reprocessed into more appropriate alternative actions and thoughts. Reprocessing of this kind takes place over the entire frontal lobe and it renders action optional. Choice about what action to take (if any) is the basis for the feeling of autonomy and ultimately for the sense-of-self. When thoughts and actions occur automatically (without choice) they appear to originate outside of the self, thereby providing prima facie evidence for some of the bizarre delusions that define schizophrenia such as delusional misidentification, delusions of control and Cotard's delusion. Automatic actions and thoughts are triggered by residual stimulation whenever reprocessing is insufficient to balance automatic excitatory cues (for whatever reason). These may not be noticed if they are neutral and therefore unimportant or where actions and thoughts have a positive bias and are desirable. Responses to negative stimulus, on the other hand, are always unwelcome, because the actions that are triggered will carry the negative bias. Automatic thoughts may include spontaneous positive feelings of love and joy, but automatic negative thoughts and visualisations are experienced as hallucinations. Not only do these feel like they emerge from elsewhere but they carry a negative bias (they are most commonly critical, rude and are irrationally paranoid). Automatic positive actions may include laughter and smiling and these are welcome. Automatic behaviours that carry a negative bias, however, are unwelcome and like hallucinations, occur without a sense of choice. These include crying, stereotypies, perseveration, ataxia, utilization and imitation behaviours and catatonia.
Midbrain dopamine neurons are well known for their strong responses to rewards and their critical role in positive motivation. It has become increasingly clear, however, that dopamine neurons also transmit signals related to salient but nonrewarding experiences such as aversive and alerting events. Here we review recent advances in understanding the reward and nonreward functions of dopamine. Based on this data, we propose that dopamine neurons come in multiple types that are connected with distinct brain networks and have distinct roles in motivational control. Some dopamine neurons encode motivational value, supporting brain networks for seeking, evaluation, and value learning. Others encode motivational salience, supporting brain networks for orienting, cognition, and general motivation. Both types of dopamine neurons are augmented by an alerting signal involved in rapid detection of potentially important sensory cues. We hypothesize that these dopaminergic pathways for value, salience, and alerting cooperate to support adaptive behavior.
In the 20th century it was thought that novel behaviors are mediated primarily in cortex and that the development of automaticity is a process of transferring control to subcortical structures. However, evidence supports the view that subcortical structures, such as the striatum, make significant contributions to initial learning. More recently, there has been increasing evidence that neurons in the associative striatum are selectively activated during early learning, whereas those in the sensorimotor striatum are more active after automaticity has developed. At the same time, other recent reports indicate that automatic behaviors are striatum- and dopamine-independent, and might be mediated entirely within cortex. Resolving this apparent conflict should be a major goal of future research.
Urbanicity has been repeatedly associated with increased incidence of schizophrenia. This article (a) presents results of a prospective study of urbanicity and schizophrenia in Ireland and (b) reviews the literature relating to urbanicity and schizophrenia. We prospectively compared incidence of schizophrenia and other psychoses in urban and rural catchment areas (over 4years and 7years, respectively) using face-to-face, DSM-III-R diagnostic interviews. Incidence of schizophrenia in males was higher in urban compared to rural areas, with an age-adjusted incidence rate ratio (IRR) of 1.92 (1.52-2.44) for males and 1.34 (1.00-1.80) for females. Incidence of affective psychosis was lower in urban compared to rural areas for males (IRR 0.48; 0.34-0.67) and females (IRR 0.60; 0.43-0.83). These findings are consistent with the literature, which provides persuasive evidence that risk for schizophrenia increases with urban birth and/or upbringing, especially among males. Register-based studies support this conclusion more consistently than studies using face-to-face diagnostic interviews, the difference being related to power. The mechanism of association is unclear but may relate to biological or social/environmental factors or both, acting considerably before psychotic symptoms manifest. There is a diversity of potential candidates, including air pollution, cannabis and social exclusion. Urbanicity may have a synergistic effect with genetic vulnerability. Future research is likely to focus on the relationship between urbanicity and neural maldevelopment, the possibility of rural protective factors (e.g. social capital, low social fragmentation), urbanicity in developing countries, cultural variables and geographical location, and associations between urbanicity and other disorders (e.g. affective psychosis).
Central to contemporary cognitive science is the notion that mental processes involve computations defined over internal representations. This notion stands in sharp contrast with another prevailing view ??e direct theory of perception whose most prominent proponent has been J.J. Gibson. The publication of his recent book (The Ecological Approach to Visual Perception ??oston, Houghton Mifflin Company, 1979) offers an opportunity to examine the theory of direct perception and to contrast it with the computational/representational view. In this paper the notion of direct perception is examined primarily from a theoretical standpoint, and various objections are raised against it. An attempt is made to place the theory of direct perception in perspective by embedding it in a more comprehensive framework.
I have written this article from my personal experiences of schizophrenia as fundamentally a self-disturbance and not simply a biochemical imbalance. In the article, I attempt to use a theory of “existential permeability” to explain the various symptoms of the condition and how psychiatrists could help in recognizing the patient's self-disturbance.
While the evidence is strong that dopamine plays some fundamental and special role in the rewarding effects of brain stimulation, psychomotor stimulants, opiates, and food, the exact nature of that role is not clear. One thing is clear: Dopamine is not the only reward transmitter, and dopaminergic neurons are not the final common path for all rewards. Dopamine antagonists and lesions of the dopamine systems appear to spare the rewarding effects of nucleus accumbens and frontal cortex brain stimulation (Simon et al 1979) and certainly spare the rewarding effects of apomorphine (Roberts & Vickers 1988). It is clear that reward circuitry is multisynaptic, and since dopamine cells do not send axons to each other or receive axons from each other, dopamine can at best serve as but a single link in this circuitry. If dopamine is not a final common path for all rewards, could it be an intermediate common path for most rewards? Some workers have argued against such a view, but at present they must do so on incomplete evidence. For example, Phillips (1984) has argued that there must be multiple reward systems, functionally independent and organized in parallel with one another. His primary evidence, however, is the fact that brain stimulation is rewarding at different levels of the nervous system. As we have seen in the case of midline mesencephalic stimulation, the location of the electrode tip in relation to the dopamine cells and fibers tells us little about the role of dopamine in brain stimulation reward. It seems clear that the ventral tegmental dopamine system plays a critical role in midline mesencephalic reward, despite the distance from the electrode tip to the dopamine cells where morphine causes its dopamine-dependent facilitory effects or to the dopamine terminals where low-dose neuroleptics presumably cause theirs. Until pharmacological challenge has been extended to the cases discussed by Phillips, we can only speculate as to the role of dopamine in each of those cases. In the cases where pharmacological challenge has been examined, only nucleus accumbens and frontal cortex have been found to have dopamine-independent reward sites. It is not consistent with the dopamine hypothesis that dopamine-independent reward sites should exist in these areas, since any reward signals carried to nucleus accumbens or frontal cortex by dopamine fibers would-unless we are to believe that reward "happens" at these sites-have to be carried to the next stage of the circuit by nondopaminergic fibers (there are no dopaminergic cell bodies in any of the dopamine terminal areas).(ABSTRACT TRUNCATED AT 400 WORDS)
Imitation and utilization behavior have previously been described in terms of a simple interaction between an examiner and a patient, and were interpreted as an excessive dependence on environmental cues. In this study, patient dependence was observed in complex situations of everyday life. Two patients with focal unilateral frontal lobe lesions were observed while in a doctor's office, a lecture room, a car, and a garden, while visiting an apartment where various activities were possible, and while in a gift shop. The patients' behavior was striking, as though implicit in the environment was an order to respond to the situation in which they found themselves. The term environmental dependency syndrome is proposed for this condition. It implies a disorder in personal autonomy. Individual psychological traits influenced the way in which loss of autonomy was manifested. This study does not offer a physiological model of autonomy, but it does provide clinical and behavioral observations on the loss of autonomy secondary to unilateral lesions of the frontal lobe.
A type of pathological behavior, imitation behavior (IB), is newly described. In this behavior patients imitate the examiner's gestures, although not instructed to do so. Patients explain that they thought they had to imitate the examiner. IB is the first stage of utilization behavior (UB). Neuropsychological examination of 40 patients with IB, of 35 with UB, and of 50 disease controls demonstrates the existence of a frontal syndrome and two determining features of such behavior: dependence on (1) the social and (2) the physical environments. Loss of intellectual control was also required for the occurrence of such behavior. UB and/or IB were present in 96% of the 29 patients with focal lesions of the frontal lobes. Computed tomographic scans in 26 of these patients showed involvement of the inferior half of the anterior part of one or both frontal lobes. IB and UB are interpreted as release of parietal lobe activities, resulting from impairment of frontal lobe inhibition.
A new type of behaviour, termed 'utilization behaviour', was observed among patients affected with left or right unilateral, or bilateral, frontal lesions. It is an extension of bilateral manual grasping behaviour (magnetic apraxia). The tactile, visuotactile and visual presentation of objects compels the patients to grasp and use them. This behaviour was obtained with miscellaneous utilitarian objects. For the patients, the presentation of objects implies the order to grasp and use them. It is proposed that the balance between the subject's dependence on and independence from the outside world is disturbed. With frontal lesions, the inhibitory function of the frontal lobes on the parietal lobes is suppressed. The result is a release of the activities of the parietal lobes so that the subject becomes dependent on visual and tactile stimulation from the outside world. Five cases are reported as examples: one anatomoclinical case with bilateral lesions of the frontal lobe. The role of lesions affecting different parts of the frontal lobes is discussed. The neuropathological observations lead to the suggestion that lesions of the orbital surface of the frontal lobe, and perhaps of the head of the caudate nucleus, are responsible for this behaviour.
Brain research on mental illnesses has made substantial advances in recent years, supported by conceptual and technological
developments in cognitive neuroscience. Brain-based cognitive models of illnesses such as schizophrenia and depression have
been tested with a variety of techniques, including the lesion method, tract tracing, neuroimaging, animal modeling, single-cell
recording, electrophysiology, neuropsychology, and experimental cognitive psychology. A relatively sophisticated picture is
emerging that conceptualizes mental illnesses as disorders of mind arising in the brain. Convergent data using multiple neuroscience
techniques indicate that the neural mechanisms of mental illnesses can be understood as dysfunctions in specific neural circuits
and that their functions and dysfunctions can be influenced or altered by a variety of cognitive and pharmacological factors.
Pennebaker summarizes and highlights the work he and his colleagues from around the world have done over more than ten years in their studies of the health-promoting qualities of writing. His essay focuses primarily on the physical health benefits of writing about traumatic or difficult experience.