Integrating dynamical systems theory and phenomenology to enhance early identification and treatment of psychotic disorders.

Abstract

In the past three decades, psychiatric research has increasingly focused on the early subthreshold stages of psychosis, with the aim of improving the early identification and treatment of individuals at increased risk of psychotic disorder. Yet, despite considerable research effort, current early psychosis research faces several limitations. In this Personal View, we consider how integrating principles and insights from dynamical systems theory and the phenomenological self-disturbance model of schizophrenia can enhance understanding and prediction of psychosis (on both an individual and group level). We argue that this integration allows the specification of causal processes-ie, distinctive alterations of self-awareness and reality-awareness-whose dynamics can be modelled in dynamical systems terms to anticipate future onset and recurrence of psychotic episodes. We consider how insights afforded by this approach could help to improve early personalised and targeted therapeutic intervention. Empirical hypotheses emerging from this model require testing through intensive longitudinal designs and assessment approaches informed by phenomenological research. To conclude, we discuss theoretical and methodological challenges related to the implementation of our proposal.