Psychiatric research has long sought to identify and treat people in the early stages of psychosis, but progress has been limited. This paper argues that combining dynamical systems theory with the phenomenological self-disturbance model of schizophrenia can improve understanding and prediction of psychosis. The integration specifies causal processes involving altered self-awareness and reality-awareness, whose dynamics can be modeled to anticipate the onset and recurrence of psychotic episodes. This approach may enable earlier, personalized therapeutic interventions. Empirical testing of the model requires intensive longitudinal studies and phenomenological assessment methods. The authors also discuss theoretical and methodological challenges to implementing their proposal.
Psychedelic compounds like psilocybin and LSD are being studied again as potential treatments, but research usually excludes people at risk for psychosis. This narrative review examines the historical and theoretical links between psychedelics and schizophrenia spectrum disorders (SSDs), including the psychotomimetic hypothesis. The authors compare the phenomenological experiences induced by psychedelics with those of SSDs, finding both overlap and important qualitative differences that challenge a simple equivalence. They review neural mechanisms involving serotonin, dopamine, and glutamate. Clinical evidence shows psychedelics can worsen existing psychotic illness and may trigger psychosis in vulnerable individuals, though the risk magnitude is not well quantified. The authors suggest potential therapeutic applications for carefully selected symptoms in stable patients using low-dose, controlled approaches and provide recommendations for managing psychosis-related risk.