This study examined the hypothesis that developmental expression of psychometric risk in the form of subclinical psychotic experiences in the general population is usually transitory but in some instances may become abnormally persistent and progress to a clinical psychotic state. A prospective cohort study was conducted in a general population sample of 845 adolescents, aged 14–17 years, in Munich, Germany (Early Developmental Stages of Psychopathology Study). Expression of psychosis was assessed 4 times (T0–T3) over a period of 8.4 years. Transition from subclinical psychosis at T0–T2 to clinical psychosis in terms of impairment at T3 was examined as a function of the level of prior persistence of subclinical psychosis (present never, once, twice, or thrice). The more the subclinical psychosis persisted over the period T0–T2, the greater the risk of transition to clinical psychosis at T3 in a dose-response fashion (subclinical psychosis expression once over T0–T2: odds ratio [OR] = 1.5 [95% confidence interval {CI} = 0.6–3.7], posttest probability [PP] = 5%; twice: OR = 5.0 [95% CI = 1.6–15.9], PP = 16%; at all 3 measurements: OR = 9.9 [95% CI = 2.5–39.8], PP = 27%). Of all clinical psychosis at T3, more than a third (38.3%) was preceded by subclinical psychotic experiences at least once and a fifth (19.6%) at least twice. Consequently, a significant proportion of psychotic disorder may be conceptualized as the rare poor outcome of a common developmental phenotype characterized by persistence of psychometrically detectable subclinical psychotic experiences. This may be summarized descriptively as a psychosis proneness-persistence-impairment model of psychotic disorder.

Während die Krankheit einen pathologischen Zustand des Körpers beschreibt, ist der Raum der Krankheit ein spatiotemporaler Zustand, welcher Krankheit ermöglicht. Historisch gesehen blühten Krankheiten in urbaner Umgebung auf – in jener städtischen Umgebung, in der große Konzentrationen von Körpern und Mengen von Materialströmen vorkamen. Das heißt, verschiedene urbane Bedingungen können für den Ausbruch von Epidemien verantwortlich gemacht werden. Ganz gleich, auf welchem Maßstab wir diese Räume der Krankheit betreten (auf der Größenordnung eines überkontinentalen Handelsweges, einer Stadt, oder eines Gebäudes), der physische Raum stellt lediglich einen potenziellen Risikofaktor dar. Erst der Fluss von physischen, chemischen und biologischen Bestandteilen konditioniert den Raum für Krankheiten. Folglich ist jede Krankheit als räumlicher Arbeitsablauf zu begreifen und somit architektonisch und operativ beschreibbar. Auf diesem Schauplatz von Krankheit und Stadt wurde der Raum in Form von räumlichen Maßnahmen notwendigerweise bis zum Äußersten ausgereizt. Raum engt ein, behandelt, erschließt und kultiviert Krankheiten – und ist selbst Gegenstand von Medikation. Im Kontext dieser Forschung dient das Krankenhaus als Hauptvertreter der städtischen Architektur. Das Krankenhaus der Charité in Berlin wird hier im Rahmen einer Fallstudie untersucht, ihre 300-jährige Geschichte definiert den Zeitrahmen dieser Forschung. Diese Arbeit ist der Versuch, die Geschichte des Krankenhauses der klinischen Medizin zu erweitern; deshalb werden erstens unterschiedliche Räume von Krankheiten und deren Einfluss auf die Stadt rekonstruiert, zweitens verschiedene räumliche Maßnahmen, welche die Stadt historisch gegen Krankheiten implementierte, im Vergleich zum Krankenhaus kontextualisiert und drittens die einhergehenden Veränderungen des Krankenhauses im Anbetracht zunehmender klinischer Spezialisierung analysiert. / While disease describes a body’s pathological state, space of disease is the spatio-temporal condition that allows disease to come into existence. Conceptually speaking, a space of disease both preconditions a disease and holds it in place for a certain time. Historically, disease has flourished in urban environments that rely on large concentrations of bodies and a vast amount of material flows; that is, various urban conditions can be held responsible for the outbreak of epidemics. No matter on what scale we enter these particular spaces of disease (on the scale of a cross-continental trade route, a city, or a building), physical space represents only a potential risk factor, requiring the flow of physical, chemical, and biological components through it to precondition that space for disease. Hence, each disease should be viewed as a spatial flow, which can be described architecturally and operatively. In this arena of disease and the city, the spatial measures that have evolved in response to disease have by necessity pushed space to its limits—space confines, treats, accesses, and cultivates disease, and is itself subject to medication. In the context of this research, the hospital serves as the primary representative of the architecture of the city. While the hospital of the Charité in Berlin is the subject of this case study (and its three-hundred-year history defines the time frame of this research), the attempt here is to expand upon the history of the hospital of clinical medicine by framing various spaces of disease and their impact upon the city; by positioning the hospital within the context of the diverse spatial measures that the city historically has implemented against disease; and by analyzing the hospital’s move toward greater clinical specialization.

This study examined the hypothesis that developmental expression of psychometric risk in the form of subclinical psychotic experiences in the general population is usually transitory but in some instances may become abnormally persistent and progress to a clinical psychotic state. A prospective cohort study was conducted in a general population sample of 845 adolescents, aged 14–17 years, in Munich, Germany (Early Developmental Stages of Psychopathology Study). Expression of psychosis was assessed 4 times (T0–T3) over a period of 8.4 years. Transition from subclinical psychosis at T0–T2 to clinical psychosis in terms of impairment at T3 was examined as a function of the level of prior persistence of subclinical psychosis (present never, once, twice, or thrice). The more the subclinical psychosis persisted over the period T0–T2, the greater the risk of transition to clinical psychosis at T3 in a dose-response fashion (subclinical psychosis expression once over T0–T2: odds ratio [OR] = 1.5 [95% confidence interval {CI} = 0.6–3.7], posttest probability [PP] = 5%; twice: OR = 5.0 [95% CI = 1.6–15.9], PP = 16%; at all 3 measurements: OR = 9.9 [95% CI = 2.5–39.8], PP = 27%). Of all clinical psychosis at T3, more than a third (38.3%) was preceded by subclinical psychotic experiences at least once and a fifth (19.6%) at least twice. Consequently, a significant proportion of psychotic disorder may be conceptualized as the rare poor outcome of a common developmental phenotype characterized by persistence of psychometrically detectable subclinical psychotic experiences. This may be summarized descriptively as a psychosis proneness-persistence-impairment model of psychotic disorder.