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UBC Theses and Dissertations

Longitudinal characterization of psychosis among adults living in marginal housing Jones, Andrea Amy


People living in marginal or inadequate housing experience increased risk for premature mortality and face accumulating health challenges associated with poverty, substance use, and physical and mental illness. In particular, psychotic disorders, such as schizophrenia or schizoaffective disorder, may be more common. Psychosis, or grossly impaired reality testing, is a key feature of these disorders, but remains poorly understood, due to the heterogeneous course, multifaceted etiology, and complex clinical presentation. As part of a five-year longitudinal study of adults living in urban marginalized housing in Vancouver, Canada, we sought to characterize the consequences, risk factors, and dynamics of psychosis over time. First, we demonstrated that psychotic disorders were a significant risk factor for premature mortality over the study period, beyond other potentially treatable illnesses. Second, through direct clinical interviews each month, we observed a high prevalence of psychosis and psychosis risk factors. Among those without schizophrenia or schizoaffective disorder, the number of days of methamphetamine, powder cocaine, cannabis, or alcohol use predicted dose-related increases in odds of psychosis, without evidence of interaction or reverse causation. Recent trauma, and histories of early-life trauma or brain injury, also had independent effects on psychosis. No relationships with risk factors were demonstrated in the schizophrenia/schizoaffective group. Lastly, we examined how psychosis may evolve over time through the interplay between psychotic symptoms themselves. By assessing symptoms monthly and applying a multilevel dynamic network analytic approach, we disentangled the within-individual temporal dynamics of psychotic symptoms from the stable between-individual differences. Psychotic symptoms fluctuated and were positively reinforcing over time. Delusions had a central role in the symptom network, at both the between-individual and within-individual levels. Delusions were associated with more severe unusual thought content or suspiciousness, but not conceptual disorganization. In the dynamic symptom network, suspiciousness was upstream and hallucinations were downstream in the symptom activation cascade. Dynamic network connectivity was greatest in the group with schizophrenia or schizoaffective disorder. Overall, these studies identify multiple risk factors and psychopathological processes that contribute to the longitudinal characteristics of psychosis and suggest potential targets for intervention and prevention strategies among adults at risk for psychosis.

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