Risk factors for cognitive impairment and substance-induced psychosis in people living in precarious housing or homelessness.

Social marginalization is a risk factor for poor health and is associated with psychotic and substance use disorders, traumatic brain injury (TBI), HIV and hepatitis C infection. Substance use and brain insults, such as TBIs, can lead to changes in brain function, yet we do not fully understand how they contribute to cognitive impairment (possibly due to accelerated aging) and other symptoms like psychosis. This study aims to assess the extent to which individuals with brain insults using substances are at risk of cognitive impairment or psychosis, and if using antipsychotics can affect these symptoms. This study will use data from the Hotel Study, an ongoing longitudinal community-based study aimed at characterizing factors affecting health of marginalized individuals based in Vancouver’s Downtown Eastside. Participants completed comprehensive assessments at study entry and monthly evaluations of prescription and non-prescription substance use, symptoms of psychosis, and annual cognitive assessments including brain imaging. Statistical modelling will be used to address objectives. We anticipate that our results will help better guide clinicians in engaging and treating this vulnerable population to prevent chronic disability.