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Study Links Drug-Induced Movement Disorders and Psychosis in Homeless Population

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A recent study published in the Journal of Psychiatric Research reveals significant associations between drug-induced movement disorders (DIMDs) and psychotic symptoms in individuals experiencing precarious housing or homelessness. Conducted by a team of researchers from the University of British Columbia and other institutions, the study highlights the intricate relationship between DIMDs and various dimensions of psychosis, offering insights into the mental health challenges faced by this vulnerable population.

Homelessness and precarious housing remain critical public health issues globally. In Canada alone, more than 235,000 people experience homelessness annually. These individuals often endure a heavy burden of physical and mental illnesses, contributing to mortality rates significantly higher than those in the general population. Among the myriad health issues faced by the homeless, psychotic disorders are notably prevalent, with studies indicating a prevalence rate of 21.2% for any psychotic disorder and 10.3% for schizophrenia within this group.

Previous research has established connections between DIMDs and psychotic symptoms in patients with schizophrenia, particularly focusing on concurrent associations. However, the potential temporal relationships between these symptoms remain largely unexplored. The current study aimed to fill this gap by examining both concurrent and temporal associations between DIMDs and psychotic symptoms in a community-based sample of homeless individuals.

Participants were recruited from an impoverished neighbourhood in Vancouver, Canada, as part of an ongoing naturalistic, prospective study. Eligibility criteria included being 18 years or older, fluent in English, and capable of providing informed consent. The study involved comprehensive assessments of addiction and mental health, conducted annually. DIMDs were evaluated using the Extrapyramidal Symptom Rating Scale (ESRS) and the Barnes Akathisia Rating Scale (BARS), while psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) .

The study included 401 participants, with a mean age of 40.7 years and 77.4% male. The findings indicated differential associations between specific types of DIMDs and psychotic symptoms. Parkinsonism was linked to greater negative symptoms, dyskinesia to disorganised symptoms, and akathisia to excited symptoms. Interestingly, DIMDs were not associated with depressive symptoms.

Regarding temporal associations, the study found that preceding delusions and unusual thought content were associated with parkinsonism, while dyskinesia predicted subsequent conceptual disorganization. These results suggest a directionality in the relationship between DIMDs and psychotic symptoms, highlighting the complexity of managing mental health in homeless populations.

The study’s findings underscore the need for targeted interventions to address both DIMDs and psychotic symptoms in homeless individuals. The temporal associations observed suggest that early detection and management of DIMDs could potentially mitigate the severity of subsequent psychotic symptoms, thereby improving overall quality of life for these individuals.

Future research should aim to unravel the underlying mechanisms driving these associations. This could involve exploring the impact of prolonged antipsychotic treatment and psychostimulant use on the development of DIMDs and psychotic symptoms. Additionally, understanding the role of external factors such as traumatic brain injury and chronic substance use could further inform effective intervention strategies.

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