Neurocognitive functioning and associated symptoms of psychosis in homeless and precariously housed adults with multimorbidity

It has been fairly well-established that discrete psychiatric symptoms, such as the positive, negative, and general symptoms of psychosis, are differentially related to distinct deficits in neurocognition. Less well-known are the relationships between symptoms of psychosis and profiles of neurocognitive strengths and weaknesses and no previous study has delineated these relationships in homeless and precariously housed persons living with multimorbidity. Using a unique three-factorial solution on the Positive and Negative Syndrome Scale in a large sample of marginalized persons living in the Downtown Eastside in Vancouver, Canada, we examined the relationships between neurocognitive profiles derived by Latent Profile Analysis and symptoms of psychosis and other psychiatric and psychosocial variables. A three-class solution was found to be of optimal fit, consisting of a comparatively cognitively higher-functioning subgroup, with a relative strength in fluid reasoning (Class 1), and two comparatively cognitively impaired subgroups: one subgroup displaying the same profile of relative strength as Class 1 (Class 2), and a selectively severely cognitively impaired subgroup with a relative strength in attentional control, processing speed, and encoding and retrieval (Class 3). Subsequent between-group comparisons revealed that the two cognitively impaired subgroups overall suffered from more severe symptoms of psychosis and worse psychosocial and adaptive functioning. Our findings contrast the links between cognitive profiles and symptoms of psychosis detected in clinical samples featuring patients with schizophrenia, underscoring the importance of considering the unique interrelationships between neurocognition and psychosis that exist in marginalized persons with multimorbid conditions when implementing targeted intervention strategies.