Internet-based hoarding assessment: The reliability and predictive validity of the internet-based Hoarding Rating Scale, Self-Report.

The Hoarding Rating Scale, Self Report (HRS-SR) is a 5-item assessment developed to ascertain the presence and severity of hoarding symptoms. This study aimed to evaluate the validity of an online adaptation of the HRS-SR in a remote, unsupervised internet sample of 23,214 members of the Brain Health Registry (BHR), an online research registry that evaluates and longitudinally monitors cognition, medical and psychiatric health status. Convergent validity was assessed among a sub-sample of 1,183 participants who completed additional, remote measures of self-reported hoarding behaviors. Structured clinical interviews conducted in-clinic and via video conferencing tools were conducted among 230 BHR participants; ROC curves were plotted to assess the diagnostic performance of the internet-based HRS-SR using best estimate hoarding disorder (HD) diagnoses as the gold standard. The area under the curve indicated near-perfect model accuracy, and was confirmed with 10-fold cross validation. Sensitivity and specificity for distinguishing clinically relevant hoarding were optimized using an HRS-SR total score cut-off of 5. Longitudinal analyses indicated stability of HRS-SR scores over time. Findings indicate that the internet-based HRS-SR is a useful and valid assessment of hoarding symptoms, though additional research using samples with more diverse hoarding behavior is needed to validate optimal cut-off values.

Analysis of patients referred for aged care assessment with concerns related to hoarding or squalor.

Patients referred with concerns related to hoarding and squalor frequently pose significant management challenges. We conducted a retrospective analysis of 120 patients referred to an Aged Care Assessment Service. The hoarding only group comprised 27%, squalor only 15% and hoarding and squalor 53%. Mild cognitive impairment was the most common cognitive diagnosis, no cognitive diagnosis was made in 25% and the usual diagnostic process could not be followed in 13%. This analysis provides relevant Australian specific data to assist with planning service delivery for a group of patients with complex management issues.

[Management of Uninhabitable Homes - Investigation of 186 Cases of Hoarding, Domestic Neglect and Squalor in Dortmund (Germany)]. / Der Dortmunder Vorschlag zum praktischen Vorgehen bei unbewohnbar gewordenen Wohnungen - Untersuchung von 186 Fällen von Vermüllung, Wohnungsverwahrlosung und pathologischem Horten (Messie-Syndrom).

OBJECTIVE: To develop an intervention concept for the management of uninhabitable homes. METHODS: Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem. RESULTS: All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41 %), psychosis (F2: 17 %), depression (F3: 17 %), and hoarding disorder (F63.8: 12 %). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48 %), male gender (73 %), isolated situation (only 7 % married, 84 % living alone), normal schooling (only 4 % without completion of schooling, 7 % attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5 % employed, 44 % unemployment benefit, 7 % welfare, 39 % pension or invalidity benefit).Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13 %, compliance with help and interventions was lowest in the hoarder group (F1: 27 %, F2: 26 %, F3: 38 %). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44 %, F1: 27 %, F2: 26 %, F3: 38 %). CONCLUSIONS: Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases. They don't constitute a syndrome and they are not characteristic for one specific diagnosis. It is important to recognise the underlying psychiatric disease as diagnosis influences acceptance of help, choice of appropriate interventions, outcome and prognosis. Tab. 1 shows our suggestion for a diagnosis differentiated approach, relating appearance of the home and behaviour of the patient to diagnosis, appropriate interventions and prognosis. Hard to reach is the group of hoarders. Patients with a psychotic illness and with hoarding disorder require implementation of long-term outreach help in their homes.

Caregiver burden, family accommodation, health, and well-being in relatives of individuals with hoarding disorder.

BACKGROUND: Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking. METHOD: Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment. RESULTS: Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives. LIMITATIONS: The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation. CONCLUSIONS: HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.

Diagnosis and assessment of hoarding disorder.

The acquisition and saving of a large number of possessions that interfere with the use of living areas in the home are remarkably common behaviors that can pose serious threats to the health and safety of the affected person and those living nearby. Recent research on hoarding has led the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Post-traumatic, and Dissociative Disorders Work Group to propose the addition of hoarding disorder to the list of disorders in the upcoming revision of the diagnostic manual. This review examines the research related to the diagnosis and assessment of hoarding and hoarding disorder. The proposed criteria appear to accurately define the disorder, and preliminary studies suggest they are reliable. Recent assessment strategies for hoarding have improved our understanding of the nature of this behavior. Areas in need of further research have been highlighted.

An exploration of economic reasoning in hoarding disorder patients.

Current models of hoarding disorder (HD) emphasize problems of decision-making. Evidence for neuropsychological impairment in HD, however, has been mixed. The present study examined whether HD patients show problems of economic reasoning that could be associated with decision-making problems. Forty-two HD patients, 29 obsessive-compulsive disorder (OCD) patients, and 36 healthy control participants completed the Iowa gambling task (IGT), a computerized card playing game that assesses participants' ability to learn and utilize a rule of sacrificing short-term gain for long-term gain, and a cognitive dissonance reduction task that measured changes in preference for items (art prints) after selecting or rejecting them. Results showed no deficits on the IGT for HD participants, and no difference in dissonance reduction results after selecting or rejecting items on the dissonance reduction task. Furthermore, performance on these two tasks was unrelated to hoarding symptom severity or self-reported indecisiveness. It is suggested that the problems of cognitive processing in HD patients may be largely related to as-yet understudied processes, including idiosyncratic categorization problems for personally-owned items as well as other aspects of economic reasoning.