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1.
Psychiatry Res ; 336: 115888, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38608540

RESUMEN

Hoarding Disorder (HD) is a prominent and disabling neuropsychiatric condition defined by the inability to discard objects resulting in impairing levels of clutter. The prevalence rate is 2-6 % and increases with age. The aging Veteran population is a high risk group for impairment associated with HD. Medical and psychiatric comorbidities as well as associated rates of disability and poor quality of life are very common in both HD and the related disorder of OCD. We examined rates of HD and OCD diagnoses at the VA San Diego Healthcare System. Data were obtained from medical records for all Veterans with these diagnoses over 8-years and included information on medical and psychiatric care, homelessness services, and Care Assessment Needs (CAN) scores. Rates of diagnosis for both HD and OCD were well below epidemiological estimates. Veterans with HD were older, had higher rates of medical hospital admissions with longer stays; had more cardiac, neurological, and acquired medical conditions; had more psychiatric comorbidities; had more interactions with the suicide prevent team and homelessness services; and had higher CAN scores than Veterans with OCD. The low rate of diagnosis and high services utilization of Veterans with HD demonstrates an area of unmet need.


Asunto(s)
Trastorno de Acumulación , Veteranos , Humanos , Veteranos/estadística & datos numéricos , Trastorno de Acumulación/epidemiología , Trastorno de Acumulación/diagnóstico , Trastorno de Acumulación/terapia , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Comorbilidad , Estados Unidos/epidemiología , Anciano de 80 o más Años , Servicios de Salud Mental/estadística & datos numéricos , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/terapia
2.
J Clin Psychol ; 80(3): 610-624, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38215456

RESUMEN

OBJECTIVE: Families of individuals with hoarding symptoms report substantial burden; however, there has been no investigation of potential positive experiences. The objective of this study was to examine the experiences reported by individuals with a relative with elevated hoarding symptoms using a cross-sectional design. The current investigation expands on the literature in this area by incorporating a detailed interview of experiences in conjunction with validated measures of hoarding symptomology. METHODS: Twenty-nine adults with relatives with elevated hoarding symptoms completed self-report measures of hoarding severity for themselves and their relative and a clinician-administered assessment of their experiences with their family member with hoarding symptoms. RESULTS: Participants endorsed significant burden across a range of areas, including permanent changes in their daily routine. The majority (93%) of participants reported at least one positive experience, with 69% endorsing companionship as a benefit of the relationship. Greater symptom severity of the relative with hoarding symptoms was associated with greater subjective burden and decreased positive experiences. CONCLUSION: Our results add further evidence to the potential for interpersonal psychotherapy to lead to a reduction in hoarding symptomology.


Asunto(s)
Trastorno de Acumulación , Acaparamiento , Adulto , Humanos , Estudios Transversales , Conducta Compulsiva/diagnóstico , Autoinforme , Familia , Trastorno de Acumulación/terapia
3.
Int Psychogeriatr ; 33(9): 977-986, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-32131916

RESUMEN

OBJECTIVES: The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). DESIGN: This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. SETTING: Program activities took place in San Diego County, mainly within clients' homes or community, with some activities in-office. PARTICIPANTS: Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. INTERVENTION: A manualized, mobile protocol that incorporated CREST was utilized. MEASUREMENTS: The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. RESULTS: Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. CONCLUSION: Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno de Acumulación , Acaparamiento , Anciano , Acaparamiento/terapia , Trastorno de Acumulación/terapia , Humanos , Encuestas y Cuestionarios
4.
Curr Psychiatry Rep ; 21(9): 91, 2019 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-31410591

RESUMEN

PURPOSE OF REVIEW: The purpose of the following paper is to review recent literature trends and findings in hoarding disorder (HD). Our goal is to highlight recent research on etiology, associated features, and empirically based treatments. RECENT FINDINGS: Recent literature has added support for cognitive differences as a risk factor for HD; however, there is evidence that individuals with HD may overestimate their level of cognitive impairment. Several associated features have been highlighted in recent studies, including emotion regulation, intolerance of uncertainty and distress intolerance, and attachment. Finally, several psychotherapeutic treatments for hoarding have been recently validated, including group-based therapy and treatments using the cognitive-behavioral model. Although recent research demonstrates that hoarding can be effectively treated with available psychotherapeutic modalities, the effectiveness of current treatments is not as robust as that for other psychiatric disorders and more work is needed in treatment precision.


Asunto(s)
Investigación Conductal , Trastorno de Acumulación/psicología , Trastorno de Acumulación/terapia , Terapia Cognitivo-Conductual , Acaparamiento/psicología , Acaparamiento/terapia , Humanos , Apego a Objetos , Psicoterapia de Grupo , Factores de Riesgo
5.
JAMA Psychiatry ; 76(8): 791-799, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31017639

RESUMEN

Importance: Co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common and associated with psychiatric and functional problems. Understanding whether exposure therapy is tolerable and efficacious for treating PTSD and AUD is critical to ensure that best practice treatments are available. Objective: To compare the efficacy of integrated (ie, targeting both PTSD and alcohol use) prolonged exposure (I-PE) therapy with present-centered integrated coping skills (I-CS) therapy, a more commonly available treatment, in reducing PTSD symptoms and alcohol use. Design, Setting, and Participants: This prospective randomized clinical trial with masked assessments considered 186 veterans seeking Veterans Affairs mental health services. A total of 119 veterans with PTSD and AUD were randomized. Data were collected from February 1, 2013, to May 31, 2017, before treatment, after treatment, and at 3- and 6-month follow-ups. Intention-to-treat analyses were performed. Interventions: Veterans underwent I-PE (Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure) or I-CS (Seeking Safety) therapy. Main Outcomes and Measures: A priori planned outcomes were PTSD symptoms (Clinician Administered PTSD Scale for DSM-5) and percentage of heavy drinking days (Timeline Follow-Back) before treatment, after treatment, and at 3- and 6-month follow-ups. Results: A total of 119 veterans (mean [SD] age, 41.6 [12.6] years; 107 [89.9%] male) were randomized. Linear mixture models found that PTSD symptoms decreased in both conditions, with a significantly greater decrease for I-PE treatment compared with I-CS treatment (treatment × time interaction, -2.83; F3,233.1 = 4.92; Cohen d = 0.41; P = .002). The percentage of heavy drinking days improved in both conditions but was not statistically different between I-PE and I-CS treatment (treatment × time interaction, 1.8%; F3,209.9 = 0.18; Cohen d = 0.04; P = .91). Conclusions and Relevance: The I-PE arm had a greater reduction in PTSD symptoms than the I-CS arm and comparable drinking decreases. The study provides evidence that exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and AUD. Trial Registration: ClinicalTrials.gov identifier: NCT01601067.


Asunto(s)
Adaptación Psicológica , Alcoholismo/terapia , Terapia Cognitivo-Conductual , Terapia Implosiva , Evaluación de Resultado en la Atención de Salud , Trastornos por Estrés Postraumático/terapia , Adulto , Alcoholismo/epidemiología , Terapia Cognitivo-Conductual/métodos , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Terapia Implosiva/métodos , Masculino , Persona de Mediana Edad , Trastornos por Estrés Postraumático/epidemiología , Estados Unidos , United States Department of Veterans Affairs , Veteranos
6.
J Obsessive Compuls Relat Disord ; 21: 97-101, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32670782

RESUMEN

BACKGROUND: Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)-a condition characterized by excessive urges to acquire and difficulties discarding possessions-core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD. METHOD: Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response. RESULTS: IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response. CONCLUSIONS: Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.

7.
Compr Psychiatry ; 86: 1-5, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30041076

RESUMEN

BACKGROUND: Because Veterans have higher rates of mental health conditions and both physical and mental health comorbidities are known to affect treatment outcomes, the purpose of this investigation was to compare the rates of risk factors for poor hoarding treatment outcomes between Veterans and non-Veterans with hoarding disorder (HD). This is the first study to investigate differences between Veterans and non-Veterans with HD. MATERIAL AND METHODS: Baseline data were used from three different treatment studies of adults with hoarding disorder (n = 159). Demographic characteristics, baseline hoarding symptom severity, baseline medical and psychiatric comorbidities, and treatment attrition and response were compared between Veterans and non-Veterans. RESULTS: Veterans were significantly less likely to be employed than non-Veterans. Veterans did not report significantly more severe hoarding symptoms at baseline when compared to non-Veterans. Veterans reported having a greater mean number of overall medical and psychiatric comorbidities. Veterans were more likely than non-Veterans to meet criteria for major depressive disorder and post-traumatic stress disorder. There was no significant difference in the rate of attrition between Veterans and non-Veterans and Veterans were not significantly more likely to be classified as treatment responders. CONCLUSION: Many similarities were observed between the two groups, including demographic characteristics, hoarding symptom severity, and rates of treatment response. Given that Veterans with HD may suffer from greater medical and psychiatric comorbidities, clinicians should ensure that their clients are receiving adequate medical care and that any other psychiatric comorbidities should be addressed in conjunction for treatment with HD.


Asunto(s)
Trastorno de Acumulación/psicología , Trastorno de Acumulación/terapia , Índice de Severidad de la Enfermedad , Veteranos/psicología , Adulto , Anciano , Terapia Cognitivo-Conductual/tendencias , Comorbilidad , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Femenino , Trastorno de Acumulación/diagnóstico , Humanos , Terapia Implosiva/tendencias , Masculino , Persona de Mediana Edad , Estrés Psicológico/diagnóstico , Estrés Psicológico/terapia , Resultado del Tratamiento
8.
Artículo en Inglés | MEDLINE | ID: mdl-32670783

RESUMEN

While a number of hoarding disorder-specific therapeutic interventions have been developed over recent years, hoarding disorder (HD) remains difficult to treat. The purpose of this investigation is to inform HD treatment efforts by examining factors that influence treatment attrition and treatment response. Secondary data analysis of baseline and post-treatment data from two previously published psychotherapy treatment studies for hoarding were performed to identify predictors of hoarding symptom improvement and treatment attrition in 106 adults with HD. No demographic variables were associated with symptom improvement or treatment attrition. However, higher levels of avoidant coping (i.e., self-distraction combined with behavioral disengagement) significantly predicted symptom improvement. The maintenance stage of change along with high readiness for change also significantly predicted symptom improvement. Participants who dropped from treatment had significantly higher baseline levels of denial and clutter, both of which independently predicted treatment attrition. The findings from this study suggest that emotion-related constructs, such as managing stress and motivation for change, may play an important role in patients' response to and participation in HD treatment.

9.
J Clin Psychiatry ; 79(2)2018.
Artículo en Inglés | MEDLINE | ID: mdl-28541646

RESUMEN

OBJECTIVE: To compare the efficacy of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with geriatric case management (CM) in a sample of older adults meeting DSM-5 diagnostic criteria for hoarding disorder (HD). METHODS: Fifty-eight older adults with HD were enrolled in a randomized controlled trial between December 2011 and March 2014. Thirty-one participants received CREST, and 27 participants received CM. Both interventions consisted of 26 individual sessions over a period of 6 months and included several home visits by the study therapists (CREST) or nurses (CM). The Saving Inventory-Revised (SI-R) and the UCLA Hoarding Severity Scale (UHSS) were the main outcome measures. RESULTS: Participants in the CREST condition had significantly greater improvement on the SI-R than participants in the CM group (group × time interaction: ß = 3.95, SE = 1.81, P = .029), with participants who completed the CREST condition averaging a 38% decrease in symptoms and participants who completed the CM condition averaging a 25% decrease in symptoms. In contrast, there was not a significant group × time interaction effect on the UHSS (ß = 1.23, SE = 0.84, P = .144), although participants did report greater improvement in symptoms in the CREST condition (35%) than in the CM condition (24%). Treatment gains were maintained at 6-month follow-up. CONCLUSIONS: CREST appears to be an efficacious treatment compared to CM for older adults, but CM also showed meaningful benefits. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01227057​.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno de Acumulación , Visita Domiciliaria , Anciano , Cognición , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Evaluación Geriátrica/métodos , Trastorno de Acumulación/diagnóstico , Trastorno de Acumulación/psicología , Trastorno de Acumulación/terapia , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
10.
Clin Gerontol ; 40(3): 191-196, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28452663

RESUMEN

OBJECTIVES: Hoarding disorder (HD) is a chronic condition characterized by severe impairment in health and functioning for older adults. Researchers and clinicians commonly use the Saving Inventory-Revised (SI-R), a self-report measure validated for the assessment of HD, to establish symptom severity. This study represents the first evaluation of the psychometric properties of the SI-R in a sample of older adults with HD. METHODS: Participants were 156 older adults with HD and 23 older adults with no psychiatric diagnoses. Demographic and HD symptom severity measures were compared between the two samples. Convergent and discriminant validity was examined in the HD sample. A confirmatory factor analysis was used to test the replicability of the three-factor structure observed in the original sample. RESULTS: Participants in the HD sample scored significantly higher on the SI-R than did the non-psychiatric sample. The SI-R was significantly correlated with clutter level and symptoms of anxiety and depression. A three-factor model demonstrated poor fit in the HD sample. CONCLUSIONS: The SI-R can be used to validly assess hoarding severity in geriatric populations. CLINICAL IMPLICATIONS: Clinicians working with geriatric patients should consider refraining from use of the SI-R subscales as they may be less theoretically distinct in older adults.


Asunto(s)
Evaluación Geriátrica/métodos , Trastorno de Acumulación/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , California , Análisis Factorial , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Trastorno de Acumulación/psicología , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica/normas , Psicometría , Autoinforme , Índice de Severidad de la Enfermedad
11.
Cognit Ther Res ; 41: 799-805, 2017 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-32669747

RESUMEN

A defining feature of hoarding disorder (HD) is excessive attachment to possessions. Several existing self-report measures assess emotional attachment to items but do not explicitly assess the level of interconnectedness between the individual and their items. The current study investigated a new self-report measure of object attachment based on a measure of interconnectedness among individuals. The visual nature of this measure may be especially useful in HD patients since hoarding is often characterized by low insight. Participants completed the Relationship between Self and Items (RSI) measure and measures of hoarding severity, clutter, anxiety, and depression. HD participants reported significantly higher scores on the RSI than did community controls. The RSI was positively associated with hoarding symptoms, but was not significantly correlated with symptoms of anxiety or depression. Results also suggested that the RSI is sensitive to change from pre to post-treatment. This brief, one-item measure may be useful as a screen for HD and to provide further clinical data on level of interconnectedness to possessions.

12.
Cognit Ther Res ; 42: 315-327, 2017 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-32669748

RESUMEN

While cognitive-behavioral therapy for hoarding disorder (HD) has resulted in significant reductions in symptoms, most individuals continue to have significant hoarding symptoms following treatment. This investigation sought to extend the literature on the behavioral treatments for hoarding by examining (1) group cognitive rehabilitation and exposure/sorting therapy (CREST) and (2) group exposure therapy (ET) for hoarding. Participants in both studies reported significant decreases in hoarding symptom severity from baseline to post-treatment on all primary outcome measures using mixed-effects linear regression models with the intent to treat sample. Participants who received group CREST reported statistically significant reductions in anxiety, depression, and overall severity at post-treatment, while participants who received group ET did not. Results provide preliminary evidence for both group CREST and group ET as effective treatments for hoarding disorder.

13.
Clin Gerontol ; 38(4): 235-250, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-29386745

RESUMEN

This study describes the initial contact of 255 potential participants, recruitment of 63 participants, and retention of 57 participants from three geriatric Hoarding Disorder (HD) studies. Patients with HD were easily recruited from the community, primarily through the use of clinician referrals and posted flyers, as evidenced by steady patient flow despite lack of compensation for participation. Contrary to treatment outcomes of late life mood and anxiety disorders, geriatric HD patients are largely retained in clinical research treatment studies. Results demonstrate that older adults with HD can be engaged in treatment. Participants often needed the study staff to provide substantial support, including informal motivational interviewing and problem solving, in scheduling and attending the initial visit.

14.
Am J Geriatr Psychiatry ; 23(4): 416-422, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24953872

RESUMEN

OBJECTIVE: Hoarding disorder (HD) is a chronic condition associated with moderate to severe impairment in health and functioning. HD has been primarily studied in midlife adults, and there is limited research on HD in late life. METHODS: In this review, we summarize research on the presentation and characteristics of HD and hoarding symptoms in older adults, including evidence for associated impairment in daily functioning, physical health, and cognitive function. Finally, we review the evidence available for intervention outcomes for treating HD in older adults. RESULTS: Geriatric HD is characterized by severe functional impairment, medical and psychiatric comorbidities, and cognitive dysfunction. CONCLUSION: There is a lack of randomized controlled trials investigating evidence-based treatments for geriatric HD.


Asunto(s)
Demencia/epidemiología , Trastorno de Acumulación/epidemiología , Enfermedades de Inicio Tardío/epidemiología , Actividades Cotidianas/psicología , Edad de Inicio , Envejecimiento/psicología , Enfermedad Crónica , Comorbilidad , Estado de Salud , Trastorno de Acumulación/diagnóstico , Trastorno de Acumulación/psicología , Trastorno de Acumulación/terapia , Humanos , Enfermedades de Inicio Tardío/diagnóstico , Enfermedades de Inicio Tardío/psicología , Enfermedades de Inicio Tardío/terapia , Prevalencia , Evaluación de Síntomas
15.
Int J Geriatr Psychiatry ; 29(7): 741-6, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24343998

RESUMEN

OBJECTIVE: Late-life hoarding is a serious psychiatric condition with significant implications in health and functioning. Geriatric hoarding patients show greater impairment in activities of daily living and have a greater number of medical conditions compared with same-aged nonhoarders. This study examined the relationship between geriatric hoarding severity and functional disability severity. METHODS: Sixty-five subjects age 60 or older with hoarding disorder (HD) participated in the current study. Participants were assessed with measures of hoarding severity, psychiatric symptoms, and general disability. Hierarchical regression was used to test the unique association of hoarding symptoms with functional disability beyond the effects of demographic factors, anxiety, and depression. RESULTS: When controlling for demographics (age and gender) and psychiatric symptoms (anxiety and depression), hoarding severity predicts functional disability severity. Analyses also show that clinician-administered measures of hoarding are stronger predictors of disability than patient self-report measures. CONCLUSIONS: When treating older adults with HD, clinicians must consider symptom impact on daily life. A multidisciplinary team must be utilized to address the wide-ranging consequences of hoarding symptoms. Future work should examine how psychiatric treatment of HD affects functional disability.


Asunto(s)
Actividades Cotidianas , Trastorno de Acumulación/psicología , Factores de Edad , Anciano , California , Evaluación de la Discapacidad , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Índice de Severidad de la Enfermedad , Factores Sexuales
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