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Van Patten R, Chan L, Tocco K, Mordecai K, Altalib H, Cotton E, Correia S, Gaston TE, Grayson LP, Martin A, Fry S, Goodman A, Allendorfer JB, Szaflarski J, LaFrance WC. Reduced Subjective Cognitive Concerns With Neurobehavioral Therapy in Functional Seizures and Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2024; 36:197-205. [PMID: 38481168 DOI: 10.1176/appi.neuropsych.20230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Functional seizures are common among people with traumatic brain injury (TBI). Subjective cognitive concerns refer to a person's own perception of problems with cognitive functioning in everyday life. The authors investigated the presence and correlates of subjective cognitive concerns and the response to neurobehavioral therapy among adults with TBI and functional seizures (TBI+FS group). METHODS In this observational study, participants in the TBI+FS group (N=47) completed a 12-session neurobehavioral therapy protocol for seizures, while participants in the comparison group (TBI without seizures) (N=50) received usual treatment. Subjective cognitive concerns, objective cognition, mental health, and quality of life were assessed before and after treatment. Data collection occurred from 2018 to 2022. RESULTS Baseline subjective cognitive concerns were reported for 37 (79%) participants in the TBI+FS group and 20 (40%) participants in the comparison group. In a multivariable regression model in the TBI+FS group, baseline global mental health (β=-0.97) and obsessive-compulsive symptoms (β=-1.01) were associated with subjective cognitive concerns at baseline. The TBI+FS group had fewer subjective cognitive concerns after treatment (η2=0.09), whereas the TBI comparison group showed a nonsignificant increase in subjective cognitive concerns. CONCLUSIONS Subjective cognitive concerns are common among people with TBI and functional seizures and may be related to general mental health and obsessive-compulsive symptoms. Evidence-based neurobehavioral therapy for functional seizures is a reasonable treatment option to address such concerns in this population, although additional studies in culturally diverse samples are needed. In addition, people with functional seizures would likely benefit from rehabilitation specifically targeted toward cognitive functioning.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Lawrence Chan
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Krista Tocco
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Kristen Mordecai
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Hamada Altalib
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Erica Cotton
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Stephen Correia
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Tyler E Gaston
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Leslie P Grayson
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Amber Martin
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Samantha Fry
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Adam Goodman
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jane B Allendorfer
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jerzy Szaflarski
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
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Worden BL, Tolin DF, Stevens MC. An exploration of neural predictors of treatment compliance in cognitive-behavioral group therapy for hoarding disorder. J Affect Disord 2024; 345:410-418. [PMID: 38706461 PMCID: PMC11068362 DOI: 10.1016/j.jad.2023.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A persistent and influential barrier to effective cognitive-behavioral therapy (CBT) for patients with hoarding disorder (HD) is treatment retention and compliance. Recent research has suggested that HD patients have abnormal brain activity identified by functional magnetic resonance (fMRI) in regions often engaged for executive functioning (e.g., right superior frontal gyrus, anterior insula, and anterior cingulate), which raises questions about whether these abnormalities could relate to patients' ability to attend, understand, and engage in HD treatment. We examined data from 74 HD-diagnosed adults who completed fMRI-measured brain activity during a discarding task designed to elicit symptom-related brain dysfunction, exploring which regions' activity might predict treatment compliance variables, including treatment engagement (within-session compliance), homework completion (between-session compliance), and treatment attendance. Brain activity that was significantly related to within- and between-session compliance was found largely in insula, parietal, and premotor areas. No brain regions were associated with treatment attendance. The results add to findings from prior research that have found prefrontal, cingulate, and insula activity abnormalities in HD by suggesting that some aspects of HD brain dysfunction might play a role in preventing the engagement needed for therapeutic benefit.
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Affiliation(s)
| | - David F Tolin
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
| | - Michael C Stevens
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
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Fossati P. Challenges in Sheltering Seized Animals from Hoarders from a One Welfare Perspective. Animals (Basel) 2023; 13:3303. [PMID: 37958058 PMCID: PMC10647514 DOI: 10.3390/ani13213303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Animal hoarding is a complex issue that, when discovered, frequently necessitates opening shelter doors to many animals. This is due to hoarders' inability to provide even the most basic welfare standards for their animals, resulting in poor welfare conditions that frequently border on mistreatment. These people are frequently unaware of their failure to care for their animals, as well as of the harm that they cause to people around them and the environment. They usually do not care for themselves either. The majority of hoarders have difficult histories, and they all need help getting back on track. When the agencies discover the status quo, the animals are usually seized and taken to shelters, where they face a variety of welfare consequences, beginning with confinement in an unknown environment that is associated with additional risks (e.g., infectious diseases, behavioral deterioration, and distress). Furthermore, the targeted shelters are frequently overcrowded and cannot adequately accommodate the large numbers of animals found in hoarders' environments. The One Welfare approach, which is increasingly being used alongside One Health to work at the intersection of human and animal health and welfare, could be adopted to benefit animals while also addressing the poor states of humans. This concept's depiction of the interconnections between animal welfare, human well-being, and the environment can fit with all the components of the animal-hoarding phenomenon, including the peculiarities of the hoarding environment, as well as those of shelters where animals are often moved. The purpose of this paper is to offer insights into how the One Welfare concept may be critical in tackling all of the interests concerned in these cases and offering solutions.
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Affiliation(s)
- Paola Fossati
- Department of Environmental Science and Policy, Università degli Studi di Milano, Via Celoria 2, 20133 Milano, Italy
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Grassi G, Moradei C, Cecchelli C, van Ameringen M. Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls. J Psychiatr Res 2023; 166:74-79. [PMID: 37741062 DOI: 10.1016/j.jpsychires.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Although hoarding disorder (HD) is included in the DSM-5 in the obsessive-compulsive and related disorders chapter, in the last few years, HD has been consistently associated with attention-deficit hyperactivity disorder (ADHD). Some studies on HD patients show higher comorbidity with ADHD than with OCD and some studies on ADHD patients found significant higher rates of HD symptoms compared to the general population. However, the aim of the present study was to be the first direct comparison of the prevalence of HD and HD symptoms across adults with a primary diagnosis of ADHD, OCD and a sample of matched healthy controls (HCs). METHODS 57 adult patients with a primary diagnosis of ADHD and 50 adult patients with a primary diagnosis of OCD were enrolled and matched with 50 HCs. The presence of hoarding disorder and symptoms were assessed though the Saving Inventory Revised (SI-R). RESULTS ADHD patients showed significantly higher prevalence of HD comorbidity (32.1%) with respect to both OCD patients (8%) and HCs (4%). The prevalence of HD symptoms was also significantly higher in ADHD patients than in both OCD and HCs. Although OCD patients showed a higher prevalence of HD and HD symptoms with respect to HCs, these differences did not reach statistical significance. CONCLUSION HD is significantly more comorbid in ADHD patients than in OCD and HCs. A better understanding and definition of the boundaries between HD and the OCD and ADHD spectrum could lead to the development of a more precise treatment approach for hoarding disorder.
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Affiliation(s)
| | | | | | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, MacAnxiety Research Centre, Canada
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5
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Cognitive impairment in hoarding disorder: a systematic review. CNS Spectr 2022; 28:300-312. [PMID: 35477853 DOI: 10.1017/s1092852922000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the present study, we aimed to perform a systematic review evaluating the cognitive performance of patients with hoarding disorder (HD) compared with controls. We hypothesized that HD patients would present greater cognitive impairment than controls. METHODS A systematic search of the literature using the electronic databases MEDLINE, SCOPUS, and LILACS was conducted on May 2020, with no date limit. The search terms were "hoarding disorder," "cognition," "neuropsychology," "cognitive impairment," and "cognitive deficit." We included original studies assessing cognitive functioning in patients with HD. RESULTS We retrieved 197 studies initially. Of those, 22 studies were included in the present study. We evaluated 1757 patients who were 41 to 72 years old. All selected studies comprised case-control studies and presented fair quality. Contrary to our hypothesis, HD patients showed impairment only in categorization skills in comparison with controls, particularly at confidence to complete categorization tasks. Regarding attention, episodic memory, working memory, information-processing speed, planning, decision-making, inhibitory control, mental flexibility, language, and visuospatial ability, HD patients did not show impairment when compared with controls. There is a paucity of studies on social cognition in HD patients, although they may show deficits. The impact of emotion in cognition is also understudied in HD patients. CONCLUSION Except for categorization skills, the cognitive performance in HD patients does not seem to be impaired when compared with that in controls. Further work is needed to explore social cognition and the impact of emotion in cognitive performance in HD patients.
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Zakrzewski JJ, Henderson R, Archer C, Vigil OR, Mackin S, Mathews CA. Subjective cognitive complaints and objective cognitive impairment in hoarding disorder. Psychiatry Res 2022; 307:114331. [PMID: 34920395 DOI: 10.1016/j.psychres.2021.114331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022]
Abstract
Individuals with Hoarding Disorder (HD) frequently complain of problems with attention and memory. These self-identified difficulties are often used as justification for saving and acquiring behaviors. Research using neuropsychological measures to examine verbal and visual memory performance and sustained attention have reported contradictory findings. Here we aim to determine the relationship between self-reported problems with memory and attention, objective memory and attention performance, and self-reported depression and anxiety symptoms in HD. Data was available for 319 individuals who participated in a treatment study of HD. Multiple regression was used to assess the relationship between self-reported complaints and objective measures, with age, education, and measures of depression and anxiety included as covariates. We found no association between self-reported memory difficulties and objective verbal or visual memory performance. Self-reported problems with attention were associated with objective attentional performance, although this relationship was partially accounted for by anxiety symptom severity. There was a small association between visual memory performance at baseline and improvements in hoardingrelated functional abilities following treatment. Improvements in subjective memory complaints pre-to-post treatment were associated with improvements in hoarding symptom severity and hoarding-related functioning. These results demonstrate a dissociation between perceived and objective functioning in HD.
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Affiliation(s)
- Jessica J Zakrzewski
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America.
| | - Rebecca Henderson
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Christian Archer
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Ofilio R Vigil
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Scott Mackin
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
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Pellegrini L, Maietti E, Rucci P, Burato S, Menchetti M, Berardi D, Maina G, Fineberg NA, Albert U. Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis. Compr Psychiatry 2021; 108:152246. [PMID: 34062378 DOI: 10.1016/j.comppsych.2021.152246] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs). OBJECTIVES This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. METHODS Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. RESULTS Thirty-eigth studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4-47.8), 37.2% (CI:23.8-51.6) and 66.1% (CI:53.5-77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8-37.6), 18.4% (CI:10.2-28.3) and 38.3% (CI:35.0-41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9-22.8) and 40.4% (CI:35.7-45.3), respectively (no data available for lifetime suicidal ideation). CONCLUSIONS The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.
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Affiliation(s)
- Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Sofia Burato
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Italy
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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Information processing in hoarding disorder: A systematic review of the evidence. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Kuwano M, Nakao T, Yonemoto K, Yamada S, Murayama K, Okada K, Honda S, Ikari K, Tomiyama H, Hasuzawa S, Kanba S. Clinical characteristics of hoarding disorder in Japanese patients. Heliyon 2020; 6:e03527. [PMID: 32181397 PMCID: PMC7063155 DOI: 10.1016/j.heliyon.2020.e03527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/19/2019] [Accepted: 02/28/2020] [Indexed: 11/30/2022] Open
Abstract
Previous studies have reported clinical characteristics of hoarding disorder (HD), such as early onset, a chronic course, familiality, high unmarried rate, and high rates of comorbidities. However, clinical research targeting Japanese HD patients has been very limited. As a result, there is a low recognition of HD in Japan, leading to insufficient evaluation and treatment of Japanese HD patients. The aim of the current study was to delineate the clinical characteristics of Japanese HD patients. Thirty HD patients, 20 obsessive-compulsive disorder (OCD) patients, and 21 normal controls (NC) were targeted in this study. The HD group had a tendency toward higher familiality, earlier onset, and longer disease duration compared to the OCD group. In addition, the HD group showed a significantly higher unmarried rate than the NC group. The top two comorbidities in the HD group were major depressive disorder (56.7%) and attention-deficit/hyperactivity disorder (26.7%). The HD group had significantly higher scores on hoarding rating scales and lower scores on the Global Assessment of Functioning Scale than the other two groups. The current study showed a clinical trend in Japanese HD patients similar to previous studies in various countries, suggesting that HD may be a universal disease with consistent clinical symptoms.
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Affiliation(s)
- Masumi Kuwano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Nagasaki Support Center for Children, Women and People with Disabilities, Nagasaki, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yonemoto
- Advanced Medical Research Center, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Satoshi Yamada
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Fukuoka Prefectural Psychiatric Center Dazaifu Hospital, Fukuoka, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kayo Okada
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Okehazama Hospital Fujita Mental Care Center, Aichi, Japan
| | - Shinichi Honda
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuropsychiatry, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Keisuke Ikari
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Suguru Hasuzawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Stevens MC, Levy HC, Hallion LS, Wootton BM, Tolin DF. Functional Neuroimaging Test of an Emerging Neurobiological Model of Hoarding Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:68-75. [PMID: 31676206 DOI: 10.1016/j.bpsc.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Over the past decade, functional neuroimaging studies have found abnormal brain function in several cortical systems when patients with compulsive hoarding behaviors make decisions about personal possessions. The purpose of this study was to use functional magnetic resonance imaging to test a neurobiological model of hoarding disorder (HD) that has begun to emerge from these small studies by confirming HD-related brain dysfunction in previously implicated brain regions in the largest sample of HD patients examined to date. METHODS We compared 79 adults diagnosed with DSM-5 HD with 44 non-HD control participants using a functional magnetic resonance imaging task of decision making to acquire or discard material possessions and on a control task involving semantic processing. RESULTS HD brain activation profiles prominently featured insular and anterior cingulate cortex overengagement during possession-related choices that were not seen in non-HD brain activation profiles and also correlated with hoarders' clutter and difficulty discarding. Although HD patients overengaged the insula when deciding to discard, relative to when performing the non-decision making task contrast, the HD insula also was generally blunted. CONCLUSIONS This study links the defining behavioral symptoms of HD to localized brain dysfunction within cingulo-opercular brain systems and firmly establishes the context-dependent importance of this network dysfunction in HD. The relevance of dysfunction in these brain regions is highlighted by a failure to replicate HD-related abnormalities in other brain regions implicated in prior HD functional magnetic resonance imaging studies. This study also raises the novel possibility that HD may involve abnormality in the inferior frontal cortex engaged for executive control over semantic processing.
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Affiliation(s)
- Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Hannah C Levy
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut
| | - Lauren S Hallion
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bethany M Wootton
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David F Tolin
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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11
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Davidson EJ, Dozier ME, Pittman JOE, Mayes TL, Blanco BH, Gault JD, Schwarz LJ, Ayers CR. Recent Advances in Research on Hoarding. Curr Psychiatry Rep 2019; 21:91. [PMID: 31410591 PMCID: PMC7294597 DOI: 10.1007/s11920-019-1078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Eliza J Davidson
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mary E Dozier
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - James O E Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Tina L Mayes
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Brian H Blanco
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - John D Gault
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Lauren J Schwarz
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
| | - Catherine R Ayers
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA.
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12
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Nakao T, Kanba S. Pathophysiology and treatment of hoarding disorder. Psychiatry Clin Neurosci 2019; 73:370-375. [PMID: 31021515 DOI: 10.1111/pcn.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
Hoarding disorder (HD) is a newly listed disease in the new category of Obsessive-Compulsive and Related Disorders in the DSM-5. Patients with HD find it difficult to discard possessions regardless of their actual value and to organize those things. As a result, the possessions overflow the living space and hinder living functions. Though the hoarding symptom had been regarded as a subtype of obsessive-compulsive disorder (OCD) to date, recent studies have revealed many differences in clinical characteristics, including onset, course, degree of insight, and treatment responses, between hoarding and other subtypes. Moreover, several neuroimaging studies have found specific changes of brain structure and function in OCD patients with hoarding symptoms compared to patients with non-hoarding OCD. Meanwhile, strategies for treatment of HD have not been standardized. At present, psychological treatment using cognitive behavioral therapy techniques has a certain effect. In this review, we outline the pathophysiology and treatment of HD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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Tolin DF, Das A, Hallion LS, Levy HC, Wootton BM, Stevens MC. Quality of Life in Patients with Hoarding Disorder. J Obsessive Compuls Relat Disord 2019; 21:55-59. [PMID: 31595215 PMCID: PMC6783256 DOI: 10.1016/j.jocrd.2018.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate health-related quality of life (QoL) in patients with hoarding disorder (HD). Fifty-four patients with a primary diagnosis of HD, and 24 age- and sex-matched healthy control (HC) participants, completed a battery of questionnaires including the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), Saving Inventory-Revised, and Depression, Anxiety, Stress Scales. Compared to HC participants, those with HD reported poorer health-related QoL across all domains of the SF-36. When controlling for comorbid affective symptoms, HD participants scored lower than did HC participants in the QoL domains of social functioning, emotional well-being, role limitations due to emotional problems, vitality, and general health. HD symptom severity predicted, beyond the effects of affective symptoms, lower QoL in social functioning, emotional well-being, role limitations due to emotional problems, vitality, and general health.
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Affiliation(s)
- David F. Tolin
- Institute of Living, Hartford, CT
- Yale University School of Medicine, New Haven, CT
| | | | - Lauren S. Hallion
- Institute of Living, Hartford, CT
- University of Pittsburgh, Pittsburgh, PA
| | | | - Bethany M. Wootton
- Institute of Living, Hartford, CT
- University of Technology Sydney, Sydney, Australia
| | - Michael C. Stevens
- Institute of Living, Hartford, CT
- Yale University School of Medicine, New Haven, CT
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