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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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2
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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3
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Sivakanthan A, Basu A, Jacob T. A Case of Clutter and Chaos: Attention Deficit Hyperactivity Disorder Confounding Hoarding. J Nerv Ment Dis 2021; 209:481-483. [PMID: 33782251 DOI: 10.1097/nmd.0000000000001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hoarding disorder is a chronic disorder defined as the persistent difficulty in parting with possessions and the need to save items, regardless of their actual value. Severe hoarding has largely been a hidden clinical problem, and awareness has mostly been limited to voyeuristic depictions of the plight of hoarders in popular media. Approximately 28% to 32% of individuals with attention deficit hyperactivity disorder (ADHD), especially the inattentive subtype, have been reported to have clinically significant hoarding. It has been hypothesized that patients with ADHD initially acquire objects impulsively and later develop emotional attachments or intrinsic meaning, resulting in a perpetuating cycle of reliance on hoarding as a coping mechanism. Treatment focused on impaired attention has shown improved prognosis, which further signifies the relationship between inattentive ADHD and hoarding. We discuss the case of a patient with ADHD (inattentive type), major depressive disorder, and hoarding traits.
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4
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Abstract
Hoarding and squalor are complex conditions with a range of physical and mental comorbidities GPs play a key role in identifying people who experience these conditions, screening for safety risks, referral to specialist services and encouraging people to accept treatment and ongoing monitoring. Treatment for contributing and comorbid conditions should be optimised, with the help of specialist services when required. Medicines should be reviewed and adherence confirmed For moderate to severe hoarding and squalor, referral to specialist psychiatry, geriatrics and allied health services is recommended for thorough assessment, treatment of underlying conditions and ongoing management.
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Affiliation(s)
- Andrew Gleason
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
| | - Danielle Perkes
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
| | - Anne Pf Wand
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
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5
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Piacentino D, Pasquini M, Cappelletti S, Chetoni C, Sani G, Kotzalidis GD. Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD? Curr Neuropharmacol 2020; 17:808-815. [PMID: 30678629 PMCID: PMC7059160 DOI: 10.2174/1570159x17666190124153048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/10/2023] Open
Abstract
This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.
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Affiliation(s)
- Daria Piacentino
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | - Massimo Pasquini
- Department of Neurosciences, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Simone Cappelletti
- Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences (SAIMLAL) Department, Sapienza University, Rome, Italy
| | - Chiara Chetoni
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
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6
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Zheng H, Jia F, Han H, Wang S, Guo G, Quan D, Li G, Huang H. Combined fluvoxamine and extended-release methylphenidate improved treatment response compared to fluvoxamine alone in patients with treatment-refractory obsessive-compulsive disorder: A randomized double-blind, placebo-controlled study. Eur Neuropsychopharmacol 2019; 29:397-404. [PMID: 30595354 DOI: 10.1016/j.euroneuro.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 01/04/2023]
Abstract
More effective, tolerable interventions for treatment-refractory obsessive-compulsive disorder (OCD) are needed. Preliminary findings encourage optimism that methylphenidate augmentation may be of benefit in the treatment of OCD. To test modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) a safe and effective add-on therapy for refractory OCD, a pilot randomized, placebo-controlled, double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor (SRI) treatment-refractory OCD and receiving a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. Data were analyzed in the intention-to-treat sample. All subjects were randomized into two parallel groups to receive fluvoxamine (250 mg daily) plus MPH-ER (36 mg daily) or fluvoxamine (250 mg daily) plus identical placebo tablets under double-blind conditions and followed for 8 weeks. Forty-four patients (29 [66%] men), with a mean (SD) age of 24.7 (6) years participated; with a mean (SD) duration of episode 5.7 (3) were randomized and forty-one finished the trial. In the intention-to-treat analysis, the improvement in the Y-BOCS total score and Y-BOCS obsession subscale score was more prominent in the fluvoxamine and MPH-ER group compared with those receiving placebo (P < .001). Additionally, cumulative response rates were higher in the MPH-ER vs placebo groups (59% vs 5%; P < .001). MPH-ER was well tolerated; No subjects dropped out due to side effects. In summary, combined treatment with MPH-ER demonstrated an enhanced clinical rate of response compared to placebo. Further trials should examine MPH-ER efficacy in a larger sample.
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Affiliation(s)
- Huirong Zheng
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China.
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China
| | - Hongying Han
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, PR China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China
| | - Guangquan Guo
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China
| | - Dongming Quan
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China
| | - Gang Li
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, No. 123 Huifu Xi Road, Guangzhou 510180, Guangdong, PR China
| | - Huiyan Huang
- Pharmacy Department of Guangdong General Hospital, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, PR China
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7
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Pertusa A, Lopez Gaston R, Choudry A. Hoarding revisited: there is light at the end of the living room. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSince 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.LEARNING OBJECTIVES•Be able to define the criteria of hoarding disorder•Be able to recognise the difference between hoarding and collecting•Understand potential treatment options for patients with hoarding disorderDECLARATION OF INTERESTNone.
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8
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Baldwin PA, Whitford TJ, Grisham JR. Psychological and electrophysiological indices of inattention in hoarding. Psychiatry Res 2018; 270:915-921. [PMID: 30551344 DOI: 10.1016/j.psychres.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022]
Abstract
Individuals with elevated hoarding symptoms report elevated symptoms of ADHD and these symptoms are related to impaired daily functioning. Neuropsychological studies have found specific deficits in attention, and a recent review of attentional data from numerous hoarding studies concluded that inattention likely represents an etiological factor in hoarding, rather than a comorbidity. Our study aimed to examine which symptoms of ADHD, inattention or hyperactivity, are related to hoarding symptom severity, and whether individuals with hoarding symptoms display a neurophysiological marker of poor attention (Theta/Beta Ratio; THBR) that might explain these associations. The THBR indexes theta power relative to beta power in the frontal cortex and is often atypical in individuals with ADHD. We hypothesised that individuals would report more severe problems with inattention and would exhibit an elevated theta/beta ratio relative to a healthy control group. We also predicted that any relationship between hoarding and inattention would be independent of anxiety and depression symptoms. 17 hoarding-symptomatic participants and 16 healthy control participants completed self-report measures relating to ADHD, hoarding and general psychopathology, and then underwent resting measures of electroencephalography (EEG). Individuals with hoarding symptoms reported greater difficulties with inattention and hyperactivity, however they did not exhibit an elevated theta/beta ratio. When taking into account recent anxiety and depression, only inattention predicted hoarding symptom severity. Further investigations may help clarify this association and help inform attention-based treatments for hoarding.
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Affiliation(s)
- Peter A Baldwin
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Thomas J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia
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9
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Thompson C, Fernández de la Cruz L, Mataix-Cols D, Onwumere J. A systematic review and quality assessment of psychological, pharmacological, and family-based interventions for hoarding disorder. Asian J Psychiatr 2017; 27:53-66. [PMID: 28558897 DOI: 10.1016/j.ajp.2017.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hoarding disorder (HD) affects at least 1.5% of the population and is considered to be hard to treat. The current study aimed to systematically review the treatments designed to improve HD symptoms and family impact. METHOD Searches of PsycINFO, MEDLINE, EMBASE, and Web of Science were undertaken. Studies were included if: (i) the study evaluated an intervention for hoarding problems; (ii) outcome measures were reported; and (iii) study results were published in an indexed journal or were a published abstract from a professional/research conference. The quality of the studies was assessed using the Clinical Trials Assessment Measure (CTAM). RESULTS Twenty studies, comprising 492 participants with clinically significant hoarding symptoms or HD and 21 relatives of individuals with HD, met inclusion criteria. Treatments reviewed included cognitive-behavior therapy, medication, cognitive remediation, and multi-component interventions for relatives. Most studies yielded statistically significant improvements in hoarding symptoms, although reductions were generally modest and many participants remained in the clinical range after treatment. According to the CTAM, most studies were judged to be of low methodological quality. CONCLUSIONS HD is a chronic and highly burdensome condition for which efficacious treatments are needed. The current evidence base is somewhat limited and of low quality. Further research is needed to improve treatments, identify mechanisms of change, and increase the availability of evidence-based interventions for this group.
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Affiliation(s)
- Claire Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK.
| | - Lorena Fernández de la Cruz
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
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10
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Millen A, Linkovski O, Dunn LB, Rodriguez CI. Ethical Challenges in Treating Hoarding Disorder: Two Primary Care Clinical Case Studies. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:185-189. [PMID: 31975851 DOI: 10.1176/appi.focus.20170002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Millen
- The authors, Andrea Millen, Psy.D., Omer Linkovski, Ph.D., Laura B. Dunn, M.D., Carolyn I. Rodriguez, M.D., Ph.D., are with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Rodriguez is also with the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Omer Linkovski
- The authors, Andrea Millen, Psy.D., Omer Linkovski, Ph.D., Laura B. Dunn, M.D., Carolyn I. Rodriguez, M.D., Ph.D., are with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Rodriguez is also with the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Laura B Dunn
- The authors, Andrea Millen, Psy.D., Omer Linkovski, Ph.D., Laura B. Dunn, M.D., Carolyn I. Rodriguez, M.D., Ph.D., are with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Rodriguez is also with the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Carolyn I Rodriguez
- The authors, Andrea Millen, Psy.D., Omer Linkovski, Ph.D., Laura B. Dunn, M.D., Carolyn I. Rodriguez, M.D., Ph.D., are with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Rodriguez is also with the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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11
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Abstract
Hoarding disorder is characterized by a persistent difficulty discarding items, the desire to save items to avoid negative feelings associated with discarding them, significant accumulation of possessions that clutter active living areas and significant distress or impairment in areas of functioning. We present a case of a 52-year-old married man who was referred to the psychiatry department for collecting various objects that were deposited unorganized in the patient's house. He reported to get anxious when someone else discarded some of these items. This behavior had started about 20 years earlier and it worsened with time. The garage, attic, and surroundings of his house were cluttered with these objects. On admission, in the mental status examination, it was observed that the patient was vigil, calm, and oriented; his mood was depressed; his speech was organized, logic, and coherent; and there were no psychotic symptoms. A psychotherapeutic plan was designed for the patient, including psychoeducation, cognitive restructuring, and exposure to discarding objects. A pharmacological treatment with fluvoxamine 100 mg tid and quetiapine 200 mg was added to the therapeutic plan, with the progressive improvement of the symptoms. Nine months later, the patient was able to sell/recycle most of the items. Studies evaluating treatment for HD are necessary to improve the quality of life of the patients and to reduce the hazards associated with the disorder.
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Affiliation(s)
| | | | - Pedro Morgado
- Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS-3Bs PT Government Associate Laboratory, Braga, Portugal
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12
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Grassi G, Micheli L, Di Cesare Mannelli L, Compagno E, Righi L, Ghelardini C, Pallanti S. Atomoxetine for hoarding disorder: A pre-clinical and clinical investigation. J Psychiatr Res 2016; 83:240-248. [PMID: 27665536 DOI: 10.1016/j.jpsychires.2016.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
Despite several studies suggested that inattention and impulsivity-compulsivity could represent two core dimensions of hoarding disorder (HD), only a small case series study investigated the effectiveness of attention-deficit-hyperactivity-disorder (ADHD) medications in HD. The aim of the present study was to target attentional and inhibitory control networks in HD patients through the ADHD medication atomoxetine, moving from a preclinical investigation on an animal model of compulsive-like behavior (marble burying test) to a clinical investigation on both medicated and unmedicated patients with a primary diagnosis of HD without ADHD. Our preclinical investigation showed that acute administration of atomoxetine significantly reduced the compulsive-like behaviours of mice in the marble burying test without affecting neither locomotor activity and coordination nor exploration behaviours. When compared, atomoxetine and fluoxetine showed similar effects on the marble burying test. However, fluoxetine impaired both locomotor and exploratory activity. In our clinical investigation 12 patients were enrolled and 11 patients completed an open trial with atomoxetine at flexible dose (40-80 mg) for 12 weeks. At the endpoint the mean UCLA Hoarding Severity Scale score decreased by 41.3% for the whole group (p = 0003). Six patients were classified as full responders (mean symptom reduction of 57.2%) and three patients as partial responders (mean symptom reduction of 27.3%). Inattentive and impulsivity symptoms showed a significant mean score reduction of 18.5% from baseline to the endpoint (F (1,9) = 20.9, p = 0.0013). Hoarding symptoms improvement was correlated to reduction of patients' disability and increased in their global functioning. These preclinical and clinical data suggest that atomoxetine may be effective for HD and therefore should be considered for future controlled trials.
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Affiliation(s)
- Giacomo Grassi
- University of Florence, Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, via delle Gore 2H, 50141, Florence, Italy; Institute of Neuroscience, via La Marmora 24, 50121, Florence, Italy.
| | - Laura Micheli
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Elisa Compagno
- University of Florence, Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, via delle Gore 2H, 50141, Florence, Italy
| | - Lorenzo Righi
- University of Siena, Department of Molecular and Developmental Medicine, Siena, Italy
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Stefano Pallanti
- University of Florence, Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, via delle Gore 2H, 50141, Florence, Italy; Institute of Neuroscience, via La Marmora 24, 50121, Florence, Italy
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13
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Park JM, Samuels JF, Grados MA, Riddle MA, Bienvenu OJ, Goes FS, Cullen B, Wang Y, Krasnow J, Murphy DL, Rasmussen SA, McLaughlin NC, Piacentini J, Pauls DL, Stewart SE, Shugart YY, Maher B, Pulver AE, Knowles JA, Greenberg BD, Fyer AJ, McCracken JT, Nestadt G, Geller DA. ADHD and executive functioning deficits in OCD youths who hoard. J Psychiatr Res 2016; 82:141-8. [PMID: 27501140 DOI: 10.1016/j.jpsychires.2016.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/29/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
Hoarding is common among youth with obsessive compulsive disorder (OCD), with up to 26% of OCD youth exhibiting hoarding symptoms. Recent evidence from adult hoarding and OCD cohorts suggests that hoarding symptoms are associated with executive functioning deficits similar to those observed in subjects with attention deficit hyperactivity disorder (ADHD). However, while hoarding behavior often onsets during childhood, there is little information about executive function deficits and ADHD in affected children and adolescents. The study sample included 431 youths (ages 6-17 years) diagnosed with OCD who participated in the OCD Collaborative Genetics Study and the OCD Collaborative Genetics Association Study and completed a series of clinician-administered and parent report assessments, including diagnostic interviews and measures of executive functioning (Behavior Rating Inventory of Executive Functioning; BRIEF) and hoarding severity (Hoarding Rating Scale-Interview; HRS-I). 113 youths (26%) had clinically significant levels of hoarding compulsions. Youths with and without hoarding differed significantly on most executive functioning subdomains and composite indices as measured by the parent-rated BRIEF. Groups did not differ in the frequency of full DSM-IV ADHD diagnoses; however, the hoarding group had significantly greater number of inattention and hyperactivity symptoms compared to the non-hoarding group. In multivariate models, we found that overall BRIEF scores were related to hoarding severity, adjusting for age, gender and ADHD symptoms. These findings suggest an association between hoarding and executive functioning deficits in youths with OCD, and assessing executive functioning may be important for investigating the etiology and treatment of children and adolescents with hoarding and OCD.
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Affiliation(s)
- Jennifer M Park
- Stanford University School of Medicine, Department of Child and Adolescent Psychiatry, 1195 W Fremont Ave, Sunnyvale, CA, 94087, USA.
| | - Jack F Samuels
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Marco A Grados
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - O Joseph Bienvenu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Fernando S Goes
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Bernadette Cullen
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Ying Wang
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Janice Krasnow
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Dennis L Murphy
- Laboratory of Clinical Science, National Institute of Mental Health, National Institute of Health, 6001 Executive Boulevard, Rm 6200, MSC 9663, Bethesda, MD, 20892-9663, USA
| | - Steven A Rasmussen
- Brown Medical School, Department of Psychiatry and Human Behavior, Box G-A1, Providence, RI, 02912, USA
| | - Nicole C McLaughlin
- Brown Medical School, Department of Psychiatry and Human Behavior, Box G-A1, Providence, RI, 02912, USA
| | - John Piacentini
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David L Pauls
- Massachusetts General Hospital and Harvard Medical School, Department of Psychiatry, 55 Fruit Street, Boston, MA, 02114, USA
| | - S Evelyn Stewart
- Faculty of Medicine, University of British Columbia, Department of Psychiatry, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Yin-Yao Shugart
- Unit of Statistical Genomics, Division of Intramural Research, National Institute of Mental Health, 6001 Executive Boulevard, Rm 6200, MSC 9663, Bethesda, MD, 20892-9663, USA
| | - Brion Maher
- Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Ann E Pulver
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - James A Knowles
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Benjamin D Greenberg
- Brown Medical School, Department of Psychiatry and Human Behavior, Box G-A1, Providence, RI, 02912, USA
| | - Abby J Fyer
- College of Physicians and Surgeons at Columbia University and the New York State Psychiatric Institute, Department of Psychiatry, 630 W 168th, Street, New York, NY, 10032, USA
| | - James T McCracken
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Gerald Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Daniel A Geller
- Massachusetts General Hospital and Harvard Medical School, Department of Psychiatry, 55 Fruit Street, Boston, MA, 02114, USA
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14
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Rodriguez CI, Levinson A, Patel SR, Rottier K, Zwerling J, Essock S, Shuer L, Frost RO, Simpson HB. Acceptability of Treatments and Services for Individuals with Hoarding Behaviors. J Obsessive Compuls Relat Disord 2016; 11:1-8. [PMID: 28163996 PMCID: PMC5287410 DOI: 10.1016/j.jocrd.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the acceptability of currently available treatments and services for individuals who self-report hoarding behaviors. METHOD Between 10/2013 and 8/2014, participants were invited to complete an online survey that provided them descriptions of eleven treatments and services for hoarding behaviors and asked them to evaluate their acceptability using quantitative (0 [not at all acceptable] -10 [completely acceptable]) Likert scale ratings. The a priori definition of acceptability for a given resource was an average Likert scale score of six or greater. Two well-validated self-report measures assessed hoarding symptom severity: the Saving Inventory-Revised and the Clutter Image Rating Scale. RESULTS Two hundred and seventy two participants who self-reported having hoarding behaviors completed the questionnaire. Analyses focused on the 73% of responders (n=203) who reported clinically significant hoarding behaviors (i.e., Saving Inventory-Revised scores of ≥40). The three most acceptable treatments were individual cognitive behavioral therapy (6.2 ±3.1 on the Likert scale), professional organizing service (6.1 ±3.2), and use of a self-help book (6.0 ±3.0). CONCLUSION In this sample of individuals with self-reported clinically significant hoarding behaviors (n=203), only 3 out of 11 treatments and services for hoarding were deemed acceptable using an a priori score. While needing replication, these findings indicate the need to design more acceptable treatments and services to engage clients and maximize treatment outcomes for hoarding disorder.
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Affiliation(s)
- Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Amanda Levinson
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Sapana R. Patel
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
| | - Kim Rottier
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Jordana Zwerling
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Susan Essock
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
| | - Lee Shuer
- Mutual Support Consulting, Easthampton, MA, 01027
| | - Randy O. Frost
- Smith College, Department of Psychology, Northampton, MA. 01063
| | - Helen Blair Simpson
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
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15
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Huisman-van Dijk HM, van de Schoot R, Rijkeboer MM, Mathews CA, Cath DC. The relationship between tics, OC, ADHD and autism symptoms: A cross- disorder symptom analysis in Gilles de la Tourette syndrome patients and family-members. Psychiatry Res 2016; 237:138-46. [PMID: 26826899 PMCID: PMC5137472 DOI: 10.1016/j.psychres.2016.01.051] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/21/2015] [Accepted: 01/21/2016] [Indexed: 01/22/2023]
Abstract
Gilles de la Tourette's syndrome (GTS) is a disorder in which obsessive-compulsive (OC), Attention Deficit Hyperactivity Disorder (ADHD) and autism symptoms occur in up to 60% of patients, suggesting shared etiology. We explored the phenotypic structure of tic, OC, ADHD, and autism symptoms as measured by the YGTSS,Y-BOCS,CAARS and AQ, in 225 GTS patients and 371 family members. First, Confirmatory Factor Analyses (CFA) were performed on the symptom structure of each separate symptom scale. Second, the symptom dimensions derived from each scale were combined in one model, and correlations between them were calculated. Using the correlation matrix, Exploratory Factor Analyses (EFA) were performed on the symptom dimensions across the scales. EFA revealed a five factor structure: tic/aggression/symmetry; OC symptoms/compulsive tics/ numbers and patterns; ADHD symptoms; autism symptoms; and hoarding/inattention symptoms. The results are partly in line with the traditional categorical boundaries of the symptom scales used, and partly reveal a symptom structure that cuts through the diagnostic categories. This phenotypic structure might more closely reflect underlying etiologies than a structure that classically describes GTS patients according to absence or presence of comorbid OCD, ADHD and autism, and might inform both future genetic and treatment studies.
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Affiliation(s)
- Hilde M. Huisman-van Dijk
- Department of Clinical and Health Psychology, Faculty of Social
Sciences, Utrecht University, Netherlands,Altrecht Academic Anxiety Center, Utrecht, Netherlands
| | - Rens van de Schoot
- Department of Methods & Statistics, Faculty of Social
Sciences, Utrecht University, Netherlands,Optentia Research Program, Faculty of Humanities, North-West
University, South Africa
| | - Marleen M. Rijkeboer
- Department of Clinical and Health Psychology, Faculty of Social
Sciences, Utrecht University, Netherlands
| | - Carol A Mathews
- Department of Psychiatry, School of Medicine, University of
California, San Francisco, United States of America
| | - Dainelle C Cath
- Department of Clinical and Health Psychology, Faculty of Social
Sciences, Utrecht University, Netherlands,Altrecht Academic Anxiety Center, Utrecht, Netherlands
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16
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Abstract
Although some studies have reported a relationship between hoarding and bipolar disorder, we are unaware of any previous description of how they may interact with each other and how they should be managed appropriately. A 48-year-old male depressed patient with hoarding symptoms and obsessive-compulsive disorder (OCD) was diagnosed with bipolar II disorder after 2 hypomanic episodes. The patient was treated unsuccessfully with different high-dose serotonin reuptake inhibitors and atypical antipsychotics, maintaining a pattern of 6 to 8 discrete, but severe, depressive episodes each year, always in association with a drastic worsening of his OCD and hoarding symptoms. T.he patient did not improve until the dose of the serotonin reuptake inhibitor was decreased and a combination of lamotrigine and methylphenidate was initiated. On this treatment regimen, the patient did not show clinically significant levels of depression or hoarding or other OCD symptoms. This case suggests that, in some patients, (1) hoarding-related cognitions and behaviors may be a part of bipolar depression, (2) the episodic nature of rapid cycling bipolar II disorder may protect against the development of severe clutter, and (3) treatment focusing on bipolar depression (eg, lamotrigine plus methylphenidate) may result in an improvement of hoarding symptoms when these are present in patients with rapid cycling bipolar II disorder.
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17
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Abstract
This meta-analysis aimed to identify all studies that have assessed treatment response for pathological hoarding treated with pharmacological agents. Seven studies were identified with a total of 92 participants. Most participants had a diagnosis of obsessive-compulsive disorder. Studies assessed response to serotonin-reuptake inhibitors (SRIs); venlafaxine; methylphenidate; and augmentation of SRIs with quetiapine, minocycline and naltrexone. More than half (ER=0.58, 95% CI=0.37-0.76) of the participants treated with pharmacotherapy responded. This study encourages us to consider the use of SRIs in patients with hoarding disorder. The study also encourages more studies of pharmacotherapy for pathological hoarding, noting that these studies should use validated outcome measures that specifically assess pathological hoarding and novel agents that target the unique neurobiological correlates of pathological hoarding.
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Affiliation(s)
- Vlasios Brakoulias
- Discipline of Psychiatry, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia.
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, The Discipline of Surgery, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia
| | - Vladan Starcevic
- Discipline of Psychiatry, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia
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18
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Abstract
OBJECTIVES To provide a brief selective review of the current literature regarding Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Hoarding Disorder, with an emphasis on its associated risks, assessment and management approaches. CONCLUSIONS Hoarding disorder is defined by clear diagnostic criteria. It can be a severe and disabling disorder that can pose significant safety risks to the individual and to others. Management is often challenging, due to the poor level of insight that people with hoarding disorder often have. Psychological approaches tend to adapt cognitive-behavioural approaches, in order to specifically target areas such as impaired decision-making and motivation. Several trials of pharmacological agents have been conducted, but the limitations of these studies call for further research.
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Affiliation(s)
- Vlasios Brakoulias
- Senior Lecturer, Psychiatry, Sydney Medical School, University of Sydney, and; Psychiatrist, Department of Psychiatry, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Denise Milicevic
- Senior Clinical Psychologist and Clinic Co-ordinator, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Penrith NSW, Australia
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19
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Serata D, Kotzalidis GD, Rapinesi C, Janiri D, Di Pietro S, Callovini G, Piacentino D, Gasperoni C, Brugnoli R, Ferri VR, Girardi N, Tatarelli R, Ferracuti S, Angeletti G, Girardi P, Del Casale A. Are 5-HT3 antagonists effective in obsessive-compulsive disorder? A systematic review of literature. Hum Psychopharmacol 2015; 30:70-84. [PMID: 25676060 DOI: 10.1002/hup.2461] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/25/2014] [Accepted: 12/12/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this literature database search-based review was to critically consider and evaluate the findings of literature focusing on efficacy and safety of 5-HT3 antagonists in the treatment of obsessive-compulsive disorder (OCD), so as to test whether preclinical data match clinical therapeutic trials. DESIGN The PubMed database has been searched for papers on 5-HT3 antagonists and OCD in humans and for animal models of OCD and 5-HT3 receptors. RESULTS Of the clinically tested 5-HT3 receptor antagonists, ondansetron has been used to treat OCD in five therapeutic studies, whereas granisetron only in one recent trial. Both showed some efficacy in open studies and superiority to placebo in double-blind studies, along with fair safety. No animal OCD model directly implicated 5-HT3 receptors. CONCLUSIONS Overall, results indicate some utility, but the available literature is too scanty to allow for valid conclusions to be drawn. The mismatch between animal models of obsessive-compulsive disorder and clinical data with 5-HT3 antagonists needs more clinical data to ensure that it is not an artefact.
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Affiliation(s)
- Daniele Serata
- Neurosciences, Mental Health, and Sensory Organs (NeSMOS) Department, School of Medicine and Psychology, Sapienza University of Rome, UOC Psychiatry, Sant'Andrea Hospital, Roma, Italy; Department of Neuropsychiatry, Villa Rosa Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy
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20
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Abstract
Hoarding disorder (HD) is associated with significant personal impairment in function and constitutes a severe public health burden. Individuals who hoard experience intense distress in discarding a large number of objects, which results in extreme clutter. Research and theory suggest that hoarding may be associated with specific deficits in information processing, particularly in the areas of attention, memory, and executive functioning. There is also growing interest in the neural underpinnings of hoarding behavior. Thus, the primary aim of this review is to summarize the current state of evidence regarding neuropsychological deficits associated with hoarding and review research on its neurophysiological underpinnings. We also outline the prominent theoretical model of hoarding and provide an up-to-date description of empirically based psychological and medical treatment approaches for HD. Finally, we discuss important future avenues for elaborating our model of HD and improving treatment access and outcomes for this disabling disorder.
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Affiliation(s)
- Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Peter A Baldwin
- School of Psychology, University of New South Wales, Sydney, Australia
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21
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Affiliation(s)
- Carol A Mathews
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143-0984
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22
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Fontenelle LF, Grant JE. Hoarding disorder: a new diagnostic category in ICD-11? BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 36 Suppl 1:28-39. [DOI: 10.1590/1516-4446-2013-1269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Leonardo F. Fontenelle
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Instituto D'Or de Pesquisa e Ensino, Brazil; Monash University, Australia
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