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Córcoles D, Guerrero L, Malagon A, Bellsolà M, Gonzalez AM, León J, Sabaté A, Pérez V, Bulbena A, Martín LM, Mane A. Hoarding behaviour: special features and complications in real-world clinical practice. Int J Psychiatry Clin Pract 2024; 28:17-26. [PMID: 38019133 DOI: 10.1080/13651501.2023.2287755] [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] [Received: 06/01/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Hoarding behaviour is a common but poorly characterised problem in real-world clinical practice. Although hoarding behaviour is the key component of Hoarding Disorder (HD), there are people who exhibit hoarding behaviour but do not suffer from HD. The aim of the present study was to characterise a clinical sample of patients with clinically relevant hoarding behaviour and evaluate the differential characteristics between patients with and without HD. METHODS This study included patients who received treatment at the home visitation program in Barcelona (Spain) from January 2013 through December 2020, and scored ≥ 4 on the Clutter Image Rating scale. Sociodemographic, DSM-5 diagnosis, clinical data and differences between patients with and without an HD diagnosis were assessed. RESULTS A total of 243 subjects were included. Hoarding behaviour had been unnoticed in its early stages and the median length in the sample was 10 years (IQR 15). 100% of the cases had hoarding-related complications. HD was the most common diagnosis in 117 patients (48.1%). CONCLUSIONS The study found several differential characteristics between patients with and without HD diagnosis. Alcohol use disorder could play an important role among those without HD diagnosis. Home visitation programs could improve earlier detection, preventing hoarding-related complications.
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Affiliation(s)
- David Córcoles
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Lucía Guerrero
- Servei de Salut de l' Ajuntament de L'Hospitalet, Hospitalet de Llobregat, Barcelona, España
| | - Angeles Malagon
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Magda Bellsolà
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Ana Maria Gonzalez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Jordi León
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Agnès Sabaté
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Victor Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Luis Miguel Martín
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Anna Mane
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Norton M, Kellett S, Huddy V, Simmonds-Buckley M. Household factors and prevalence of squalor: meta-analysis and meta-regression. BMC Public Health 2024; 24:479. [PMID: 38360612 PMCID: PMC10870488 DOI: 10.1186/s12889-024-17983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Severe domestic squalor occurs when a person lives in a dwelling that is significantly unclean, disorganised and unhygienic. The limited previous research has primarily focused on the characteristics of those who live in squalor and the associated risk factors. Robust and reliable studies of squalor prevalence have not been conducted. This study sought to produce a reliable estimate of the point prevalence of squalor. METHODS Using data from 13-years of the English Housing Survey, N = 85,681 households were included in a prevalence meta-analysis. Squalor prevalence over time, subgroup analysis and logistic regression investigated the role played by household and community characteristics. RESULTS The point prevalence of squalor was estimated to be 0.85% and squalor was seen to decrease significantly over time. More significant community deprivation, a rented dwelling, lower income and high numbers of people in the home was associated with a greater risk of squalor. CONCLUSIONS Squalor prevalence was higher than previous estimates and supports community care services in associated service planning. The results regarding household characteristics help to inform which households and individuals may be at a higher risk of living in squalid conditions.
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Affiliation(s)
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Trust, Rotherham, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Vyv Huddy
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Melanie Simmonds-Buckley
- Rotherham Doncaster and South Humber NHS Trust, Rotherham, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Lee SM, Martino E, Bismark M, Bentley R. Evidence to guide ethical decision-making in the management of older people living in squalor: a narrative review. Intern Med J 2022; 52:1304-1312. [PMID: 35762169 PMCID: PMC9544969 DOI: 10.1111/imj.15862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
Older people living in squalor present healthcare providers with a set of complex issues because squalor occurs alongside a variety of medical and psychiatric conditions, and older people living in squalor frequently decline intervention. To synthesise empirical evidence on squalor to inform ethical decision‐making in the management of squalor using the bioethical framework of principlism. A systematic literature search was conducted using Medline, Embase, PsycINFO and CINAHL databases for empirical research on squalor in older people. Given the limited evidence base to date, an interpretive approach to synthesis was used. Sixty‐seven articles that met the inclusion criteria were included in the review. Our synthesis of the research evidence indicates that: (i) older people living in squalor have a high prevalence of frontal executive dysfunction, medical comorbidities and premature deaths; (ii) interventions are complex and require interagency involvement, with further evaluations needed to determine the effectiveness and potential harm of interventions; and (iii) older people living in squalor utilise more medical and social resources, and may negatively impact others around them. These results suggest that autonomous decision‐making capacity should be determined rather than assumed. The harm associated with squalid living for the older person, and for others around them, means a non‐interventional approach is likely to contravene the principles of non‐maleficence, beneficence and justice. Adequate assessment of decision‐making capacity is of particular importance. To be ethical, any intervention undertaken must balance benefits, harms, resource utilisation and impact on others.
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Affiliation(s)
- Sook Meng Lee
- Department of Geriatric Medicine, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Erika Martino
- Research Fellow and PhD candidate in the NHMRC Centre of Research Excellence in Healthy Housing, The Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Professor of the Law and Public Health Unit of the Centre for Health Policy, The Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Bentley
- Professor and Director of the NHMRC Centre of Research Excellence in Healthy Housing, The Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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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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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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Guinane J, Bailey D, Fuge W, Lee SM. Analysis of patients referred for aged care assessment with concerns related to hoarding or squalor. Intern Med J 2019; 49:1313-1316. [DOI: 10.1111/imj.14449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/18/2019] [Accepted: 05/05/2019] [Indexed: 11/28/2022]
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Lee SM, Lewis M, Leighton D, Harris B, Long B, Macfarlane S. A comparison of the neuropsychological profiles of people living in squalor without hoarding to those living in squalor associated with hoarding. Int J Geriatr Psychiatry 2017; 32:1433-1439. [PMID: 27911004 DOI: 10.1002/gps.4631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Squalor affects 1 in 1000 older people and is regarded as a secondary condition to other primary disorders such as dementia, intellectual impairment and alcohol abuse. Squalor frequently is associated with hoarding behaviour. We compared the neuropsychological profile of people living in squalor associated with hoarding to those presenting with squalor only. METHODS This study is a retrospective case series of hospital inpatient and community healthcare services of 69 people living in squalor (49 from aged care, 16 from aged psychiatry, 3 from acute medical and 1 from a memory clinic). Forty per cent had co-morbid hoarding behaviours. The main outcomes were neuropsychologists' opinions of domain-specific cognitive impairment. RESULTS The squalor-hoarding group (M age 75.8, SD = 6.9,) was significantly older (p < 0.05) than the squalor-only group (M age 69.9 years, SD = 13.1), significantly more likely to have vascular or Alzheimer's type neurodegeneration (p < 0.05) and significantly less likely to have alcohol-related impairment (p < 0.05). Chi-square analyses revealed significantly greater rates of impairment for the squalor-only group (p < 0.05) in visuospatial reasoning, abstraction, planning, organisation, problem solving and mental flexibility, compared with the squalor-hoarding group. Logistic regression analysis indicated that impaired mental flexibility was a significant predictor and strongly indicated squalor only (odds ratio = 0.07; 95% confidence interval: 0.01-0.82). CONCLUSIONS Preliminary evidence suggests that squalor associated with hoarding may have distinct neuropsychological features compared against squalor only. Future work should be conducted using a larger sample and a common neuropsychological battery to better understand the deficits associated with hoarding-related squalor. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sook Meng Lee
- Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Western Health, Melbourne, Victoria, Australia
| | - Matthew Lewis
- Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Deborah Leighton
- Neuropsychology, The Royal Melbourne Hospital, Melbourne Health, Parkville, Victoria, Australia
| | - Ben Harris
- Neuropsychology, Kingston Centre, Monash Health, Cheltenham, Victoria, Australia
| | - Brian Long
- Neuropsychology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Stephen Macfarlane
- Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia.,The Dementia Centre, HammondCare, Sydney, New South Wales, Australia
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