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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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Wilkins VM, Kiosses DN. Developing Psychosocial Interventions for Late-Life Depression and Comorbid Hoarding Disorder. Am J Geriatr Psychiatry 2024; 32:148-150. [PMID: 37980198 DOI: 10.1016/j.jagp.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Victoria M Wilkins
- Weill Cornell Medicine (VMW, DNK), Weill-Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Dimitris N Kiosses
- Weill Cornell Medicine (VMW, DNK), Weill-Cornell Institute of Geriatric Psychiatry, White Plains, NY.
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McElroy LM, Mohottige D, Cooper A, Sanoff S, Davis LA, Collins BH, Gordon EJ, Wang V, Boulware LE. Improving Health Equity in Living Donor Kidney Transplant: Application of an Implementation Science Framework. Transplant Proc 2024; 56:68-74. [PMID: 38184377 DOI: 10.1016/j.transproceed.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Interventions to improve racial equity in access to living donor kidney transplants (LDKT) have focused primarily on patients, ignoring the contributions of clinicians, transplant centers, and health system factors. Obtaining access to LDKT is a complex, multi-step process involving patients, their families, clinicians, and health system functions. An implementation science framework can help elucidate multi-level barriers to achieving racial equity in LDKT and guide the implementation of interventions targeted at all levels. METHODS We adopted the Pragmatic Robust Implementation and Sustainability Model (PRISM), an implementation science framework for racial equity in LDKT. The purpose was to provide a guide for assessment, inform intervention design, and support planning for the implementation of interventions. RESULTS We applied 4 main PRISM domains to racial equity in LDKT: Organizational Characteristics, Program Components, External Environment, and Patient Characteristics. We specified elements within each domain that consider perspectives of the health system, transplant center, clinical staff, and patients. CONCLUSION The applied PRISM framework provides a foundation for the examination of multi-level influences across the entirety of LDKT care. Researchers, quality improvement staff, and clinicians can use the applied PRISM framework to guide the assessment of inequities, support collaborative intervention development, monitor intervention implementation, and inform resource allocation to improve equity in access to LDKT.
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Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina.
| | | | - Alexandra Cooper
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Scott Sanoff
- Department of Medicine, Duke University, Durham, North Carolina
| | - LaShara A Davis
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | | | - Elisa J Gordon
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Virginia Wang
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
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Lin N, Bacala L, Martin S, Bratiotis C, Muroff J. Hoarding Disorder: The Current Evidence in Conceptualization, Intervention, and Evaluation. Psychiatr Clin North Am 2023; 46:181-196. [PMID: 36740352 DOI: 10.1016/j.psc.2022.10.007] [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: 12/15/2022]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions due to strong urges to save the items, leading to the excessive accumulation of items. High clutter levels result in varied personal, social, and legal consequences. Specialized treatments, including individual, virtual, and group cognitive and behavioral therapies, community-based interventions, and peer support approaches have shown preliminary effectiveness. Animal, attachment, and neurobiological models are expanding our understanding of the etiological bases of the disorder. Specialized populations such as children, older adults, and involuntary patients are highlighted as requiring special consideration for intervention and risk mitigation. Directions for future research are identified.
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Affiliation(s)
- Nancy Lin
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Lindsay Bacala
- University of Manitoba, Faculty of Social Work, 521 Tier Building, 173 Dafoe Road West, Winnipeg, Manitoba R3J 2N2, Canada
| | - Spenser Martin
- Canadian Mental Health Association, 930 Portage Avenue, Winnipeg, Manitoba R3G 0P8, Canada
| | - Christiana Bratiotis
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Jordana Muroff
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
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Lindamer L, Almklov E, Pittman JOE, Shi S, Maye J, Jak A, Twamley E, Rabin B. Multi-method study of the implementation of Cognitive Symptom Management and Rehabilitation Training (CogSMART) in real-world settings. BMC Health Serv Res 2022; 22:1542. [PMID: 36528588 PMCID: PMC9758865 DOI: 10.1186/s12913-022-08941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Cognitive Symptom Management and Rehabilitation Training (CogSMART) and Compensatory Cognitive Training (CCT) are evidence-based compensatory cognitive training interventions that improve cognition in persons with a history of traumatic brain injury or other neuropsychiatric disorders. Despite demonstrated efficacy, use and effectiveness of CogSMART/CCT in real-world settings is not known.We used a multi-method design to collect and analyze quantitative and qualitative survey data from several domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to gather information about use of CogSMART/CCT in real-world settings from provider and patient perspectives. Surveys were sent to email addresses from persons who registered on the CogSMART website seeking access to training manuals and other resources. Descriptive statistics were generated, and we used Natural Language Processing methods to study the self-report free responses. Using n-gram analysis, we identified the most frequently reported responses.We found CogSMART/CCT was broadly used in real-world settings and delivered by a variety of providers for several patient groups with high attendance and overall high satisfaction. CogSMART/CCT seemed to be offered in VA- or university-related clinics more than in private practice or rehabilitation centers. The diversity of providers and variety of formats by which to deliver CogSMART/CCT (i.e., individual, group, telehealth) seemed to play a role in its widespread implementation, as did its adaptability. Most providers made adaptations to the intervention that reduced the length or number of sessions. These changes were most likely to be based on client characteristics. The low rates of formal training, however, may have contributed to lower levels of perceived helpfulness among patients.Reach and Adoption of a cognitive rehabilitation intervention improved by increasing access to the manuals. Attention to characteristics of dissemination and implementation in the design of an intervention may enhance its use in real-world settings. The relevant outcomes, easy access to training manuals, and adaptability of CogSMART/CCT seem to have been important factors in its use in a variety of settings and for several disorders with cognitive impairment. The adoption of CogSMART/CCT by a variety of providers other than neuropsychologists suggests its use may be broadened to other healthcare providers, if adequately trained, to increase access to an intervention with demonstrated efficacy for cognitive rehabilitation for several neuropsychiatric disorders.
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Affiliation(s)
- Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA
| | - James O. E. Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Shuyuan Shi
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Jacqueline Maye
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Amy Jak
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Elizabeth Twamley
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093 USA
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Rabin BA, Cakici J, Golden CA, Estabrooks PA, Glasgow RE, Gaglio B. A citation analysis and scoping systematic review of the operationalization of the Practical, Robust Implementation and Sustainability Model (PRISM). Implement Sci 2022; 17:62. [PMID: 36153628 PMCID: PMC9509575 DOI: 10.1186/s13012-022-01234-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Practical, Robust Implementation and Sustainability Model (PRISM) was developed in 2008 as a contextually expanded version of the broadly used Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. PRISM provides researchers a pragmatic and intuitive model to improve translation of research interventions into clinical and community practice. Since 2008, the use of PRISM increased across diverse topics, populations, and settings. This citation analysis and scoping systematic review aimed to assess the use of the PRISM framework and to make recommendations for future research. Methods A literature search was conducted using three databases (PubMed, Web of Science, Scopus) for the period of 2008 and September 2020. After exclusion, reverse citation searches and invitations to experts in the field were used to identify and obtain recommendations for additional articles not identified in the original search. Studies that integrated PRISM into their study design were selected for full abstraction. Unique research studies were abstracted for information on study characteristics (e.g., setting/population, design), PRISM contextual domains, and RE-AIM outcomes. Results A total of 180 articles were identified to include PRISM to some degree. Thirty-two articles representing 23 unique studies integrated PRISM within their study design. Study characteristics varied widely and included studies conducted in diverse contexts, but predominately in high-income countries and in clinical out-patient settings. With regards to use, 19 used PRISM for evaluation, 10 for planning/development, 10 for implementation, four for sustainment, and one for dissemination. There was substantial variation across studies in how and to what degree PRISM contextual domains and RE-AIM outcomes were operationalized and connected. Only two studies directly connected individual PRISM context domains with RE-AIM outcomes, and another four included RE-AIM outcomes without direct connection to PRISM domains. Conclusions This is the first systematic review of the use of PRISM in various contexts. While there were low levels of ‘integrated’ use of PRISM and few reports on linkage to RE-AIM outcomes, most studies included important context domains of implementation and sustainability infrastructure and external environment. Recommendations are provided for more consistent and comprehensive use of and reporting on PRISM to inform both research and practice on contextual factors in implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01234-3.
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Yap K, Chen W, Wong SF, Isemann S, Svehla J, Grisham JR. Is it as good as being in person? The effectiveness of a modified clinician facilitated buried in treasures group for hoarding disorder using video teleconferencing. Psychiatry Res 2022; 314:114631. [PMID: 35640322 DOI: 10.1016/j.psychres.2022.114631] [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: 11/16/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
The COVID-19 pandemic has necessitated the use of video-teleconferencing (VTC) for psychological treatments but VTC effectiveness studies are sparse. We examined treatment outcomes for a modified Buried in Treasures (BIT) group program for hoarding disorder (HD) delivered via VTC. Participants were 10 individuals with HD. Hoarding severity was evaluated at pre, mid, post, and six-month follow-up. Results showed significant decrease in hoarding symptoms over time (with an average decrease of 32%). The dropout rate was low (9%) and 30% of participants were fully recovered at follow-up. These results support the adaptation of in-person BIT for HD into a VTC format.
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Affiliation(s)
- Keong Yap
- School of Psychology, University of New South Wales, Sydney, NSW 2034, Australia; School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW 2035, Australia.
| | - Wenting Chen
- School of Psychology, University of New South Wales, Sydney, NSW 2034, Australia
| | - Shiu Fung Wong
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC 3086, Australia
| | - Simone Isemann
- Lifeline Habour to Hawkesbury, Gordon, NSW 2072, Australia
| | | | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, NSW 2034, Australia
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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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Volkan K. Hoarding and Animal Hoarding: Psychodynamic and Transitional Aspects. Psychodyn Psychiatry 2021; 49:24-47. [PMID: 33635102 DOI: 10.1521/pdps.2021.49.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hoarding is a disorder that has only recently begun to be understood by researchers and clinicians. This disorder has been examined from a biopsychosocial perspective and has features that overlap with obsessive-compulsive disorder as well as some unique characteristics. Hoarding disorder is widespread and maybe related to the evolution of collecting and storing resources among humans and other animals. While there have been a number of non-analytic theories related to hoarding and its treatment, psychoanalytic thinkers have rarely described the disorder or explored its underlying psychodynamics. Beginning with Freud, it is possible to understand hoarding in relationship to the vicissitudes of the anal stage of development. However, loss of a loved object, especially loss of the mother, can play an important role in the development of hoarding behavior in adults. The hoarding of inanimate items, examined from a developmental object-relations perspective, appears to involve transitional phenomena. Animal hoarding also involves transitional phenomena, but animals, which can serve as animated transitional objects, also have a repetition compulsion function. These psychodynamic characteristics are relevant for establishing a working transference with the analyst or therapist, in order to promote positive therapeutic outcomes.
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Affiliation(s)
- Kevin Volkan
- Professor of Psychology at California State University Channel Islands. He also currently serves on the Graduate Medical Education faculty for the Community Memorial Hospital System in Ventura, California
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