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Norberg MM, Meares S, Stevenson RJ, Tame J, Wong G, Aldrich P, Olivier J. Attention, response inhibition, and hoarding: A neuropsychological examination. J Behav Addict 2023; 12:827-839. [PMID: 37773748 PMCID: PMC10562813 DOI: 10.1556/2006.2023.00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/30/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
Background and aims The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context that drastically differs from their own homes. Methods One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order. Results Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and that these participants reported greater hoarding severity and greater distress in the cluttered room. Discussion and conclusions Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.
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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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Information processing in hoarding disorder: A systematic review of the evidence. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Davidson EJ, Dozier ME, Pittman JOE, Mayes TL, Blanco BH, Gault JD, Schwarz LJ, Ayers CR. Recent Advances in Research on Hoarding. Curr Psychiatry Rep 2019; 21:91. [PMID: 31410591 PMCID: PMC7294597 DOI: 10.1007/s11920-019-1078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of the following paper is to review recent literature trends and findings in hoarding disorder (HD). Our goal is to highlight recent research on etiology, associated features, and empirically based treatments. RECENT FINDINGS Recent literature has added support for cognitive differences as a risk factor for HD; however, there is evidence that individuals with HD may overestimate their level of cognitive impairment. Several associated features have been highlighted in recent studies, including emotion regulation, intolerance of uncertainty and distress intolerance, and attachment. Finally, several psychotherapeutic treatments for hoarding have been recently validated, including group-based therapy and treatments using the cognitive-behavioral model. Although recent research demonstrates that hoarding can be effectively treated with available psychotherapeutic modalities, the effectiveness of current treatments is not as robust as that for other psychiatric disorders and more work is needed in treatment precision.
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Affiliation(s)
- Eliza J Davidson
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mary E Dozier
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - James O E Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Tina L Mayes
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Brian H Blanco
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - John D Gault
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Lauren J Schwarz
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
| | - Catherine R Ayers
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Pushkarskaya H, Tolin DF, Henick D, Levy I, Pittenger C. Unbending mind: Individuals with hoarding disorder do not modify decision strategy in response to feedback under risk. Psychiatry Res 2018; 259:506-513. [PMID: 29154203 PMCID: PMC5742085 DOI: 10.1016/j.psychres.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023]
Abstract
Cognitive-behavioral models of hoarding disorder emphasize impairments in information processing and decision making in the genesis of hoarding symptomology. We propose and test the novel hypothesis that individuals with hoarding are maladaptively biased towards a deliberative decision style. While deliberative strategies are often considered normative, they are not always adaptable to the limitations imposed by many real-world decision contexts. We examined decision-making patterns in 19 individuals with hoarding and 19 healthy controls, using a behavioral task that quantifies selection of decision strategies in a novel environment with known probabilities (risk) in response to feedback. Consistent with prior literature, we found that healthy individuals tend to explore different decision strategies in the beginning of the experiment, but later, in response to feedback, they shift towards a compound strategy that balances expected values and risks. In contrast, individuals with hoarding follow a simple, deliberative, risk-neutral, value-based strategy from the beginning to the end of the task, irrespective of the feedback. This seemingly rational approach was not ecologically rational: individuals with hoarding and healthy individuals earned about the same amount of money, but it took individuals with hoarding a lot longer to do it: additional cognitive costs did not lead to additional benefits.
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Affiliation(s)
- Helen Pushkarskaya
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, United States.
| | - David F Tolin
- Department of Psychology, Yale University, New Haven, CT 06510, United States; Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT 06114, United States
| | - Daniel Henick
- Department of Psychology, Yale University, New Haven, CT 06510, United States
| | - Ifat Levy
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, United States; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, United States; Department of Psychology, Yale University, New Haven, CT 06510, United States; Child Study Center, Yale School of Medicine, New Haven, CT 06510, United States
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Pushkarskaya H, Tolin D, Ruderman L, Henick D, Kelly JM, Pittenger C, Levy I. Value-based decision making under uncertainty in hoarding and obsessive- compulsive disorders. Psychiatry Res 2017; 258:305-315. [PMID: 28864119 PMCID: PMC5741294 DOI: 10.1016/j.psychres.2017.08.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/20/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
Difficulties in decision making are a core impairment in a range of disease states. For instance, both obsessive- compulsive disorder (OCD) and hoarding disorder (HD) are associated with indecisiveness, inefficient planning, and enhanced uncertainty intolerance, even in contexts unrelated to their core symptomology. We examined decision-making patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid OCD and HD, and 57 individuals from the general population, using a well-validated choice task grounded in behavioral economic theory. Our results suggest that difficulties in decision making in individuals with OCD (with or without comorbid HD) are linked to reduced fidelity of value-based decision making (i.e. increase in inconsistent choices). In contrast, we find that performance of individuals with HD on our laboratory task is largely intact. Overall, these results support our hypothesis that decision-making impairments in OCD and HD, which can appear quite similar clinically, have importantly different underpinnings. Systematic investigation of different aspects of decision making, under varying conditions, may shed new light on commonalities between and distinctions among clinical syndromes.
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Affiliation(s)
- Helen Pushkarskaya
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - David Tolin
- Department of Psychology, Yale University, New Haven, CT 06510, USA,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT 06114, USA
| | - Lital Ruderman
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Daniel Henick
- Department of Psychology, Yale University, New Haven, CT 06510, USA
| | - J. MacLaren Kelly
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA,Department of Psychology, Yale University, New Haven, CT 06510, USA,Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
| | - Ifat Levy
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA,Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
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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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