Functional and Cognitive Rehabilitation of Hoarding Disorder

囤积障碍(HD)是一种慢性、进行性和衰弱的精神疾病，会导致 对个人和公共健康造成毁灭性的后果。HD的定义是持续的难以丢弃或 由于与丢弃、拯救的冲动和/或制造困难相关的痛苦而放弃财产 关于保留什么和丢弃什么的决定。随之而来的杂乱堆积可能会变成这样 危险的是，它将个人置于跌倒、火灾、感染、食物污染、药物治疗的风险中 管理不善、社会孤立、营养匮乏和被驱逐。医疗问题，日常活动 生活(ADL)障碍、生活质量下降和功能障碍与HD症状相关 严肃性。HD在生命早期就开始了，如果不治疗就不会缓解，并且随着年龄的增长病情会越来越严重。最高的 HD的发生率在老年人中可见，高达25%的人出现HD症状。老年人口 退伍军人人数很多，预计到2030年，41%的人将超过65岁。最近的研究发现， 患有HD的退伍军人经历了更多的医疗和精神并存；因此，退伍军人代表了一个群体 高度需要有效的HD治疗，以减少残疾和改善多方面的功能。 艾尔斯博士的团队开发并评估了认知康复和暴露/分类疗法 (CREST)随机对照试验。波峰干预提供了补偿性的认知策略 解决HD患者的典型执行功能障碍，然后使用暴露疗法来减少 与丢弃物品相关的痛苦。佳洁士改善退伍军人HD症状和功能 HD，但该计划的密集性质(6-8个月)给精神卫生诊所带来了负担，并减缓了进展。 考虑到家庭是杂乱的主要场所，并且需要在 治疗方面，需要一种以家庭为基础的治疗方法。减少执行的负担和障碍 对于CREST，我们将使用一种新的方法，称为个性化CREST，旨在反映 HD循证治疗的医学途径。个性化--佳洁士将更加个性化 (使认知策略与退伍军人的需求和优先事项相匹配)，更高效(比12小时更短的时间框架 几周)，更易于访问(家庭会议和基于家庭的视频远程医疗[HBVT]会议)。 最近的试验数据表明，HBVT治疗HD是可行的、有效的，只需要最小的适应，是一种 首选。基于73名非资深社区个性化CREST完成者，结果统计表明 功能障碍、残疾和HD症状严重程度显著降低。 拟议的随机对照试验将把个性化冠脉与病例管理进行比较 (Cm)130名成年退伍军人HD的控制情况。个性化-Crest将每周交付两次 家庭(一次面对面和一次HBVT会议)，每次会议60分钟。共24场会议将于 在3个月内提供。根据对退伍军人的照顾标准，一名社会工作者将每周探望一次退伍军人 他们的家。彻底评估治疗结果，包括多方面的功能和康复 结果，包括生活质量和囤积严重程度，将在基线(0个月)、年中进行 治疗结束(3个月)，随访6个月。我们还将研究调解因素 改善个性化-顶峰(改善执行功能和减少回避 丢弃物品)。个人因素(例如，年龄、基线执行功能、基线HD严重程度、性别 和经济因素)和治疗因素(例如，出席率)将作为主持人进行探讨。建议数 研究将产生知识，以促进患有HD的退伍军人的康复护理。

Hoarding Disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and public health consequences. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. Subsequent accumulation of clutter can become so dangerous that it puts individuals at risk of falls, fires, infestations, food contamination, medication mismanagement, social isolation, nutritional deprivation, and eviction. Medical problems, activities of daily living (ADL) impairment, decreased quality of life, and functional disability are associated with HD symptom severity. HD starts early in life, does not remit if left untreated, and increases in severity with age. The highest rates of HD are seen in older adults, with up to 25% experiencing HD symptoms. The population of older Veterans is substantial, with 41% expected to be over the age of 65 by 2030. Recent research has found that Veterans with HD experience more medical and psychiatric comorbidities; thus, Veterans represent a group with high needs for effective HD treatment to reduce disability and improve multiple aspects of functioning. Dr. Ayers’ group has developed and evaluated Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) in randomized controlled trials. The CREST intervention provides compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, and then uses exposure therapy to reduce the distress associated with discarding items. CREST improves HD symptoms and functioning in Veterans with HD, but the intensive nature of the program (6-8 months) burdens mental health clinics and slows progress. Given that the home is the primary site of clutter and the need for sorting of a large volume of items during treatment, a home-based treament approach is needed. To reduce the burdens and barriers to implementation of CREST, we will use a novel approach, referred to as Personalized-CREST, designed to reflect a precision medicine approach to evidence-based treatment for HD. Personalized-CREST will be more individualized (matching cognitive strategies to Veteran needs and priorities), more efficient (shorter timeframe over 12 weeks), and easier to access (in-home sessions and home-based video telemedicine [HBVT] sessions). Recent pilot data suggest that HBVT for HD is feasible, efficacious, requires minimal adaptation, and is a preferred. Based on 73 non-Veteran community Personalized-CREST completers, results indicated statistically significant decreases in functional impairment, disability, and of HD symptom severity. The proposed randomized controlled trial will compare Personalized-CREST to a case management (CM) control condition for 130 adult Veterans with HD. Personalized-CREST will be delivered twice a week in the home (one face-to-face and one HBVT session) for 60 minutes per session. A total of 24 sessions will be provided over 3 months. Per the standard of care for CM, a social worker will visit the Veteran once a week in their home. A thorough evaluation of treatment outcomes, including multifaceted functional and rehabilitative outcomes, including quality of life and hoarding severity will be conducted at baseline (0 months), mid- treatment, end of treatment (3 months), and 6-month follow-up. We will also examine factors that mediate improvement in Personalized-CREST (improved executive functioning and reduction in avoidance of discarding items). Individual factors (e.g., age, baseline executive functioning, baseline HD severity, gender and economic factors) and treatment factors (e.g., attendance) will be explored as moderators. The proposed study will generate knowledge to advance the rehabilitative care of Veterans with HD.