Functional and Cognitive Rehabilitation of Hoarding Disorder

囤积症的功能和认知康复

• 批准号: 10182605
• 负责人: Catherine Ayers
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10182605
• 关键词: Activities of Daily Living; Address; Adult; Aftercare; Age; Caregiver Burden; Caring; Case Management; Chronic; Clinic; Cognitive; Communities; Compulsive Hoarding; Dangerousness; Data; Decision Making; Disease; Distress; Economic Factors; Elderly; Evaluation; Evidence based treatment; Executive Dysfunction; Fire - disasters; Food Contamination; Gender; Home; Home visitation; Housing; Impairment; Individual; Individual Differences; Interruption; Intervention; Knowledge; Left; Life; Measures; Mediating; Mediation; Medical; Mental Health; Modality; Nature; Older Population; Outcome; Participant; Pharmaceutical Preparations; Primary Health Care; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Recovery of Function; Rehabilitation Outcome; Rehabilitation therapy; Research; Services; Severities; Site; Social Workers; Social isolation; Sorting - Cell Movement; Symptoms; Telemedicine; Telemental; Therapeutic Intervention; Training; Treatment Factor; Treatment outcome; Veterans; Visit; base; care delivery; clinical practice; cognitive rehabilitation; cognitive testing; comorbidity; disability; executive function; experience; fall risk; follow-up; functional disability; functional improvement; functional outcomes; human old age (65+); improved; innovation; novel strategies; nutrient deprivation; precision medicine; preference; primary outcome; programs; reduce symptoms; rehabilitative care; secondary outcome; standard of care; therapy design; trial comparing

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.

囤积症（HD）是一种慢性、进行性和使人衰弱的精神疾病， 对个人和公共健康造成毁灭性的后果。HD定义为持续难以丢弃或 由于与丢弃有关的痛苦而放弃财产，敦促保存，和/或难以制作 决定什么该保留什么该抛弃随后的杂乱积累会变得如此 危险的是，它把个人的风险福尔斯，火灾，虫害，食品污染，药物 管理不善、社会孤立、营养匮乏和驱逐。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 严重性。HD在生命早期开始，如果不治疗不会缓解，并且随着年龄的增长严重程度增加。最高 HD的发病率见于老年人，高达25%的人出现HD症状。老年人口 退伍军人人数众多，预计到2030年，41%的人将超过65岁。最近的研究发现， HD退伍军人经历更多的医疗和精神病合并症;因此，退伍军人代表了一个群体， 高度需要有效的血液透析治疗，以减少残疾并改善多方面的功能。 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。CREST干预提供了补偿性认知策略 解决HD患者典型的执行功能障碍，然后使用暴露疗法来减少 与丢弃物品有关的苦恼。CREST改善HD症状和功能在退伍军人与 HD，但该计划的密集性（6-8个月）负担心理健康诊所和减缓进展。 考虑到家庭是杂乱的主要场所，并且需要在整个过程中对大量物品进行分类， 治疗，需要一个以家庭为基础的治疗方法。减少执行工作的负担和障碍 的CREST，我们将使用一种新的方法，称为个性化CREST，旨在反映精度 循证医学方法治疗HD。个性化--CREST将更加个性化 （将认知策略与退伍军人的需求和优先事项相匹配），更高效（12年内更短的时间框架 周），并且更容易访问（家庭会议和基于家庭的视频远程医疗[HBVT]会议）。 最近的试点数据表明，HBVT治疗HD是可行的，有效的，需要最小的适应，是一种 preferred.基于73名非退伍军人社区个性化CREST完成者，结果显示统计学 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比较个性化-CREST与病例管理 (CM)130名HD成人退伍军人的对照条件。个性化-CREST将每周交付两次， 家庭（一次面对面和一次HBVT会话），每次会话60分钟。共24场会议将在 提供了超过3个月。根据CM的护理标准，社会工作者将每周访问退伍军人一次， 他们的家全面评估治疗结果，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）、中期和中期进行评估。 治疗、治疗结束（3个月）和6个月随访。我们还将研究介导 个性化CREST改善（改善执行功能和减少回避 丢弃物品）。个体因素（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，将作为主持人进行探讨。拟议 这项研究将产生知识，以促进退伍军人与HD的康复护理。