Functional and Cognitive Rehabilitation of Hoarding Disorder

囤积症的功能和认知康复

• 批准号: 10378634
• 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/10378634
• 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; disability; executive function; experience; fall risk; follow-up; functional disability; functional improvement; functional outcomes; human old age (65+); implementation barriers; improved; innovation; novel strategies; nutrient deprivation; precision medicine; preference; primary outcome; programs; psychiatric comorbidity; 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、使人衰弱的精神疾病，会导致 毁灭性的个人和公共健康后果。 HD 的定义是持续困难丢弃或 由于与丢弃、渴望保存和/或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。随后杂乱的积累就会变得如此 危险的是它会使个人面临跌倒、火灾、感染、食品污染、药物治疗的风险 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 严重程度。 HD 开始于生命早期，如果不治疗则不会缓解，并且随着年龄的增长而严重程度增加。最高的 HD 的发病率多见于老年人，高达 25% 的人有 HD 症状。老年人口数量 退伍军人数量庞大，预计到 2030 年，其中 41% 的人年龄将超过 65 岁。最近的研究发现， 患有 HD 的退伍军人会经历更多的医疗和精神合并症；因此，退伍军人代表了一个群体 非常需要有效的 HD 治疗，以减少残疾并改善多个方面的功能。 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 与丢弃物品相关的痛苦。 CREST 可改善退伍军人的 HD 症状和功能 HD，但该计划的密集性质（6-8 个月）给心理健康诊所带来了负担并减慢了进展。 鉴于家庭是杂乱的主要场所，并且需要在期间对大量物品进行分类 治疗，需要采取家庭治疗方法。减少实施的负担和障碍 对于 CREST，我们将使用一种新颖的方法，称为个性化 CREST，旨在反映精确度 HD 循证治疗的医学方法。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（更短的时间超过 12 周），并且更容易访问（家庭会议和家庭视频远程医疗 [HBVT] 会议）。 最近的试点数据表明，HBVT 治疗 HD 是可行的、有效的、需要最少的适应，并且是一种 首选。基于 73 名非退伍军人社区个性化 CREST 完成者，结果显示为统计数据 功能障碍、残疾和 HD 症状严重程度显着降低。 拟议的随机对照试验将个性化 CREST 与病例管理进行比较 (CM) 130 名患有 HD 的成年退伍军人的控制状况。个性化的 CREST 将每周交付两次 在家（一次面对面治疗和一次 HBVT 治疗），每次治疗 60 分钟。共计24场 提供3个月以上。根据 CM 的护理标准，社会工作者将每周拜访退伍军人一次 他们的家。对治疗结果的全面评估，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）、中期进行 治疗、治疗结束（3 个月）和 6 个月随访。我们还将研究调解因素 个性化 CREST 的改进（改善执行功能并减少避免 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（例如出勤率）将作为调节因素进行探讨。拟议的 研究将产生知识来促进患有 HD 的退伍军人的康复护理。