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.

ho积障碍（HD）是一种慢性，进步和衰弱的精神病病，导致 毁灭性的个人和公共卫生后果。高清是通过持续的困难丢弃或 由于与丢弃相关的困扰，保存和/或难以制定的迫使遇到的可能性分开 关于保留什么和丢弃什么的决定。随后的混乱积累可能会变得如此 危险的是，它使个人有跌倒，火灾，侵扰，食物污染，药物的风险 管理不善，社会隔离，营养剥夺和驱逐。医疗问题，每日活动 生活（ADL）损害，生活质量降低和功能障碍与高清症状有关 严重程度。 HD在生命的早期开始，如果不进行治疗，则不会发出汇率，并且随着年龄的增长而严重程度增加。最高 老年人可见高清率，高达25％的高清症状。年龄较大的人口 退伍军人是大量的，预计到2030年将超过65岁。最近的研究发现 拥有高清的退伍军人经历更多的医学和精神病合并症；因此，退伍军人代表一个群体 高清治疗的需求很高，以减少残疾并改善功能的多个方面。 艾尔斯博士小组已经开发和评估了认知康复和曝光/分类疗法 （波峰）在随机对照试验中。波峰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 与丢弃物品有关的困扰。 Crest改善了HD症状和在退伍军人中的功能 高清，但该计划的密集性（6-8个月）伯恩斯心理健康诊所并放慢了进步。 鉴于房屋是混乱的主要地点，并且需要在 需要治疗，需要一种基于家庭的宝藏方法。减少燃烧器和实施障碍 在波峰上，我们将使用一种新颖的方法，称为个性化克雷斯特，旨在反映精度 医学方法用于基于循证的高清治疗。个性化的克雷斯特将更加个性化 （将认知策略与退伍军人的需求和优先级相匹配），更有效（超过12个时间范围 几周），易于访问（家庭内部和基于家庭的视频远程医疗[HBVT]会议）。 最近的试点数据表明，HD的HBVT是可行的，有效的，需要最少的适应性，并且是一个 首选。基于73个非退伍军人社区个性化的克雷斯特完成者，结果在统计上表示 功能障碍，残疾和HD症状严重程度的显着下降。 拟议的随机对照试验将将个性化克雷斯特与案件管理进行比较 （CM）130名具有HD的成年退伍军人的控制条件。个性化克雷斯特每周将两次交付 每个会议60分钟，房屋（一个面对面和一次HBVT会话）。总共24个会议将是 提供了3个月的时间。根据商业标准，社会工作者将每周访问老将 他们的家。对治疗结果的彻底评估，包括多方面的功能和康复性 结果，包括生活质量和ho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个月的随访。我们还将研究调解的因素 个性化克雷斯特的改善（改善了执行功能和避免的减少 丢弃物品）。个体因素（例如，年龄，基线执行功能，基线高清严重程度，性别 和经济因素）和治疗因素（例如出勤率）将作为主持人探索。提议 研究将产生知识，以提高使用高清退伍军人的康复护理。