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18.07.2015

Adhd cognitive symptoms genetics and treatment outcomes, ginkgo biloba tinnitus cure - For You

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Clinically significant hoarding affects between 6 million and 15 million persons in the United States, according to recent epidemiological studies, occurring at twice the rate of obsessive-compulsive disorder (OCD) and at 4 times the rate of bipolar disorder and schizophrenia. The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample.
Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls. Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender. A number of self-report and clinician-administered hoarding-specific measures aid in the assessment of symptoms and severity. A set of provisional criteria for hoarding disorder has been proposed and will require further study in the future. A recent study conducted by Frost and colleagues that examined the largest sample of participants to date confirmed that major depressive disorder was the most frequently occurring comorbid condition (more than 50%) and that kleptomania was a factor in 10% of the sample. This article highlights treatment options for hoarding that are available to practitioners, including alternative approaches focusing on self-help, support group, and Web-based delivery models. Individually administered CBT, following the protocol developed by Steketee and Frost, appears to be the most effective treatment, with a 70% to 80% rate of clinical improvement for patients who complete treatment. Given the expense and limited availability of individual treatment, alternatives, including group CBT, Web-based treatment, in-person self-help groups, and in-home coaching assistance, may provide sustainable and affordable approaches to this significant societal problem.


Progressive research efforts have advanced the definition and measurement of hoarding, providing a more reliable diagnosis and assessment of comorbidity.12,31,32 A recent study by Frost and colleagues (R.
Glossner, unpublished data, 2011) examined 217 hoarding participants, the largest sample to date, who were recruited to meet diagnostic criteria for hoarding disorder (HD) currently under review for DSM-5.12 The study confirmed that a minority of participants with HD (fewer than 20%) also had OCD diagnoses and that MDD was the most frequent comorbid condition (more than 50%). This finding is consistent with earlier research about the frequency of traumatic events among those who hoard.17,33,34 Inattentive ADHD was significantly more frequent in hoarding than in OCD (30% vs 3%), which supports the speculation that attention deficits are relatively common among those who hoard, but certainly this is not a universal characteristic. It is not surprising that compulsive buying and excessive acquiring of free things were common among the hoarding sample (about 60%), and even the prevalence of kleptomania was surprisingly high at 10% of the sample. Theoretical model The manifestations of hoarding (acquisition, difficulty with discarding, clutter), outlined in an emerging cognitive-behavioral model, are hypothesized to evolve from core vulnerabilities based on early life experiences, genetic predisposition, current mood state, and personality traits (Figure).4,39,40 On the basis of this model, cognitive information processing deficits (focusing attention, decision making, organizing, and possibly perception) are thought to be persistent factors in generating hoarding.
A combination of early experiences and cognitive challenges result in mistaken beliefs about and attachments to possessions, with resulting negative emotions that lead to avoidance behaviors (saving unneeded items) and clutter. In addition, objects that evoke feelings of positive attachment and experiences of pleasure may result in excessive acquiring and clutter.8 CBT methods and outcomes The elements of mental health treatment for hoarding are based on the theoretical model for this multidimensional problem. Because individual and even group treatment can be expensive and unavailable to many individuals with this highly prevalent condition, alternative approaches have focused on the application of self-help bibliotherapy, online and in-person support groups, coaching, and Web-based CBT.
Participants read Buried in Treasures: Help for Compulsive Hoarding,44 a book describing hoarding, and were encouraged to practice the strategies proposed. At the close of the group sessions, 41% of participants rated themselves “much improved.” This student-led group yielded a surprisingly positive outcome for group members in a relatively short period. In 2010, a Web-based self-help group for hoarding, established in 1998, was studied by Muroff and colleagues.45 Members participated in online chats, accessed an archive of resources hosted on the Web site, and were required to post action steps and progress reports at least monthly.
Both long-term and recent members showed reductions in clutter and hoarding symptoms over a 15-month period.


This group represents an intervention model that holds the potential to economically extend treatment to a geographically dispersed group. Muroff and colleagues8 introduced non-clinician, in-home assistants (trained undergraduate student coaches) into a hoarding treatment group to reinforce skills learned in group treatment and boost CBT-based outcomes for participants. Clinicians who led the group communicated with coaches through in-person and telephone group supervision and use of a system to track and docu-ment home visits throughout the 20-week treatment period. Although reductions in hoarding symptoms were not statistically significant, additional in-home assistance appeared to offer improved (albeit small) outcomes. Additional studies will help further define the effect of this enhancement to group treatment.
A pilot study is under way to test the feasibility, acceptability, and effectiveness of computer- and Webcam-delivered CBT for hoarding symptoms.
Preliminary results show potential for a cost-effective, direct service solution to in-home locations where hoarding occurs.8 Initial outcomes of this 26-session, weekly home-based CBT treatment delivered via Webcam showed moderate improvement of participant’s hoarding symptoms and was administered over a 30- to 38-week period compared with an average 49 weeks of in-person treatment. These stepped-care strategies demonstrate potential to assist a broader spectrum of patients using CBT hoarding interventions and offer a sustainable, economic approach to this societal problem. Given the large number of persons who hoard, the debilitating and potentially deadly consequences, and the sometimes limited insight into the severity of their symptoms, it seems essential to learn more about this complicated problem. Accordingly, more research is needed to better understand the disorder and to provide relief from this chronic problem.



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