Hoarding Disorder

This study explores whether rapid non-invasive brain stimulation can help reduce hoarding disorder symptoms.

Hoarding disorder is characterized by excessive amassment of objects in the home and difficulty of getting rid of the objects. It is associated with a high level of somatic and psychiatric comorbidity, suicidality, social marginalization, damage to property and risk of eviction. Previous clinical studies have mainly been in help-seeking groups. However, social services engage severe cases with poor insight, whereas few as 10% have contact with mental health services. This study investigates: 1. The prevalence of severe mental illness and comorbidities among 60 individuals with hoarding disorder that have led to contact with social services at Copenhagen Municipality 2. the effect of a cross-sectoral intervention aiming to establish contact with regional mental health services for these individuals. The intervention consists of an outreach team of clinicians and municipal social workers who refer participants to clinical services based on a systematic clinical assessment. Primary outcomes are 1) primary and comorbid diagnoses assigned at the clinical assessment and 2) contact with mental health services after the intervention, at 3- and 6-months follow-up. Six to 12 months after the baseline assessment, a qualitative follow-up interview will be carried out, including approximately 14 participants. The aim is to explore the participants' experience of the intervention and subsequent clinical and social services to provide a more nuanced understanding of the quantitative outcomes of the study. The hypotheses of the study are 1. more than 75% of the participants will be identified to have comorbid diagnoses including more than 50% with associated severe mental illness (schizophrenia, other psychotic disorders, bipolar disorder and periodic depression). It is expected that 10% will suffer from underlying organic disorders of dementia or mental retardation. 2. Fifty percent of the sample will establish contact with mental health services within 3 months after attempt of referral, and 30% of the sample will remain in contact for more than 6 months

This study will compare two behavioral interventions for hoarding disorder in older adults.

Hoarding disorder (HD) is characterized by difficulty discarding personal possessions due to significant emotional distress when parting with personal items. This leads to the accumulation of excessive clutter which compromises the normal use of living spaces. In addition to emotional distress, individuals with HD experience significant impairment in physical health. One study found an 11-fold increase in stroke risk, a 10-fold increase in cancer risk, and a 7-fold increase in cardiovascular disease in individuals with HD relative to a general population comparison group. Patients with HD are also more likely to experience obesity and metabolic diseases such as diabetes. The short-term goal of the proposed study is to determine whether a brief exercise intervention improves discarding-related distress and brain-derived neurotropic factor (BDNF) in individuals with HD relative to a relaxation control condition. Preliminary evidence suggests that BDNF may be associated with greater body mass index and more severe HD symptoms in patients with HD. BDNF is a well-studied growth factor which is involved in neuronal transmission, plasticity, and survival of many neuron systems that have been implicated in psychiatric disorders, including serotonin, glutamate, and dopamine. BDNF has been proposed as a mechanism of exercise interventions for psychiatric disorders, as even one session of exercise has been shown to increase BDNF levels. This study represents an initial first step towards the long-term goal of improving current treatments for HD. This is important because although current cognitive-behavioral treatments (CBT) are effective, only 35% of patients who receive these treatments actually benefit from them. In the proposed pilot study, the investigators will test whether 30 minutes of moderate-intensity exercise reduces the distress associated with discarding and increases BDNF levels in individuals with HD relative to a relaxation control. The investigators will recruit 22 individuals with a primary diagnosis of HD. They will be randomly assigned to exercise or control. Following the intervention, the investigators will assess BDNF via serum. Participants will complete a standardized discarding task which consists of sorting and discarding personal possessions. The central hypothesis is that those in the exercise condition will demonstrate lower distress during the discarding task and greater BDNF levels as compared to those in the relaxation control condition. Should the hypothesis be confirmed, the investigators will be well poised to conduct large-scale clinical trials testing exercise interventions as adjunctive or alternative treatments to standard CBT.