Hoarding >> How To Stop Hoarding Possessions

Pharmacologically, there is little high-quality evidence for benefit of medications. Saxena recently published an open-label study showing positive effects using serotonin reuptake inhibitors (both selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors) in OCD and non-OCD hoarding using paroxetine and venlafaxine, How To Stop Hoarding Possessions with the latter agent being particularly effective. 

Treatment of dementia with cholinesterase How To Stop Hoarding Possessions inhibitors or memantine (for moderate to severe Alzheimer disease) can be considered, but patient safety and adherence are obvious concerns. In patients with behaviour variant frontotemporal dementia, selective serotonin reuptake inhibitors and atypical neuroleptics are sometimes used to treat disinhibition, agitation, and aggressive behaviour; there are no published studies to show whether these medications improve hoarding.   

Despite a lack of randomized controlled How To Stop Hoarding Possessions trials, memantine is sometimes used by frontotemporal dementia experts, but there is no evidence of benefit for hoarding behaviour. The use of antipsychotics in OCD-related hoarding is not recommended unless psychosis is present. 

Treatment of psychiatric diseases contributing to hoarding behaviour, such as severe depression and How To Stop Hoarding Possessions schizophrenia or psychosis, might decrease hoarding symptoms, especially if apathy is a factor in clutter or squalor. An antipsychotic medication might be indicated if a thought disorder is driving the behaviour (eg, a patient with schizophrenia collecting rubbish because the voices in his head are telling him to do so.

Or a patient with dementia saving used coffee cups because of a delusion they are valuable), assuming the How To Stop Hoarding Possessions benefits outweigh the recognized risks. Given the increased awareness of the problem of hoarding, multidisciplinary models of care and Web listings of resources are becoming more common. 

An example is the Gatekeepers Program in Hamilton, Ont, which identifies potential clients by training nonhealth care staff such as bank tellers and postal workers (and even the beer delivery man) to How To Stop Hoarding Possessions recognize signs of hoarding and refer individuals of concern to a central intake office. The Gatekeeper approach provides multidisciplinary support and advocacy for the vulnerable elderly hoarder through case management. 

Decreasing social isolation, reducing safety risks (eg, by helping to reduced excess clutter and unsanitary living conditions), and connecting such hoarders to community support programs is thought to improve quality of life How To Stop Hoarding Possessions and reduce the need for unplanned hospitalization. Long-term How To Stop Hoarding Possessions monitoring also takes place for those enrolled in the program. 

Similar programs exist in Vancouver, BC, and Calgary, Alta, and in Toronto, Ottawa, and Kingston in Ontario, but we did not find a central listing of coalitions and treatment programs when we did a Web search. When involved with hoarding situations, How To Stop Hoarding Possessions it is hard to not feel the sentiments described by an American task force: 

Everyone working in Adult Protective Services and Elder Abuse and Neglect Offices knows that referrals of people who hoard will be simultaneously amazing How To Stop Hoarding Possessions and confounding. Can a person possibly be both legally competent and living on top of three feet of a mix of garbage and newly purchased gifts, trinkets, and food? 

Or living in an apartment or home in which all but one small corner of one room is totally filled? Or living amid a few How To Stop Hoarding Possessions dozen pets and their waste? One of the biggest management dilemmas is clarifying patient capacity to decide to remain in a potentially hazardous environment. The ability to make personal care and financial capacity decisions might be affected, depending on the cause of the hoarding. 

Patients with dementia or other mental health diagnoses might lack the ability to understand and appreciate the nature of their situation and the risks. People with nonorganic hoarding commonly lack insight into how far from societal norms their behaviour has strayed, but they often are able to identify the risks and justify their choices. 

Removal of the patient from their home without considering capacity is not only unethical but, as noted earlier, might not How To Stop Hoarding Possessions always be in the patient’s best interest. Case resolution Ms L. was found to be incapable of making financial decisions based on her use of limited resources to buy unnecessary items.

The fact that she donated substantial sums to a number of charities despite the need for home repairs and necessities of life (she donated to animal welfare funds but had the carcasses of several dogs in garbage bags on her porch). She was found to be incapable of deciding on How To Stop Hoarding Possessions long-term care placement owing to her insistence on returning home despite full knowledge that her house was condemned. 

The provincial Public Guardian and Trustee upheld both decisions. She received a full psychometric evaluation that included frontal lobe testing but that did not emphasize medial frontal lobe tasks. There was no evidence of How To Stop Hoarding Possessions depression or dementia (including FTLD). No other psychiatric comorbidities were identified, and she was not treated pharmacologically. 

She participated in therapy, did not reaccumulate possessions within her room, and was accepting of personal care and assistance with hygiene. She did complain bitterly throughout about the discharge plan and the loss of her How To Stop Hoarding Possessions house. She remained skeptical about her access to her finances, feeling that the "government" had "stolen" her money. 

She was discharged to a nursing home but continually expressed her eventual goal of returning home. The Public Guardian and Trustee remained her substitute decision maker for placement and living situation. The consulting psychiatry service did not provide a diagnostic label but believed Ms L. would meet the How To Stop Hoarding Possessions proposed criteria in DSM-V for hoarding disorder. 

Conclusion Hoarding behaviour is more common than reported, and family physicians should be alert to its presence, particularly in older patients. Hoarding might arise from a primary mental health disorder or be the result of secondary causes such as dementia, stroke, or brain injury. Treatment should be multidisciplinary, with the goal of reducing harm and allowing patients to remain at home except in circumstances of severe risk or decisional How To Stop Hoarding Possessions incapacity. 

Pharmacologic treatment of secondary causes can be helpful. Hoarding behaviour is more common than reported, and family physicians should be alert to its presence, particularly in older patients. Hoarding might arise from a primary mental health disorder or be the result of secondary How To Stop Hoarding Possessions causes such as dementia, stroke, or brain injury. 

Treatment should be multidisciplinary, with the goal of reducing harm and allowing patients to remain at home except in circumstances of severe risk or decisional incapacity. Pharmacologic How To Stop Hoarding Possessions treatment of secondary causes can be helpful. 

The Care of the Elderly series was developed as an initiative of the Continuing Professional Development Committee of the Canadian Geriatrics Society in collaboration with Canadian Family Physician to provide articles on geriatric topics written by How To Stop Hoarding Possessions family physicians for family physicians.

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