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Hoarding symptoms in patients on a geriatric psychiatry inpatient unit
D J Stein1, B Laszlo, E Marais
1Department of Psychiatry, University of Stellenbosch, Tygerberg, W, Cape.
Insights
Hoarding in older adults is linked to schizophrenia and dementia, not obsessive-compulsive disorders. Antipsychotic treatment showed promise in managing hoarding symptoms in some patients.
Area of Science:
- Geriatric Psychiatry
- Psychopathology
- Neurobiology
Background:
- Hoarding is a symptom of psychiatric disorders like obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD).
- Anecdotal evidence suggests hoarding is prevalent in geriatric psychiatry, but its correlates are poorly understood.
Purpose of the Study:
- To characterize the psychopathological correlates of hoarding in a geriatric psychiatry inpatient population.
- To investigate the association between hoarding symptoms and specific psychiatric diagnoses and cognitive decline in older adults.
Main Methods:
- Screened 100 geriatric psychiatry inpatients for hoarding symptoms.
- Obtained patient and collateral histories, including detailed phenomenology via questionnaire for those with hoarding.
- Monitored treatment response during hospitalization.
Main Results:
- Clinically significant hoarding was identified in 5% of patients.
- Four of these patients had paranoid schizophrenia with concurrent dementia symptoms.
- One patient had bipolar disorder, dementia, and a lifelong history of hoarding.
Conclusions:
- Hoarding in geriatric psychiatry is associated with paranoid schizophrenia and dementia, not OCD/OCPD.
- Antipsychotic medications (dopamine blockers) may help reduce hoarding symptoms in some older patients.
- These findings suggest age-related variations in hoarding's neurobiology and clinical presentation.
Background:
While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised.
Methods:
The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored.
Results:
Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients.
Conclusions:
A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.