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Cognitive behavioral therapy for obsessive-compulsive disorder
22%
15/68
Admission to psychiatric facility
4%
3/68
High dose SSRI for hoarding disorder
62%
42/68
Tricyclic antidepressant for hoarding disorder
Intervention by patient’s mother to declutter the home
1%
1/68
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This patient has been collecting items in her home to the extent that it is interfering with her social function, and she is no longer able to fully utilize her space, suggesting a diagnosis of hoarding disorder. High dose SSRI's (selective serotonin reuptake inhibitor), used with cognitive behavioral therapy, is the best next step in management. Hoarding disorder is a distinct entity from obsessive-compulsive disorder (OCD) and involves difficulty discarding possessions, even those that may not have great value. One of the biggest differentiating factors is that hoarding disorder is egosyntonic, whereas OCD is egodystonic. Hoarding disorder results in excessive cluttering of the living space and impairs social or occupational functioning. Cognitive behavioral therapy is a mainstay of treatment, and SSRIs may also be used in conjunction to control symptoms. Paroxetine in particular has a Federal Drug Administration indication for treatment of hoarding disorder. Incorrect Answers: Answer 1: Cognitive behavioral therapy is effective for both hoarding disorder and OCD, but this patient’s presentation is more consistent with hoarding disorder. While the two entities are sometimes similar, they are separate diagnoses. Answer 2: Admission to a psychiatric facility is not warranted at this time. The patient does endorse hopelessness and possibly passive suicidal ideation, but she does not have a specific plan for harming herself or others. Answer 4: Tricyclic antidepressants are not indicated for hoarding disorder, despite their use in OCD. Clomipramine, in particular, is frequently used for OCD in conjunction with cognitive behavioral therapy or exposure therapy. Answer 5: Intervention by the patient’s mother to declutter the home is an inappropriate method of forcing the patient to discard her possessions. However, after some time in therapy and on medication, the patient may be receptive to having a professional (such as the therapist or psychiatrist) make a home visit to facilitate decluttering. Bullet Summary: Hoarding disorder involves difficulty discarding of items to the extent that the patient experiences functional impairment, and treatment includes cognitive behavioral therapy with SSRI.
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