Assessment
Here descriptive characteristics are reported for three patients with HD. These patients were recently hospitalized for decompensated HF. Typical HF symptoms include dyspnea, palpitation, and fatigue at rest or on mild exertion, while decompensation requires immediate intervention, often consisting of diuretic medication to reduce pulmonary congestion and peripheral edema [13]. Each patient was referred to a psychologist as part of a HF self-management program (HFSMP). Written informed consent was obtained from each patient (#HREC/12/TQEHLMH/188).
Each patient underwent a HFSMP nurse screening assessment for depression, (Patient Health Questionnaire-9 items, PHQ-9), anxiety (Generalized Anxiety Disorder-7 items, GAD-7) and panic-attack (“In the last 4 weeks, have you had an anxiety attack – suddenly feeling fear or panic ?”) [14]. Patients underwent structured psychiatric interview with the Structured Clinical Interview for DSM-IV [15, 16]. Psychiatric diagnoses were verified by two senior clinical psychologists once per month. Other ratings included Global Assessment of Functioning (GAF) score and a Clinical Global Impression (CGI) – Severity and Improvement scale [17].
A detailed assessment of hoarding symptoms was conducted utilizing the Clutter Image Rating Scale (CIR) at the domicile [18]. The CIR provides a pictorial self-report of hoarding severity without the caveats of descriptive definitions of ‘clutter’ that may lead to unreliable estimates of hoarding behaviors. This nine-point visual analogue scale consists of a series of nine photographs of a room with increasing levels of clutter. Respondents select the picture that best represents the clutter in the rooms (kitchen, bedroom, living room). A score of 4 or higher indicates clinically significant clutter on the CIR [18]. The patient and psychologist each rated rooms on the CIR, with the psychologists’ ratings verified by a second rater using digital photographs (blinded to pre- and post-treatment).