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).