INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #103 Insight and Cognitive Performance in Hoarding Disorder Jessica Zakrzewski, UCSD, San Diego, United States Elizabeth Twamley, UCSD, La Jolla, United States Catherine Ayers, UCSD, La Jolla, United States Category: Psychiatric Disorders Keyword 1: anosognosia Keyword 2: inhibitory control Keyword 3: executive functions Objective: Hoarding Disorder (HD) is a common and highly impairing neuropsychiatric condition defined by the inability to discard objects until clutter becomes functionally impairing. A DSM-5 specifier for HD, and frequent complaint of family members and clinicians, is lack of insight. Level of insight can be inferred from the difference between an objective rater’s assessment of clutter volume compared to the patient’s assessment of their own clutter volume using the Clutter Image Rating Scale (CI-R). A recent study found links between insight and inhibitory/cognitive control in HD. The aim of this study was to explore associations between insight and cognition, symptom severity, and functioning, in a larger, treatment seeking sample of Veterans with HD. Participants and Methods: A total of 122 Veterans seeking treatment for HD completed pre-treatment assessments, including home-based assessments of clutter volume using the CI-R. CI-R error (CIR-E) was the difference of assessor minus self rating, divided by the assessor rating. Veterans were mostly male (62%), White/Non-Hispanic (65%) with an average age of 62 and 16 years of education. Additional in-home assessment measures included questionnaires for symptom severity and functioning, as well as neuropsychological testing emphasizing executive functioning (Wisconsin Card Sorting Test [WCST]; Delis-Kaplan Executive Function System [D-KEFS] Color Word, Trails, Tower, Design Fluency, and Verbal Fluency). T-test, Pearson, or Spearman rank correlations, and multiple regression were used to evaluate the relationships between CIR-E scores and the other measures. Results: Self and assessor CI-R ratings were significantly different from one another (t(121)=-2.1, sd=1.2, p=0.018; d=0.19). CIR-E scores were normally distributed, with a mean of 0.02 (sd=0.3), with 28% of the sample having a score above 0, indicating underestimation of clutter. Demographics and depression/anxiety symptoms were not related to CIR-E scores. Hoarding symptom severity was negatively correlated with CIR-E, with higher total score (r=-0.20, p=0.026) and higher acquiring behaviors (r=-0.23, p=0.013) associated with better insight. Functioning scales also had higher self-reported levels of impairment correlating with better insight. Scaled scored for errors on Verbal Fluency (r=-0.24, p=0.011) and Color Word Inhibition/Switching (r=-0.21, p=0.033) correlated with more errors related to lower insight. In contrast, scaled scores for total errors on WCST, correlated with lower CIR-E scores(r=0.23, p=0.032) indicating those with worse insight made fewer errors. Multiple regression using all associated factors found more Verbal Fluency repetition errors (b=-0.05, p=0.014) and better WCST performance (b=0.004, p=0.029) were significantly associated with worse insight. Conclusions: Overall, our findings replicate and expand on previous work demonstrating subjective self-report measures are often unrelated to objective measures in HD. Specifically, our measure of insight for HD severity was contradictory to self-report of severity and functioning. Furthermore, we found associations with insight and error performance. Interestingly, on a sorting task with trial-by-trial feedback (WCST), we found better performance in those with lower insight. These findings implicate different possible relationships between inhibitory/cognitive control and feedback as they relate to errors and insight in HD. These are the first findings to implicate a possible task-specific effect of feedback on performance in individuals with HD who have low insight.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #103

Insight and Cognitive Performance in Hoarding Disorder

Jessica Zakrzewski, UCSD, San Diego, United States
Elizabeth Twamley, UCSD, La Jolla, United States
Catherine Ayers, UCSD, La Jolla, United States

Category: Psychiatric Disorders

Keyword 1: anosognosia
Keyword 2: inhibitory control
Keyword 3: executive functions

Objective:

Hoarding Disorder (HD) is a common and highly impairing neuropsychiatric condition defined by the inability to discard objects until clutter becomes functionally impairing. A DSM-5 specifier for HD, and frequent complaint of family members and clinicians, is lack of insight. Level of insight can be inferred from the difference between an objective rater’s assessment of clutter volume compared to the patient’s assessment of their own clutter volume using the Clutter Image Rating Scale (CI-R). A recent study found links between insight and inhibitory/cognitive control in HD. The aim of this study was to explore associations between insight and cognition, symptom severity, and functioning, in a larger, treatment seeking sample of Veterans with HD.

Participants and Methods:

A total of 122 Veterans seeking treatment for HD completed pre-treatment assessments, including home-based assessments of clutter volume using the CI-R. CI-R error (CIR-E) was the difference of assessor minus self rating, divided by the assessor rating. Veterans were mostly male (62%), White/Non-Hispanic (65%) with an average age of 62 and 16 years of education. Additional in-home assessment measures included questionnaires for symptom severity and functioning, as well as neuropsychological testing emphasizing executive functioning (Wisconsin Card Sorting Test [WCST]; Delis-Kaplan Executive Function System [D-KEFS] Color Word, Trails, Tower, Design Fluency, and Verbal Fluency). T-test, Pearson, or Spearman rank correlations, and multiple regression were used to evaluate the relationships between CIR-E scores and the other measures.

Results:

Self and assessor CI-R ratings were significantly different from one another (t(121)=-2.1, sd=1.2, p=0.018; d=0.19). CIR-E scores were normally distributed, with a mean of 0.02 (sd=0.3), with 28% of the sample having a score above 0, indicating underestimation of clutter. Demographics and depression/anxiety symptoms were not related to CIR-E scores. Hoarding symptom severity was negatively correlated with CIR-E, with higher total score (r=-0.20, p=0.026) and higher acquiring behaviors (r=-0.23, p=0.013) associated with better insight. Functioning scales also had higher self-reported levels of impairment correlating with better insight. Scaled scored for errors on Verbal Fluency (r=-0.24, p=0.011) and Color Word Inhibition/Switching (r=-0.21, p=0.033) correlated with more errors related to lower insight. In contrast, scaled scores for total errors on WCST, correlated with lower CIR-E scores(r=0.23, p=0.032) indicating those with worse insight made fewer errors. Multiple regression using all associated factors found more Verbal Fluency repetition errors (b=-0.05, p=0.014) and better WCST performance (b=0.004, p=0.029) were significantly associated with worse insight.

Conclusions:

Overall, our findings replicate and expand on previous work demonstrating subjective self-report measures are often unrelated to objective measures in HD. Specifically, our measure of insight for HD severity was contradictory to self-report of severity and functioning. Furthermore, we found associations with insight and error performance. Interestingly, on a sorting task with trial-by-trial feedback (WCST), we found better performance in those with lower insight. These findings implicate different possible relationships between inhibitory/cognitive control and feedback as they relate to errors and insight in HD. These are the first findings to implicate a possible task-specific effect of feedback on performance in individuals with HD who have low insight.