The London field trial for hoarding disorder

BackgroundA new diagnostic category, hoarding disorder (HD), has been proposed for inclusion in DSM-5. This study field-tested the validity, reliability and perceived acceptability of the proposed diagnostic criteria for HD.MethodFifty unselected individuals with prominent hoarding behavior and 20 unselected, self-defined ‘collectors’ participated in thorough psychiatric assessments, involving home visits whenever possible. A semi-structured interview based on the proposed diagnostic criteria for HD was administered and scored by two independent raters. ‘True’ diagnoses were made by consensus according to the best-estimate diagnosis procedure. The percentage of true positive HD cases (sensitivity) and true negative HD cases (specificity) was calculated, along with inter-rater reliability for the diagnosis and each criterion. Participants were asked about their perceptions of the acceptability, utility and stigma associated with the new diagnosis.ResultsTwenty-nine (58%) of the hoarding individuals and none of the collectors fulfilled diagnostic criteria for HD. The sensitivity, specificity and inter-rater reliability of the diagnosis, and of each individual criterion and the specifiers, were excellent. Most participants with HD (96%) felt that creating a new disorder would be very or somewhat acceptable, useful (96%) and not too stigmatizing (59%).ConclusionsThe proposed HD criteria are valid, reliable and perceived as acceptable and useful by the sufferers. Crucially, they seem to be sufficiently conservative and unlikely to overpathologize normative behavior. Minor changes in the wording of the criteria are suggested.

Five-year Outcome and Prognosis in Schizophrenia: A Report from the London Field Research Centre of the International Pilot Study of Schizophrenia

A sample of 100 schizophrenic patients admitted to London area psychiatric hospitals were examined as part of the International Pilot Study of Schizophrenia. Clinical and social outcome were variable. At 5-year follow-up, 49% had good symptomatic outcome and 42%, good social outcome. Poor social functioning at inclusion was predictive of poor symptomatic outcome. Illness history (IH), occupational functioning (OF), social relationship functioning (SRF), negative and non-specific symptoms (NNS) at initial evaluation, and their interaction with sex and race accounted for 32% of the 5-year symptomatic outcome variance (n = 84; F=3.48; P<0.001). OF, SRF, housing status, NNS and their interaction with sex, race and age accounted for 47% of the social outcome variance (n = 62; F=2.62; P<0.007).