Introdução: Em suas áreas urbanas, o Brasil vem enfrentando graves epidemias de Dengue, Zika e Febre Chikungunya. Sabe-se que a principal forma de transmissão se deve à veiculação dos vírus causadores destes agravos pelo mosquito Aedes aegypti, sendo fundamental o desenvolvimento de atividades de vigilância entomológica e controle vetorial. Além disso, Ae. aegypti é vetor do vírus da Febre Amarela e Mayaro, entre outros agravos. Entre as diferentes formas que contribuem para a proliferação de Ae. Aegypti, estão os imóveis onde residem pessoas que estão em situação de acumulação, e que podem se configurar como locais importantes para o aumento da densidade do vetor. Objetivo: Avaliar a relação entre os imóveis onde residem esses indivíduos, e a ocorrência de agravos causados por vírus veiculados por Ae. aegypti; elaborar um caderno de orientação aos profissionais de saúde para o atendimento de pessoas com transtorno de acumulação na esfera da Vigilância Ambiental. Materiais e Métodos: A pesquisa foi desenvolvida em uma região da zona norte da cidade de São Paulo, no período de agosto de 2013 a julho de 2017. Foram geocodificados os endereços das pessoas que estão em situação de acumulação, dos Pontos Estratégicos e dos casos autóctones de Dengue, e demais agravos envolvendo Ae. aegypti. Os imóveis das pessoas que estão em situação de acumulação e os PE foram caracterizados no espaço e temporalmente. A existência de aglomerados de casos das arboviroses em torno dos imóveis foi testada por meio da estatística espacial e focal denominada Gi, sendo considerada uma distância máxima de 500 metros, com intervalos a cada 100 metros. O caderno de orientação foi produzido com base na consolidação da estrutura de atendimento de pessoas com transtorno de acumulação existente no âmbito da Vigilância Ambiental. Resultados: Dos 93 imóveis de pessoas em situação de acumulação, foram utilizados 78, dos quais se constituíram como plausíveis para a análise. Em relação aos Pontos Estratégicos, foram considerados todos os 94 presentes na área de estudo. No período, foram confirmados 3112 casos autóctones de Dengue. Quanto às demais arboviroses, foram confirmados apenas 5 autóctones de Chikungunya. Dos imóveis de pessoas em situação de acumulação e dos Pontos Estratégicos, em apenas 6 (7,69%) e 4 (4,26%) respectivamente, foi constatada a formação de aglomerados de casos de dengue, todos pertencentes ao Distrito Administrativo de Vila Medeiros. Conclusões: Os imóveis e os Pontos Estratégicos não se mostraram relevantes para a constituição de aglomerados de casos de arboviroses. O caderno de orientação é apresentado no corpo do trabalho. / Introduction: Brazil has been facing severe epidemics of Dengue Zika and Chikungunya Fever in urban areas. It is widely known that the main form of transmission is due to the dispersion of the virus, which leads to diseases caused by the mosquito Aedes aegypti. Thus, the development of entomological surveillance and vector control activities are fundamental. In addition, Ae. aegypti is a vector of Yellow Fever, Mayaro virus and other diseases. Among different ways of contributing for the proliferation of Ae. aegypti, are the houses where people accumulate objects, who suffer from the so-called accumulation disorder, that can be configured as important places for the increase of the vector\'s density. Objective: To evaluate the relationship between the houses where people who are in a situation of accumulation reside and the occurrence of diseases caused by virus transmitted by Ae. aegypti; to elaborate a guidebook for health professionals to care for people with accumulation disorders in the ambit of Environmental Surveillance. Materials and Methods: The research was conducted in a region situated in the northern part of the city of São Paulo, from August 2013 to July 2017. The addresses of the people in the accumulation situation, the Strategic Points and the cases were geocoded. autochthonous diseases of Dengue and other diseases involving Ae. aegypti. The properties of the people afflicted by hoarding disorder and the PE were characterized in space and temporarily. The existence of arboviruses clusters around real estate was tested using the spatial and focal statistics called Gi, considering a maximum distance of 500m, with intervals every 100m. The guidance document was produced based upon the consolidation of the care structure for people with accumulation disorder existing in the scope of Environmental Surveillance. Results: Of the 93 properties of people in a situation of accumulation, 78 were used, of which they were constituted as plausible for an analysis. Regarding the Strategic Points, we considered all the 94 presents in the study area. During the period, 3,112 autochthonous cases of Dengue were confirmed. As for the other arboviruses, only 5 autochthonous cases of Chikungunya were confirmed. Regarding the properties of the people in a situation of accumulation and of the Strategic Points, only in a total of 6 (7.69%) and 4 (4.26%) were respectively identified the formation of agglomerates of Dengue cases, all belonging to the Administrative District of Vila Medeiros. Conclusions: The properties and Strategic Points were not relevant for the formation of clusters of arboviruses cases. The orientation notebook is displayed in the body of the work.

Introdução: Em suas áreas urbanas, o Brasil vem enfrentando graves epidemias de Dengue, Zika e Febre Chikungunya. Sabe-se que a principal forma de transmissão se deve à veiculação dos vírus causadores destes agravos pelo mosquito Aedes aegypti, sendo fundamental o desenvolvimento de atividades de vigilância entomológica e controle vetorial. Além disso, Ae. aegypti é vetor do vírus da Febre Amarela e Mayaro, entre outros agravos. Entre as diferentes formas que contribuem para a proliferação de Ae. Aegypti, estão os imóveis onde residem pessoas que estão em situação de acumulação, e que podem se configurar como locais importantes para o aumento da densidade do vetor. Objetivo: Avaliar a relação entre os imóveis onde residem esses indivíduos, e a ocorrência de agravos causados por vírus veiculados por Ae. aegypti; elaborar um caderno de orientação aos profissionais de saúde para o atendimento de pessoas com transtorno de acumulação na esfera da Vigilância Ambiental. Materiais e Métodos: A pesquisa foi desenvolvida em uma região da zona norte da cidade de São Paulo, no período de agosto de 2013 a julho de 2017. Foram geocodificados os endereços das pessoas que estão em situação de acumulação, dos Pontos Estratégicos e dos casos autóctones de Dengue, e demais agravos envolvendo Ae. aegypti. Os imóveis das pessoas que estão em situação de acumulação e os PE foram caracterizados no espaço e temporalmente. A existência de aglomerados de casos das arboviroses em torno dos imóveis foi testada por meio da estatística espacial e focal denominada Gi, sendo considerada uma distância máxima de 500 metros, com intervalos a cada 100 metros. O caderno de orientação foi produzido com base na consolidação da estrutura de atendimento de pessoas com transtorno de acumulação existente no âmbito da Vigilância Ambiental. Resultados: Dos 93 imóveis de pessoas em situação de acumulação, foram utilizados 78, dos quais se constituíram como plausíveis para a análise. Em relação aos Pontos Estratégicos, foram considerados todos os 94 presentes na área de estudo. No período, foram confirmados 3112 casos autóctones de Dengue. Quanto às demais arboviroses, foram confirmados apenas 5 autóctones de Chikungunya. Dos imóveis de pessoas em situação de acumulação e dos Pontos Estratégicos, em apenas 6 (7,69%) e 4 (4,26%) respectivamente, foi constatada a formação de aglomerados de casos de dengue, todos pertencentes ao Distrito Administrativo de Vila Medeiros. Conclusões: Os imóveis e os Pontos Estratégicos não se mostraram relevantes para a constituição de aglomerados de casos de arboviroses. O caderno de orientação é apresentado no corpo do trabalho. / Introduction: Brazil has been facing severe epidemics of Dengue Zika and Chikungunya Fever in urban areas. It is widely known that the main form of transmission is due to the dispersion of the virus, which leads to diseases caused by the mosquito Aedes aegypti. Thus, the development of entomological surveillance and vector control activities are fundamental. In addition, Ae. aegypti is a vector of Yellow Fever, Mayaro virus and other diseases. Among different ways of contributing for the proliferation of Ae. aegypti, are the houses where people accumulate objects, who suffer from the so-called accumulation disorder, that can be configured as important places for the increase of the vector\'s density. Objective: To evaluate the relationship between the houses where people who are in a situation of accumulation reside and the occurrence of diseases caused by virus transmitted by Ae. aegypti; to elaborate a guidebook for health professionals to care for people with accumulation disorders in the ambit of Environmental Surveillance. Materials and Methods: The research was conducted in a region situated in the northern part of the city of São Paulo, from August 2013 to July 2017. The addresses of the people in the accumulation situation, the Strategic Points and the cases were geocoded. autochthonous diseases of Dengue and other diseases involving Ae. aegypti. The properties of the people afflicted by hoarding disorder and the PE were characterized in space and temporarily. The existence of arboviruses clusters around real estate was tested using the spatial and focal statistics called Gi, considering a maximum distance of 500m, with intervals every 100m. The guidance document was produced based upon the consolidation of the care structure for people with accumulation disorder existing in the scope of Environmental Surveillance. Results: Of the 93 properties of people in a situation of accumulation, 78 were used, of which they were constituted as plausible for an analysis. Regarding the Strategic Points, we considered all the 94 presents in the study area. During the period, 3,112 autochthonous cases of Dengue were confirmed. As for the other arboviruses, only 5 autochthonous cases of Chikungunya were confirmed. Regarding the properties of the people in a situation of accumulation and of the Strategic Points, only in a total of 6 (7.69%) and 4 (4.26%) were respectively identified the formation of agglomerates of Dengue cases, all belonging to the Administrative District of Vila Medeiros. Conclusions: The properties and Strategic Points were not relevant for the formation of clusters of arboviruses cases. The orientation notebook is displayed in the body of the work.

Hoarding disorder (HD) is characterized by (a) the acquisition of and inability to discard a large number of possessions; (b) clutter that interferes with the use of appliances and general living areas in the home; and (c) clinically significant distress or impairment in functioning. Although previous studies have reported that individuals with HD exhibit emotional dysregulation when discarding personal items, this investigation is the first to examine the biological indices of distress. The current study aimed to examine whether individuals with HD differed from healthy controls in their psychological and biological responses to a general psychosocial stressor and to investigate whether individual differences in stress response relate to differences in symptom severity and impairment. Twenty-one individuals with HD and 22 healthy controls (CTLs) completed the Trier Social Stress Task and self-reported affect and salivary cortisol responses to the stressor were assessed. Individuals with HD did not significantly differ compared to CTLs in their salivary cortisol levels in relation to the stressor. However, individuals with HD significant-ly differed compared to CTLs in their subjective levels of distress in relation to the stressor. Contrary to our hypotheses, responses to stress were not significantly correlated with measures of symptom severity and impairment due to hoarding. The current findings indicate that individuals with HD exhibit a greater self-reported emotional response to a general stressor. The implications of these findings are discussed. / Thesis / Master of Science (MS)

Hoarding disorder is a mental illness that affects about 2-5 % of the population. The most prominent symptoms of hoarding disorder are the inability to discard things and the excessive acquisition of possessions. The home becomes cluttered, often to the point where one no longer can use the rooms for their intended purposes. For example, one can no longer sleep in the bed or use the kitchen for cooking because of the clutter that takes up space. People with hoarding disorder often experience shame because of their disability and as a consequence they withdraw from social engagements and risk isolation. The purpose of this study was to give a literary review of treatment methods for hoarding disorder and their efficacy in Swedish, but also to show the impact of shame on treatment effect through Thomas Scheff’s theory of shame. The primary treatment method is Cognitive behavioral therapy designed especially for hoarding disorder, and has been tested in different forms such as individual-, group-, and internet based treatment. New treatments using Compassion-focused therapy and Acceptance and commitment therapy have also been developed. Studies on hoarding disorder and shame have shown a correlation between shame, symptom severity and identity. These new treatments address the shame experienced and they can hopefully increase the efficacy rate for hoarding treatment. Important factors for treatment progress were, among others, continued high motivation, frequent contact with clinician and a supportive family. A surprising result was that one study showed almost equal result in treatment led by a non-professional as a professional. More research is needed to further develop effective treatment.

Hoarding disorder is a relatively new diagnosis in the DSM-5, only just included in the most recent edition. The disorder has piqued the interest of many in the community, in part because of the hit TV show called “Hoarders.” Although there is interest, there continues to be relatively few research studies into the causes, treatment, and management of this disorder specifically in adolescences. Yet, in the research that has been published, it often sites the disorder first appearing in adolescents. This paper will discuss the following elements of adolescent hoarding disorder: The potential etiology and risk factors noted in the literature, the DSM-5 criteria for the diagnosis of hoarding disorder, and the characteristic signs and symptoms found in the adolescent presentation, as well as treatment. Finally, it will also include recommendations for healthcare professionals for early screening and treatment.

This qualitative interview study examines the shared and discrepant experiences that nine professionals, three from each field of psychiatry, social service, and housing have from working with people with hoarding disorder, and their view on help. The main difficulty when working with hoarding disorder is described as lack of insight and understanding of the severity and consequences of the disorder among people with the disability. Professionals highlight the importance of proper diagnosis and cooperation among disciplinary teams working with hoarding disorder. Approaches differ regarding the issue of how to best help a person with hoarding disorder, especially as the emphasis of autonomy becomes more prevalent. The landlords who were interviewed expressed the hoarders’ need of help from the society, whereas the social service interviewees accentuated voluntariness and motivation as a favorable long-term management. The psychiatry interviewees stressed that coercive measures are devastating, but sometimes necessary. The opinion that the view of normality in the context of hoarding needs to be questioned, was shared by the interviewees from all the three fields. In conclusion, the professionals describe their work with hoarding behavior as complex and emphasize the need for more knowledge concerning this subject. Empowerment theory is applied in the study.

The interest in hoarding has peaked since its first clinical definition in 1996 and is evident by six television shows centered on the topic. This thesis reports the results a content analysis of two seasons (21 episodes) of the popular T.V. series A&E’s Hoarders. People rationalize hoarding in ways that both differ and overlap. Doctors, professional organizers, hoarders and their loved ones collectively frame hoarding as a medical and mental health problem. The results suggest that Americans’ perceptions of hoarding behavior has shifted from one that is deviant behavior to one that is medicalized.

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.