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Research on Child and Adolescent Health: New Starts, Fiscal Year 2011

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Articles of Interest, February 24, 2012

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Guidelines for Field Triage of Injured Patients

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CLINICAL TRIALS

Sertraline and Habit Reversal in the Treatment of Patients With Trichotillomania

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Cognitive Behavioral Treatment of Pediatric Trichotillomania

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Olanzapine in the Treatment of Hair Pulling (Trichotillomania)

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Trichotillomania

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September 1, 2003

Trichotillomania

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MULTIMEDIA

Treating Patients with Trichotillomania and Other Related Behaviors
September 8, 2011

Here, Dr Jon E. Grant talks about the genetics, neurobiology, and cognitive processes of body-focused repetitive behaviors, which include trichotillomania, skin picking, and other behaviors.

JOURNAL SCAN

Systematic review: pharmacological and behavioral treatment for trichotillomania.

pubmed.gov - 10/14/07

Trichotillomania is a psychiatric condition characterized by compulsive hair pulling. Three interventions have been studied in the treatment of trichotillomania: habit-reversal therapy (HRT) and pharmacotherapy with either selective-serotonin reuptake inhibitors (SSRI) or clomipramine. This systematic review compared the efficacy of these interventions in blinded, randomized clinical trials. The electronic databases of Medline, Premedline, PsychINFO, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant trials using the search terms "trichotillomania" or "hair pulling." Trials were eligible for inclusion if they compared habit-reversal therapy, SSRI pharmacotherapy, or clomipramine pharmacotherapy to each other or placebo and employed randomization and blinded assessment of outcome. Our primary outcome measure was mean change in trichotillomania severity. The summary statistic was standardized mean difference. Seven studies were eligible for

MEDLINE

Cladosporium scalp infection.

pubmed.gov - 1/24/13

An 11-year-old healthy red-haired girl presented with a 3-year history of hair loss and mild pruritus of her scalp. She had previously been diagnosed with trichotillomania. Cutaneous examination showed scant hair loss with neither crusting nor scaly lesions. The scalp hair was diffusely thin, dry, and brittle on the frontal, mid-parietal, and anterior occipital scalp (Figure 1A). A pull test was negative, and a significant number of hair shafts were not detached on repeated traction. Closer examination using a dermatoscope showed follicles with broken hair shafts. The dermatoscopic evaluation also showed frequent pinpoint black dots scattered among the terminal hair shafts at their bases. No scale, scar, or inflammatory changes were seen in the involved areas (Figure 1B). A 20% potassium hydroxide (KOH) preparation of material obtained after gentle scrapping of the black dots on the scalp provided fragments of hair fibers containing aggregates of pigmented yeast forms (Figure 2A) and

Impulse-control disorders in gilles de la tourette syndrome.

pubmed.gov - 11/30/12

Impulse-control disorders (ICDs) are more common in clinic populations with Gilles de la Tourette syndrome (GTS) than in the general population. The clinical phenomenology of ICDs differ between men with GTS (who tend to be externally impulsive) and women with GTS (who tend to be internally impulsive). This article reviews the relevant literature to-date on impulsivity in GTS, with special focus on intermittent, explosive disorder, self-injurious behavior, trichotillomania, and impulsive-compulsive sexual behavior. The medical and legal community should be aware of the full spectrum of organically-based behaviors that may predispose patients with GTS to unwanted legal disciplinary action.

pubmed.gov - 11/1/12

Hair pulling disorder (HPD; trichotillomania) and skin picking disorder (SPD) are relatively common and potentially severe psychiatric conditions that have received limited empirical attention. Researchers are increasingly recognizing the similarities and co-occurrence of HPD and SPD, and several authors have suggested that the two disorders should be categorized together in the DSM-5. In the present article, we critically examined the evidence for comorbidity of HPD and SPD, and reviewed a diverse literature pertaining to shared risk factors and similarities in clinical characteristics. Evidence suggests that the two disorders co-occur more often than can be expected by chance, have substantial similarities in a variety of clinical characteristics (e.g., symptom presentation and course of illness) and may have some distal risk factors in common (e.g., genetic vulnerabilities). Implications for classification in the DSM-5, clinical management and research on etiology were discussed.

'Impulsive compulsivity' in obsessive-compulsive disorder: a phenotypic marker of patients with poor clinical outcome.

pubmed.gov - 8/31/12

Although traditionally obsessive-compulsive disorder (OCD) and impulse control disorders (ICD) have represented opposing ends of a continuum, recent research has demonstrated a frequent co-occurrence of impulsive and compulsive behaviours, which may contribute to a worse clinical picture of some psychiatric disorders. We hypothesize that individuals with 'impulsive' OCD as characterized by poor insight, low resistance, and reduced control towards their compulsions will have a deteriorative course, greater severity of hoarding and/or symmetry/ordering symptoms, and comorbid ICD and/or substance use disorders (SUD). The sample consisted of 869 individuals with a minimum score of 16 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Of these, 65 had poor insight, low resistance, and reduced control towards compulsions ('poor IRC') and 444 had preserved insight, greater resistance and better control over compulsions ('good IRC'). These two groups were compared on a number of clinical

Eyelash alopecia areata: case series and literature review.

pubmed.gov - 8/1/12

To characterize the clinical presentations, features, and outcomes of eyelash alopecia areata.|Retrospective chart review of patients evaluated for eyelash loss and found to have eyelash alopecia areata. A 3-year follow-up was required.|The study involved 15 patients.|Patients who presented at a tertiary care eye clinic for evaluation of eyelash loss and were found to have eyelash alopecia areata were reviewed. Demographic considerations were categorized; they included age at presentation, areas of other hair loss, other relevant history, and treatment responses.|Patients were young (mean age 18 years) and had a large female predominance (female-to-male ratio, 14:1). Concurrent scalp and brow involvement, either in isolation (20% and 13%, respectively) or together (13%), were seen in half of the patients (46%). Upper eyelid involvement was more common and severe than lower eyelid involvement, and 40% of patients experienced complete regrowth of lashes, with a mean time to regrowth of