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Ali A, Ioannidis K, Grant JE, Chamberlain SR. Cognition in trichotillomania: a meta-analysis. CNS Spectr 2024; 29:158-165. [PMID: 38477170 DOI: 10.1017/s1092852924000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Trichotillomania (TTM) is a mental health disorder characterized by repetitive urges to pull out one's hair. Cognitive deficits have been reported in people with TTM compared to controls; however, the current literature is sparse and inconclusive about affected domains. We aimed to synthesize research on cognitive functioning in TTM and investigate which cognitive domains are impaired. METHODS After preregistration on the International Prospective Register of Systematic Reviews (PROSPERO), we conducted a comprehensive literature search for papers examining cognition in people with TTM versus controls using validated tests. A total of 793 papers were screened using preestablished inclusion/exclusion criteria, yielding 15 eligible studies. Random-effects meta-analysis was conducted for 12 cognitive domains. RESULTS Meta-analysis demonstrated significant deficits in motor inhibition and extradimensional (ED) shifting in people with TTM versus controls as measured by the stop-signal task (SST) (Hedge's g = 0.45, [CI: 0.14, 0.75], p = .004) and ED set-shift task (g = 0.38, [CI: 0.13, 0.62], p = .003), respectively. There were no significant between-group differences in the other cognitive domains tested: verbal learning, intradimensional (ID) shifting, road map spatial ability, pattern recognition, nonverbal memory, executive planning, spatial span length, Stroop inhibition, Wisconsin card sorting, and visuospatial functioning. Findings were not significantly moderated by study quality scores. CONCLUSIONS Motor inhibition and ED set-shifting appear impaired in TTM. However, a cautious interpretation of results is necessary as samples were relatively small and frequently included comorbidities. Treatment interventions seeking to improve inhibitory control and cognitive flexibility merit exploration for TTM.
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Affiliation(s)
- Aliza Ali
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Jon E Grant
- Department of Psychiatry, University of Chicago, USA
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
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2
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Akbari M, Jamshidi S, Sheikhi S, Alijani F, Kafshchi P, Taylor D. Aripiprazole and its adverse effects in the form of impulsive-compulsive behaviors: A systematic review of case reports. Psychopharmacology (Berl) 2024; 241:209-223. [PMID: 38227009 DOI: 10.1007/s00213-024-06529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/06/2024] [Indexed: 01/17/2024]
Abstract
Aripiprazole is an efficacious treatment for both the positive and negative symptoms of schizophrenia and is also commonly used as a mood stabilizer. It is associated with better tolerability compared with other antipsychotics. However, there are reports of patients who experience problem gambling, hypersexuality, obsessive-compulsive symptoms, and other impulsive and/or compulsive behaviors as a result of aripiprazole administration and/or dosage increase. We aimed to do a systematic review of case reports published in this regard. After screening more than 6000 titles and abstracts in ten scientific search engines, we found 35 related records comprising 59 cases. The majority of cases (n = 42, 71.18%) were male, the mean age was 33.83 years (± 13.40), and the average daily dose of aripiprazole was 11.63 mg (± 6.94). The results of our review showed that the most frequently published impulsivity adverse effect of aripiprazole is gambling, followed by hypersexuality, obsessive-compulsive symptoms/disorder, problem eating, trichotillomania, problem shopping, and kleptomania. These symptoms were experienced both by patients who had previous problems in these areas and those who did not. In the majority of cases, the symptoms appeared within 30 days after aripiprazole administration started and ceased within 30 days of its discontinuation and/or dose decrease. Clinicians should be aware of impulsivity adverse effects, monitor them, and educate both patients and the family about them.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No.43. South Mofatteh Ave, Tehran, Iran.
| | - Shiva Jamshidi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No.43. South Mofatteh Ave, Tehran, Iran
| | - Sonay Sheikhi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No.43. South Mofatteh Ave, Tehran, Iran
| | - Farhad Alijani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No.43. South Mofatteh Ave, Tehran, Iran
| | - Parsa Kafshchi
- Department of Human Sciences, Faculty of Psychology, Islamic Azad University, Zanjan, Iran
| | - David Taylor
- Pharmacy Department, Maudsley Hospital, Denmark Hill, London, SE5 8AF, England, UK
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3
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Bhat RR, Vellekkat F, Goutama IL, Gill PS, Kakar G, Jabeen H, Gireesh K, Sanker V, Gupta U. A case of trichotillomania and bulimia nervosa in a patient with adult-onset attention-deficit/hyperactivity disorder (ADHD). Clin Case Rep 2023; 11:e7800. [PMID: 37601423 PMCID: PMC10432585 DOI: 10.1002/ccr3.7800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Key Clinical Message Identifying any potential comorbidity such as bulimia nervosa (BN) and ADHD in trichotillomania patients is essential for a thorough treatment plan. Combining a multidisciplinary approach was found to be feasible and effective in the treatment. Abstract Trichotillomania is frequently considered an isolated disorder; nevertheless, emerging evidence suggests that other psychiatric conditions, including obsessive-compulsive disorder (OCD), eating disorders, and attention-deficit/hyperactivity disorder (ADHD), are often found to coexist. Several studies showed that eating disorders, such as bulimia nervosa, were found in chronic hair-pullers, while OCD was considered a factor in predicting the prevalence of eating disorders, as well as the severity of trichotillomania in the populations. While the relationship between trichotillomania and OCD has been quite well-documented, the evidence of its association with bulimia nervosa and ADHD remains limited. Here, we report a case of trichotillomania with comorbid bulimia nervosa, major depressive disorder, and ADHD.
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Affiliation(s)
- Rakshita Ramesh Bhat
- Bangalore Medical College and Research InstituteBangaloreIndia
- Team ErevnitesTrivandrumIndia
| | - Faheem Vellekkat
- Team ErevnitesTrivandrumIndia
- Indira Gandhi Medical College and Research InstitutePuducherryIndia
| | - Ivany Lestari Goutama
- Team ErevnitesTrivandrumIndia
- Faculty of MedicineTarumanagara UniversityJakartaIndonesia
| | | | - Gauri Kakar
- Team ErevnitesTrivandrumIndia
- Jawaharlal Nehru Medical CollegeWardhaIndia
| | - Hafsa Jabeen
- Team ErevnitesTrivandrumIndia
- Dow Medical CollegeKarachiPakistan
| | - Krishnan Gireesh
- Team ErevnitesTrivandrumIndia
- School of Behavioural SciencesTamil NaduIndia
| | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumIndia
| | - Umang Gupta
- Team ErevnitesTrivandrumIndia
- Nepalgunj Medical CollegeNepalgunjNepal
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4
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Topal Hangül Z, Tuman TC, Altunay-Tuman B, Saygılı GY, Tufan AE. Body-focused repetitive behaviors in children and adolescents, clinical characteristics, and the effects of treatment choices on symptoms: a single-center retrospective cohort study. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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5
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Sani G, Gualtieri I, Paolini M, Bonanni L, Spinazzola E, Maggiora M, Pinzone V, Brugnoli R, Angeletti G, Girardi P, Rapinesi C, Kotzalidis GD. Drug Treatment of Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-picking) Disorder, and Nail-biting (Onychophagia). Curr Neuropharmacol 2020; 17:775-786. [PMID: 30892151 PMCID: PMC7059154 DOI: 10.2174/1570159x17666190320164223] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Trichotillomania (TTM), excoriation (or skin-picking) disorder and some severe forms of onychophagia are classified under obsessive-compulsive and related disorders. There are different interacting neurotransmitter systems involved in the pathophysiology of impulse-control disorders, implicating noradrenaline, serotonin, dopamine, opioid peptides and glutamate, hence investigators focused on drugs able to act on these transmitters. Our aim was to critically review the efficacy of the drugs employed in impulse-control disorders. METHODS We searched for controlled drug trials to treat TTM, excoriation, and/or nail-biting six databases (PubMed, Cochrane, Scopus, CINAHL, PsycINFO/PsycARTICLES, and Web of Science), using the search strategy: (trichotillomania OR "excoriation disorder" OR "face picking" OR "skin picking" OR "hair pulling" OR onychophagia OR "nail-biting") AND drug treatment on 12 March 2018 for all databases. We followed in our method of identifying relevant literature the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS SSRIs and clomipramine are considered first-line in TTM. In addition, family members of TTM patients are often affected by obsessive-compulsive spectrum disorders. Other drugs used in the treatment of TTM are lamotrigine, olanzapine, N-Acetylcysteine, inositol, and naltrexone. CONCLUSION The treatment of TTM, excoriation disorder and nail-biting is still rather disappointing. Conjectures made from preclinical studies and the relative pathophysiological hypotheses found poor confirmations at a clinical level. There is a need for further studies and the integration of pharmacological and psychotherapeutic. Our results point to the need of integrating personalised medicine principles in the treatment of these patients.
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Affiliation(s)
- Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.,Centro "Lucio Bini", Rome, Italy.,Tufts University School of Medicine, Boston, United States
| | - Ida Gualtieri
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Marco Paolini
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Luca Bonanni
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Edoardo Spinazzola
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Matteo Maggiora
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Vito Pinzone
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gloria Angeletti
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NeSMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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6
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Zengin Eroğlu M, Sahan E, Demirkol ME, Gelegen V, Tamam L. Trikotillomani tanılı hastalarda dürtüsellik ve dikkat eksikliği hiperaktivite bozukluğu. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.618470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Trichotillomania can present in childhood, with many families seeking initial evaluation by a dermatologist for hair loss. Prompt and accurate diagnosis by dermatologists is crucial, as children can suffer from academic or social impairments as well as mental health sequelae. Children are especially vulnerable to lasting psychological distress from appearance-related bullying. This article reviews the psychosocial impacts of pediatric trichotillomania and the current interventions studied in this population. Included are studies evaluating behavioral therapies as well as pharmacologic options. This review highlights the importance of early and appropriate identification, intervention, and the need for more treatment studies in the pediatric population.
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Affiliation(s)
- Emily D Henkel
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sasha D Jaquez
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, Texas.,Texas Child Study Center, Austin, Texas.,Dell Children's Medical Center, Austin, Texas
| | - Lucia Z Diaz
- Dell Children's Medical Center, Austin, Texas.,Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas
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8
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de Haas EN, van der Eijk JA. Where in the serotonergic system does it go wrong? Unravelling the route by which the serotonergic system affects feather pecking in chickens. Neurosci Biobehav Rev 2018; 95:170-188. [DOI: 10.1016/j.neubiorev.2018.07.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/16/2022]
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9
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Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. Clin Dermatol 2018; 36:728-736. [DOI: 10.1016/j.clindermatol.2018.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Aumond S, Bitton E. The eyelash follicle features and anomalies: A review. JOURNAL OF OPTOMETRY 2018; 11:211-222. [PMID: 30017866 PMCID: PMC6147748 DOI: 10.1016/j.optom.2018.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/19/2018] [Accepted: 05/26/2018] [Indexed: 05/03/2023]
Abstract
The primary role of eyelashes is to protect and maintain the health of the lid margin. However, the mechanisms to fulfill this role are not fully understood. Unraveling these mechanisms will stand to greatly improve the efficiency of eye care professionals' interventions in anomalies of the eyelashes. The aim of this article is to provide a review on eyelashes including highlights and new avenues for research; the biology of both the lash and its follicle; the pathophysiology and management of lash anomalies by eye care professionals; and the effect of iatrogenic factors on lashes. Using the database of Ovid MEDLINE, we reviewed studies specifically directed on human/mammalian eyelashes and key articles on current trends in scalp hair methodologies that can be applicable to lash research. The eyelash morphology, pigmentation and growth rate have been documented using techniques ranging from lash imaging to follicle immunohistochemistry. Furthermore, studies have demonstrated that the lash follicle is sensitive to many factors of the external environment, a variety of systemic/topical medications and cosmetics. Recently, aerodynamic studies using a mammalian eye model confirmed that an optimal lash length was needed so that eyelashes serve a protective role in reducing the number of particles that can reach the eye. Despite recent advances in lash research, studies are still scarce, due to the limited availability of the human lid for sampling. This review brings awareness that further research is needed with respect to eyelashes and will hopefully reduce the gap with scalp hair research.
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Affiliation(s)
- Sarah Aumond
- École d'optométrie, Université de Montréal, 3744 Rue Jean-Brillant, Montréal, Québec, Canada H3T 1P1.
| | - Etty Bitton
- École d'optométrie, Université de Montréal, 3744 Rue Jean-Brillant, Montréal, Québec, Canada H3T 1P1
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11
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Abstract
An adolescent with autism spectrum disorder and improperly treated attention deficit hyperactivity disorder presented with recurrent hair pulling. Treatment with selective serotonin reuptake inhibitor and stimulant improved these conditions.
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Affiliation(s)
- Ruziana Masiran
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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12
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Chamberlain SR, Harries M, Redden SA, Keuthen NJ, Stein DJ, Lochner C, Grant JE. Cortical thickness abnormalities in trichotillomania: international multi-site analysis. Brain Imaging Behav 2018; 12:823-828. [PMID: 28664230 PMCID: PMC5640149 DOI: 10.1007/s11682-017-9746-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Trichotillomania is a prevalent but often hidden psychiatric condition, characterized by repetitive hair pulling. The aim of this study was to confirm or refute structural brain abnormalities in trichotillomania by pooling all available global data. De-identified MRI scans were pooled by contacting authors of previous studies. Cortical thickness and sub-cortical volumes were compared between patients and controls. Patients (n = 76) and controls (n = 41) were well-matched in terms of demographic characteristics. Trichotillomania patients showed excess cortical thickness in a cluster maximal at right inferior frontal gyrus, unrelated to symptom severity. No significant sub-cortical volume differences were detected in the regions of interest. Morphometric changes in the right inferior frontal gyrus appear to play a central role in the pathophysiology of trichotillomania, and to be trait in nature. The findings are distinct from other impulsive-compulsive disorders (OCD, ADHD, gambling disorder), which have typically been associated with reduced, rather than increased, cortical thickness. Future work should examine sub-cortical and cerebellar morphology using analytic approaches designed for this purpose, and should also characterize grey matter densities/volumes.
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Affiliation(s)
- Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, Box 189 Level E4, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Michael Harries
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Sarah A Redden
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dan J Stein
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Christine Lochner
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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13
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Casarotto PC, Biojone C, Montezuma K, Cunha FQ, Joca SRL, Castren E, Guimaraes FS. Inducible nitric oxide synthase (NOS2) knockout mice as a model of trichotillomania. PeerJ 2018; 6:e4635. [PMID: 29682419 PMCID: PMC5909682 DOI: 10.7717/peerj.4635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Trichotillomania (TTM) is an impulse control disorder characterized by repetitive hair pulling/trimming. Barbering behavior (BB) observed in laboratory animals is proposed as a model of TTM. The neurobiological basis of TTM is unclear, but involves striatal hyperactivity and hypoactivation of the prefrontal cortex. Methods In this study, we evaluated the BB in knockout mice for the inducible isoform of nitric oxide synthase (NOS2KO) and the consequences of silencing this enzyme in PC12 cell differentiation. Results NOS2KO exhibit exacerbated BB, starting four weeks of age, and increased repetitive movements compared to wild-type mice (WT). The expression of BB was attenuated by repeated treatment with clomipramine, a clinically approved drug to treat TTM in humans, or memantine, an antagonist of NMDA receptors, as well as partial rescue of NOS2 expression in haploinsufficient animals. The silencing of NOS2 expression reduced the MAP2 (microtubule-associated protein 2) levels in activity-induced differentiated PC12 cells. Discussion Our data led us to propose that NOS2 is putatively involved in the neuronal maturation of the inhibitory afferent pathways during neurodevelopment, and such inadequate inhibition of motor programs might be associated to the observed phenotype.
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Affiliation(s)
- Plinio C Casarotto
- Neuroscience Center, University of Helsinki, Helsinki, Finland.,Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Caroline Biojone
- Neuroscience Center, University of Helsinki, Helsinki, Finland.,Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Montezuma
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Q Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Samia R L Joca
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eero Castren
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Francisco S Guimaraes
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,NAPNA: Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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14
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Systematic Review of Published Primary Studies of Neuropsychology and Neuroimaging in Trichotillomania. J Int Neuropsychol Soc 2018; 24:188-205. [PMID: 28835311 DOI: 10.1017/s1355617717000819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Existing models of trichotillomania (TTM; hair pulling disorder) rely heavily on a biological predisposition or biological pathogenesis of the disorder, but fail to capture the specific neuropsychological mechanisms involved. The present systematic review aims to scope existing neuropsychological studies of TTM to explore gaps in current models. METHODS A systematic literature search was conducted to detect all published primary studies using neuropsychological and neuroimaging measures in a cohort of individuals experiencing TTM. Studies addressing neuropsychological function were divided into domains. Findings from imaging studies were considered within brain regions and across methodology. RESULTS Thirty studies with a combined 591 participants with TTM, 372 healthy controls and 225 participants in other types of control group were included. Sixteen studies investigated neuropsychological parameters, and 14 studies pursued neuroimaging technologies. Available studies that used neuropsychological assessments and reported a statistically significant difference between those with TTM and controls ranged in effect size from 0.25 to 1.58. All domains except verbal ability and visual ability reported a deficit. In neuroimaging studies, several structural and functional brain changes were reported that might be of significance to TTM. Only tentative conclusions can be made due to the use of multiple methodologies across studies, a major limitation to meaningful interpretations. CONCLUSIONS Positive neuropsychological and neuroimaging results require replication, preferably with multi-site studies using standardized methodology. Increased standardized testing and analyses across the literature, as a whole, would improve the utility and interpretability of knowledge in this field. (JINS, 2018, 24, 188-205).
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16
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Abstract
Trichotillomania is characterized by repetitive pulling that causes noticeable hair loss. Data on the pharmacological treatment of trichotillomania are limited, with no clear first-line agent. The aim of the current study was to determine the efficacy and tolerability of inositol in adults with trichotillomania. A total of 38 individuals (35 women; mean age: 28.9±11.4) with trichotillomania entered a 10-week, double-blind, placebo-controlled trial to evaluate the safety and efficacy of inositol (dosing ranging from 6 to 18 g/day). Patients were assessed using the Massachusetts General Hospital Hair Pulling Scale, the NIMH Trichotillomania Severity Scale, Clinical Global Impression Scale, and measures of depression, anxiety, and psychosocial functioning. Outcomes were examined using a linear mixed-effects model. Patients assigned to inositol failed to show significantly greater reductions on primary or secondary outcomes measures compared with placebo (all P>0.05). At study endpoint, 42.1% of patients were 'much or very much improved' on inositol compared with 35.3% on placebo. This is the first study assessing the efficacy of inositol in the treatment of trichotillomania, but found no differences in symptom reductions between inositol and placebo. Future studies should examine whether inositol may be beneficial in controlling pulling behavior in a subgroup of individuals with trichotillomania.
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17
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Obinwa O, Cooper D, Khan F, O’Riordan JM. Rapunzel syndrome is not just a mere surgical problem: A case report and review of current management. World J Clin Cases 2017; 5:50-55. [PMID: 28255548 PMCID: PMC5314261 DOI: 10.12998/wjcc.v5.i2.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/07/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
Recurrent Rapunzel syndrome (RRS) is a rare clinical presentation with fewer than six cases reported in the PubMed literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.
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Abstract
PURPOSE OF REVIEW Hair loss is common in infants and children and the ability to distinguish why a child is losing hair enables providers to distinguish hair loss that is related to infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders such as ectodermal dysplasias. Making these distinctions leads to best management and guidance for patients and their families. RECENT FINDINGS Careful physical examination of the hair, scalp, skin, and nails coupled with dermoscopy or trichoscopy, or both, can yield more accurate and faster diagnosis. Biopsy is rarely needed in children for hair loss conditions. SUMMARY Hair loss, particularly on the scalp, can affect all ages and can impact patients socially and emotionally. The majority of hair loss in children is nonscarring. Diagnosis begins with a good history, including personal and family history, medication use, a thorough physical examination, and use of dermoscopy or trichoscopy, or both. With these, providers can begin to divide hair loss into congenital vs. acquired, and then further subdivide into focal vs. diffuse and scarring vs. nonscarring. Secondary change, including scale and erythema, can further help with diagnosis.
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