Trichotillomania as a Manifestation of Dementia

Trichotillomania in Dementia: A Case Report and Literature Review

Introduction: Dementia presents with a variety of behavioral and psychiatric disorders, including a range of psychosis, anxiety, depression, behavioral aggression, and delirium. Case Presentation: This study aimed to report a 74-year-old man showing gradually progressive deterioration in his memory for five years. The patient developed trichotillomania (TTM) subsequent to his dementia. Neuropsychological examination indicated the deficits to be more predominantly in the frontal lobe. Conclusions: This study reviewed the literature on TTM in dementia case reports that had mostly investigated the cases of right-handed men aged > 65 years. TTM Patients with underlying disease had not any improvement. Although there was some heterogeneous evidence for the presence of brain abnormalities in individuals with hair-pulling behavior, no definitive conclusion was drawn. Mild to severe generalized atrophy in the cerebral cortex was observed in the frontal, parietal, temporal, occipital, and cingulate lobes.

«Doctora, yo como pelo». Tricotilomanía con tricofagia

Se presenta caso de mujer que dice que se come el pelo desde la infancia para lograr alivio momentáneo en situaciones estresantes. En la anamnesis, refiere antecedentes familiares con otros comportamientos compulsivos, incluyendo un familiar que también come pelo. Conclusiones: es clave una anamnesis bien estructurada que explore trastornos neurológicos y psiquiátricos bien definidos, así como el diseño de un árbol genealógico lo más exhaustivo posible para descartar implicaciones genéticas. Descartar trastornos dermatológicos con la dermatoscopia. Es fundamental concienciar a la paciente de posibles complicaciones y comorbilidades como las obstrucciones digestivas y avanzar la pobre eficacia de los tratamientos con psicofármacos. Palabras clave: tricotilomanía, tricofagia, compulsión.

Trichotillomania Ranging from "Ritual to Illness" and as a Rare Clinical Manifestation of Frontotemporal Dementia: Review of Literature and Case Report

Frontotemporal dementia (FTD) is the most common form of dementia in the younger age group and often exists with comorbid obsessions and compulsions in up to 80% of the patients. Trichotillomania or compulsive “hair-pulling” disorder is a rare manifestation of FTD and is a poorly evaluated symptom in this condition. The release of “grooming functions” due to frontal disinhibition is often attributed to the evolutionary perspective; however, recent findings also implicate the role of neurotransmitter dysfunction. Trichotillomania is currently classified under obsessive and compulsive behavioral spectrum disorders and is often encountered in the younger population with research evidence of response to selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and newer drugs such as N-acetyl cysteine. The role of behavioral therapy also has robust evidence in trichotillomania. We herewith report the case of a middle-aged male patient who presented with features of personality change and behavioral problems in terms of anger, agitation, and disinhibitory behavior who on detailed clinical evaluation and radiological assessment had features consistent with behavioral variant of FTD along with compulsive “hair plucking” behavior which responded minimally with SSRIs. FTD can have features of trichotillomania which is an often overlooked and relatively uncommon manifestation of dementias. Treatment options such as N-acetyl cysteine and behavioral therapy could have potential utility in this degenerative condition hitherto at an earlier stage.