Management of trichotillomania

Trichoscopy in Trichotillomania - Monitoring Treatment Response

Trichotillomania is nonscarring alopecia with recurrent pulling out of one's hair and repeated attempts to reduce hair pulling. Clinical improvement in the urge to pull out hairs in trichotillomania is often not quantifiable and based on unreliable history. Here, we present a case of trichotillomania with follow-up features on trichoscopy during treatment. By this, we propose trichoscopy as an objective tool to visualize clinical improvement in the urge to pull out hairs and assess treatment efficacy.

Autism and trichotillomania in an adolescent boy

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.

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.

Women psychiatrists in India: A reflection of their contributions

The increasing number of women joining psychiatry is a relatively new phenomenon in the field of medicine. Keeping with the trends world over, the number of women psychiatrists in India has been on the rise over the last two to three decades. The authors searched various volumes of the Indian Journal of Psychiatry, recent membership directories of the Indian Psychiatric Society, website of the Medical Council of India and personal communications for contributions of the women psychiatrists in India. Women psychiatrists have a number of contributions to their credit in India. They have played important roles in the affairs of national professional organizations like the Indian Psychiatric Society and have contributed to the psychiatry education and research. However, they also suffer limitations because of the absence of adequate institutional support and policies looking into their specific needs.

Research in child and adolescent psychiatry in India

The primary source for this annotation on child and adolescent psychiatry is Indian Journal of Psychiatry. Articles covering various dimensions of child and adolescent mental health were searched from its electronic data base to discuss relevant articles. Literature was mainly in the form of original research articles, review articles, case reports, editorials, orations and presidential address.

Indian contribution to behavior therapy

Publication of papers related to psycho-social interventions in general and Behavior Therapy, in particular, in Indian Journal of Psychiatry has been limited. Though the first paper related to Behavior Therapy was published in 1952, a manual search of all available issues of the journal from 1949 showed that only 42 papers related to Behavior Therapy have been published till 2009. Among them 10 are case reports. Methodological limitations abound even in the papers on larger groups of patients. Studies using operant conditioning have been very few. Aversion therapy and progressive muscle relaxation have been very frequently used. The published articles are reviewed under the various diagnostic categories. Publications in the recent years have been mostly on Cognitive Behavior Therapy. Even after 57 years of co-existence, the relationship between Behavior Therapy and Indian Psychiatry remains a tenuous one.