Clinical Characteristics and Comorbidities of Patients with Trichotillomania and Skin Picking Disorder Who Admitted to a Psychodermatology Outpatient Clinic: A Comparative Study. / Psikodermatoloji Poliklinigine Basvuran Trikotillomani ve Deri Yolma Bozuklugu Tanili Hastalarin Klinik Özellikleri ve Es Tanilari: Bir Karsilastirma Çalismasi.

OBJECTIVE: Trichotillomania (TTM) and Skin Picking Disorder (SPD) are psychiatric disorders characterized by chronic and compulsive pulling and picking to remove hair and skin. There are very few studies on the clinical and phenomenological differences of TTM and SPD. In this study we aimed to compare the clinical characteristics and comorbidities of patients diagnosed with TTM and SPD. METHOD: We enrolled 56 TTM and 113 SPD patients who were assessed with SCID-I for DSM-IV. In addition, we evaluated the DSM- 5 criteria for Obsessive and Compulsive Disorder spectrum. We also utilized sociodemographic form, the Clinical Global Impression Scale, the Beck Anxiety Inventory and the Beck Depression Inventory. RESULTS: Although patients with TTM and SPD had many common clinical features and comorbidities, statistically significant differences were determined in the number of the pulling/picking sites (Z=- 7.084; p<0.001), the type of the outpatient clinics which they initially consulted (χ2=19.451; p<0.001), reasons for pulling/picking behavior (p<0.05) and comorbidities of depression (χ2=3.878; p=0.049) and onychophagia (χ2=7.173; p=0.007). Disease severity and depression and anxiety scores of patients with TTM and SPD who had comorbid diseases were statistically significantly higher compared to the patients without comorbidities (p<0.005). CONCLUSION: TTM and SPD often present with common clinical characteristics and a high incidence of psychiatric comorbidities. Finding out the clinical characteristics, the triggering factors and determining the comorbidities are important to gain an understanding of the course and determine the appropriate treatment for these disorders. Hence, phenomenological studies on large patient populations are needed.

Screening for bipolar disorder among migraineurs: the impact of migraine-bipolar disorder comorbidity on disease characteristics.

PURPOSE: The aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine-BD comorbidity on disease characteristics. PATIENTS AND METHODS: A total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD. RESULTS: The diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94-70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12-12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively. CONCLUSION: Our findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.

Schizophrenia-like psychosis and dandy-walker variant comorbidity: case report.

Dandy-Walker variant is a developmental malformation consisting of cerebellar hypoplasia and cystic dilatation of the fourth ventricle. Previous research has proposed a possible role for the cerebellum in cognition and in schizophrenia. In this paper we report a schizophrenia-like psychotic disorder in a 30 year-old woman with Dandy-Walker variant. The patient was treated with risperidone 6 mg/day, biperiden 4 mg/day and risperidone depot 50 mg injections fortnightly, and most of the symptoms were ameliorated within 2 months. The similar cognitive profile to populations with cerebellar pathology and rarity of the condition strongly suggests that there may be direct relationship between cerebellar pathology and appearence of psychotic symptoms.