Neurocognitive functioning in adults with trichotillomania: Predictors of treatment response and symptom severity in a randomized control trial.

Trichotillomania (TTM) is associated with impairments in response inhibition and cognitive flexibility, but it is unclear how such impairments relate to treatment outcome. The present study examined pre-treatment response inhibition and cognitive flexibility as predictors of treatment outcome, change in these domains from pre-to post-treatment, and associations with TTM severity. Participants were drawn from a randomized controlled trial comparing acceptance-enhanced behavior therapy (AEBT) to psychoeducation and supportive therapy (PST) for TTM. Adults completed assessments at pre-treatment (n = 88) and following 12 weeks of treatment (n = 68). Response inhibition and cognitive flexibility were assessed using the Stop Signal Task and Object Alternation Task, respectively. Participants completed the MGH-Hairpulling Scale. Independent evaluators administered the NIMH-Trichotillomania Severity Scale and Clinical Global Impressions-Improvement Scale. Higher pre-treatment TTM severity was associated with poorer pre-treatment cognitive flexibility, but not response inhibition. Better pre-treatment response inhibition performance predicted positive treatment response and lower post-treatment TTM symptom severity, irrespective of treatment assignment. Cognitive flexibility did not predict treatment response. After controlling for age, neither neurocognitive variable changed during treatment. Response inhibition and cognitive flexibility appear uniquely related to hair pulling severity and treatment response in adults with TTM. Implications for treatment delivery and development are discussed.

Impulsivity in adolescent girls diagnosed with trichotillomania: an evaluation of clinical and neuropsychological characteristics.

The aim of this study is to compare the clinical and neuropsychological features of impulsivity in adolescent girls with trichotillomania (TTM) and healthy controls, and to assess the relationships between the severity of TTM and the impulsivity/concomitant symptoms of anxiety and depression. The study sample consisted of 43 adolescent girls who were 12 to 18 years old. The Kiddie-Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version DSM-5 (K-SADS-PL) was administered to the adolescents and their parents. All of the participants completed a sociodemographic data form, the Revised Children's Anxiety and Depression Scale-Child Version (RCADS-CV), the Barratt Impulsiveness Scale-Brief (BIS-Brief), and the Massachusetts General Hospital Hairpulling Scale (MGH-HPS). The Eriksen Flanker task, the Stop Signal Reaction Time (SSRT) task, the Go/No-Go task, and the Balloon Analog Risk Task (BART) were used to assess behavioral impulsivity. The adolescents with TTM reported higher levels of impulsivity and anxiety/depression symptoms than the healthy controls, and they also performed worse on the behavioral tasks. While there were no relationships between clinical and behavioral impulsivity and TTM severity, social anxiety symptoms were the most important predictor of the severity of TTM. It seems important to better understand the role of impulsivity in the onset and persistence of TTM symptoms in adolescents.

The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

ABSTRACT CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

Histopatología de las alopecias. Parte I: alopecias no cicatriciales / Histologic Features of Alopecias-Part I: Nonscarring Alopecias

El diagnóstico de las enfermedades del cabello y del cuero cabelludo se basa, en la mayoría de las ocasiones, en el reconocimiento de signos clínicos; sin embargo, dichos signos no siempre son característicos y, en ocasiones, tenemos que recurrir a técnicas más invasivas como la realización de una biopsia. En este artículo se revisa de forma detallada las principales formas de alopecia desde un punto de vista histopatológico, y para ello se utiliza la clasificación tradicional de las alopecias que las divide en 2 grandes grupos: las alopecias cicatriciales y las no cicatriciales. Las alopecias cicatriciales son aquellas en las cuales el folículo piloso es sustituido por tejido fibroso cicatricial, causando una pérdida permanente del cabello. En las alopecias no cicatriciales el folículo permanece intacto y puede retomar su actividad cuando cesa el estímulo desencadenante. La primera parte de este artículo revisa las principales formas de alopecia no cicatricial desde un punto de vista histopatológico. Dado que una buena correlación clínico-patológica es fundamental para realizar el correcto diagnóstico histopatológico de las alopecias, en este artículo se incluye también una breve descripción de las características clínicas de las principales formas de alopecia

The diagnosis of disorders of the hair and scalp can generally be made on clinical grounds, but clinical signs are not always diagnostic and in some cases more invasive techniques, such as a biopsy, may be necessary. This 2-part article is a detailed review of the histologic features of the main types of alopecia based on the traditional classification of these disorders into 2 major groups: scarring and nonscarring alopecias. Scarring alopecias are disorders in which the hair follicle is replaced by fibrous scar tissue, a process that leads to permanent hair loss. In nonscarring alopecias, the follicles are preserved and hair growth can resume when the cause of the problem is eliminated. In the first part of this review, we describe the histologic features of the main forms of nonscarring alopecia. Since a close clinical-pathological correlation is essential for making a correct histologic diagnosis of alopecia, we also include a brief description of the clinical features of the principal forms of this disorder

Síndrome de Rapunzel: tratamiento laparoscópico / Rapunzel syndrome: Laparoscopic treatment

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Trichotillomania and trichophagia: the causes of Rapunzel syndrome

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Tricotilomanía en un lactante: una expresión de ansiedad / Trichotillomania in infants: an expression of anxiety

La tricotilomanía se considera, según el DSM-IV-TR, un trastorno del control de los impulsos caracterizado por una compulsión recurrente de arrancarse el cabello. La edad de máxima incidencia es la adolescencia, con una mayor prevalencia en las mujeres, y existen muy pocos casos publicados en lactantes. Su etiología parece ser multifactorial, en la que intervienen factores genéticos, temperamentales y ambientales asociados. La alopecia del cuero cabelludo es la manifestación clínica más habitual en niños. Hasta en el 30% de los casos se asocia tricofagia, y puede originar sintomatología digestiva y ciertas complicaciones, como la obstrucción intestinal por tricobezoares que requieren la extracción quirúrgica. El diagnóstico es habitualmente tardío, ya que los adolescentes suelen negar el trastorno y en niños pequeños no suele sospecharse. Es obligado realizar el diagnóstico diferencial con otras alopecias orgánicas y psiquiátricas. El pronóstico depende fundamentalmente de la edad de inicio. Los tratamientos actuales combinan la terapia conductual con fármacos ansiolíticos. Dado el impacto de la tricotilomanía en la calidad de vida y la autoestima de los pacientes, se aboga por el enfoque multidisciplinario de esta patología, que requiere una estrecha colaboración del entorno familiar y escolar. Se presenta el caso de una lactante de 14 meses de edad, que se inicia con una placa de alopecia en la región occipitoparietal de 4,5 cm de diámetro(AU)

Trichotillomania is considered, according to DSM-IVR, a disorder of impulse control characterized by recurrent compulsive hair pulling. The age of peak incidence is adolescence, with higher prevalence in women, there are very few reported cases in infants. The etiology appears to be multifactorial; intervening genetic, temperamental and environmental partners. Alopecia of the scalp is the most common clinical manifestation in children. Up to 30% is associated trichophagia and can cause gastrointestinal symptoms and complications such as intestinal obstruction requiring surgical removal trichobezoars. The diagnosis is usually delayed, because adolescents tend to deny and young children is usually not suspected. It forced the differential diagnosis with other organic and psychiatric alopecia. The prognosis depends primarily on age of onset. Current treatments combining behavior therapy with anxiolytic drugs. Given the impact of the trichotillomania in the quality of life and self-esteem, calls for a multidisciplinary approach to this disease, requiring close collaboration of family and school environment. The case of an infant 14 months of age who presents with a plate of alopecia in occipitoparietal region of 4.5 cm in diameter(AU)

Síndrome de Rapunzel: revisão de literatura / Rapunzel syndrome: a literature review

Tricobezoar gastroduodenal é definido como o acúmulo de cabelos e pelos no trato gastrointestinal, tendo como origem a ingestão dessas substâncias. As autoras relatam o caso de um volumoso tricobezoar associado à síndrome de Rapunzel, em jovem do sexo feminino com história de tricotilofagia e emagrecimento. Foram utilizados, como base de dados, a revisão de prontuário, a avaliação dos exames realizados e o acompanhamento durante o ato operatório. Apesar de ser um caso incomum, é necessário aventar sua hipótese diagnóstica diante de uma clínica exuberante como a da referida paciente. Não somente o bezoar deve ser adequadamente tratado, mas também a causa subjacente que levou a paciente à ingestão de cabelos.

Gastroduodenal trichobezoar is the accumulation of hair inside the gastroduodenal tract, originated by the ingestion of such object. On the presented study is reported the case of a voluminous trichobezoar associated with Rapunzel's syndrome on a young female with history of trichophagia and weight loss. With this purpose, chart review, assessment of the tests, and monitoring during the surgery were used. Despite being an unusual case, it should be suspected in a clinical exuberant as the patient, and must be properly treated, not only the bezoar itself, but the underlying cause that led to the ingestion of hair.

Tricotilomanía, tricobezoar de repetición y síndrome de Rapunzel: informe de un caso y revisión de la literatura / Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review

Introducción: Un bezoar es un conglomerado de material extraño en el tracto intestinal. El tricobezoar (acumulación de cabello en la cámara gástrica) y el síndrome de Rapunzel (acumulación en el intestino delgado) suelen aparecer en niños y mujeres adolescentes con antecedente de tricotilomanía y tricofagia. Caso clínico: Mujer de 22 años de edad con dolor abdominal intermitente, plenitud gástrica, náuseas, vómito ocasional y pérdida ponderal de 10 meses de evolución. Antecedentes de tricotilomanía, tricofagia y gastrotomía a los 16 años. Los exámenes de laboratorio revelaron anemia microcítica hipocrómica y el ultrasonido mostró una sombra sónica posterior en la cámara gástrica. Por gastrotomía se extrajo un conglomerado de cabello que ocupaba el estómago y parte del intestino delgado. Conclusiones: La tricotilomanía y tricofagia son más comunes en las mujeres menores de 30 años. La sensación que experimentaba la paciente al deglutir los cabellos provocaba la ingesta. La recopilación de datos puede proporcionar información acerca de los determinantes que influyen en la aparición de la enfermedad.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

Tricotilomania: revisão da literatura / Trichotillomania

Um número substancial de pacientes sofrre de tricotilomania, uma doença psiquiátrica com manifestações dermatológicas. Pessoas que sofrem de tricotilomania normalmente sabem de sua doença, mas não procuram ajuda devido à vergonha que sentem. Neste artigo, os autores discutem as características clinicas e propedêuticas da tricotilomania, com ênfase nos aspectos psiquiátricos dos pacientes.

A substancial number of patients are suffering about trichotilomania, a psychiatric disease that has dermatological manifestations. People who suffer about trichotillomania, generally know about their disease, but they don't look after help due to the shame that feel. In this article, the authors discuss the clinical characteristics and propedeutic of trichotillomania, with emphasis on the psychiatric aspects of the patients.

Tricotilomania / Trichotillomania

A tricotilomania é caracterizada por alopecia, resultante de hábito repetitivo de puxar o cabelo exercido pelo próprio paciente. Além do comprometimento estético e conseqüências sociais, o hábito pode levar a complicações. O artigo procura familiarizar o leitor com os principais aspectos clínicos e o tratamento a ser utilizado nos casos de tricotilomania, com ênfase nas técnicas de terapia comportamental.

Trichotillomania is characterized by hair loss from a patient's repetitive self-pulling of hair. This habit is embarrassing, unattractive, socially undesirable, and can predispose to some complications. The purpose of this article is to familiarize the reader with clinical features of trichotillomania and to describe appropriate therapeutic approach to be applied, with particular attention to behavior therapy techniques.

Alopecia difusa en una niña de dos años de edad / Did the Duchess of Urbino have Frontal Fibrosing Alopecia?

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Obstrucción intestinal causada por tricobezoar: Síndrome de Rapunzel / Intestinal obstruction due to a tríchobezoar or Rapunzel Syndrome: report of one case

Rapunzel syndrome or gastrointestinal trichobezoar is caused by hair ingestion. The diagnosis may be suspected in young females with important weight loss, who deny hair eating. We report a 16 year-old female consulting in the emergency room for abdominal pain. She was subjected to an exploratory laparotomy and a big mass was palpated in the stomach. A gastrostomy and enterostomy were performed and a 17x6x5 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to Psychiatry.

Tribezoar gigante associado a maus-tratos na infância: relato de um caso / Giant trychobezoar associated to child abuse and neglect: a case report

Relata-se o caso de uma paciente de 9 anos portadora de tricotilomania que desenvolveu um tricobezoar gigante e a associaçäo deste com maus-tratos. Säo revisados os principais tipos de bezoar, bem como suas apresentaçöes clínicas, diagnósticos e terapêuticas. Ressalta-se a importância do diagnóstico diferencial de patologias gástricas em crianças, a necessidade do tratamento dos estressores psicológicos que levam à tricotilomania e o papel da endoscopia digestiva associada à cirurgia no manejo destes casos

Tricotilomania: revisäo da literatura e relato de caso / Trichotillomania: a review of the literature and a case report

A tricotilomania, impulso irresístivel de arrancar os próprios cabelos, tem sido alvo de crescente atençäo da comunidade psiquiátrica nos últimos anos. Entretanto, informaçöes precisas acerca de sua prevalência, história natural e tratamento säo escassas. Os autores fazem uma revisäo da literatura sobre o tema e apresentam um caso clínico a título de ilustraçäo