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1.
Expert Opin Pharmacother ; 21(12): 1455-1466, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32633577

RESUMO

INTRODUCTION: Currently conceptualized as an obsessive compulsive and related disorder, trichotillomania, or hair-pulling disorder, is a common illness that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania also have other comorbid diagnoses. Treating trichotillomania with pharmacotherapy is complicated since there are currently no FDA-approved drugs for its treatment. AREAS COVERED: The databases PubMed, PsychINFO, CINAHL, Evidence-based Medicine Reviews, and Cochrane Database of Systematic Reviews were searched, yielding a total of 10 open trials and 10 controlled trials selected. This review aims to examine pharmacotherapeutic options for the treatment of trichotillomania in adults and makes recommendations for the assessment and management of the disorder. EXPERT OPINION: There is preliminary evidence that clomipramine, olanzapine, and N-acetylcysteine may be effective in cases of trichotillomania, however, given the paucity of controlled studies with large sample sizes, decisions regarding the use of drugs should be made on a case-by-case basis taking into account the severity of trichotillomania and the nature of psychiatric comorbidity.


Assuntos
Acetilcisteína/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Clomipramina/uso terapêutico , Olanzapina/uso terapêutico , Tricotilomania/tratamento farmacológico , Adulto , Ensaios Clínicos como Assunto , Comorbidade , Feminino , Humanos , Resultado do Tratamento , Tricotilomania/epidemiologia , Tricotilomania/psicologia
3.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 87-104, Jan.-Feb. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1055353

RESUMO

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.


Assuntos
Humanos , Masculino , Feminino , Tricotilomania/classificação , Síndrome de Tourette/classificação , Transtorno Obsessivo-Compulsivo/classificação , Tricotilomania/etiologia , Tricotilomania/terapia , Neurobiologia , Comorbidade , Resultado do Tratamento , Manual Diagnóstico e Estatístico de Transtornos Mentais , Neuropsicologia
4.
Arch. argent. pediatr ; 118(1): e61-e62, 2020-02-00.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1096074

RESUMO

Los fármacos estimulantes se usan, habitualmente, en la población pediátrica para tratar el trastorno por déficit de atención e hiperactividad, y sus efectos secundarios están bien descritos. Sin embargo, la tricotilomanía no aparece como uno de ellos. En la literatura, hay algunos casos publicados de tricotilomanía en relación con la administración de metilfenidato y dextroanfetamina. Se presentan dos casos de tricotilomanía de nueva aparición en niños en seguimiento en nuestro Centro por déficit de atención e hiperactividad y en tratamiento con fármacos psicoestimulantes (metilfenidato y lisdexanfetamina), como probable efecto adverso de estos.


Stimulant drugs are commonly used in pediatric population in the treatment of attention deficit hyperactivity disorder, and their side effects are well described, however trichotillomania does not appear as one of them. In the literature we found some published cases of trichotillomania in relation to methylphenidate and dextroamphetamine. We present two cases of new-onset trichotillomania in children followed up in our center by attention deficit hyperactivity disorder and treated with psychostimulant drugs (methylphenidate and lisdexamfetamine), as a probable adverse effect of this treatment


Assuntos
Humanos , Masculino , Criança , Tricotilomania/induzido quimicamente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos
5.
Braz J Psychiatry ; 42(1): 87-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31576938

RESUMO

OBJECTIVE: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.


Assuntos
Transtorno Obsessivo-Compulsivo/classificação , Síndrome de Tourette/classificação , Tricotilomania/classificação , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Neurobiologia , Neuropsicologia , Resultado do Tratamento , Tricotilomania/etiologia , Tricotilomania/terapia
6.
Behav Modif ; 44(1): 70-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30117327

RESUMO

The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).


Assuntos
Terapia de Aceitação e Compromisso , Tricotilomania/terapia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Tricotilomania/diagnóstico , Tricotilomania/psicologia , Adulto Jovem
7.
BMJ Case Rep ; 12(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31801773

RESUMO

This is a case of a 14-year-old woman diagnosed with acute pancreatitis based on history and laboratory investigations. CT scan confirmed the diagnosis of acute pancreatitis along with the presence of two bezoars in the stomach and proximal jejunum. Gastroscopy showed a large trichobezoar with difficult endoscopic extraction. Accordingly, the patient underwent laparotomy, gastrostomy and enterotomy with successful removal of the large gastric and jejunal daughter bezoars. Following surgery, pancreatitis resolved and investigations returned to normal. Child psychiatry consultation was sought, and she was diagnosed with trichotillomania and trichophagia.


Assuntos
Bezoares/complicações , Pancreatite/etiologia , Estômago , Tricotilomania/complicações , Dor Abdominal/etiologia , Adolescente , Bezoares/cirurgia , Feminino , Humanos , Tomografia Computadorizada por Raios X
8.
Psychiatry Res ; 281: 112578, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31586836

RESUMO

Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.


Assuntos
Conflito Familiar/psicologia , Relações Familiares/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Poder Familiar/psicologia , Tricotilomania/psicologia , Adolescente , Criança , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Relações Interpessoais , Masculino , Transtorno Obsessivo-Compulsivo/epidemiologia , Tricotilomania/epidemiologia
9.
Pediatr Dermatol ; 36(6): 803-807, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31588617

RESUMO

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.


Assuntos
Tricotilomania/diagnóstico , Tricotilomania/terapia , Acetilcisteína/uso terapêutico , Criança , Terapia Cognitivo-Comportamental , Humanos , Hipnose , Psicoterapia de Grupo , Dispositivos Eletrônicos Vestíveis
10.
Compr Psychiatry ; 94: 152123, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31518848

RESUMO

BACKGROUND: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Tricotilomania/epidemiologia , Adulto , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Disruptivos, de Controle do Impulso e da Conduta/genética , Feminino , Ligação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/genética , Tricotilomania/genética , Adulto Jovem
12.
Dermatol Ther ; 32(5): e13073, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31444827

RESUMO

Treatment of psychodermatological conditions, particularly body-focused repetitive behavior disorders, is often unsatisfactory. Various psychopharmacological and non-pharmacological treatments have been used to ameliorate the symptoms of these disorders. N-Acetylcysteine (NAC) is a newer modality in the treatment of these disorders. This short review focuses on pharmacology, mode of action, and use of NAC in common body-focused repetitive disorders such as trichotillomania, skin-picking disorders, and onychotillomania (nail biting). Current research and literature review have been evaluated and will be discussed.


Assuntos
Acetilcisteína/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Tricotilomania/tratamento farmacológico , Dermatologia/métodos , Feminino , Humanos , Masculino , Hábito de Roer Unhas/psicologia , Hábito de Roer Unhas/terapia , Transtorno Obsessivo-Compulsivo/diagnóstico , Prognóstico , Técnicas Projetivas , Índice de Gravidade de Doença , Dermatopatias , Resultado do Tratamento , Tricotilomania/psicologia
13.
Bull Menninger Clin ; 83(4): 399-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380699

RESUMO

Trichotillomania (TTM) involves the chronic pulling out of hair to the point of hair loss or thinning, which continues despite repeated attempts to stop. Behavior therapy is a promising treatment for the condition, but studies have been limited by the lack of a credible control condition, small sample sizes, follow-up periods of short duration, and low participation by underrepresented populations. In the current article, the authors describe the theoretical rationale for an acceptance-enhanced form of behavior therapy for TTM in adults and describe the methodology used to test the efficacy of this intervention against a psychoeducation and supportive control condition. In addition, the authors discuss the importance of and difficulties encountered with enrolling minority participants into TTM research, as well as strategies used to enhance minority recruitment. Finally, the authors discuss the instruments, procedures, and related outcomes of the fidelity measures used in the randomized controlled trial.


Assuntos
Afro-Americanos/etnologia , Terapia Comportamental/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Tricotilomania/etnologia , Tricotilomania/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Wisconsin/etnologia , Adulto Jovem
16.
Clin Neuropharmacol ; 42(4): 139-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31232748

RESUMO

OBJECTIVES: Skin-picking disorders, trichotillomania, and nail biting are all characterized by repetitive behaviors resulting in functional deterioration and remarkable changes in physical appearance with repeated attempts to stop or decrease the behavior. While standard pharmacotherapy for obsessive-compulsive disorder and related disorders consists of serotonergic reuptake inhibitors, their moderate efficacy pushed researchers to find alternative treatment approaches. Some of these alternatives are glutamate-modulating agents. The most widely studied of these glutamate modulator agents is N-acetylcysteine (NAC), which is a derivative of the amino acid cysteine. METHODS: This report describes a case series of 3 patients in whom skin-picking disorders, trichotillomania, and nail biting were diagnosed at a center in Turkey. RESULTS: First case was a 42-year-old female patient who had been picking her skin from her arm area, especially in stressful times. Second case was a 31-year-old female patient who has a habit of pulling her hair for the last 20 years. The third case was 24-year-old male patient with a habit of eating his own nails that he has had for as long as he could remember. We successfully treated 3 of our patients who suffer from previously mentioned disorders with NAC. CONCLUSIONS: Outcome of our cases demonstrates the efficacy of NAC, which is effective and well tolerated on the treatment of obsessive-compulsive disorder-related disorders.


Assuntos
Acetilcisteína/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno de Movimento Estereotipado/tratamento farmacológico , Tricotilomania/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
17.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229972

RESUMO

Trichobezoars are relatively uncommon problems with a known female predominance. We report two female children with gastric bezoars. Main presenting symptoms were abdominal distension, weight loss and anaemia. Upper abdominal mass was palpable in both. Diagnosis was suspected on initial abdominal radiograph and ultrasound scan then confirmed by upper endoscopy. No bowel extension was recorded in either case. We report here a modification of the surgical technique in which the gastrostomy cut edges were anchored to the laparotomy skin. This modification aided easy and complete delivery of hair balls avoiding any spillage or wound contamination.


Assuntos
Dor Abdominal/cirurgia , Bezoares/cirurgia , Gastrostomia , Laparotomia , Radiografia Abdominal , Tricotilomania/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Bezoares/diagnóstico por imagem , Bezoares/patologia , Criança , Pré-Escolar , Feminino , Gastrostomia/métodos , Humanos , Laparotomia/métodos , Tricotilomania/complicações , Tricotilomania/diagnóstico por imagem , Infecção dos Ferimentos/prevenção & controle
19.
Arch. argent. pediatr ; 117(3): 284-287, jun. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1001203

RESUMO

Los bezoares son acumulaciones de sustancias orgánicas en el tracto gastrointestinal. El tricobezoar hace referencia a la acumulación de cabello, por lo general, en el estómago e incluso más allá de este (síndrome de Rapunzel). La incidencia de esta enfermedad es extremadamente rara; el 90 % de los casos se presentan en las mujeres, y el 80 % de estos ocurren en menores de 30 años y se encuentran relacionados con conductas de ansiedad y trastornos psiquiátricos. El abordaje integral en estos pacientes es fundamental, junto con el seguimiento interdisciplinario, para tratar las causas psicoemocionales subyacentes y realizar una adecuada psicoeducación con los pacientes y sus familiares, para disminuir el riesgo de posibles recidivas. Se presenta el caso clínico de una paciente en edad escolar, con antecedente de maltrato físico por parte de su padrastro y posteriores conductas ansiosas (tricotilomanía y tricofagia).


Bezoar is an accumulation of organic substances in the gastrointestinal tract; trichobezoar refers to the accumulation of hair usually in the stomach and even beyond it (Rapunzel syndrome). The incidence of this condition is extremely rare, 90 % of cases occur in women, and 80 % of these occur in those under 30 years of age and are related to anxiety behaviors and psychiatric disorders. The integral approach in these patients is fundamental, together with the interdisciplinary follow-up, treating the underlying psycho-emotional causes and adequate psychoeducation with the patients and their relatives, in order to reduce the risk of possible recurrences. We present the clinical case of a patient of school age, with a history of physical abuse by her stepfather and subsequent anxious behaviors (trichotillomania and trichophagia).


Assuntos
Humanos , Feminino , Criança , Ansiedade , Tricotilomania , Bezoares , Maus-Tratos Infantis , Psiquiatria Infantil
20.
Arch Argent Pediatr ; 117(3): e284-e287, 2019 06 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31063318

RESUMO

Bezoar is an accumulation of organic substances in the gastrointestinal tract; trichobezoar refers to the accumulation of hair usually in the stomach and even beyond it (Rapunzel syndrome). The incidence of this condition is extremely rare, 90 % of cases occur in women, and 80 % of these occur in those under 30 years of age and are related to anxiety behaviors and psychiatric disorders. The integral approach in these patients is fundamental, together with the interdisciplinary follow-up, treating the underlying psycho-emotional causes and adequate psychoeducation with the patients and their relatives, in order to reduce the risk of possible recurrences. We present the clinical case of a patient of school age, with a history of physical abuse by her stepfather and subsequent anxious behaviors (trichotillomania and trichophagia).


Assuntos
Bezoares/diagnóstico , Maus-Tratos Infantis/psicologia , Tricotilomania/complicações , Bezoares/psicologia , Criança , Feminino , Humanos , Tricotilomania/psicologia
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