Improvements in Social Cognition, Executive Functioning, and Trichotillomania with Characteristics of Trichophagia in a 26-year-old Female Patient Following Neurological Rehabilitation.

Abstract

Event Abstract Back to Event Improvements in Social Cognition, Executive Functioning, and Trichotillomania with Characteristics of Trichophagia in a 26-year-old Female Patient Following Neurological Rehabilitation. Trevor D. Eason1* 1 Carrick Institute, United States Presentation: A 26-year-old female patient presented with social cognitive impairment, memory decline, executive function limitations, persistent episodes of pica via trichophagia, and trichotillomania. The history included episodes of hair pulling and ingestion with no memory or recollection of the episode. Social cognition and executive functioning cues were slow and mild cognitive impairment had been made evident in the previous diagnosis. The patient stated that she had never been able to act appropriately in society after a history of multiple streptococcus A and mycoplasma pneumonia infections when she was 2 years old. The patient's mother stated that the mental processing of the patient is evident yet slower than the expected norm. Findings: During neurocognitive testing on the C3 Logix program, upon intake, Trails A time was measured at 49.1 seconds while Trails B time was measured at 55.9 seconds. Her simple reaction time was 423 milliseconds and her choice reaction time was 511 milliseconds. Her initial symptom severity score was 56% based on the associated subjective questionnaire where 0% is no symptoms. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing the patient's balance and stability, on both a solid and foamed surface, with his eyes opened, eyes closed, and with multiple head positions. Her average balance and stability score on intake was calculated as 67.12%. Comprehensive behavioral Intervention score of 23.5%. Videonystagography (VNG®) demonstrated saccadic oscillations. These eye movements were observed with similar frequency (15-20 Hz.) and equality sided to side with gaze fixation eliminated in primary position. Methods: A 12-day multi-modal neurological rehabilitation program was administered in 12 one-hour treatment sessions (Carrick, 2017). Each session consisted of neurological and vestibular rehabilitation exercises directed towards the cerebellum and basal ganglia integration, somatosensory evoked potentials, comprehensive behavioral intervention for tics (CBIT) treatment associated with habit reversal training and function-based treatments, orthoptic training, and off-vertical axis rotation (Gdowski 1999) using a multi-axis rotational chair. Based on clinical symptoms indicating alterations in energy production, she was placed on multiple nutrient formulas containing pantothenic acid (300 mg), L-α glycerylphosphorylcholine (100 mg), acetyl L-carnitine hydrochloride (25 mg), Butyric acid and calcium propionate blend (575 mg) and Huperzia serrata (75 mcg) 3 times daily. Also, the patient administered a gastrointestinal tissue repair compound containing a proprietary blend of sodium (10 mg), L-Glutamine (3.5 g), deglycyrrhizinated licorice extract (500 mg), aloe vera gel concentrate (50 mg), ginger extract (40 mg), and an enzymatic blend once daily with a meal. Outcomes: Upon discharge, Trails A time decreased to 37.6 seconds (-23.4%), and Trails B time decreased to 42.7 seconds (-23.6%). Simple reaction time decreased to 347 seconds (-18.0%), and choice reaction time decreased to 386 seconds (-24.5%). Symptom severity score decreased to 23 (-58.9%) where 0 is no symptoms. The average balance and stability score improved resulting in a score of 79.17% (+18.0%). Upon Videonystagography (VNG®), saccadic oscillation frequency was diminished per time observed with gaze stability in primary position, 20 degrees horizontally and 15 degrees vertically (circumferentially). Comprehensive behavioral Intervention score 49.8% (+111.9 %). No nystagmus was observed with gaze fixation eliminated in primary gaze position. Concurrently, the patient is now able to implement awareness strategies to compete against her trichotillomania and trichophagia episodes which ultimately proves an increase in executive functioning. Conclusions: The author suggests further investigation into the use of multi-modal neurological rehabilitation strategies, comprehensive behavioral interventions and supplemental clinical nutrition strategies for the treatment of trichotillomania with associated trichophagia, and cognitive impairment.​ The author also suggests further investigation into multi-modal, intensive approaches to improve stability scores, simple and choice reaction times, symptom severity scores and multimodal integration associated with proper neurological and cognitive function. Acknowledgements The author would like to thank and acknowledge Professor Frederick Carrick and his pioneering work in the field of clinical neuroscience. The author would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.