Abstract
Pathological hair-pulling or trichotillomania, which is commonly associated with anxiety and depression, obsessive-compulsive disorder, and neurodevelopmental disorders, has been rarely associated with dementing illnesses. Investigators have not clarified the neural correlates and treatment of trichotillomania in dementia. We report a patient who developed an early-onset cognitive decline with genetic, cerebrospinal fluid biomarker and structural and functional neuroimaging studies consistent with Alzheimer's disease. Eight years into her disease, she developed severe, repetitive hair-pulling behavior leading to marked hair loss, along with other repetitive and “frontal” behaviors. Selective serotonin reuptake inhibitors (SSRIs) were ineffective in controlling her hair-pulling behavior, which subsequently responded to quetiapine 150 mg/day. This patient and a review of the literature suggest that trichotillomania may be a compulsive-related symptom in dementias of different etiologies as they involve frontal areas and release primitive grooming behavior from frontostriatal dysfunction. Dopamine blockade, rather than SSRIs, may be effective in managing trichotillomania in dementia.
Highlights
Trichotillomania is characterized by an overwhelming urge to pull out one’s own hair with resultant noticeable hair loss
Trichotillomania occurs with other body focused repetitive behaviors (BFRB) such as excoriation or skin-picking and nail or cheek biting, in addition to repetitive handbiting, head-banging, self-hitting, or lip-biting in neurodevelopmental disorders such as Lesch-Nyhan syndrome, Rett’s syndrome, fragile X syndrome, autism, and mental retardation [1, 3]
The literature on this is sparse [5,6,7], trichotillomania can be a significant disability among patients with different dementing illnesses and a challenge for clinicians to effectively treat it
Summary
Trichotillomania is characterized by an overwhelming urge to pull out one’s own hair with resultant noticeable hair loss. Trichotillomania is a distinct diagnostic entity [1], in as many as 3 out or 4 patients it occurs along with a comorbid condition [2,3,4], most commonly depressive disorder followed by obsessive-compulsive disorder (OCD) [2,3,4]. Clinicians may be unware that trichotillomania can be a neuropsychiatric symptom of dementia. The literature on this is sparse [5,6,7], trichotillomania can be a significant disability among patients with different dementing illnesses and a challenge for clinicians to effectively treat it. We describe a dementia patient with intractable trichotillomania, review what is known about this association, and discuss the possible etiology. This report is part of an Institutional Review Board approved study
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
