Repetitive Pulling Research Articles

The clay-shoveler’s fracture, a rare occupational injury in the modern era: a case report

BackgroundThe clay-shoveler fracture, named after Australian clay shovelers from the 1930s, results from high-energy, repetitive pulling mechanisms and is commonly associated with shoveling or digging. This injury primarily affects the lower cervical and upper thoracic vertebrae, particularly the C7 and T1 vertebrae. The avulsion mechanism, caused by stress on the spinous processes, may lead to sudden, severe upper back pain, limiting the affected individual’s ability to work effectively.Case presentationThis report presents the case of a 27-year-old boiler operator who experienced persistent neck pain, which did not respond to conservative management. Imaging studies revealed a T1 spinous process fracture with associated soft tissue edema, diagnosed as a clay-shoveler fracture. Conventional treatment with a semirigid cervical collar, analgesia, and rest was administered, leading to a favorable outcome.The clay-shoveler fracture, though rare, should be considered in cases involving repetitive stress on the cervical and thoracic spine, especially in occupations that require heavy lifting. In most instances, conservative management proves effective in relieving pain and enabling recovery.ConclusionRecognizing the clay-shoveler fracture is crucial for timely diagnosis and treatment. This case report underscores the occupational nature of the injury and its association with specific work activities. Further research and reporting of similar cases will contribute to a deeper understanding of this unusual fracture pattern, its risk factors, and optimal management strategies.

Prevalence and Factors Influencing Trichotillomania Among Healthcare Workers and Students in Saudi Arabia: A Cross-Sectional Analytical Study.

Trichotillomania (TTM) is a psychiatric disorder characterized by repetitive pulling out of one's own hair, in which the scalp, brows, and eyelids are the most common sites. This study aimed to measure the prevalence of TTM among healthcare workers and students and to determine its association with psychiatric disorders. This cross-sectional study was conducted among healthcare workers and students in Saudi Arabia. Data were collected through an online self-administered questionnaire. The questionnaire consisted of sociodemographic characteristics, the Massachusetts General Hospital (MGH) Hairpulling Scale to measure TTM, and the Depression and Anxiety Stress Scale (DASS-21) to measure the psychiatric disorders of the participants. A convenience sampling technique was implemented. The sample size was calculated to be 385. Of the total 460 participants, 62% (n = 285) were students, 55% were females and 61.7% (n = 284) were aged between 18 and 24 years. The most commonly associated chronic disease was diabetes (n = 34, 7.4%), followed by asthma (n = 30, 6.5%). The prevalence of TTM was 4.8% (n = 22), which was higher among medical students (n = 15, 5.3%) as compared to medical workers (n = 7, 4%). While taking psychiatric medication (AOR = 0.197; 95% CI = 0.076-0.508 p = 0.001) was identified as the protective factor for TTM, previous diagnoses of psychiatric illness (AOR = 4.298; 95% CI = 1.759-10.499; p = 0.001), stress (AOR = 4.759; 95% CI = 1.541-14.695; p = 0.007), and depression (AOR = 3.149; 95% CI = 1.190-8.334; p = 0.021) were recognized as independent risk factors of TTM. Trichotillomania was less common among health workers and students in Saudi Arabia. However, if trichotillomania is present, the disorder was found to be more common among those with associated psychiatric illnesses, including those who wereanxious and depressed. Hence, further research is required to validate the impact of psychiatric conditions on the prevalence of TTM in the study region.

An unusual case of trichotillomania and trichophagia associated with authentic hair extension as seen in a young African-American female adult

Trichotillomania refers to repetitive pulling of hair from the body and may be accompanied by trichophagia, the ingesting of extracted hair. It is frequently comorbid with other psychiatric disorders and resulting hair loss can seriously affect quality of life. Trichophagia can lead to trichobezoars, indigestible aggregations of hair in the gastrointestinal tract that can cause pain and bowel obstruction. Descriptions of trichotillomania and trichophagia have generally assumed European hair texture and styling conventions with little attention to Black hair. Here we report the case of a 23-year-old African-American female patient that presented with a small bowel obstruction from ingestion of hair extracted from a hair weave, a popular styling practice and form of hair extension frequently used with women of African descent and various ethnic groups.

Trichotillomania in adulthood, a case report

IntroductionTrichotillomania is a disorder (estimated prevalence 0.5-2.0%) with common onset in childhood, rarely seen in adulthood, characterized by the repetitive pulling out of one’s own hair leading to hair loss and functional impairment, associated with other comorbidities: major depression (39-65%), anxiety disorder (23-32%), SUDs (15-19%), OCD (13-27%).ObjectivesTo present a case of late-onset trichotillomania in a 60-year-old woman.MethodsThe present study is a case report of a patient visited in outpatient psychiatry for trichotillomania. We also searched previously case reports, series and systematic reviews of clinical trichotillomania using a pubmed query.ResultsThis is a 60-year-old morbidly obese woman diagnosed with dysthymia, binge eating disorder and histrionic personality disorder. She explained a worsening of anxiety associated with work problems of one year of evolution and, for six months, the beginning of the plucking of eyebrow hairs and scabs to decrease this symptom, with inability to avoid the behaviour and without eating the hairs. The mental evaluation highlighted psychic anxiety, hypothymia, low self-esteem and feelings of failure and did not suggest a delirium. We started treatment with topiramate up to 150mg/day which was not successful. After that we switched to fluoxetine up to 60mg/day associated to psychotherapy observing a slight gradual improvement.ConclusionsThe clinical presentation suggested the diagnosis of trichotillomania in the context of dysthymia. No particular medication demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on individual trials with small sample sizes. Research findings also recommend psychotherapy based on habit reversal.DisclosureNo significant relationships.

Comorbid trichotillomania and attention-deficit hyperactivity disorder in adults

BackgroundIndividuals with trichotillomania (TTM), a disorder characterized by repetitive pulling out of one's own hair, often have co-occurring ADHD, but little is known about this comorbidity. Additionally, there have been intimations in the literature that treatment of ADHD with stimulants may worsen TTM symptoms. This study aims to examine clinical aspects of individuals with TTM and co-occurring ADHD. Methods308 adults with a current diagnosis of TTM were assessed for ADHD using the Mini International Neuropsychiatric Interview 7.0.2 and Adult ADHD Self Report Scale. Participants also completed clinical measures related to TTM severity, impulsivity, quality of life, and psychosocial dysfunction. A series of analyses of variance were used to calculate differences in scale scores among subjects with and without co-occurring ADHD. ResultsOf the 308 participants, 47 (15.3%) met the clinical threshold for ADHD. Participants with ADHD reported significantly higher scores in all first and second factor traits of impulsivity, including attentional impulsiveness (p < .0001), motor impulsiveness (p < .0001), and non-planning impulsiveness (p < .0001). Interestingly, participants with ADHD did not report significant differences in TTM severity, perceived quality of life, or functional impairment, regardless of medication status. DiscussionThe data suggest that ADHD is common in adults with TTM, and the comorbidity is associated with heightened impulsivity. The co-occurrence of ADHD does not affect individuals' quality of life, symptom severity, or functionality. Taking stimulant medications for ADHD also did not appear to affect TTM severity, despite past case reports suggesting these medications may lead to onset or worsening of TTM.

Follow-up outcomes of mucosal defect closures after endoscopic resection using a helix tacking system and endoclips.

Background and AimsThe X-Tack endoscopic HeliX tacking system (Apollo Endosurgery, Austin, Tex, USA) has recently been approved by the Food and Drug Administration and is slowly gaining popularity for the closure of large tissue defects. Despite its increasing use, outcome data of using the X-Tack system for mucosal defect closure after endoscopic resection (ER) are limited. Here, we report the follow-up outcomes of a series of cases that underwent ER and mucosal closure aided by the HeliX tacking system.MethodsWe identified a total of 5 cases in which the X-Tack system and endoclips were used for mucosal defect closure after ER. The cases involved ER of large and/or flat polyps in the duodenum and colon. The patients were followed up at 4, 6, and 9 months after ER.ResultsIn all cases, X-Tacks with endoclips achieved complete closure of the large mucosal defects. None of the patients experienced any adverse events, such as abdominal pain or bleeding. At follow-up, the X-Tacks either fell off or were seen grouped or situated as a single piece (tack) in the mucosa where initially placed. None of the endoclips were found during the follow-up endoscopic examinations.ConclusionsThe X-Tack system together with endoclips facilitated complete closure of large mucosal defects, especially for lesions located in difficult locations. At follow-up, several retained X-Tacks were found either in groups or as a single piece. The X-Tacks seen in groups will likely fall off with repetitive pulling forces with food or feces. However, the single tacks that were secured in the wall may stay indefinitely. The novel HeliX tacking system seems to be a promising aid for the effective closure of large mucosal defects; however, further studies are needed to assess the long-term outcome of this novel system.

Natural recovery in trichotillomania.

Trichotillomania is characterized by repetitive pulling out of one's hair, leading to distress and/or functional impairment. Long considered a chronic condition if left untreated (albeit with fluctuating intensity), there have been intimations that the disorder may be of limited duration in some people. A sample of 10,169 adults, aged 18-69 years, representative of the general US population, were recruited and screened for current and lifetime trichotillomania. Potential differences in demographic and clinical variables and lifetime comorbidities, between those with natural recovery from trichotillomania, and those with current trichotillomania, were identified using analysis of variance or likelihood-ratio chi-square tests as appropriate. Additional analyses using binary logistic regression were used to control for potential confounding differences between the groups initially identified. In total, 24.9% of the entire sample of people with lifetime trichotillomania reported that they no longer had symptoms of trichotillomania and had never received therapy or medication treatment for it (i.e. they experienced natural recovery). Those who experienced natural recovery did not differ from those with current trichotillomania in terms of demographic or clinical characteristics, except that they were currently older. Natural recovery was associated with significantly lower rates of related comorbidities: obsessive-compulsive disorder, attention-deficit hyperactivity disorder, panic disorder, skin picking disorder and tic disorder. These findings from the first epidemiology study examining natural recovery in trichotillomania highlight the importance of screening for and treating such comorbidities in patients with trichotillomania, in order to maximize chance of clinical recovery.

Childhood Trichotillomania: A Case and a Review of the Available Evidence-Based Pharmacologic Therapies.

1. Abstract Background: Trichotillomania is a self-induced psychocutaneous dermatosis that is considered an impulse control disorder associated with obsessive-compulsive features. The disorder is characterized alopecia caused by repetitive pulling of own hair which cause irregular shape areas, partially devoid of hair. Treatment of the condition is generally unsatisfactory, because the condition is commonly resistant to treatment and relapse is common. Patients and methods: The case of girl with persistent alopecia of several months despite several treatments by several dermatologists was studied. The available evidence-based pharmacologic therapies that can be useful for the child’s condition was reviewed. Results: A thirteen-year old girl was referred to pediatric psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City because of persistent alopecia of several months despite several treatments by several dermatologists. The parents didn’t give clues to any a psychosocial stress in the family. Although the parents were finding at several occasions tufts of hair in the bed of girl when awakening her at the morning, they were surprised to learn that her condition is self-induced. The girl was rather shy and denied pulling her hair. Examination of her scalp showed irregular shape areas, partially devoid of hair suggesting trichotillomania. The patient was not from Baghdad and there was no pediatric psychiatry service in the province where she came from. It was not possible to the girl a cognitive behavioral therapy in a busy tertiary center, nor was this convenient to her family. The need for a pharmacologic therapy was clearly demanded. Review of the available research evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. Conclusion: Trichotillomania remains a challenging psychiatric condition with no first- line medications universally approved. The available evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. The combination of a safer antidepressant, clomipramine with a safer neuroleptic, risperidone with or without the addition of N-acetylcysteine represents the current evidence-based recommendation for the pharmacologic treatment of childhood trichotillomania.

Co-Occurrence of Trichotillomania and Polycystic Ovarian Syndrome: A Case Report

Trichotillomania (TTM) or hair pulling disorder is characterized by repetitive pulling of hair on the body whereas Polycystic Ovarian Syndrome (PCOS) is a metabolic-endocrine disorder, manifested by irregular menstrual cycle and clinical hyperandrogenism. Both disorders commonly occur in young females. TTM and PCOS may be related and share the same pathophysiology. We reported a case of a teenager with TTM and PCOS, which were triggered by stress. Neurobiological mechanism may explain the co-occurrences between TTM and PCOS. Further research in the neurobiology of TTM and PCOS may better explain the cooccurrences between the two disorders.

Prevalence, gender correlates, and co-morbidity of trichotillomania

Trichotillomania is a mental health condition characterized by repetitive pulling out of one's hair, often leading to functional impairment and/or distress. A convenience sampling of 10,169 adults, aged 18–69 years, representative of the general US population, completed a survey to establish occurrence of trichotillomania, other mental health concerns, and impact of the illness. 175 (1.7%) identified as having current trichotillomania. Rates of trichotillomania did not differ significantly based on gender (1.8% of males and 1.7% of females). The mean age of onset for trichotillomania was 17.7 years. The mean age of onset differed significantly for males (mean 19.0 years) versus females (mean 14.8 years (p = 0.020). The average amount of distress reported due to trichotillomania was relatively high, and 79% of people with trichotillomania had one or more mental health comorbidities, the most common being anxiety/depressive disorders, OCD, PTSD, and ADHD. This study suggests trichotillomania is relatively common in the general population and typically characterized by moderate-high distress and high rates of comorbidity.

Duration of illness and cortical thickness in trichotillomania: Preliminary evidence for illness change over time

Trichotillomania is a psychiatric condition characterized by repetitive pulling out of one's hair, leading to marked functional impairment. The aim of this study was to examine the association between duration of trichotillomania (defined as time between initial age of onset and current age) and structural brain abnormalities by pooling all available global data. Authors of published neuroimaging studies of trichotillomania were contacted and invited to contribute de-identified MRI scans for a pooled analysis. Freesurfer pipelines were used to examine whether cortical thickness and sub-cortical volumes were associated with duration of illness in adults with trichotillomania. The sample comprised 50 adults with trichotillomania (100% not taking psychotropic medication; mean [SD] age 34.3 [12.3] years; 92% female). Longer duration of illness was associated with lower cortical thickness in bilateral superior frontal cortex and left rostral middle frontal cortex. Volumes of the a priori sub-cortical structures of interest were not significantly correlated with duration of illness (all p > 0.05 uncorrected). This study is the first to suggest that trichotillomania is associated with biological changes over time. If this finding is supported by prospective studies, it could have important implications for treatment (i.e. treatment might need to be tailored for stage of illness). Viewed alongside prior work, the data suggest that brain changes in trichotillomania may be differentially associated with vulnerability (excess thickness in right inferior frontal cortex) and with chronicity (reduced thickness in medial and superior frontal cortex). Longitudinal research is now indicated.

Behavioral Treatment of Trichotillomania in a College Woman: A Case Study

Trichotillomania (TTM) is a disorder that involves repetitive pulling of one’s hair to the point of hair loss and clinically significant distress or functional impairment. Using Diagnostic and Statistical Manual of Mental Disorders-5 ( DSM-5) criteria, which include repeated attempts to decrease or stop pulling, the 12-month prevalence of TTM is 1% to 2%. Treatment commonly involves behavior therapies. These behavior therapies conceptualize TTM using operant learning theory and explain hair-pulling behavior as caused and maintained by environmental antecedents and consequences interacting with an individual’s biological makeup. This clinical case study describes use of an Acceptance and Commitment Therapy Enhanced Behavior Therapy for Trichotillomania (AEBT-T) protocol to facilitate treatment of a 20-year-old woman who was referred for TTM. The client remained in treatment for 14 months. After the completion of 32 therapy sessions, the client reported significantly reduced hair-pulling and anxiety, as well as increased engagement in valued activities. Implications of these findings are discussed, with an emphasis on the challenges of treating TTM in a college population.

Trichotillomania (hair pulling disorder).

Trichotillomania is characterized by the repetitive pulling out of one's own hair leading to hair loss and possibly functional impairment. Trichotillomania has been documented in the medical literature since the 19th century. Prevalence studies suggest that trichotillomania is a common disorder (point prevalence estimates of 0.5%–2.0%). Although grouped with the obsessive-compulsive disorder (OCD) in the diagnostic and statistical manual of mental disorders-5, trichotillomania is distinct from OCD in many respects. For example, the treatment of trichotillomania generally employs habit reversal therapy and medication (n-acetylcysteine or olanzapine), both of which are quite different from those used to treat OCD. Conversely, some first-line treatments used for OCD (e.g., selective serotonin reuptake inhibitors) appear ineffective for trichotillomania. This article presents what is known about trichotillomania and the evidence for a variety of treatment interventions.

Atomoxetine in the Treatment of Adolescent With Trichotillomania and Attention-Deficit/Hyperactivity Disorder

To the Editor:Trichotillomania (TTM) is a mental disorder identified through repetitive pulling out of one's own hair and prominent hair loss. Trichotillomania has an estimated lifetime prevalence of approximately 0.5% to 1%, and mean age of onset is commonly in early adolescence (12–13 years).1

Ayurvedic approach to Osgood Schlatter disease: A case report

Osgood Schlatter disease (OSD) is an inflammatory injury of the growth plate on the tibia just below the level of the knee at the tibial tubercle. The tibial tubercle is the bony attachment of the quadriceps (front thigh muscle). Contraction of the quadriceps results primarily in straightening of the leg at the level of the knee. A growth plate is an area of developing tissue near the ends of long bones or areas of muscle attachment. The growth plate in children allows the bones to expand in length thus allowing a child to reach his/her full height by the age of 16-19years. Compared to the surrounding bones and muscles, the growth plate serves as a weak point. Thus, repetitive pulling on a growth plate, especially from a larger powerful muscle like the quadriceps, can result in injury to the growth plate and subsequent pain. Pain is usually worse during or just after activity, and tends to improve with rest. It is commonly seen in growing, active adolescents between the ages of 11 and 15 years. In this article, a case of 14 years old boy diagnosed as Osgood Schlatter treated with Panchakarma and oral medicines. Encouraging results were observed in the form of reduction in pain and range of movements.

Striatal abnormalities in trichotillomania: a multi-site MRI analysis.

Trichotillomania (hair-pulling disorder) is characterized by the repetitive pulling out of one's own hair, and is classified as an Obsessive-Compulsive Related Disorder. Abnormalities of the ventral and dorsal striatum have been implicated in disease models of trichotillomania, based on translational research, but direct evidence is lacking. The aim of this study was to elucidate subcortical morphometric abnormalities, including localized curvature changes, in trichotillomania. De-identified MRI scans were pooled by contacting authors of previous peer-reviewed studies that examined brain structure in adult patients with trichotillomania, following an extensive literature search. Group differences on subcortical volumes of interest were explored (t-tests) and localized differences in subcortical structure morphology were quantified using permutation testing. The pooled sample comprised N = 68 individuals with trichotillomania and N = 41 healthy controls. Groups were well-matched in terms of age, gender, and educational levels. Significant volumetric reductions were found in trichotillomania patients versus controls in right amygdala and left putamen. Localized shape deformities were found in bilateral nucleus accumbens, bilateral amygdala, right caudate and right putamen. Structural abnormalities of subcortical regions involved in affect regulation, inhibitory control, and habit generation, play a key role in the pathophysiology of trichotillomania. Trichotillomania may constitute a useful model through which to better understand other compulsive symptoms. These findings may account for why certain medications appear effective for trichotillomania, namely those modulating subcortical dopamine and glutamatergic function. Future work should study the state versus trait nature of these changes, and the impact of treatment.

A double-blind, placebo-controlled study of inositol in trichotillomania.

Trichotillomania is characterized by repetitive pulling that causes noticeable hair loss. Data on the pharmacological treatment of trichotillomania are limited, with no clear first-line agent. The aim of the current study was to determine the efficacy and tolerability of inositol in adults with trichotillomania. A total of 38 individuals (35 women; mean age: 28.9±11.4) with trichotillomania entered a 10-week, double-blind, placebo-controlled trial to evaluate the safety and efficacy of inositol (dosing ranging from 6 to 18 g/day). Patients were assessed using the Massachusetts General Hospital Hair Pulling Scale, the NIMH Trichotillomania Severity Scale, Clinical Global Impression Scale, and measures of depression, anxiety, and psychosocial functioning. Outcomes were examined using a linear mixed-effects model. Patients assigned to inositol failed to show significantly greater reductions on primary or secondary outcomes measures compared with placebo (all P>0.05). At study endpoint, 42.1% of patients were 'much or very much improved' on inositol compared with 35.3% on placebo. This is the first study assessing the efficacy of inositol in the treatment of trichotillomania, but found no differences in symptom reductions between inositol and placebo. Future studies should examine whether inositol may be beneficial in controlling pulling behavior in a subgroup of individuals with trichotillomania.

Trichotillomania Among Young Adults: Prevalence and Comorbidity.

Trichotillomania is an impulse control disorder characterized by repetitive pulling out of one's hair. The aim of this study was to estimate the prevalence of trichotillomania in young adults and its association with anxiety and obsessive-compulsive disorders (OCD). A total of 339 individuals completed a questionnaire to determine the presence of trichotillomania. OCD and anxiety disorders were diagnosed according to the diagnostic criteria of the International Classification of Diseases 10th Revision (ICD-10), based on the Composite International Diagnostic Interview. Twelve persons (3.5%) reported hair pulling during their lifetime, but only 8 of them met the criteria of trichotillomania according to the ICD-10. Four individuals had stopped their behaviour prior to the study participation. The lifetime anxiety disorders were diagnosed in 5 participants with trichotillomania (62.5%), while in the group without trichotillomania, 67 persons (20.2%) met the diagnostic criteria for anxiety disorders (p < 0.01). OCD were not diagnosed in individuals with trichotillomania, among participants without trichotillomania, 14 persons (4.2%) reported symptoms of OCD.

Periodic forces trigger knot untying during translocation of knotted proteins.

Proteins need to be unfolded when translocated through the pores in mitochondrial and other cellular membranes. Knotted proteins, however, might get stuck during this process, jamming the pore, since the diameter of the pore is smaller than the size of maximally tightened knot. The jamming probability dramatically increases as the magnitude of the driving force exceeds a critical value, Fc. In this numerical study, we show that for deep knots Fc lies below the force range over which molecular import motors operate, which suggest that in these cases the knots will tighten and block the pores. Next, we show how such topological traps might be prevented by using a pulling protocol of a repetitive, on-off character. Such a repetitive pulling is biologically relevant, since the mitochondrial import motor, like other molecular motors transforms chemical energy into directed motions via nucleotide-hydrolysis-mediated conformational changes, which are cyclic in character.

Clinical features and comorbid psychiatric disorders in children and adolescents with trichotillomania: a clinical sample

Objective: Trichotillomania (TTM) is characterized by the repetitive pulling out of one's own hair from the scalp, eyebrows, eyelashes, or other areas of the body and is often associated with other psychiatric disorders. In this study we aimed to investigate the clinical and sociodemographic characteristics and comorbid psychiatric disorders in children with TTM. Methods: Twenty-three children and adolescents (15 females and 8 males, median age: 12, range: 6-18 years), who were followed at our outpatient clinic with the diagnosis of TTM, were included in the study. The Turkish version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime version was used to detect the comorbid psychiatric disorders. Depression and anxiety levels were measured by Childhood Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children, respectively. Results: The most commonly affected areas were; the scalp (n=13). Nine cases have been affected more than two areas. Median duration of the symptoms were 7±20.01 months (range: 7 days-72 months) at admission. 65.2% of the cases reported precipitating stress factors before the beginning of TTM symptoms. Nineteen (82.6%) subjects suffered from at least one psychiatric disorder and 14 (60.8%) from at least two psychiatric disorders. The most common comorbid disorders were anxiety disorders (n=15), disruptive behavioral disorders (n=6), tic disorder (n=3) and enuresis nocturna (n=3). The mean score in the CDI was 13.25±8.45. Mean state and trait anxiety scores were 37.19±8.01 and 37.62±7.61, respectively. There was a significant relationship between the time passed until admission to a psychiatry clinic and having multiple comorbid psychiatric disorders. Conclusion: High rates of comorbid psychiatric disorders were found in children and adolescents with TTM. Delay in psychiatric help-seeking seems to be associated with other psychiatric disorders. Early intervention may decrease comorbid psychiatric disorders, which may affect treatment options and prognosis.