Trichotillomania in a dementia case

Abstract

-We report an 87-year-old male case of hair pulling associated with a white-matter vascular dementia (Binswanger's disease). Trichotillomania in our case did not resolve using mirtazapine or anticholinesterasic medication. Trichotillomania seems to be related to a form of perseveration associated with dementia. The findings in this case suggest the abnormality involving white matter in the pathogenesis of trichotillomania, may constitute a defect in connectivity in the right frontal-subcortical circuit. Key words: Trichotillomania, impulse-control disorder, dementia, Binswanger's disease, perseveration.Tricotilomania em um caso de demência Resumo -Relatamos o caso de um homem de 87 anos com tricotilomania associada com uma demência vascular da substância branca (doença de Binswanger). Tricotilomania no nosso caso não se resolveu com mirtazapina nem com medicação anticolinesterásica. Tricotilomania parece se relacionar a uma forma de perseveração associada à demência. Podemos sugerir com este caso que a alteração que envolve a substância branca na patogênese da tricotilomania pode ser uma falha na conectividade no circuito fronto-subcortical direito. Palavras-chave: Tricotilomania, distúrbio de controle do impulso, demência, doença de Binswanger, perseveração.

Very late onset hair‐pulling disorder—a geriatric case report

“…The maximum evidence is comprised of work on selective serotonin reuptake inhibitors and clomipramine with several open‐label trials showing significant treatment effects from antipsychotics 2 . Case reports of treating trichotillomania in geriatric patients having comorbid vascular or Alzheimer's type of dementia with various selective serotonin reuptake inhibitors, antipsychotics, mirtazapine, and opioid antagonists such as naltrexone have been reported 3,4 . It is presumed to be a part of perseveration in dementia and often responds poorly to medications.…”

“…2 Case reports of treating trichotillomania in geriatric patients having comorbid vascular or Alzheimer's type of dementia with various selective serotonin reuptake inhibitors, antipsychotics, mirtazapine, and opioid antagonists such as naltrexone have been reported. 3,4 It is presumed to be a part of perseveration in dementia and often responds poorly to medications. Bartley and colleagues reported a case of a 70-year-old female with a past history of anxiety disorder and anankastic traits presenting with new onset trichotillomania treated with clomipramine.…”

Trichotillomania associated with bipolar disorder and obsessive compulsive disorder: Pathoplasty or comorbidity?

“…[12] It is often associated with psychiatric comorbidity, such as depression or anxiety disorders. The nosological status of TTM remains in debate, since it can presents as an independent entity ("primary" TTM) or as a syndrome accompanying and straight related to a major nocological category such as an affective disorder or an organic brain disease ("secondary" TTM).…”

“…Trichotillomania (TTM), a disorder of compulsive self-directed hair pulling that often results in focal alopecia, is an impulse control disorder that occurs in a chronic course, with functional and organic potential etiologies. [ 1 2 ] It is often associated with psychiatric comorbidity, such as depression or anxiety disorders. The nosological status of TTM remains in debate, since it can presents as an independent entity ("primary" TTM) or as a syndrome accompanying and straight related to a major nocological category such as an affective disorder or an organic brain disease ("secondary" TTM).…”

“…The nosological status of TTM remains in debate, since it can presents as an independent entity ("primary" TTM) or as a syndrome accompanying and straight related to a major nocological category such as an affective disorder or an organic brain disease ("secondary" TTM). [ 2 ] The relationship between bipolar disorder (BD) and TTM also remains unclear. [ 1 3 ] Pathoplastic presentation of a disease refers to the ability of a disorder in mimicking clinical features of another known disorder.…”