Posted by Sunnely on January 13, 2001, at 23:49:01
In reply to Re: TRICHOTILLOMANIA, posted by Chellise Scranton on January 13, 2001, at 1:47:20
Hi Chellise,
Allow me to express my 2-cent worth of opionion.
TRICHOTILLOMANIA (TTM), A SHORT CLIP:
The term "trichotillomania" was coined by Hallopeau in 1889 with the report of an epidemic of hair pulling among children in an orphanage. The onset of TTM usually occurs as a child and may continue to adulthood. The majority of studies report the onset of symptoms to occur between 9 and 13 years of age. Hair pulling appears to be more common in girls than in boys during adolescence, while very young children may have equal or greater occurrence rates in boys. TTM sufferers can pull their hair from a range of sites, including the eyelashes, eyebrows, scalp, arms, legs, and pubic region. Children may also pull hair from dolls, pets, and other family members. Other "habits" in children that may also be associated with hair pulling include thumb sucking, nail biting, or knuckle cracking.
TTM: NOT JUST ANOTHER BAD-HAIR-DAY STORY
The exact reason as to how TTM occur remains unclear. Some of the biological causes of TTM have been proposed. These include: 1. disturbance in the brain serotonin make up (i.e., low serotonin) based on the beneficial effects of SSRIs, 2. disturbance in brain dopamine make up (i.e., high dopamine) based on the beneficial effect of haloperidol (Haldol), pimozide (Orap), risperidone (Risperdal), 3. disturbance in the opioid system based on the beneficial effect of naltrexone (Revia, Trexan) in the treatment of TTM in one study, 4. disturbance in hormones based on the findings that TTM is, in clinical setting, predominantly a disorder of women, 5. abnormal findings in certain structures of the brain, 6. possible role of streptococcal infection, 7. possible of role of neuropsychological dysfunctions, and 8. possible role of genetics - one report indicates that 8% of 161 TTM patients had first-degree relatives with hair pulling.
TREATMENT OF TTM: SOME HAIR-RAISING IDEAS
Clinical intervention remains a challenge with conflicting documentation of treatment effectiveness and often-reported treatment relapse.
1. DRUG THERAPY:
a. Serotonin-reuptake inhibitors (SRIs) such as clomipramine (Anafranil), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox) have been reported beneficial in patients with TTM in some studies. However, 2 placebo-controlled studies with Prozac failed to find a significant difference in hair pulling. SSRIs are also beneficial in relieving stress, anxiety, and depressive symptoms associated with TTM.
b. Serotonin and norepinephrine reuptake inhibitor, venlafaxine (Effexor), was found beneficial in TTM in 2 studies.
3. Nonserotonin agents in the treatment of TTM have not been evaluated in controlled studies. Individual reports or case series record successful treatment with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), trazodone (Desyrel), and nefazodone (Serzone). Naltrexone (Revia, Trexan) and lithium show promise in the treatment of TTM.
d. Dopamine blockers such as haloperidol (Haldol) and pimozide (Orap), in conjunction with an SSRI have been found beneficial in 2 studies. Three case reports in the treatment of TTM with the use of risperidone (Risperdal) in addition to an SSRI were reported. It was postulated that the dopamine blocking effect of Risperdal and the serotonin effect of the SSRI was responsible for the improvements observed in these cases.
2. PSYCHOTHERAPY
Cognitive-behavior therapy (CBT) has emphasized the use of habit-reversal training, either alone or in combination with other strategies such as stimulus control, relaxation training, and cognitive techniques. CBT has been sown to be very effective in several case reports. It was proposed that CBT may be more effective than drug therapy in acute treatment of TTM.
3. COMBINATION DRUG AND BEHAVIOR THERAPY
In a study of hair pullers regarding their treatment outcomes, patients who received both medication and behavior therapy showed greater improvement on a standardized hair pulling scale than those patients receiving either treatment alone.
TTM: HAIR TODAY, GONE TOMORROW?
Although most patients show response to the acute treatment of TTM, there appears to be a high rate of relapse and recurrence of illness even with continuation and maintenance of treatment. It is not clear as to why patients with TTM relapse after responding initially to treatment. It may be that conditioned associations rekindle the urge to pull hair even with continued treatment, thus resulting in greater likelihood of relapse.
poster:Sunnely
thread:9431
URL: http://www.dr-bob.org/babble/20010111/msgs/51649.html