Trichotillomania as a Manifestation of Dementia

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.

Trichotillomania ranging from “ritual to illness” and as a rare clinical manifestation of frontotemporal dementia: Review of literature and case report

“…[ 3 9 ] Self-harm syndrome is described as a nonstereotypical impulse control disorder characterized by the irresistible intention to harm oneself, mounting anxiety, and a subsequent feeling of relief after the act. [ 2 ] Major and self-directed acts of self-harm results in significant tissue damage are usually due to psychosis or acute intoxication of substances such as alcohol and cannabis, though they are also seen in syndromes as described before. The etiology of SIBs in FTD is unclear, though it has been postulated as due to a heightened sense of tension or arousal seen with FTD, and SIB is regarded as a maladaptive coping mechanism for the same.…”

“…Hair plucking is a sign of distress, atonement, and penance for wrongdoings and has also been described in the books of Job and Ezra in Bible which date back to the 15 th century BC and 4 th century BC, respectively. [ 1 2 ] Trichotillomania also occurs with other body-focused repetitive behaviors (BFRBs) such as excoriation or skin picking and nail or cheek biting, in addition to repetitive hand or finger biting, head banging, self-hitting, or cutting, or lip biting in neurodevelopmental disorders such as Lesch–Nyhan syndrome, Rett's syndrome, fragile X syndrome, autism, and mental retardation. Self-cutting behaviors are also seen to be associated with certain personality disorders.…”

Neurotransmitter-based diagnosis and treatment: A hypothesis (Part 3)

“…We conclude the series by exploring gamma aminobutyric acid (GABA)-and glutamate-based clinical symptoms. Table 1 (page 36) outlines medical and psychiatric symptoms that likely reflect GABA excess [1][2][3][4][5][6][7][8][9] and deficiency, [1][2][3][4]6,[9][10][11][12][13][14][15][16][17] and Table 2 (page 38) lists symptoms that likely reflect glutamate excess 9,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] and deficiency. 9,[32][33][34][35][36][37][38] It is essential to note that both the quantity of neurotransmitters as well as the quality of the transmission (as in receptors, cellular pumps, and distribution mechanisms) are important.…”

“…B is anxious and bites his fingernails and cheek while you interview him. 18 He has scars on his lower arms that were caused by years of picking his skin. 18 He complains of headache [28][29][30] and deep muscle, whole body, [19][20][21][22][23] and abdominal pain.…”

Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana

“…115 The literature indicates that simple motor stereotypy such as skin-picking, head rocking, and lip pursing and complex motor stereotypy like hair-pulling, skin-picking, hand flapping, and wriggling with leg movement (kaashtena bhumim vilikhan) involve frontostriatal disease or dysfunction. 116 The above verse denotes stereotypic movement disorder or TTM or BFRBs due to various underlying neurological syndromes. 10 FTD is a neurodegenerative disorder occurs due to frontal and temporal lobar atrophy and it is characterized by troubling & progressive changes in behavior, personality, judgment, language, and cognition.…”