Trichotillomania in a dementia case

Caixeta, Leonardo; Lopes, Danielly Bandeira

doi:10.1590/S1980-57642011DN05010011

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

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

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References

Rochat L, Delbeuck X, Billieux J, et al. Assessing impulsivity changes in Alzheimer disease. Alzheimer Dis Assoc Disord 2008;22:278-283.
Kisa C, Yildirim SG, Göka E. Impulsivity and mental disorders. Turk Psikiyatri Derg 2005;16:46-54.
Stein DJ, Grant JE, Franklin ME, et al. Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V. Depress Anxiety 2010;27:611-626.
Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: a current review. Clin Psychol Rev 2010;30:181-193.
Mittal D, O'Jile J, Kennedy R, Jimerson RN. Trichotillomania associated with dementia: a case report. Gen Hosp Psychiatry 2001;23:163-165.
American Psychiatric Association. Diagnostic, and statistical manual of mental disorders, 4th ed. American Psychiatric Association, Washington DC, 1994.
O'Sullivan RL, Rauch SL, Breiter HC, et al. Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry 1997; 42:39-45.
Keuthen NJ, Makris N, Schlerf JE, et al. Evidence for reduced cerebellar volumes in trichotillomania. Biol Psychiatry 2007;61:374-381.
Stein DJ, Coetzer R, Lee M, Davids B, Bouwer C. Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Res 1997; 74:177-182.
Christenson GA, Mackenzie TB, Mitchell JE. Characteristics of 60 adult hair pullers. Am J Psychiatry 1991;48:365-370.
Bohne A, Savage CR, Deckersbach T, et al. Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive-compulsive disorder. J Clin Exp Neuropsychol 2005;27:385-399.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.

Publication Dates

Publication in this collection
Jan-Mar 2011

History

Received
02 Dec 2010
Accepted
10 Feb 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Rochat L, Delbeuck X, Billieux J, et al. Assessing impulsivity changes in Alzheimer disease. Alzheimer Dis Assoc Disord 2008;22:278-283.

[2] Kisa C, Yildirim SG, Göka E. Impulsivity and mental disorders. Turk Psikiyatri Derg 2005;16:46-54.

[3] Stein DJ, Grant JE, Franklin ME, et al. Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V. Depress Anxiety 2010;27:611-626.

[4] Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: a current review. Clin Psychol Rev 2010;30:181-193.

[5] Mittal D, O'Jile J, Kennedy R, Jimerson RN. Trichotillomania associated with dementia: a case report. Gen Hosp Psychiatry 2001;23:163-165.

[6] American Psychiatric Association. Diagnostic, and statistical manual of mental disorders, 4th ed. American Psychiatric Association, Washington DC, 1994.

[7] O'Sullivan RL, Rauch SL, Breiter HC, et al. Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry 1997; 42:39-45.

[8] Keuthen NJ, Makris N, Schlerf JE, et al. Evidence for reduced cerebellar volumes in trichotillomania. Biol Psychiatry 2007;61:374-381.

[9] Stein DJ, Coetzer R, Lee M, Davids B, Bouwer C. Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Res 1997; 74:177-182.

[10] Christenson GA, Mackenzie TB, Mitchell JE. Characteristics of 60 adult hair pullers. Am J Psychiatry 1991;48:365-370.

[11] Bohne A, Savage CR, Deckersbach T, et al. Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive-compulsive disorder. J Clin Exp Neuropsychol 2005;27:385-399.

[12] Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontology 1982;37:323-329.

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