scholarly journals Trichotillomania: What Do We Know So Far?

2021 ◽  
pp. 1-7
Author(s):  
Daniel Fernandes Melo ◽  
Caren dos Santos Lima ◽  
Bianca Maria Piraccini ◽  
Antonella Tosti
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Interdisciplinary Approach ◽  
Comprehensive Treatment ◽  
Reversal Training ◽  
Pharmacological Management ◽  
Related Disorder ◽  
Pull Out ◽  
Habit Reversal Training

Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.

Trichotillomania – A case report on online treatment

2016 ◽  
Vol 33 (S1) ◽  
pp. S559-S559
Author(s):  
S. Onrust ◽  
V. Nunic
Keyword(s):  
Case Report ◽  
Behavioural Therapy ◽  
Panic Attacks ◽  
Traumatic Experiences ◽  
Reversal Training ◽  
Hair Pulling ◽  
Frustration Tolerance ◽  
Self Confidence ◽  
Pull Out ◽  
Habit Reversal Training

IntroductionICD-10 classifies trichotillomania (TTM) as one of the habit and impulse disorders. It is characterized by noticeable hair-loss due to a recurrent failure to resist impulses to pull out hairs. The hair pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification. Persons suffering from TTM often hide it. TTM is often unrecognised by doctors, treated by dermatologists or untreated, causing a lot of suffering.ObjectiveTo present treatment of trichotillomania.AimTo present one case report of trichotillomania treated online.MethodsThis is case report of female patient with TTM untreated 13 years. She had earlier been treated for depression and had multiple traumatic experiences. Patient both self-diagnosed TTM and asked for treatment online. During two months, there were 7 sessions and 2 follow-ups. Sessions were online and based on Habit Reversal Training (HRT) and Rational Emotional Behavioural Therapy (REBT). The following issues were addressed: hair pulling, shame, guilt, low self-confidence, assertiveness, low frustration tolerance, panic attacks, sadness. No medications were used.ResultsHair pulling has almost completely stopped. Social functioning and self-acceptance were improved. Guilt and shame have reduced, self-confidence and frustration tolerance have increased.ConclusionHRT and REBT online treatments have reduced hair pulling and the associated emotional problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Stimulant treatment for children and adolescents with ADHD - An update on efficacy and safety issues

2011 ◽  
Vol 26 (S2) ◽  
pp. 2144-2144
Author(s):  
T. Banaschewski
Keyword(s):  
Children And Adolescents ◽  
Pharmacological Treatment ◽  
Treatment Plan ◽  
Comprehensive Treatment ◽  
Efficacy And Safety ◽  
Pharmacological Management ◽  
Stimulant Treatment ◽  
Safety Issues ◽  
Group A ◽  
Long Acting

Pharmacological management for children and adolescents with ADHD should be part of a comprehensive treatment plan including psychological, behavioural, and educational advice and interventions. If pharmacological treatment is appropriate, stimulant medications and atomoxetine are the most effective medications for ADHD. The European ADHD Guidelines Group (a panel of ADHD experts from several European countries) has developed guidelines for the diagnosis and treatment of ADHD and published algorithms on the use of long-acting medications. Recently, the Guidelines Group has conducted a comprehensive review of the published literature on adverse effects of the drugs that are licensed in Europe, and most commonly used, for the treatment of ADHD or hyperkinetic disorder. This presentation will summarize those results and give an update on efficacy and safety issues concerning the pharmacological treatment of children and adolescents with ADHD.

Sad mood and changes in behavior after exposure to a traumatic reminder

2021 ◽  
pp. 157-166
Author(s):  
Joshua R. Smith
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Empirical Support ◽  
Serotonin Reuptake Inhibitors ◽  
Emotional States ◽  
Related Disorder ◽  
Sad Mood

Posttraumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that may affect individuals who have experienced a traumatic event. Symptoms of PTSD include intrusion symptoms, avoidance of stimuli associated with the traumatic event, negative alterations in cognition and mood, and alterations in arousal and reactivity. Intrusion symptoms in children may manifest as repetitive play in which themes from the trauma are expressed. Children are often unaware of the connection between their repetitive play and the trauma. Additionally, children may experience frightening dreams without recognizable content. Compared to adults, youth may be less able to describe traumatic events and complex emotional states. It is not uncommon to be unable to recall specific events about the trauma. The evidence supporting the use of selective serotonin reuptake inhibitors (SSRIs) in youth with PTSD is mixed. Trauma-focused cognitive behavioral therapy (TF-CBT) has the greatest empirical support for pediatric PTSD.

A Reinforcement-learning Account of Tourette Syndrome

2017 ◽  
Vol 41 (S1) ◽  
pp. S10-S10
Author(s):  
T. Maia
Keyword(s):  
Reinforcement Learning ◽  
Basal Ganglia ◽  
Tourette Syndrome ◽  
Behavioral Therapy ◽  
Mathematical Explanation ◽  
Reversal Training ◽  
Computational Theory ◽  
Habit Reversal Training ◽  
Habit Learning

BackgroundTourette syndrome (TS) has long been thought to involve dopaminergic disturbances, given the effectiveness of antipsychotics in diminishing tics. Molecular-imaging studies have, by and large, confirmed that there are specific alterations in the dopaminergic system in TS. In parallel, multiple lines of evidence have implicated the motor cortico-basal ganglia-thalamo-cortical (CBGTC) loop in TS. Finally, several studies demonstrate that patients with TS exhibit exaggerated habit learning. This talk will present a computational theory of TS that ties together these multiple findings.MethodsThe computational theory builds on computational reinforcement-learning models, and more specifically on a recent model of the role of the direct and indirect basal-ganglia pathways in learning from positive and negative outcomes, respectively.ResultsA model defined by a small set of equations that characterize the role of dopamine in modulating learning and excitability in the direct and indirect pathways explains, in an integrated way: (1) the role of dopamine in the development of tics; (2) the relation between dopaminergic disturbances, involvement of the motor CBGTC loop, and excessive habit learning in TS; (3) the mechanism of action of antipsychotics in TS; and (4) the psychological and neural mechanisms of action of habit-reversal training, the main behavioral therapy for TS.ConclusionsA simple computational model, thoroughly grounded on computational theory and basic-science findings concerning dopamine and the basal ganglia, provides an integrated, rigorous mathematical explanation for a broad range of empirical findings in TS.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Treatment of anxiety disorders

2017 ◽  
Vol 19 (2) ◽  
pp. 93-107 ◽  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Burden Of Illness ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Meta Analyses

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

scholarly journals The German Guidelines for the treatment of anxiety disorders: first revision

2021 ◽  
Author(s):  
Borwin Bandelow ◽  
Antonia M. Werner ◽  
Ina Kopp ◽  
Sebastian Rudolf ◽  
Jörg Wiltink ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Individual Treatment ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Noradrenaline Reuptake ◽  
Virtual Reality Exposure

AbstractStarting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363–373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6–12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.

scholarly journals Behavioral therapy for Tourette syndrome and chronic tic disorders

2017 ◽  
Vol 7 (2) ◽  
pp. 148-156 ◽  
Author(s):  
Odette Fründt ◽  
Douglas Woods ◽  
Christos Ganos
Keyword(s):  
Behavioral Interventions ◽  
Negative Reinforcement ◽  
Behavioral Therapy ◽  
Tic Disorders ◽  
Reversal Training ◽  
Exposure And Response Prevention ◽  
Treatment Practices ◽  
Habit Reversal Training ◽  
Chronic Tic Disorders ◽  
Habitual Responses

AbstractPurpose of review:To summarize behavioral interventions for the treatment of primary tic disorders.Recent findings:Although tics were attributed to a disordered weak volition, the shift towards neurobiological models of tic disorders also transformed nonpharmacologic treatment practices. Current international guidelines recommend habit reversal training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics. Appropriate patient selection, including age and presence of comorbidities, are salient clinical features that merit consideration. Evidence for further behavioral interventions is also presented.Summary:Currently recommended behavioral interventions view tics as habitual responses that may be further strengthened through negative reinforcement. Although availability and costs related to these interventions may limit their effect, Internet-based and telehealth approaches may facilitate wide accessibility. Novel nonpharmacologic treatments that take different approaches, such as autonomic modulation or attention-based interventions, may also hold therapeutic promise.

Chronically irritable mood with frequent temper outbursts

2021 ◽  
pp. 71-78
Author(s):  
Lauren N. Deaver
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Plan ◽  
Comprehensive Treatment ◽  
Diagnostic And Statistical Manual ◽  
Psychotherapeutic Interventions ◽  
Second Generation Antipsychotics ◽  
Critical Components ◽  
New Diagnosis ◽  
Property Destruction ◽  
Temper Outbursts

Disruptive mood dysregulation disorder (DMDD) is a new diagnostic addition to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The core feature of the disorder is chronic, severe, and persistent irritability that manifests as frequent temper outbursts that are inconsistent with the patient’s developmental level. The temper outbursts can be verbal or behavioral including physical aggression or property destruction. Between outbursts, the child remains persistently irritable or angry for most of the day, nearly every day. These symptoms persist across time and settings and are easily observable by others. Psychotherapeutic interventions including parent training and individual psychotherapy are critical components of a comprehensive treatment plan. Since DMDD is a new diagnosis, there are no published randomized controlled medication trials. The use of selective serotonin reuptake inhibitors (SSRIs) or second-generation antipsychotics may be considered for decreasing irritability.

The Psychiatric Interview and Mental Status Examination

2017 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Differential Diagnosis ◽  
Social History ◽  
Mental Status ◽  
Treatment Plan ◽  
Essential Elements ◽  
Comprehensive Treatment ◽  
Psychiatric Interview ◽  
Psychomotor Activity ◽  
History Of ◽  
Mental Status Examination

The interview and mental status examination are integral to the comprehensive patient assessment and typically follow a standard approach that most medical students and residents learn. The psychiatrist should adjust his or her interview style and information-gathering approach to suit the patient and the situation. For example, inpatients are typically more symptomatic than outpatients, may be in the hospital on an involuntary basis, and may be too ill to participate in even the briefest interview. Note taking is an essential task but should not interfere with patient rapport. The interview should be organized in a systematic fashion that, although covering all essential elements, is relatively stereotyped so that it allows the psychiatrist to commit the format to memory that, once learned, can be varied. The psychiatrist should start by documenting the patient’s identifying characteristics (age, gender, marital status) and then proceed to the chief complaint, history of the present illness, past medical history, family and social history, use of drugs and alcohol, medications, and previous treatments. A formal mental status includes assessment of the patient’s appearance, attitude, and behavior; orientation and sensorium; mood and affect; psychomotor activity; thought process, speech, and thought content; memory and cognition (including attention and abstraction); and judgment and insight. With the data collected, the psychiatrist will construct an accurate history of the symptoms that will serve as the basis for developing a differential diagnosis, followed by the development of a comprehensive treatment plan. This review contains 1 figure, 3 tables, and 12 references. Key words: assessment, differential diagnosis, interviewing, mental status examination, treatment plan

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