Trichotillomania (TTM) is a psychiatric disorder can be triggered by traumatic events characterized by recurrent hair pulling. The incidence of post-traumatic stress disorder (PTSD) in TTM patients was also significantly higher than in the normal population. It is estimated that serotonergic system, dopaminergic system, hypothalamic-pituitary- adrenal (HPA) axis genes may be related with PTSD and TTM co-occurrence. When the literature is reviewed it is seen that serotonergic system gene especially 5HT-2A gene polymorphism may play an important role as a com- mon possible genetic background in the etiology of posttraumatic stress disorder and trichotillomania. It was also observed that effective results were obtained when agents acting on 5HT-2A receptor were preferred in the treatment. Here, we report a 20-year-old male patient who was diagnosed with TTM and PTSD as a result of trau- matic life event a year ago and we also aimed to discuss a possible common genetic etiology which may cause this comorbidity. (Anatolian Journal of Psychiatry 2019; 20(1):110-112)
Trikotillomani (TTM) yineleyen saç yolma davranışı ile karakterize, travmatik olaylarla tetiklenebilen bir psikiyatrik bozukluktur. TTM hastalarında travma sonrası stres bozukluğu (TSSB) görülme sıklığı normal insanlara göre anlam- lı derecede yüksektir. Serotonerjik sistem, dopaminerjik sistem ve hipotalamo-hipofiz-adrenal (HPA) aks genlerinin TSSB ve TTM hastalığının eş zamanlı meydana gelmesi ile ilişkili olabileceği tahmin edilmektedir. Literatürde özellikle 5HT-2A serotonerjik sistem gen polimorfizminin, travma sonrası stres bozukluğu ve trikotillomaninin etiyo- lojisinde ortak olası genetik temel olarak önemli rol oynayabileceği görülmekle birlikte, uygulamada da tedavide 5HT-2A reseptörü üzerine etkili ajanlar tercih edildiğinde olumlu sonuçların alındığı görülmektedir. Bu olgu sunu- munda da, bir yıl önce uğradığı travmatik bir yaşantı sonucunda gelişen TSSB ve buna eşlik eden TTM’si olan 20 yaşındaki erkek hasta, mevcut komorbiditeye neden olabilecek altta yatan olası ortak genetik etiyolojinin ışığında ele alınmıştır. (Anadolu Psikiyatri Derg 2019; 20(1):110-112)
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Christenson GA, Popkin MK, Mackenzie TB, Realmuto GM. Lithium treatment of chronic hair pulling. J Clin Psychiatry 1991; 52:116-120.
American Psychiatric Association. Diagnostic and Statis- tical Manual of Mental Disorders. Fifth ed. Arlington: American Psychiatric Association, 2013.
Boughn S, Holdom JJ. The relationship of violence and trichotillomania. J Nurs Scholarsh 2003; 35(2):165-170.
Gershuny BS, Keuthen NJ, Gentes EL, Russo AR, Emmott EC, Jameson M, et al. Current posttraumatic stress disorder and history of trauma in trichotillomania. J Clin Psychol 2006; 62(12):1521-1529.
Chatterjee K. The genetic factors influencing the develop- ment of trichotillomania. J Genet 2011; 90:259-262.
Akpinaroglu C, Ulucan K. Genetics of trichotillomania. The Journal of Neurobehavioral Sciences 2017; 4(2):90- 93.
Hemmings SM, Kinnear CJ, Lochner C, Seedat S, Corfield VA, Moolman-Smook JC, et al. Genetic corre- lates in trichotillomania–a case-control association study in the South African Caucasian population. Isr J Psychiatry Relat Sci 2006; 43:93-101.
Xian H, Chantarujikapong SI, Scherrer JF, Eisen SA, Lyons MJ, Goldberg J, et al. Genetic and environmental influences on post-traumatic stress disorder, alcohol and drug dependence in twin pairs. Drug Alcohol Depend 2000; 61:95-102.
Stein MB, Jang KL, Taylor S, Vernon PA, Livesley WJ. Genetic and environmental influences on trauma expo- sure and post-traumatic stress disorder symptoms: a twin study. Am J Psychiatry 2002; 159:1675-1681.
Cornelis MC, Nugent NR, Amstadter AB, Koenen KC. Genetics of post-traumatic stress disorder: review and recommendations for genome-wide association studies. Curr Psychiatry Rep 2010; 12(4):313-326.
Anger WK, Storzbach D, Binder LM, Campbell KA, Rohl- man DS, McCauley L, et al. Neurobehavioral deficits in Persian Gulf veterans: evidence from a population-based study. Portland Environmental Hazards Research Cen- ter. J Int Neuropsychol Soc 1999; 5:203-212.
Leygraf A, Hohoff C, Freitag C, Willis-Owen SA, Krako- witzky P, Fritze J, et al. Rgs 2 gene polymorphisms as modulators of anxiety in humans? J Neural Transm 2006; 113:1921-1925.
Lee H, Kwak S, Paik J, Kang R, Lee M. Association between serotonin 2A receptor gene polymorphism and posttraumatic stress disorder. Psychiatry Investigation 2007; 4(2):104.
Van Ameringen M, Mancini C, Patterson B, Bennett M, Oakman J. A randomized, double blind, placebo-con- trolled trial of olanzapine in the treatment of trichotillo- mania. J Clin Psychiatry 2010; 71:1336-1343.
Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a gluta- mate modulator, in the treatment of trichotillomania. Arch Gen Psychiatry 2009; 66:756-763.
VanAmeringen M, Mancini C, Oakman JM, Farvolden P. The potential role of haloperidol in treatment of trichotillo- mania. J Affect Disord 1998; 56(2-3):219-226.
Potenza MN, Wasylink S, Epperson CN, McDougle CJ. Olanzapine augmentation of fluoxetine in the treatment of trichotillomania. Am J Psychiatry 1998; 155:1299- 1300.
Franklin ME, Zagrabbe K, Benavides KL. Trichotilloma- nia and its treatment: a review and recommendations. Expert Rev Neurother 2011; 11(8):1165-1174.
Schatzberg AF, Nemeroff C. The American Psychiatric Publishing Textbook of Psychopharmacology. Fourth ed., American Psychiatric Publishing, 2009.
Epperson CN, Fasula D, Wasylink S, Price LH, McDougle CJ. Risperidone addition in serotonin reuptake inhibitör- resistant trichotillomania: three cases. J Child Adolesc Psychopharmacol 1999; 9(1):43-49.
Johnson J, El-Alfy AT. Review of available studies of the neurobiology and pharmacotherapeutic management of trichotillomania. J Adv Res 2016; 7(2):169-184.