Yedi yaşında erkek çocukta fluoksetinin tetiklediği trikotillomani: Olgu sunumu

Trikotillomani (TMN) ciddi saç kaybı ile sonlanan, yineleyici saç çekme davranışı ile karakterize bir ruhsal bozukluktur. Genellikle TMN'de üzerinde durulan ana nörotransmiter serotonin olmasına rağmen, yeni literatür bilgileri TMN patofizyolojisinde dopaminin rolünü güçlü şekilde desteklemektedir. Bu yazıda yedi yaşında fluoksetin tarafından tetiklenen trikotillomanisi olan bir erkek çocuğu sunmaktayız. Fluoksetin tedavisi ile trikotillomani belirtileri arasındaki zamansal ilgi ve fluoksetin bırakıldığında saç yolmanın olmaması göz önünde bulundurulduğunda, saç yolma davranışının fluoksetin tarafından tetiklendiği düşünülmüştür. Serotonin geri alım inhibitörlerinin dopamin artırıcı etkisi bulunmaktadır. TMN'nin fluoksetin tedavisi sonucunda ortaya çıkan dopamin artışına bağlı olduğunu düşünmekteyiz. Bilgilerimize göre sunulan olgu, antidepresan tedavisi sonucu tetiklenen ilk trikotilomani olgusudur. (Anadolu Psikiyatri Derg 2016; 17(Ek.3):45-47).

Fluoxetine induced trichotillomania in a 7-year-old boy: a case report

Trichotillomania (TTM) is a mental disorder characterized by recurrent hair pulling that result in significant hair loss. Traditionally, serotonin has been the principal neurotransmitter implicated in TTM, however, recent literature strongly supports the role of dopamine in the pathophysiology of TTM. Here we describe 7 year old boy who had fluoxetine-induced trichotillomania. According to the temporal association in time between fluoxetine treatment, the symptoms of trichotillomania and the resolution of symptoms in the absence of fluoxetine, hair pulling was likely fluoxetine induced. It is implicated that serotonin reuptake inhibitors may have facilitative effects on dopamine. We suggest that TTM may be the result of dopamine increase due to fluoxetine treatment. To our knowledge this is the first reported case of antidepressant-induced trichotillomania. (Anatolian Journal of Psychiatry 2016; 17(Suppl.3):45-47).

___

1. Golubchik P, Sever J, Weizman A, Zalsman G. Methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder and comorbid trichotillomania: a preliminary report. Clin Neuropharmacol 2011; 34: 108-110.

2. Woods WW, Houghton DC. Diagnosis, evaluation, and management of trichotillomania. Psychiatr Clin North Am 2014; 37(3):301-317.

3. Bipeta R, Yerramilli SS. Bupropion for the treatment of fluoxetine nonresponsive trichotillomania: a case report. J Med Case Reports 2011; 5:557.

4. McGuire JF, Ung D, Selles RR, Rahman O, Lewin AB, Murphy TK, et al. Treating trichotillomania: a meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors. J Psychiatr Res 2014; 58:76-83.

5. Rothbart R, Stein DJ. Pharmacotherapy of trichotillomania (hair pulling disorder): an updated systematic review. Expert Opin Pharmacother 2014; 15(18):2709-2719.

6. Van Ameringen M, Mancini C, Oakman JM, Farvolden P. The potential role of haloperidol in treatment of trichotillomania. J Affect Disord 1998; 56(2-3):219-226.

7. Van Ameringen M, Mancini B, Patterson M, Bennett J, Oakman A. A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiat 2010; 71(10):1336-1343.

8. Jefferys D, Burrows G. Reversal of trichotillomania with aripiprazole. Depress Anxiety 2008; 25(6):40.

9. Hamalian G, Citrome L. Stimulant-ınduced trichotillomania. Subst Abus 2010; 31:68-70.

10. Chiranjir N, Sajjad RS Sarwar, MD, Theodor BR. Adderall-induced trichotillomania: a case report. Innov Clin Neurosci 2013; 10(7-8):13-14.

11. Martin A, Scahill L, Vitulano L, King RA. Stimulant use and trichotillomania. J Am Acad Child Adolesc Psychiatry 1998; 37:349-350.

12. George S, Moselhy H. Cocaine-induced trichotillomania. Addiction 2005; 100(2):255-256.

13. Grant JE, Odlaug BL, Potenza MN. Addicted to hair pulling? How an alternate model of trichotillomania may improve treatment outcome. Harv Rev Psychiatry 2007; 15(2):80-85.

14. O'Leary A, Kõiv K, Raudkivi K, Harro J. Antidepressants differentially affect striatal amphetamine-stimulated dopamine and serotonin release in rats with high and low novelty-oriented behaviour. Pharmacol Res 2016; doi:10.1016/j.phrs.2016.02.003.

15. Hautmann G, Hercogova J, Lotti T. Trichotillomania. J Am Acad Dermatol 2002; 46(6):807-821.

16. Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: Neurobiology and treatment. Neurosci Biobehav Rev 2009; 33(6):831-842.