Derya YÜKSEL, Nursel DİLEK, Çiçek HOCAOĞLU, Murat ASLAN

Çok Geç Başlangıçlı "Trikotilomani": Bir Olgu Sunumu

Trikotilomani, yineleyen saç yolmalar sonucu belirgin saç kaybına yol açan, kişinin işlevselliğinin tüm alanlarını olumsuz etkileyen süregen seyirli bir ruhsal bozukluktur. Trikotilomani uzun yıllardır bilinmesine rağmen diğer ruhsal bozukluklardan daha az ilgi çekmiştir. Bu nedenle epidemiyolojisi, etiyolojisi, klinik görünümü ve tedavi yaklaşımları ile ilgili bilgiler sınırlıdır. Trikotilomani genellikle erken çocukluk ya da ergenlik döneminde başlar. Kadınlarda erkeklere göre daha sık görülmektedir. Belirgin saç kaybı nedeni ile olgular ilk kez dermatoloji polikliniklerine başvururlar. Trikotillomani psikiyatri ile dermatolojinin ortak konularından biridir. Trikotilomanili olgularda eş tanılı psikiyatrik bozukluklar da sıklıkla klinik tabloya eşlik eder. En yaygın görülen psikiyatrik eş tanılar duygudurum bozuklukları, anksiyete bozukluklarıdır. Bu çalışmada eştanılı depresyonu da olan çok geç başlangıçlı trikotillomani tanısı ile tedavisi düzenlenen bir erkek olgu sunulmuştur. Trikotillomaninin ileri yaşta başlamış olması olgumuzu ilginç kılan bir özelliktir.

Very Late Onset "Trichotillomania": A Case Report

Trichotillomania is a chronic psychiatric disorder that repetitive hair pulling which leads to marked hair loss, negative effects on all areas of the person's functioning. Although trichotillomania has been known for many years, it has attracted less attention than other psychiatric disorders. Therefore, the information about its epidemiology, etiology, clinical feature and therapeutic approaches are limited. Trichotillomania usually begins in early childhood or adolescence. It is more common in women than men. Cases are frequently referred to the first dermatology outpatient clinics due to marked hair loss. Trichotillomania is one of the common issues of psychiatry and dermatology. In patients with trichotillomania, comorbid psychiatric disorders often accompany the clinical picture. The most common psychiatric comorbidities are mood disorders and anxiety disorders. In this study, we report a male patient who was treated with a diagnosis of very late onset trichotillomania with comorbid depression. The fact that trichotillomania started at an advanced age is a feature that makes our case interesting.

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Hautmann G, Hercogova J, Lotti T. Trichotillomania. J Am Acad Dermatol 2002; 46: 807-21.
Konkan R, Şenormancı Ö, Sungur MZ. Trikotillomani: Tanı, farmakoterapi ve kognitif davranışçı terapisi. Klinik Psikofarmakoloji Bülteni 2011; 21: 265-74.
Hocaoğlu Ç. Trikotillomani. Türkiye Klinikleri Psikiyatri Özel Dergisi 2009; 2: 57-65.
Hocaoğlu Ç. Trikotillomani.Dürtü kontrol Bozuklukları. (Ed. L. Tamam), Hekimler Yayın Birliği, Ankara, 2009.
Christenson GA, Mackenzie TB. Trichotillomania, in Handbook of Prescriptive Treatment for Adults. Edited by Herson M, Ammerman RT. New York, Plenum, 1994; 217-35.
Walsh KH, McDougle CJ. Trichotillomania: presentation, etiology, diagnosis and therapy. Am J Clin Dermatol 2001; 2: 327-33.
Malhotra S, Grover S, Baweja R. Trichotillomania in children. Indian Pediatr 2008; 45: 403-5.
Flessner CA, Lochner C, Stein DJ, Woods DW, Franklin ME, Keuthen NJ. Age of onset of trichotillomania symptoms: investigating clinical correlates. J Nerv Ment Dis 2010; 198: 896900.
Chatterjee K.The genetic factors influencing the development of trichotillomania. J Genet 2011; 90: 259-62.
Chamberlain S.R, Fineberg NA, Menzies LA. Trichotillomania: neurobiology and treatment. Neurosci Biobehav Rev 2009; 33: 831-842.
Chamberlain SR, Fineberg NA, Menzies LA. Grey matter abnormalities in trichotillomania: morphometric magnetic resonance imagining study. Br J Psychiatry 2008; 193: 216-21.
APA.Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition Text Revision (DSM-IV-TR). Washington DC, 2000; American Psychiatric Association.
Annagür BB. Saçlarının döküldüğüne inanan bir trikotillomani olgusu. Selçuk Tıp Derg 2010; 26: 29-31.
. Marcks BA, Woods DW, Ridosko JL.The effects of trichotillomania disclosure on peer perceptions and social acceptability. Body Image 2005; 2: 299-306.
Duke DC, Keeley ML, Geffken GR. Trichotillomania: a current review. Clin Psychol Rev 2010; 30: 181-93.
APA.Diagnostic and Statistical Manual of Mental Disorders. Fift h Edition (DSM-5). Washington DC, 2013; American Psychiatric Association.
Gershuny BS, Keuthen N, Gentes EL. Current post traumatic stres disorder and history of trauma in trichotillomania. J Clin Psychol 2006; 62: 1521-9.
Kotcher L, Wieland N, Coffey B.Trichotillomania and co-morbid psychiatric disorders in a 10-year-old boy. J Am Acad Child Adolesc Psychiatry 2007; 17: 137-41.
Swedo SE, Leonard HL. Trichotillomania. An obsessive compulsive spectrum disorder? Psychiatr Clin North Am 1992; 15: 777-90.
Christenson GA, Mackenzie TB, Mitchell JE. A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry 1991; 148: 1566-71.
Durukan İ, Cöngüloğlu MA, Türkbay T. İki trikotillomani olgusu ve fluoksetin ile Tedavisi. Anatol J Clin Investig 2011; 5: 48-51.
Streichenwein SM, Thornby JI. A long-term, doubleblind, placebo-controlled crossover trial of the efficacy of fluoxetine for trichotillomania. Am J Psychiatry 1995; 152: 1192-6
Iancu I, Weizman A, Kindler S. Serotonergic drugs in trichotillomania: treatment results in 12 patients. J Nerv Ment Dis 1996; 184: 641-4.
Koran LM, Ringold A, Hewlett W. Fluoxetine for trichotillomania: an open clinical trial. Psychopharmacol Bull 1992; 28: 145-9.
.Pollard JA, Ibe IO, Krosanher DN. Clomipramine treatment of trichotillomania: a follow-up report on four cases. J Clin Psychiatry 1991; 52: 128-30.
Ninan PT, Rothbaum BO, Marsteller FA. A placebo controlled trial of cognitive- behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000; 61: 47-50.
Rahman O, Toufexis M, Murphy TK. Behavioral treatment of trichotillomania and trichophagia in a 29-month-old girl. Clin Pediatr (Phila) 2009; 48: 951-3.
Lerner J, Franklin ME, Meadows EA.Effectiveness of CBT Program for trichotillomania: an uncontrolled evaluation. Behav Ther 1998; 29: 157-71.
Fettahoğlu ÇE. Primer psikiyatrik bozukluklarla ilişkili saç kayıpları. Türkderm 2014; 48: 52-5.