Işık GÖRKER, SERAP TEVHİDE KARASALİHOĞLU, LEVENT ÖZTÜRK

Pulling of hair while sleeping: A pediatric case

Kişinin kendi kılını karşı konulamaz bir şekilde çekip koparması olarak tanımlanan trikotilomani, DSM-IV-TR'da Başka Türlü Adlandırılamayan Dürtü Kontrol Bozuklukları başlığı altında sınıflandırılmaktadır. Bu davranış, artmış öfke ve kaygı gibi duygular nedeni ile ortaya çıkan gerilimi ortadan kaldırmak için yapılmaktadır. Olgumuz, tüm gece boyunca uyurken saçını koparma ve altını ıslatma bulguları gösteren 11 yaşında erkek çocuğuydu. Ayırıcı tanı için olgumuza tüm gece süresince uyku sırasında polisomnografi uygulanarak, epileptik deşarjların ayırt edilmesi amaçlandı. Sonuçlar normal sınırlarda bulundu. Trikotilomani ön tanısı tartışıldı. Trikotilomaninin parasomni tanısı adı altında değerlendirilmesinin daha uygun olacağı sonucuna varıldı.

Uykuda saç koparma: Bir pediyatrik olgu

Trichotillomania, defined as an irresistible urge to pull and pluck one's own hair, is categorized as an impulse control disorder not otherwise specified in DSM-IV-TR. This behavior is performed in response to a number of emotions such as increasing temper or anxiety and gives resultant tension relief. Our case is an 11-year-old boy who showed signs of pulling his hair overnight and bedwetting when he was sleeping. Polysomnography was performed on him overnight during sleep to differentiate epileptic discharge, for a differential diagnosis. The results were within normal limits. The initial diagnosis of trichotillomania was discussed and we concluded that it would be more appropriate to evaluate the case under the diagnosis of parasomnia.

PDF

___

1) Aljabre SH. Trichotillomania: a trichotillosis, a trichotillotic, or a tic trichotillosis. Int J Dermatol 1993;32:823-4.
2) Hamdan-Allen G. Trichotillomania in childhood. Acta Psychiatr Scand 1991;83:241-3.
3) Hussain SH. Trichotillomania. Two case reports from a similar cultural background. Psychopathology 1992;25:289-93.
4) American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Pub; 2000.
5) World Healt Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1st ed. Geneva: World Health Organization; 1992.
6) Tay YK, Levy ML, Metry DW. Trichotillomania in childhood: case series and review. Pediatrics 2004;113:e494-8.
7) Görker I. Çocukluk çağı trikotilomani'sinde davranış, semptom ve komorbiditenin incelenmesi. [Yan Dal Uzmanlık Tezi] İstanbul: İstanbul Üniversitesi Tıp Fakültesi; 1997.
8) Bruce TO, Barwick LW, Wright HH. Diagnosis and management of trichotillomania in children and adolescents. Paediatr Drugs 2005;7:365-76.
9) Woods DW, Flessner C, Franklin ME, Wetterneck CT, Walther MR, Anderson ER, et al. Understanding and treating trichotillomania: what we know and what we don't know. Psychiatr Clin North Am 2006;29:487-501.
10) King RA, Scahill L, Vitulano LA, Schwab-Stone M, Tercyak KP Jr, Riddle MA. Childhood trichotillomania: clinical phenomenology, comorbidity, and family genetics. J Am Acad Child Adolesc Psychiatry 1995;34:1451-9.
11) Carskadon MA, Rechtschaffen A. Monitoring and staging human sleep. In: Kryger MH, Roth T, Dement W, editors. Principles and practice of sleep medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1359–77.
12) Rosen GM, Ferber R, Mahowald MW. Evaluation of parasomnias in children. In: Lewis M, Dahl RE, editors. Child and adolescent psychiatric clinics of North America. Philadelphia: W.B. Saunders Company; 1996. p. 601-16.
13) Spitz RA. Autoerotism—Some empirical findings and hypotheses on three of its manifestations in the first year of life. Psychoanal St Child 1949:3;85-120.
14) Galski T. Hair pulling (trichotillomania). Psychoanal Rev 1983;70:331-46.
15) Mahowald MW, Bornemann MA. NREM sleep arousal parasomnias. In: Kryger MH, Roth T, Dement W, editors. Principles and practice of sleep medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 889-96.
16) Murphy C, Valerio T, Zallek SN. Trichotillomania: an NREM sleep parasomnia? Neurology 2006;66:1276.
17) Brown LW. Sleep and epilepsy. In: Lewis M, Dahl RE, editors. Child and adolescent psychiatric clinics of North America. Philadelphia: W.B. Saunders Company; 1996. p. 701-14.