fluvoxamine and Trichotillomania

Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, which cause significant personal distress or social dysfunction. OCD is a common psychiatric illness with a prevalence of 1-2%. Because most people have regular contact with primary health care services, the patient with OCD is likely to see their general practitioner even though psychological problems may not be the main reason for consultation. Early recognition of the disorder facilitates early intervention. This reduces distress, disability and burden of illness. Pharmacological treatment with serotonin reuptake inhibitors (SRI) and cognitive-behavioral therapy have both been proven to be effective and are evidence based.

Topics: Adolescent; Adult; Anti-Anxiety Agents; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Citalopram; Clomipramine; Depression; Diagnosis, Differential; Eczema; Family Practice; Female; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Psychotherapy; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Sertraline; Surveys and Questionnaires; Time Factors; Trichotillomania

Open-label addition of a low-dose typical (pimozide) neuroleptic was shown to be beneficial in some patients with serotonin reuptake inhibitor (SRI)-refractory trichotillomania (TTM). Risperidone's potentially more benign acute and long-term side effect profile makes it a candidate for investigation in the treatment of TTM. We report our experience with the systematic addition of open-label risperidone 0.5 to 3 mg/day in three patients with SRI-refractory TTM. All three patients had a robust decrease in hair pulling as measured by clinician-rated instruments. These results suggest that risperidone addition to ongoing treatment with SRIs may be an effective treatment strategy for patients with SRI-refractory TTM.

Topics: Adult; Chronic Disease; Drug Resistance; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Trichotillomania

The present study examined the efficacy of fluvoxamine in the treatment of trichotillomania (TM) and coexistent clinical features. Twenty-one participants with a principal diagnosis of TM were given fluvoxamine in a 12-week open trial. For 13 patients who completed treatment, significant improvement was noted on only a few measures of hair pulling. End-state analyses for the entire group of participants, however, demonstrated significant improvement in measures of distress, duration, control, and resistance. Significant decreases over treatment were also found on measures of coexistent anxiety for both the completer and the entire participant groups; depressive symptoms improved for completers. Conclusions about the effectiveness of fluvoxamine for treatment of TM cannot be drawn, given the uncontrolled nature of the study; however, end-state analyses suggest the potential utility of fluvoxamine in a subset of patients with TM.

Topics: Adult; Antidepressive Agents, Second-Generation; Female; Fluvoxamine; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Trichotillomania

Topics: Adolescent; Adult; Age of Onset; Clomipramine; Female; Fluoxetine; Fluvoxamine; Humans; Male; Recurrence; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome; Trichotillomania

Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), skin picking disorder (SPD), and hair pulling disorder (HPD), which share core clinical features such as preoccupation or recurrent thoughts and/or repetitive behaviors. Repetitive behaviors in BDD and HD can be differentially characterized by the presence of cognitive components associated with preceding anxiety from those in SPD or HPD, which are only observed as motoric components that regulate emotions or alleviate tension. Thus, the validity of the OCRD category and specific interrelationships between each OCRD remain uncertain. In the present study, therefore, we presented a case of multiple comorbidities of OCRDs in order to discuss the nature of the OCRD category. Our patient was a 20-year-old female university student. At the age of 11 years old, she started picking at acne on her face. The psychopathological, and treatment features observed in this case indicated possible interrelationships among OCRDs, especially between cognitive and motoric OCRDs, which supported the clinical utility and continuous nature of this category.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Body Dysmorphic Disorders; Clonazepam; Combined Modality Therapy; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Hoarding Disorder; Humans; Obsessive-Compulsive Disorder; Psychotherapy; Self-Injurious Behavior; Skin; Trichotillomania; Young Adult

Topics: Adolescent; Dose-Response Relationship, Drug; Female; Fluvoxamine; Humans; Selective Serotonin Reuptake Inhibitors; Trichotillomania

Although patients with trichotillomania typically present to dermatologists, the diagnosis and treatment lie in the field of psychiatry. We report an unusual case of a 33-year-old woman with severe trichotillomania. We review common clinical and pathologic findings of this often chronic and socially debilitating disorder. In addition, we discuss treatment options for dermatologists and how collaboration with psychiatrists is the most effective management for these difficult-to-treat patients.

Topics: Adult; Antidepressive Agents, Second-Generation; Chronic Disease; Female; Fluvoxamine; Humans; Psychotherapy; Trichotillomania

Topics: Adult; Antipsychotic Agents; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Risperidone; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Trichotillomania