olanzapine and Trichotillomania

Currently conceptualized as an obsessive compulsive and related disorder, trichotillomania, or hair-pulling disorder, is a common illness that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania also have other comorbid diagnoses. Treating trichotillomania with pharmacotherapy is complicated since there are currently no FDA-approved drugs for its treatment.. The databases PubMed, PsychINFO, CINAHL, Evidence-based Medicine Reviews, and Cochrane Database of Systematic Reviews were searched, yielding a total of 10 open trials and 10 controlled trials selected. This review aims to examine pharmacotherapeutic options for the treatment of trichotillomania in adults and makes recommendations for the assessment and management of the disorder.. There is preliminary evidence that clomipramine, olanzapine, and N-acetylcysteine may be effective in cases of trichotillomania, however, given the paucity of controlled studies with large sample sizes, decisions regarding the use of drugs should be made on a case-by-case basis taking into account the severity of trichotillomania and the nature of psychiatric comorbidity.

Topics: Acetylcysteine; Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Clinical Trials as Topic; Clomipramine; Comorbidity; Female; Humans; Olanzapine; Treatment Outcome; Trichotillomania

Trichotillomania (TTM) is a psychiatric condition that first manifests itself in infancy and adolescence. If untreated, the condition can become chronic. TTM places a considerable burden on the individual patient. The condition is often linked to social isolation and the emergence of somatic and psychiatric comorbidity. Nevertheless, investment in research, particularly in the pharmacotherapeutical area, has been rather limited.. To provide an overview of the phenomenology of TTM, the associated comorbidity and the therapies available for treating this underexposed child psychiatric disorder.. We searched PubMed using the the MeSH term 'trichotillomania/therapy' and located 49 relevant articles.. We found 49 usable articles. Selective serotonine reuptake inhibitors (SSRIs) are the most frequently prescribed drugs for the treatment of pediatric TTM, although their efficacy is not yet proven. The results of a meta-analysis of several SSRIs did not differ significantly from the results obtained with patients who had been prescribed only placebos. The efficacy of SSRIs in youths has not been studied yet. A meta-analysis of clomipramine with adult TTM patients did show a statistical difference with the control group. The efficacy of clomipramine in youths has not yet been studied. In a randomised controlled trial (RCT), treatment of adult TTM patients with olanzapine proved to be more effective than placebos. Despite this RCT and the positive results of open-label studies with pimozide and haloperidol in adults, there is no research available concerning the efficacy of antipsychotics in children and youths. In an RCT with 7-8 year-olds, cognitive behavioural therapy was found to decrease the symptoms in 75% of the participants.. For now there's only evidence for HRT as effective intervention in children and youths with TTM.

Topics: Benzodiazepines; Child; Clomipramine; Cognitive Behavioral Therapy; Comorbidity; Female; Humans; Male; Olanzapine; Selective Serotonin Reuptake Inhibitors; Social Isolation; Treatment Outcome; Trichotillomania

Individuals affected by trichotillomania (TTM) (hair-pulling disorder) consciously or non-consciously pull out their own body hair. The disorder has recently been incorporated into a chapter entitled, 'Obsessive-Compulsive and Related Disorders' in the diagnostic and statistical manual of mental disorders, fifth edition.. The review describes the literature currently available on the pharmacotherapy for TTM, including both randomized controlled trials and open-label trials of pharmacotherapy for TTM in adults or children.. Early work focused on the serotonin reuptake inhibitors; however, the majority of the trials have been negative. There is a small body of evidence focused on pharmacotherapy for TTM. In future, larger trials are required to expand on the preliminary evidence available for N-acetylcysteine, olanzapine and dronabinol in recent trials.

Topics: Acetylcysteine; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Dronabinol; Humans; Narcotic Antagonists; Olanzapine; Selective Serotonin Reuptake Inhibitors; Trichotillomania

Trichotillomania (TTM) (hair-pulling disorder) is a prevalent and disabling disorder characterised by recurrent hair-pulling. The effect of medication on trichotillomania has not been systematically evaluated.. To assess the effects of medication for trichotillomania in adults compared with placebo or other active agents.. We searched the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (to 31 July 2013), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years); EMBASE (1974 to date); MEDLINE (1950 to date) and PsycINFO (1967 to date). Two review authors identified relevant trials by assessing the abstracts of all possible studies.. We selected randomised controlled trials (RCTs) of a medication versus placebo or active agent for TTM in adults.. Two review authors independently performed the data extraction and 'Risk of bias' assessments, and disagreements were resolved through discussion with a third review author. Primary outcomes included the mean difference (MD) in reduction of trichotillomania symptoms on a continuous measure of trichotillomania symptom severity, and the risk ratio (RR) of the clinical response based on a dichotomous measure, with 95% confidence intervals (CIs).. We identified eight studies with a total of 204 participants and a mean sample size of 25. All trials were single-centre trials, and participants seen on an outpatient basis. Seven studies compared medication and placebo (n = 184); one study compared medication and another active agent (n = 13). Duration of the studies was six to twelve weeks. Meta-analysis was not undertaken because of the methodological heterogeneity of the trials. The studies did not employ intention-to-treat analyses and were at a high risk of attrition bias. Adverse events were not well-documented in the studies.None of the three studies of selective serotonin reuptake inhibitors (SSRIs) demonstrated strong evidence of a treatment effect on any of the outcomes of interest. The unpublished naltrexone study did not provide strong evidence of a treatment effect. Two studies, an olanzapine study and a N-acetylcysteine (NAC) study, reported statistically significant treatment effects. One study of clomipramine demonstrated a treatment effect on two out of three measures of response to treatment.. No particular medication class definitively demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on three individual trials, albeit with very small sample sizes.

Topics: Acetylcysteine; Adult; Benzodiazepines; Clomipramine; Humans; Naltrexone; Olanzapine; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Trichotillomania

Trichotillomania has been considered as part of the obsessive-compulsive disorder spectrum; however, trichotillomania treatment with obsessive-compulsive disorder medications has largely been unsuccessful.. To determine whether a dopaminergic treatment as used in tics and Tourette's syndrome would be effective in trichotillomania.. Twenty-five participants with DSM-IV trichotillomania participated in a 12-week, randomized, double-blind, placebo-controlled trial of flexible-dose olanzapine for trichotillomania. Recruitment occurred between August 2001 and December 2005, and follow-up was completed in February 2006. The primary outcome measure was the Clinical Global Impressions-Improvement (CGI-I) scale, and secondary measures of efficacy included the Yale-Brown Obsessive Compulsive Scale for Trichotillomania (TTM-YBOCS) and the Clinical Global Impressions-Severity of Illness (CGI-S) scale.. Eleven of 13 participants (85%) in the olanzapine group and 2 of 12 (17%) in the placebo group were considered responders according to the CGI-I (P = .001). There was a significant change from baseline to end point in the TTM-YBOCS (P < .01) and the CGI-S (P < .001). The mean ± SD dose of olanzapine at end point was 10.8 ± 5.7 mg/d. Twenty-one of 25 patients (84%) reported at least 1 adverse event, but no adverse events resulted in early withdrawal from the study.. Olanzapine seems to be a safe and effective treatment for primary DSM-IV trichotillomania.. clinicaltrials.gov Identifier: NCT00182507.

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Olanzapine; Placebos; Psychiatric Status Rating Scales; Severity of Illness Index; Trichotillomania

Thus far, only selective serotonin reuptake inhibitors have been systematically studied in the treatment of trichotillomania, and the results are conflicting. This open-label study is the first to systematically evaluate an atypical neuroleptic, olanzapine, as a monotherapy in the treatment of trichotillomania.. Twenty-one patients were screened and 18 patients were enrolled in a 3-month open-label study of olanzapine for trichotillomania (diagnosis based on modified DSM-IV criteria). Patients with comorbid psychiatric disorders or on treatment with psychoactive medication were excluded. Olanzapine was titrated gradually in 2.5-mg/week increments up to a maximum dose of 10 mg/day.. Seventeen patients who completed at least 1 week of olanzapine treatment were evaluated. Hair pulling, as measured by the Massachusetts General Hospital Hairpulling Scale, decreased by 66% from baseline (p < or =.001), and mean scores on the Hamilton Rating Scale for Anxiety decreased by 63% (p < or =.05). Clinical Global Impressions scale scores also revealed significant improvement as a whole (p < or =.001), with 4 patients having complete symptom remission at the end of the study period.. Findings suggest that olanzapine may be an effective monotherapy for trichotillomania.

Topics: Adolescent; Adult; Age of Onset; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Depressive Disorder; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Treatment Outcome; Trichotillomania

Topics: Adolescent; Behavior Therapy; Benzodiazepines; Comorbidity; Drug Therapy, Combination; Female; Humans; Olanzapine; Paroxetine; Sertraline; Trichotillomania

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluoxetine; Humans; Middle Aged; Olanzapine; Pirenzepine; Trichotillomania

Self-inflicted dermatoses are often difficult to treat. We present three patients with excoriated acne, self-induced skin ulcers, and trichotillomania, respectively, whose symptoms responded favorably to a 2- to 4-week course of the atypical antipsychotic olanazpine at a dosage of 2.5 to 5.0 mg daily. In two of three patients, the efficacy of the olanzapine was most likely related to an attenuation of dissociative symptoms that were associated with the self-induced skin ulcers and trichotillomania.

Topics: Acne Vulgaris; Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Pirenzepine; Psychophysiologic Disorders; Skin Diseases; Skin Ulcer; Trichotillomania

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Fluoxetine; Humans; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Trichotillomania