Case Report: Schizophrenia patient with prodromal OCS is probably at increased risk of developing TTM while on atypical
antipsychotics treatment. Atypical antipsychotics and SSRI combination therapy is a useful strategy in such patient
Hair Pulling Disorder or TrichotillomaniaMoner Khabor
Hair Pulling Disorder- It is not bad to pull hair out of extreme happiness and anger or pulling hair by grandchildren, there is a comfort. But it is certainly not good to pluck hair, consciously or sub-consciously, one by one making a large portion of the head empty. ‘Trichotillomania’ is a mental disease and the patients of this disease pull and pluck their hair.
Richard S. Finkel, MD, and Diana Castro, MD, prepared useful practice aids pertaining to spinal muscular atrophy for this CME activity titled "Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcoming Diagnostic Delays, Facilitating Early Treatment, and Easing Caregiver Burden." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2L0MSrz. CME credit will be available until December 27, 2019.
Hair Pulling Disorder or TrichotillomaniaMoner Khabor
Hair Pulling Disorder- It is not bad to pull hair out of extreme happiness and anger or pulling hair by grandchildren, there is a comfort. But it is certainly not good to pluck hair, consciously or sub-consciously, one by one making a large portion of the head empty. ‘Trichotillomania’ is a mental disease and the patients of this disease pull and pluck their hair.
Richard S. Finkel, MD, and Diana Castro, MD, prepared useful practice aids pertaining to spinal muscular atrophy for this CME activity titled "Breaking Down the Barriers to Optimal Spinal Muscular Atrophy Care: Overcoming Diagnostic Delays, Facilitating Early Treatment, and Easing Caregiver Burden." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2L0MSrz. CME credit will be available until December 27, 2019.
In this lecture:
1. AED’s: Looking Beyond Epilepsy- Their Relevance & Utility in Neuropsychiatry
2. Parodoxical relationships: seizures, behavior and AEDs
3. What relevance do these findings hold for epilepsy
Conceptual Study of Migraine in Ayurveda (Ardhavbhedaka)ijtsrd
Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 30 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7% (around 1 in 7 people).1 Chronic Migraine affects about 2% of world population2 with female and male ratio 3:1.3 It is a widespread, chronic and intermittently disabling disorder characterized by recurrent headaches with or without aura. The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or has part of his vision blanked out. It is also called as 'œsick headache' because nausea and vomiting occasionally accompany the excruciating pain which lasts for as long as three days. Suppressing migraine pain with NSAIDS and analgesics gives short term relief and the pain can rebound. Dependence on medicines decreases the body's natural pain relief mechanism and long-term dependence can damage kidneys, liver or other vital organs. Ayurveda believes in treating the disease at its root cause from within. Therefore, treatments focus on balancing the vitiated Doshas in the digestive and nervous systems. This can be achieved by avoiding triggering factors and prescribing doshic specific diet, stress management, herbal formulas, lifestyle modification, Panchakarma, Kriyakalpa and other holistic modalities to create a balanced physiology. Dr Shyam Kumar Sah | Dr Deeraj BC | Dr Ashwini MJ"Conceptual Study of Migraine in Ayurveda (Ardhavbhedaka)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-4 , June 2018, URL: http://www.ijtsrd.com/papers/ijtsrd15633.pdf http://www.ijtsrd.com/medicine/other/15633/conceptual-study-of-migraine-in-ayurveda-ardhavbhedaka/dr-shyam-kumar-sah
“Epilepsy and mental disorder are two states of illness of the very closest relationship; they represent identical pathological conditions in two different areas of the nervous system”
Dr.Shukri and Dr.Ahmad Eid collaberated together to teach us how to tackle difficult cases and how to deal with a typical presentation to psychiatry symptoms
In this lecture:
1. AED’s: Looking Beyond Epilepsy- Their Relevance & Utility in Neuropsychiatry
2. Parodoxical relationships: seizures, behavior and AEDs
3. What relevance do these findings hold for epilepsy
Conceptual Study of Migraine in Ayurveda (Ardhavbhedaka)ijtsrd
Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 30 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7% (around 1 in 7 people).1 Chronic Migraine affects about 2% of world population2 with female and male ratio 3:1.3 It is a widespread, chronic and intermittently disabling disorder characterized by recurrent headaches with or without aura. The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or has part of his vision blanked out. It is also called as 'œsick headache' because nausea and vomiting occasionally accompany the excruciating pain which lasts for as long as three days. Suppressing migraine pain with NSAIDS and analgesics gives short term relief and the pain can rebound. Dependence on medicines decreases the body's natural pain relief mechanism and long-term dependence can damage kidneys, liver or other vital organs. Ayurveda believes in treating the disease at its root cause from within. Therefore, treatments focus on balancing the vitiated Doshas in the digestive and nervous systems. This can be achieved by avoiding triggering factors and prescribing doshic specific diet, stress management, herbal formulas, lifestyle modification, Panchakarma, Kriyakalpa and other holistic modalities to create a balanced physiology. Dr Shyam Kumar Sah | Dr Deeraj BC | Dr Ashwini MJ"Conceptual Study of Migraine in Ayurveda (Ardhavbhedaka)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-4 , June 2018, URL: http://www.ijtsrd.com/papers/ijtsrd15633.pdf http://www.ijtsrd.com/medicine/other/15633/conceptual-study-of-migraine-in-ayurveda-ardhavbhedaka/dr-shyam-kumar-sah
“Epilepsy and mental disorder are two states of illness of the very closest relationship; they represent identical pathological conditions in two different areas of the nervous system”
Dr.Shukri and Dr.Ahmad Eid collaberated together to teach us how to tackle difficult cases and how to deal with a typical presentation to psychiatry symptoms
An interactive case presentation during the monthly meeting of Early-career psychiatrists in Jeddah, SA. Basically, a case managed and supervised clinically by Dr Shokry Alemam, MD
Right Temporal Lobe Meningioma presenting as postpartum depression: A case re...Apollo Hospitals
Meningiomas are tumors which arise from arachnoid cells and can occur both in the brain and spinal cord. Meningiomas can present with psychiatric symptoms (such as depression, anxiety disorders, or personality changes) in the absence of any neurologic signs or symptoms.
Maintenance Electroconvulsive Therapy Augmentation on Clozapine-Resistant Psy...Zahiruddin Othman
Case Report: Maintenance electroconvulsive therapy augmentation on clozapine-resistant psychosis with neurosyphilis is effective and safe but has never been reported in the literature to the authors' knowledge. It is hoped that this case report would contribute to the scarce literature on this augmentation strategy
Schizophrenia is a chronic psychiatric disorder. People with this disorder experience distortions of reality, often experiencing delusions or hallucinations.
The exact cause of schizophrenia isn't known, but a combination of genetics, environment and altered brain chemistry and structure may play a role.
Schizophrenia is characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present.
Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services.
The Millennium-Warrior Angels Foundation 3 year TBI study Andrew Marr
The Millennium-Warrior Angels Foundation 3 year TBI study. This is the definitive lecture on what constitutes a TBI, how to identify and treat it, supported with our evidence on more than 200 documented cases.
This is a case presentation of a cancer patient having major depression disorder with discussion about the management and the effects of chemotherapy and cancer on depression and clinical picture
Isolated Cerebellar Stroke Masquerades as DepressionZahiruddin Othman
There are numerous reports on neurological conditions masquerading as psychiatric disorders. However, cerebellar
stroke is not established as one of it. The 2 case reports will highlight that this masquerade is possible and the physician's
high index of suspicion is the key to accurate diagnosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. INTRODUCTION
Trichotillomania (TTM) has been mostly a comorbid with other
obsessive-compulsive related disorders (OCRD), notably skin-picking
disorder. Until recently there have been only few reports of TTM in
schizophrenia1)
. Here, we present a case of TTM in a young man with
schizophrenia to add to the scarce literature available on this comorbidi-
ty and discuss the possible etiology.
CASE
A 25-year-old single Malay man with 2 years history of schizophre-
nia presented to our clinic with a new complaint. Shyly, he took off his
Figure 1. Initial presentation of trichotillomania. The patient was
on quetiapine 500 mg ON.
Figure 2. One year after escitalopram 10 mg ON was added to
quetiapine 500 mg ON.
International Medical Journal Vol. 26, No. 2, pp. 155 - 156 , April 2019
CASE REPORT
Trichotillomania Comorbid with Schizophrenia
Zahiruddin Othman, Nor Asyikin Fadzil
ABSTRACT
Introduction: Trichotillomania (TTM) is now part of DSM-5 classification of obsessive-compulsive and related disorders. A
quarter of schizophrenia patients suffer from obsessive-compulsive symptoms (OCS) and the use of atypical antipsychotics may
worsen or even induce new onset OCS.
Objective: A 25-year old man who presented with TTM comorbid with schizophrenia was studied. The symptomatology and
treatment will be discussed.
Results: The patient had prominent anxiety and mild OCS during the prodromal phase of schizophrenia. While on atypical
antipsychotics treatments, he developed TTM which was partially reduced with addition of selective serotonin reuptake inhibi-
tor (SSRI).
Conclusion: Schizophrenia patient with prodromal OCS is probably at increased risk of developing TTM while on atypical
antipsychotics treatment. Atypical antipsychotics and SSRI combination therapy is a useful strategy in such patient.
KEY WORDS
trichotillomania, obsessive-compulsive, schizophrenia, aypical antipsycotics, selective serotonin reuptake inhibitor
Received on June 7, 2017 and accepted on April 10, 2018
School of Medical Sciences, Universiti Sains Malaysia
Kubang Kerian, 16150 Kelantan, Malaysia
Correspondence to: Zahiruddin Othman
(e-mail: zahirkb@usm.my)
155
C 2019 Japan Health Sciences University
& Japan International Cultural Exchange Foundation
2. Othman Z. et al.156
cap which that he wore to avoid embarrassment showing bald patches
on his scalp. For the past 1 year, he developed hair pulling which was
preceded by mounting anxiety and was relieved afterward. He mini-
mized the hair loss by claiming that most of the time he just twirled and
pulled it lightly until it gave out popping sounds. There was no history
of eating the hair.
Past psychiatric history revealed that his initial presentation was 4
years prior when he presented with severe unremitting panic attacks for
which he was treated with escitalopram 15 mg nocte and alprazolam 0.5
mg tds. He also had mild and transient doubts over the cleanliness of his
undergarment whether it was acceptable during prayers. One and a half
year later, he developed auditory hallucinations for the first time. Soon
he became depressed with suicidal thoughts as the voices became more
prominent commanding him to kill himself. He was discharged well
after 2 weeks of admission with quetiapine 500 mg nocte. During the
follow-ups, he had tactile hallucinations described as being touched and
sexually aroused by invisible Jin. His father and brother were diagnosed
with schizophrenia obsessive-compulsive disorder, respectively.
Escitalopram 10 mg nocte was added to existing queatiapine 500mg
nocte. Having seen the long-term effect of schizophrenia on his father
and being unemployed caused him to constantly worry about his future.
He was referred for psychosocial rehabilitation. He sought solace in
religion through activities such as prayer and dhikr. About a year after
later, the bald patches on his scalp had become smaller in size but not
completely disappear. As he was busy working in a nearby hypermarket,
he was able to distract his mind from the worrying thoughts and thus
had greater control over his hair pulling behavior.
DISCUSSION
DSM-5 brings TTM more in line with repetitive and ritualized
behavior and impulses in obsessive-compulsive and related disorders
(OCRD) and distinguishes it from its previous roots with impulse con-
trol disorders2)
. Both TTM and OCD have underlying problems with
inhibitory control but perhaps stemming from different motivating fac-
tors driving the behaviors3)
.
This case illustrates a number of complex and interrelated psycho-
pathology such as anxiety, depression, psychosis, obsession and com-
pulsion. The initial presentation of this patient was panic attacks and
obsessive-compulsive symptoms. Later on, he developed a psychotic
episode accompanied by severe depression with suicidal ideations even
though he was already on adequate dose of antidepressant and benzodi-
azepine. As all these symptoms stabilized during the follow-up, he pre-
sented with yet another symptom which was TTM.
In this case, the TTM is most likely a comorbid with schizophrenia
due to the fact that the hair pulling behavior remains when all the other
symptoms including panic attacks, depression and psychosis were mini-
mal or absent. In contrast, if TTM was in response to commanding hal-
lucinations or delusions, we would expect improvement in tandem with
psychotic symptoms resolution with antipsychotics treatment4)
.
In second generation antipsychotics (SGA)-induced obsessive-com-
pulsive symptoms (OCS), a patient without a previous history of OCS
develops these phenomena during antipsychotic treatment5)
. A clear
association and possible causal interaction between SGA, in particular
clozapine, and the de novo occurrence of OCS has been reported6,7)
In
this patient, the onset of OCS preceded the psychotic symptoms and ini-
tiation of SGA. The onset of TTM however, was during the antipsychot-
ic treatment. Therefore, the role of SGA in this case is to aggravate
existing OCS rather than inducing de novo OCS.
Selective serotonin reuptake inhibitors (SSRI) and antipsychotics
are the most commonly use pharmacological treatments for TTM8)
.
Olanzapine9)
and quetiapine10)
for instance, have been reported as a use-
ful treatment for TTM. As this patient was already on quetiapine, an
SSRI was added which can also treat the concomitant anxiety symp-
toms.
CONCLUSION
Schizophrenia patient with prodromal OCS is probably at increased
risk of developing TTM while on atypical antipsychotics treatment.
Atypical antipsychotics and SSRI combination therapy is a useful strate-
gy in such patient. In addition, psychosocial intervention will be helpful
to alleviate the ongoing stressor and reduce the hair pulling behavior.
REFERENCES
1) Kähkönen S. Trichotillomania in a schizophrenia patient. CNS spectrums. 2002; 7(10):
751-2.
2) Van Ameringen M, Patterson B, Simpson W. DSM-5 obsessive-compulsive and related
disorders: clinical implications of new criteria. Depress Anxiety. 2014; 31(6): 487-93.
3) Fineberg NA, Potenza MN, Chamberlain SR, Berlin HA, Menzies L, Bechara A,
Sahakian BJ, Robbins TW, Bullmore ET, Hollander E. Probing compulsive and impul-
sive behaviors, from animal models to endophenotypes: a narrative review.
Neuropsychopharmacol. 2010; 35(3): 591-604.
4) Tsai SI, Chang FR. Repetitive hair pulling associated with schizophrenia. Br J
Dermatol. 1998; 138(6): 1095-6.
5) Schirmbeck F, Zink M. Comorbid obsessive-compulsive symptoms in schizophrenia:
contributions of pharmacological and genetic factors. Front Pharmacol. 2013; 4: 99
6) Khullar A, Chue P, Tibbo P. Quetiapine and obsessive-compulsive symptoms (OCS):
case report and review of atypical antipsychotic-induced OCS. J Psychiatry Neurosci.
2001; 26(1): 55-9.
7) Schirmbeck F, Zink M. Clozapine-induced obsessive- compulsive symptoms in schizo-
phrenia: a critical review. Curr Neuropharmacol. 2012; 10: 88-95.
8) Rothbart R, Stein DJ. Pharmacotherapy of trichotillomania (hair pulling disorder): an
updated systematic review. Expert Opin Pharmacother. 2014; 15(18): 2709-19.
9) Van Ameringen M, Mancini C, Patterson B, et al. A randomized, double blind, place-
bo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiatry
2010; 71: 1336-43
10) Khouzam HR, Battista MA, Byers PE. An overview of trichotillomania and its response
to treatment with quetiapine. Psychiatry. 2002; 65(3): 261-70.