Publication: Trikotillomani: Tanı, farmakoterapive kognitif davranışçı terapisi
Abstract
Trikotillomani, tekrarlayan saç yolmalar sonucu belirgin saç kaybına yol açan, süregen gidişli, kişinin işlevselliğinin tüm alanlarını olumsuz etkileyen, tedavisi güç bir bozukluktur. Uzun yıllardır bilinmesine rağmen diğer psikiyatrik bozukluklarla karşılaştırıldığında daha az ilgi çekmiştir. Dürtü kontrol bozuklukları tanı kategorisi altında sınıflandırılmasına karşın, sınıflama konusunda tartışmalar halen devam etmektedir. Trikotillomani, etyolojisi ve tedavisine yönelik çalışmalar son 20 yılda artmıştır. Etyolojik katkıda bulunan etkenler olarak evrimsel, genetik, nörofizyolojik ve nörokognitif faktörler bildirilmiştir. Trikotillomani tedavisi ile ilgili çalışmalar henüz yeterli kanıt düzeyine ulaşmamıştır. Yeterli kanıt olmamasına karşın, etkili tedaviler olarak başta SSRIlar ve klomipramin olmak üzere antidepresanlarla tedavi ve kognitif davranışçı terapiler bildirilmektedir. Kontrollü çalışmalar sonucunda ağırlıklı olarak Alışkanlığı Tersine Çevirme Eğitimi (Habit Reversal Training, HRT) olmak üzere kognitif ve davranışçı terapiler trikotillomani tedavisinde etkin tedaviler olarak gözükmektedir. Yolma davranışlarının gizlenmesi ya da utanma nedeniyle tedaviye başvurunun sınırlı olması geniş kontrollü çalışmaların yapılabilmesini engellemektedir. Çok merkezli, koordine geniş çalışmalar etyolojinin aydınlatılması, sınıflama tartışmalarının sona erdirilmesi, en uygun tedavi yaklaşımları ve algoritmaların geliştirilmesi için gerekmektedir. Bu gözden geçirmede trikotillomani etyolojisi, sınıflaması, tedavisi konusunda son gelişmelerin özetlenmesi amaçlanmıştır.
Trichotillomania is defined as significant hair loss due to individuals repetitive self-pulling of hair. It is a chronic disorder that leads to significant distress and functional impairment and is often difficult to treat. Although it has been recognized for a long time, it has attracted less attention from scholars compared to other psychiatric disorders. Despite the fact that it is classified as an impulse control disorder, there is still a debate on how it should be classified. Research regarding etiology and treatment of trichotillomania has increased over last twenty years. It has been mentioned that its etiology is based on evolutional, genetic, neurophysiological and neurocognitive factors. Although robust evidence is not available, drugs such as clomipramine and selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy are promising treatments. Habit Reversal Training (HRT), as a cognitive behavioural technique, has the highest rate of success in treating trichotillomania. However, not revealing the the habit of pulling hair or not coming forward to seek help due to embarrassment is an obstacle to running large scale controlled experiments. A series of multicentered, coordinated large scale studies are needed to explore the etiology of the disorder, reach an agreement on its classification and defining the best approach and algorithms for the treatment. In this review it is aimed to summarise the latest research and progress in etiology, classification and treatment of trichotillomania.
Trichotillomania is defined as significant hair loss due to individuals repetitive self-pulling of hair. It is a chronic disorder that leads to significant distress and functional impairment and is often difficult to treat. Although it has been recognized for a long time, it has attracted less attention from scholars compared to other psychiatric disorders. Despite the fact that it is classified as an impulse control disorder, there is still a debate on how it should be classified. Research regarding etiology and treatment of trichotillomania has increased over last twenty years. It has been mentioned that its etiology is based on evolutional, genetic, neurophysiological and neurocognitive factors. Although robust evidence is not available, drugs such as clomipramine and selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy are promising treatments. Habit Reversal Training (HRT), as a cognitive behavioural technique, has the highest rate of success in treating trichotillomania. However, not revealing the the habit of pulling hair or not coming forward to seek help due to embarrassment is an obstacle to running large scale controlled experiments. A series of multicentered, coordinated large scale studies are needed to explore the etiology of the disorder, reach an agreement on its classification and defining the best approach and algorithms for the treatment. In this review it is aimed to summarise the latest research and progress in etiology, classification and treatment of trichotillomania.