Treatment of puberty trichotillomania with low-dose aripiprazole
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CASE REPORT
Open Access
Treatment of puberty trichotillomania with low-dose aripiprazole Tsuyoshi Sasaki1,2* and Masaomi Iyo1,2
Abstract The present case is of a 14-year-old female with trichotillomania (TTM) that was treated with a low dose of aripiprazole (ARP) 1.5 mg/day. To our knowledge, this is the first published report to show an improvement of pubertal TTM using an ultra-low dose of ARP. In this case, a 50-mg fluvoxamine monotherapy for 2 years and a subsequent 4-month comprehensive cognitive behavioral therapy (CBT) monotherapy did not improve her hair-pulling symptoms. However, the treatment with a low-dose ARP of 1.5 mg/day dramatically improved her TTM symptoms without extrapyramidal symptoms. In this regard, low-dose ARP treatment for TTM might be a safe alternative to antidepressants, which carry the risk of agitation with suicidal ideation in adolescents. Keywords: Trichotillomania, Aripiprazole, Puberty
Background Trichotillomania (TTM) is a poorly understood disorder that is characterized using DSM-5 criteria as the recurrent pulling out of one’s own hair [1]. The onset of hair pulling in TTM usually coincides with or follows the onset of puberty. TTM is associated with distress as well as with social and occupational impairment [1]. Accumulating evidence suggests that pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, opioid-antagonists, or glutamate modulators has the potential to improve TTM in adults [2]. Recent empirical studies have also pointed to the potential of cognitive behavioral therapy (CBT) for the treatment of childhood TTM [3]. However, there is little information available on the treatment of TTM in puberty. In addition, caution is warranted since antidepressant therapy in children and adolescents is associated with increased rates of suicidal ideation [4–6]. Aripiprazole (ARP), a dopamine D2 receptor partial agonist, is different from other atypical antipsychotics, which usually have the profiles of D2 receptor antagonists. Moreover, ARP exhibits 5-HT2a receptor antagonism and 5-HT1a receptor partial agonism [7]. We present a pubertal patient with TTM, which was markedly improved on * Correspondence: [email protected] 1 Department of Child Psychiatry, Chiba University Hospital, Inohana 1-8-1, Chiba 260-8670, Japan 2 Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
low-dose ARP (1.5 mg/day) after failing to respond to fluvoxamine (50 mg/day) and comprehensive CBT.
Case presentation A 14-year-old girl, accompanied by her mother, was seen at our hospital for treatment of trichotillomania (TTM). She had exhibited compulsive hair pulling since the age of 11. The condition had resulted in considerable hair loss, which over the preceding 3 years she had attempted to mask by wearing a wig or bandana. She had undergone several treatments for hair pulling, including school counseling and psychoeducation for her family. Most recently, she had been receiving treatment with
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