Golubchik Pavel, Sever Jonathan, Weizman Abraham, Zalsman Gil
Child and Adolescent Outpatient Clinic, Geha Mental Health Center, Petah Tikva, Israel.
Clin Neuropharmacol. 2011 May-Jun;34(3):108-10. doi: 10.1097/WNF.0b013e31821f4da9.
Trichotillomania (TTM) is a heterogenic mental disorder with a high rate of comorbidity and stressful life events (SLEs). Serotonergic and dopaminergic dysfunction are implicated in the pathophysiology of TTM. As in other impulse control disorders, increased prevalence of attention-deficit/hyperactivity disorder (ADHD) is reported in patients with TTM as well. This study aimed to assess the efficacy and tolerability of methylphenidate (MPH) treatment in children and adolescents who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for both ADHD and TTM.
Nine children and adolescents, aged 6 to 18 years, diagnosed with ADHD and TTM, were treated with MPH for a 12-week period. The severity of ADHD was assessed using the ADHD Rating Scale, and the hair pulling was rated using the Massachusetts General Hospital Hair-Pulling Scale. Additional scales were used for assessing depression and anxiety levels, and history of SLE was recorded.
Significant improvement was detected in ADHD after MPH treatment (P < 0.003), but no significant change was observed in hair pulling, as measured by the Massachusetts General Hospital Hair-Pulling Scale (P = 0.096) or in depression and anxiety levels. Lack of response of TTM to MPH (improvement, <50%) was associated with higher rate of positive SLE history (P = 0.047).
Some efficacy of MPH treatment was shown in TTM patients with low rate of SLE. A large-scale study is mandatory to evaluate the efficacy of MPH for TTM in ADHD/TTM patients.
拔毛癖（TTM）是一种具有高共病率和应激性生活事件（SLE）的异质性精神障碍。血清素能和多巴胺能功能障碍与TTM的病理生理学有关。与其他冲动控制障碍一样，TTM患者中注意力缺陷多动障碍（ADHD）的患病率也有所增加。本研究旨在评估哌甲酯（MPH）治疗对符合《精神障碍诊断与统计手册》第四版中ADHD和TTM标准的儿童和青少年的疗效和耐受性。
9名年龄在6至18岁、被诊断为ADHD和TTM的儿童和青少年接受了为期12周的MPH治疗。使用ADHD评定量表评估ADHD的严重程度，使用马萨诸塞州总医院拔毛量表对拔毛情况进行评分。还使用了其他量表来评估抑郁和焦虑水平，并记录SLE病史。
MPH治疗后ADHD有显著改善（P < 0.003），但根据马萨诸塞州总医院拔毛量表测量，拔毛情况、抑郁和焦虑水平均无显著变化（P = 0.096）。TTM对MPH无反应（改善率<50%）与SLE阳性病史的发生率较高有关（P = 0.047）。
MPH治疗对SLE发生率较低的TTM患者有一定疗效。需要进行大规模研究来评估MPH对ADHD/TTM患者中TTM的疗效。
