儿童拔毛癖:一例及现有循证药物治疗回顾。

Aamir Jalal Al-Mosawi
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摘要

1. 摘要背景:拔毛癖是一种自我诱发的精神皮肤皮肤病,被认为是一种伴有强迫症特征的冲动控制障碍。这种疾病的特点是反复拉扯自己的头发,导致不规则形状的区域,部分缺乏头发造成脱发。这种情况的治疗通常不令人满意,因为这种情况通常对治疗有抵抗力,并且复发很常见。患者与方法:对一名女童持续脱发数月,经多名皮肤科医生多次治疗的病例进行了研究。现有的循证药物治疗可用于儿童的条件进行了审查。结果:一名13岁的女孩被转介到巴格达医学城儿童教学医院的儿科精神病学诊所,因为持续数月的脱发,尽管几位皮肤科医生进行了多次治疗。父母没有显示出家庭中存在任何心理压力的迹象。虽然父母在女孩的床上发现了几束头发,但当他们早上叫醒她时,他们惊讶地发现她的病情是自己引起的。这个女孩相当害羞,否认自己扯过头发。对她头皮的检查显示形状不规则,部分没有头发,表明她有拔毛癖。病人不是巴格达人,她所在的省也没有儿科精神科服务机构。在繁忙的三级中心不可能对女孩进行认知行为治疗,这对她的家人也不方便。显然需要进行药物治疗。对现有研究证据的回顾表明,对拔毛癖的单一治疗并不总是有效,而联合治疗更有可能成功。结论:拔毛癖仍然是一种具有挑战性的精神疾病,没有一线药物得到普遍批准。现有证据表明,单药治疗拔毛癖并非一贯有效,联合治疗更有可能成功。更安全的抗抑郁药氯丙帕明与更安全的抗精神病药利培酮(加或不加n -乙酰半胱氨酸)联合使用代表了目前儿童拔毛癖药物治疗的循证推荐。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Childhood Trichotillomania: A Case and a Review of the Available Evidence-Based Pharmacologic Therapies.
1. Abstract Background: Trichotillomania is a self-induced psychocutaneous dermatosis that is considered an impulse control disorder associated with obsessive-compulsive features. The disorder is characterized alopecia caused by repetitive pulling of own hair which cause irregular shape areas, partially devoid of hair. Treatment of the condition is generally unsatisfactory, because the condition is commonly resistant to treatment and relapse is common. Patients and methods: The case of girl with persistent alopecia of several months despite several treatments by several dermatologists was studied. The available evidence-based pharmacologic therapies that can be useful for the child’s condition was reviewed. Results: A thirteen-year old girl was referred to pediatric psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City because of persistent alopecia of several months despite several treatments by several dermatologists. The parents didn’t give clues to any a psychosocial stress in the family. Although the parents were finding at several occasions tufts of hair in the bed of girl when awakening her at the morning, they were surprised to learn that her condition is self-induced. The girl was rather shy and denied pulling her hair. Examination of her scalp showed irregular shape areas, partially devoid of hair suggesting trichotillomania. The patient was not from Baghdad and there was no pediatric psychiatry service in the province where she came from. It was not possible to the girl a cognitive behavioral therapy in a busy tertiary center, nor was this convenient to her family. The need for a pharmacologic therapy was clearly demanded. Review of the available research evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. Conclusion: Trichotillomania remains a challenging psychiatric condition with no first- line medications universally approved. The available evidence suggests that monotherapy of trichotillomania is not consistently effective and combination of therapies is more likely to be successful. The combination of a safer antidepressant, clomipramine with a safer neuroleptic, risperidone with or without the addition of N-acetylcysteine represents the current evidence-based recommendation for the pharmacologic treatment of childhood trichotillomania.
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