R
.
K
.
Srivastava
,
S
.
Sharma
,
N
.
Tiwari
,
B
.
Saluja
, Department of Psychiatry, K.G. Medical University, Lucknow, India:
Trichotillomania, first described by French dermatologist Hallopeau, is a chronic disorder characterized by an irresistible urge to pull one's hair. The mean age of onset of this disorder is the early teens. The clinical course is variable. Trichotillomania can lead to serious complications including infections at the hair pulling site, changed hair texture, carpal tunnel syndrome and trichobezoar and resultant bowel obstruction. Treatment options are many and include both pharmacological and nonpharmacological interventions. However, the results are often unsatisfactory. Here, we report two cases of trichotillomania in whom olanzapine augmentation of fluoxetine produced a satisfactory response.
Case 1: An 18-year-old man with no family history of psychiatric illness presented with a 4 year history of an irresistible urge to pull out his scalp hair resulting in hair loss. He was diagnosed with trichotillomania and prescribed fluoxetine 20 mg once daily along with behaviour therapy. In the behaviour therapy the patient was instructed to keep a daily record of his hair pulling. This included showing the hair to mother and putting a tally mark under that particular date. The patients was rewarded with things of his liking on decreased frequency of hair pulling. The dose of fluoxetine was gradually increased over the next 6 weeks to 80 mg. The patient did not show any significant reduction of symptoms even after 8 weeks. Hence, olanzapine 5 mg daily was added to the therapy. The patient showed marked improvement with this combined treatment. No sideeffects were reported.
Case 2: A 17-year-old woman with family history of obsessive-compulsive disorder in her mother, presented with chief complaints of pulling her hair from the scalp for the previous 3 years. On examination irregular, nonscarring, focal, patchy hair loss was observed on the left side of the scalp. She was diagnosed as having trichotillomania and prescribed fluoxetine 20 mg once daily. Behaviour therapy (as for Case 1) was started and the dose of fluoxetine was increased to 60 mg at 6 weeks. No significant improvement was seen after 8 weeks and olanzapine 5 mg was added. The patient showed improvement within the next 4 weeks. However, she complained of weight gain. The dose of olanzapine was reduced to 2.5 mg after 8 weeks. No deterioration in her condition was reported.
Open trials indicate a favourable response to fluoxetine in trichotillomania. There are reports of augmentation of selective serotonin reuptake inhibitors with haloperidol, pimozide and risperidone. In our cases olanzapine augmentation of fluoxetine produced beneficial responses.
