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Case Reports in Psychiatry
Volume 2016, Article ID 9782702, 5 pages
http://dx.doi.org/10.1155/2016/9782702
Case Report

Trichotillomania as a Manifestation of Dementia

1Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
2Department of Neurology, Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
3Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand

Received 21 August 2016; Revised 25 September 2016; Accepted 4 October 2016

Academic Editor: Erik Jönsson

Copyright © 2016 Pongsatorn Paholpak and Mario F. Mendez. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pathological hair-pulling or trichotillomania, which is commonly associated with anxiety and depression, obsessive-compulsive disorder, and neurodevelopmental disorders, has been rarely associated with dementing illnesses. Investigators have not clarified the neural correlates and treatment of trichotillomania in dementia. We report a patient who developed an early-onset cognitive decline with genetic, cerebrospinal fluid biomarker and structural and functional neuroimaging studies consistent with Alzheimer’s disease. Eight years into her disease, she developed severe, repetitive hair-pulling behavior leading to marked hair loss, along with other repetitive and “frontal” behaviors. Selective serotonin reuptake inhibitors (SSRIs) were ineffective in controlling her hair-pulling behavior, which subsequently responded to quetiapine 150 mg/day. This patient and a review of the literature suggest that trichotillomania may be a compulsive-related symptom in dementias of different etiologies as they involve frontal areas and release primitive grooming behavior from frontostriatal dysfunction. Dopamine blockade, rather than SSRIs, may be effective in managing trichotillomania in dementia.