ABSTRACT
Dermatotilomanía, rascado cutáneo compulsivo (compulsive skin picking) o excoriación neurótica, son sinónimos para un trastornos que comparte características con el trastorno obsesivo compulsivo y el trastorno del control del impulso. Pese a corresponder al 2 por ciento de la consulta dermatológica y al 4 por ciento de la población estudiantil, es un cuadro no diagnosticado y sin consenso en las clasificaciones actuales. Objetivos: Demostrar que la dermatotilomanía, al igual que otros trastornos del control del impulso, responden al uso de antidepresivos ISRS. Pacientes: Se presentan cuatro casos clínicos de rascado cutáneo compulsivo, que responden al uso de fluoxetina en dosis variable. Tres de estos casos corresponden a un mismo grupo familiar, y el cuarto caso se asocia a masturbación compulsiva y a trastorno por atracón. Conclusión: La fluoxetina es efectiva en el control del rascado cutáneo compulsivo. Se ha encontrado asociación familiar y relación con otras patologías del descontrol del impulso.
Subject(s)
Humans , Child , Adolescent , Adult , Skin/injuries , Obsessive-Compulsive Disorder/drug therapy , Fluoxetine/therapeutic use , Stereotypic Movement Disorder/drug therapyABSTRACT
Rhythmic movement disorder, also known as jactatio capitis nocturna, is an infancy and childhood sleep-related disorder charactherized by repetitive movements occurring immediately prior to sleep onset and sustained into light sleep. We report a 19-year-old man with a history of headbanging and repetitive bodyrocking since infancy, occurring on a daily basis at sleep onset. He was born a premature baby but psychomotor milestones were unremarkable. Physical and neurological diagnostic workups were unremarkable. A hospital-based sleep study showed: total sleep time: 178 min; sleep efficiency index 35.8; sleep latency 65 min; REM latency 189 mim. There were no respiratory events and head movements occurred at 4/min during wakefulness, stages 1 and 2 NREM sleep. No tonic or phasic electromyographic abnormalities were recorded during REM sleep. A clinical diagnosis of rhythmic movement disorder was performed on the basis of the clinical and sleep studies data. Clonazepam (0.5 mg/day) and midazolam (15 mg/day) yielded no clinical improvement. Imipramine (10 mg/day) produced good clinical outcome. In summary, we report a RDM case with atypical clinical and therapeutical features.