Síndrome de Rapunzel como complicación en una paciente lúpica / Rapunzel syndrome as a complication in a lupus patient

El lupus eritematoso sistémico es una enfermedad que causa un gran número de complicaciones de origen psicológico; estas pueden llevar a patrones inadecuados de conducta que pueden poner en riesgo la vida de los pacientes como el síndrome de Rapunzel. Se describen los elementos clínicos y diagnósticos de este síndrome mediante el caso de una paciente femenina de 25 años de edad, con diagnóstico de lupus eritematoso sistémico. Acude a consulta con manifestaciones clínicas e imagenológicas que permiten llegar al diagnóstico de síndrome de Rapunzel como complicación psicológica en el curso del lupus eritematoso sistémico. Se procede a realizar la intervención quirúrgica donde se halló una masa tumoral constituida por cabello humano. En la actualidad, la paciente se mantiene en seguimiento por las especialidades de reumatología, psiquiatría y psicología, y su recuperación y evolución han sido satisfactorias. El lupus eritematoso condiciona conductas que pueden ser perjudiciales para la salud de los pacientes. Es importante la identificación precoz de conductas como la tricotilomanía y el seguimiento psicológico especializado en pacientes con esta enfermedad(AU)

Systemic lupus erythematosus is a systemic disease that generates a large number of complications of psychological origin; these can lead to inappropriate behavior patterns that can be life-threatening for patients. To describe the clinical and diagnostic elements of Rapunzael syndrome. Clinical case: a 25-year-old female patient with a diagnosis of systemic lupus erythematosus who consulted with clinical and imaging manifestations that led to the diagnosis of Rapunzel syndrome as a psychological complication in the course of systemic lupus erythematosus. Lupus erythematosus conditions a series of behaviors that can be detrimental to the health of patients; early identification of behaviors such as trichotillomania and specialized monitoring in psychology in patients with this disease is important. The clinical evolution of the patient has been very favorable and her general condition has recovered(AU)

The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

ABSTRACT CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

Síndrome de Rapunzel con doble tricobezoar simultáneo en una adolescente: Reporte de caso / Rapunzel syndrome with double simultaneous trichobezoar in a teenager: Clinical Case Report

Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

Trichotillomania and personality traits from the five-factor model

Objective: To examine whether personality traits have predictive validity for trichotillomania (TTM) diagnosis, pulling severity and control, and hair pulling style. Methods: In study 1, logistic regression was used with TTM cases (n=54) and controls (n=25) to determine if NEO Five-Factor Inventory (NEO-FFI) personality domains predicted TTM case vs. control classification. In study 2, hierarchical multiple regression was used with TTM cases (n=164) to determine whether NEO-FFI personality domains predicted hair pulling severity and control as well as focused and automatic pulling styles. Results: TTM case vs. control status was predicted by NEO-FFI neuroticism. Every 1-point increase in neuroticism scores resulted in a 10% greater chance of TTM diagnosis. Higher neuroticism, higher openness, and lower agreeableness were associated with greater pulling severity. Higher neuroticism was also associated with less control over hair pulling. Higher neuroticism and lower openness were associated with greater focused pulling. None of the personality domains predicted automatic hair pulling. Conclusions: Personality traits, especially neuroticism, can predict TTM diagnosis, hair pulling severity and control, and the focused style of pulling. None of the personality traits predicted automatic pulling. Longitudinal studies are needed to determine whether personality variables predispose to TTM onset, impact disorder course, and/or result from hair pulling behavior.

Do retiro na tricotilomania ao mundo das trocas objetais / From the psychic retreat in trichotillomania to the world of object relation

Através deste trabalho gostaria de dar seguimento a algumas reflexões que se originaram a partir do atendimento psicanalítico a uma mulher de 34 anos, no seu sétimo ano em análise, que ainda hoje tem uma sintomatologia compulsiva, mais especificamente a tricotilomania. Esse quadro compulsivo é parte integrante de um desenvolvimento emocional bastante precário, que descrevi em um trabalho anterior (Gordon, 2009). Observei que havia uma dinâmica entre os aspectos compulsivos e os investimentos narcísicos e objetais. Neste trabalho procurarei fazer uma breve recapitulação dessas conclusões, que incluem algumas considerações sobre a tricotilomania, tal como é descrita na literatura psiquiátrica e psicanalítica, e então acrescentarei novos desdobramentos.

Through this paper I would like to give segment to a few thoughts which originated from the psychoanalytic treatment of a woman of 34 years old in its seventh year, with a compulsive symptomatology, specifically trichotillomania. This compulsive symptomatology is part of an emotional development rather poor, which was described in a previous work (Gordon, 2009). A dynamic between the compulsive aspects and narcissistic and object investments was observed and described. The aim of this present paper is to make a brief recapitulation of these conclusions, which include some considerations about trichotillomania, as described in the psychiatric and psychoanalytic literature, and further developments will be added.

A través de este trabajo me gustaría dar segmento a algunas reflexiones que se originaron a partir del atendimiento psicoanalítico a una mujer de 34 años, en su séptimo año de análisis, que aún hoy tiene una sintomatología compulsiva, más específicamente la tricotilomanía. Ese cuadro compulsivo es parte integrante de un desarrollo emocional bastante precario, que describí en un trabajo anterior (Gordon, 2009). Observé que había una dinámica entre los aspectos compulsivos y las investiduras narcísicas y objetuales. En este trabajo busqué hacer una breve recapitulación de esas conclusiones, que incluyen algunas consideraciones sobre la tricotilomanía, tal como es descrita en la literatura psiquiátrica y psicoanalítica, y entonces añadiré nuevos desdoblamientos.

Intervenção analítico-comportamental em tricotilomania / Behavioral intervention on with trichotillomania

O presente estudo objetivou analisar funcionalmente o comportamento-problema de puxar os fios de cabelo de uma pessoa diagnosticada com tricotilomania, por meio do procedimento de reversão do hábito. A participante era uma jovem solteira de 21 anos, estudante universitária e encontrava-se em tratamento médico e farmacológico desde os 12 anos de idade. Para demonstrar o controle experimental dos procedimentos, foi utilizado o delineamento de Reversão Replicação no formato ABAB, seguido por follow-up. O programa de intervenção foi efetivo na redução do comportamento de arrancar os fios de cabelos, que se manteve no follow-up.

The aim of this study wasaimed to analyze functionally the problem behavior of the selfpulling of thestrands of hair in of an individualperson diagnosed with trichotillomania, usingthrough habit reversal procedure. The participant was a young maiden of 21year olds unmarried woman; a college student who had been receivingwas in medical and drugpharmacological treatment since the age of 12. To demonstrate the experimental control of the procedures, were used to design Reversal-Replication design was employed, using the ABAB format, followed by with follow-up. The intervention program was effective in reducing the behavior of pulling out the strands of hairs, and this that remained the case in the follow-up.

Tricotilomanía: abordaje diferenciado según la franja etaria en la infancia / Trichotillomania: differentiated approach depending on the age group in children

Introducción: La tricotilomanía se caracteriza por áreas de alopecia causadas por la tracción de cabellos realizada por el mismo paciente y es más frecuente en edades pediátricas. No obstante, existen pocos trabajos sobre esta enfermedad. Este estudio tiene como objetivo delinear las características clínicas y evolutivas de la tricotilomanía en un grupo de niños Resultados: Hubo 47 casos de tricotilomanía, de los cuales 32 (68%) fueron niñas. Se observó una mayor predisposición en el género femenino luego de los 5 años (mientras en las menores de 5 años el 56% estuvo afectada, en las mayores de 5 años el porcentaje se elevó al 76%). La edad media de inicio fue de 6 años, variando entre los 7 meses y los 11 años. La presencia de factores precedentes como cambios en la dinámica familiar, problemas psicológicos y enfermedades se determinó en 29 pacientes y fue más común en los niños mayores de 5 años. La región parieto-temporal fue la más afectada y las pestañas y cejas las menos comprometidas. En el 74% de los casos se inició tratamiento con placebo y se obtuvo una buena respuesta...

Introduction: Trichotillomania is characterised by alopecic areas caused by patients pulling out their hair. There are few works on this disease in the pediatric age group. The aim of this study is to delineate the clinical characteristics and evolution of trichotillomania in childhood.Results: There were 47 cases, 32 (68%) girls, with a higher difference between genders was observed over the age of 5 (of the group of under 5, 56% were while over this age they represented the 76%). Median age at onset was 6 years, ranging from 7 months to 11 years. Prior factors such as changes in family dynamics, psychological problems and diseases occurred in 29 patients, more current in the over 5 years old. The parieto-temporal region was the most affected and eyelashes and eyebrows the least removed. Placebo treatment was instituted in 74% with good response...

Tricotilomania: revisão da literatura / Trichotillomania

Um número substancial de pacientes sofrre de tricotilomania, uma doença psiquiátrica com manifestações dermatológicas. Pessoas que sofrem de tricotilomania normalmente sabem de sua doença, mas não procuram ajuda devido à vergonha que sentem. Neste artigo, os autores discutem as características clinicas e propedêuticas da tricotilomania, com ênfase nos aspectos psiquiátricos dos pacientes.

A substancial number of patients are suffering about trichotilomania, a psychiatric disease that has dermatological manifestations. People who suffer about trichotillomania, generally know about their disease, but they don't look after help due to the shame that feel. In this article, the authors discuss the clinical characteristics and propedeutic of trichotillomania, with emphasis on the psychiatric aspects of the patients.

Trastornos del espectro obsesivo-compulsivo / Spectrum Disorders Obsessive-Compulsive

Los trastornos del espectro obsesivo-compulsivo son un conjunto de entidades relacionadas con el trastorno obsesivo-compulsivo con similitudes a éste y diferencias propias de cada trastorno. Actualmente se encuentran ubicados en diferentes apartados de los manuales diagnósticos. A lo largo del espectro se encuentran distribuidos las distintas entidades que lo componen, desde el polo impulsivo al polo compulsivo. El objetivo del siguiente artículo es analizar las características clínicas, epidemiológicas y el manejo terapéutico de los tres trastornos más importantes del polo impulsivo: el juego patológico, la tricotilomanía y las conductas autolesivas.

The Obsessive-Compulsive Spectrum Disorders are a group of entities related to the Obsessive-Compulsive Disorder having similarities with it and also differences that are characteristic of each disorder. Nowadays, they are published in different chapters of current diagnosis manuals. On the one hand, entities of the impulsive spectrum can be found, and on the other hand, entities of the compulsive pole can also be found. However, these entities will soon be included in the same chapter for a better analysis and debate. The present article aims at analyzing the clinical and epidemiological characteristics and the therapeutic management of the three most important disorders of the impulsive spectrum: the pathological gambling, the trichotillomania and the self-injury behaviour.

Trastornos del control de impulsos / Impulse control disorders

Se revisan las patologías incluidas en este grupo de trastornos, sus antecedentes históricos y principales teorías etiológicas. Se destacan los aspectos forenses y se incluyen algunos antecedentes nacionales

La tricotilomanía en niños: un trastorno benigno?

Objetivo: revisar el conocimiento sobre la tricotilomanía en niños, en particular los elementos que aportan nuevos criterios al enfoque clínico para interpretar esta entidad. Metodología: se revisaron los estudios publicados a partir de 1970, encontrando que diez artículos tienen una estructura que permite la generalización y comparación de los resultados. Resultados: las series de pacientes que se describen son pequeñas por la naturaleza secreta del trastorno, pero en todas se encuentra que aproximadamente dos tercios de los pacientes padecen de ansiedad, depresión y otras alteraciones psiquiátricas. Conclusiones: la tricotilomanía en niños no es un trastorno transitorio, se acompaña de patología psiquiátrica formal que justifica tratamiento

Tricotilomania: revisäo da literatura e relato de caso / Trichotillomania: a review of the literature and a case report

A tricotilomania, impulso irresístivel de arrancar os próprios cabelos, tem sido alvo de crescente atençäo da comunidade psiquiátrica nos últimos anos. Entretanto, informaçöes precisas acerca de sua prevalência, história natural e tratamento säo escassas. Os autores fazem uma revisäo da literatura sobre o tema e apresentam um caso clínico a título de ilustraçäo

Tricotilomania: a propósito de um caso / Trichotillomania: a case report

A tricotilomania é um distúrbio caracterizado pelo hábito que leva um indivíduo a arrancar seus próprios cabelos ou pêlos, repetitivamente. Tal impulso é precedido por uma tensäo antes de agir e uma sensaçäo de gratificaçäo quando arranca. Na literatura, há estudos que buscam a associaçäo de fatores psicológicos com essa afecçäo, tais como conflito sexual, agressäo, fetichismo, ansiedade de separaçäo e objeto transacional. O presente trabalho, desenvolvido a partir da experiência conjunta da Psiquiatria e Dermatologia do Hospital de Clínicas de Porto Alegre, propöe-se, através de revisäo da literatura e ilustraçäo de um caso clíinico, a discutir aspectos emocionais da tricotilomania