When to Choose Paroxetine Treatment in Skin-Picking Disorder: A Case Report

Skin picking disorder (SPD) characterized by repetitive compulsive scratching in the absence of a primary skin disease is strongly associated with psychiatric comorbidities, including obsessive-compulsive disorder (OCD) and depression (MDD). Selective serotonin reuptake inhibitors (SSRIs) have been used in the treatment of SPD with variable success. Nevertheless, the optimum treatment choice for SPD is an issue for clinicians. This case report presents a 32-year-old female SPD patient treated with four-week paroxetine monotherapy. Based upon the clinical interview and standardized questionnaires, the patient was diagnosed with OCD with depressive features and Skin Picking Disorder. In addition to symptom severity scales, quantitative electroencephalography (qEEG) was also applied. Paroxetine treatment was started (titrated from 5 to 40 mg/day) and doubled each week. After four-week paroxetine monotherapy, OCD symptoms were diminished, and skin lesions were completely regressed leaving solely post inflammatory hyperpigmentation. Post-treatment qEEG assessment also showed a normalization of frontal alpha power and amplitude asymmetry. It can be concluded that if OCD includes SPD with abnormal EEG patterns; then the treatment success using paroxetine will be very high.

Natural recovery in trichotillomania

Objectives: Trichotillomania is characterized by repetitive pulling out of one’s hair, leading to distress and/or functional impairment. Long considered a chronic condition if left untreated (albeit with fluctuating intensity), there have been intimations that the disorder may be of limited duration in some people. Methods: A sample of 10,169 adults, aged 18–69 years, representative of the general US population, were recruited and screened for current and lifetime trichotillomania. Potential differences in demographic and clinical variables and lifetime comorbidities, between those with natural recovery from trichotillomania, and those with current trichotillomania, were identified using analysis of variance or likelihood-ratio chi-square tests as appropriate. Additional analyses using binary logistic regression were used to control for potential confounding differences between the groups initially identified. Results: In total, 24.9% of the entire sample of people with lifetime trichotillomania reported that they no longer had symptoms of trichotillomania and had never received therapy or medication treatment for it (i.e. they experienced natural recovery). Those who experienced natural recovery did not differ from those with current trichotillomania in terms of demographic or clinical characteristics, except that they were currently older. Natural recovery was associated with significantly lower rates of related comorbidities: obsessive-compulsive disorder, attention-deficit hyperactivity disorder, panic disorder, skin picking disorder and tic disorder. Discussion: These findings from the first epidemiology study examining natural recovery in trichotillomania highlight the importance of screening for and treating such comorbidities in patients with trichotillomania, in order to maximize chance of clinical recovery.

Nutrition in Skin Picking Disorder and Trichotillomania

Objective: Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Impulsivity and compulsivity have been linked to dietary intake. However, nothing is known about dietary intake and body-focused repetitive behaviors, despite their classification as obsessive-compulsive related conditions, and high co-morbidity with impulsive and compulsive conditions.Methods: One hundred and ninety six adults with trichotillomania or skin picking disorder were recruited. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire. Relationships between dietary fat/sugar intake and behaviors were evaluated using regression modeling.Results: Sugar intake was significantly related to higher trans-diagnostic compulsivity (p = 0.011) and higher non-planning impulsivity (p = 0.013) In terms of saturated fat intake, there was no significant relationship to the explanatory variables. A combination high fat/high sugar diet was significantly associated with higher motor impulsivity (p = 0.005).Conclusions: Past-year nutrition appears to be significantly associated with trans-diagnostic impulsivity and compulsivity. The role of poor nutrition in these disorders and related conditions, and its link with impulsivity and compulsivity, requires longitudinal research attention; and clinical work should address not only psychiatric symptoms but also impact of lifestyle of overall health.