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Yıl:2011; Cilt: 21; Sayı: 3>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2011;21(3):265-274
Trikotillomani: Tanı, farmakoterapive kognitif davranışçı terapisi
R Konkan, Ö Şenormancı, MZ Sungur
Bakırköy Ruh ve Sinir Hastalıkları Hastanesi, İstanbul
Trikotillomani, tekrarlayan saç yolmalar sonucu belirgin saç kaybına yol açan, süregen gidişli, kişinin işlevselliğinin tüm alanlarını olumsuz etkileyen, tedavisi güç bir bozukluktur. Uzun yıllardır bilinmesine rağmen diğer psikiyatrik bozukluklarla karşılaştırıldığında daha az ilgi çekmiştir. Dürtü kontrol bozuklukları tanı kategorisi altında sınışandırılmasına karşın, sınışama konusunda tartışmalar halen devam etmektedir. Trikotillomani, etyolojisi ve tedavisine yönelik çalışmalar son 20 yılda artmıştır. Etyolojik katkıda bulunan etkenler olarak evrimsel, genetik, nörofizyolojik ve nörokognitif faktörler bildirilmiştir. Trikotillomani tedavisi ile ilgili çalışmalar henüz yeterli kanıt düzeyine ulaşmamıştır. Yeterli kanıt olmamasına karşın, etkili tedaviler olarak başta SSRI'lar ve klomipramin olmak üzere antidepresanlarla tedavi ve kognitif davranışçı terapiler bildirilmektedir. Kontrollü çalışmalar sonucunda ağırlıklı olarak 'a lışkanlığı Tersine Çevirme Eğitimi (Habit Reversal Training, HRT)? olmak üzere kognitif ve davranışçı terapiler trikotillomani tedavisinde etkin tedaviler olarak gözükmektedir. Yolma davranışlarının gizlenmesi ya da utanma nedeniyle tedaviye başvurunun sınırlı olması geniş kontrollü çalışmaların yapılabilmesini engellemektedir. Çok merkezli, koordine geniş çalışmalar etyolojinin aydınlatılması, sınışama tartışmalarının sona erdirilmesi, en uygun tedavi yaklaşımları ve algoritmaların geliştirilmesi için gerekmektedir. Bu gözden geçirmede trikotillomani etyolojisi, sınışaması, tedavisi konusunda son gelişmelerin özetlenmesi amaçlanmıştır.
Diagnosis, pharmacotherapy and cognitive behavioral therapy of trichotillomania
Trichotillomania is defined as significant hair loss due to individuals? repetitive self-pulling of hair. It is a chronic disorder that leads to significant distress and functional impairment and is often difficult to treat. Although it has been recognized for a long time, it has attracted less attention from scholars compared to other psychiatric disorders. Despite the fact that it is classified as an impulse control disorder, there is still a debate on how it should be classified. Research regarding etiology and treatment of trichotillomania has increased over last twenty [year]s. It has been mentioned that its etiology is based on evolutional, genetic, neurophysiological and neurocognitive factors. Although robust evidence is not available, drugs such as clomipramine and selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy are promising treatments. Habit Reversal Training (HRT), as a cognitive behavioural technique, has the highest rate of success in treating trichotillomania. However, not revealing the the habit of pulling hair or not coming forward to seek help due to embarrassment is an obstacle to running large scale controlled experiments. A series of multi-centered, coordinated large scale studies are needed to explore the etiology of the disorder, reach an agreement on its classification and defining the best approach and algorithms for the treatment. In this review it is aimed to summarise the latest research and progress in etiology, classification and treatment of trichotillomania.

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