Journal Article Annotations
2017, 4th Quarter
Annotations by J. Jewel Shim, MD, FAPM
Also of interest:
This paper reviews the literature on the use of antidepressants as mono or adjuvant therapy in inflammatory skin diseases, including psoriasis, atopic dermatitis, and alopecia areata. The cite inflammation as a common factor to both depressive disorders and inflammatory skin diseases. In 26/29 reviewed studies skin lesions improved with the use of an antidepressant (TCA, MAOI, SSRI, mirtazapine, bupropion). However, in greater than 50% of these studies, psychiatric disorders were not assessed. Interestingly, in the studies that evaluated depressive symptoms, improvement in skin problems occurred much sooner than did the mood symptoms, suggesting the direct anti-inflammatory effects of the antidepressant was separate than improvements that may have occurred as a result of the alleviation of depression symptoms.
Type of study: Cohort study
The finding: Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18-65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. 7.2% (N=40) of our TTM subjects met criteria for an ED in their lifetime. In univariable regression analysis, obsessive-compulsive disorder (OCD), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) worst-ever compulsion and total scores, certain obsessive-compulsive spectrum disorders, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and substance disorder all met the pre-specified criteria for inclusion in the multivariable analysis. In the final multivariable model, diagnosis of OCD (OR: 5.68, 95% CI: 2.2-15.0) and diagnosis of an additional body-focused repetitive behavior disorder (BFRB) (OR: 2.69, 95% CI: 1.1-6.8) were both associated with increased risk of ED in TTM. Overall, our results provide further support of the relatedness between ED and TTM. This finding highlights the importance of assessing for comorbid OCD and additional BFRBs in those with TTM. Future research is needed to identify additional predictors of comorbid disorders and to better understand the complex relationships between BFRBs, OCD and EDs.
Strength and weaknesses: Strengths include a large sample size and consideration of multiple disorders with overlapping clinical and neurobiological features. Weakness are that the sample size was comprised exclusively of adult women, there were differences in exclusion criteria and different measures were used and across the study sites, and different ED were not distinguished from each other (i.e., anorexia vs. bulimia vs. binge eating disorder). These weaknesses limit the generalizability of the study results.
Relevance: Increased awareness of the potential comorbidity of ED in patients with TTM is important as such patients may not readily disclose these symptoms. The presence of a concurrent ED may increase the risk for adverse outcomes in patients with TTM such as poorer medical outcomes, higher rates of mood and anxiety symptoms, as well as higher rates of suicide.