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Case Report Volume 9 Issue 2
N-Acetyl cysteine use in trichotillomania: dramatic improvement in two children
Sevcan Karakoç Demirkaya,
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Nevzat Yılmaz, Hatice Aksu, Hacer Demir
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Child and Adolescent Psychiatry, Adnan Menderes University School of Medicine, Turkey
Correspondence: Sevcan Karakoç Demirkaya, Child and Adolescent Psychiatry, Adnan Menderes University School of Medicine, Aydin, Turkey
Received: May 25, 2017 | Published: April 19, 2019
Citation: Yilmaz N, Demirkaya SK, Aksu H, et al. N-Acetyl cysteine use in trichotillomania: dramatic improvement in two children. J Neurol Stroke. 2019;9(2):96. DOI: 10.15406/jnsk.2019.09.00355
Abstract
N-Acetyl cysteine (NAC) has been increasingly used for several psychiatric conditions such as autism spectrum disorders, obsessive compulsive disorder, hoarding disorder etc. Here we report two cases with diagnosis of trichotillomania who had been treated with NAC successfully.
Introductıon
Trichotillomania is in the class of ''Obsessive-Compulsive Disorder (OCD) and Associated Disorders” in DSM-51 and characterized by repetetive hair pulling resulting in hair loss. N-acetylcysteine (NAC) is a precursor to the aminoacid cysteine, a modulator of the glutamatergic system and has role in oxidative stress.2 It has been shown that NAC is effective in various psychiatric problems especially in OCD and related disorders.2–5 Here we report two cases with trichotillomania who were treated with NAC successfully.
Case reports
Our first case was a 11-year-old girl with symptoms of eyebrow and eyelash picking for six months. After 3months of treatment wth risperidone (2,5mg/day) and fluoxetine (20mg/day) due to side-effects and low compliance NAC 600 mg/day monotherapy was started. The maintenance NAC dose was 1200mg/day. Her baseline and 2-months duration endpoint Clinical Global impression scale disease severity (CGI-S) score was 5 (markedly ill) and 1 (Normal, not at all ill) respectively.
Our second case was a 16-year-old male patient with complaints of hair pulling for 2months. Due to experience adverse effects with fluoxetine 20mg/day NAC (600mg/day) was started as a monotherapy. The maintenance NAC dose was 1200mg/day. His baseline CGI-S score was 5. After 2months of NAC treatment, final score was 2 (borderline ill). Both of the cases responded well without any adverse effect.
Conclusıon
Although a recent study in pediatric trichotillomania, NAC showed no superiority over placebo in a randomized controlled add-on- trial;2 symptom reductions are reported with NAC use pediatric case reports.6,7 Our cases tolerated and responded well to NAC monotherapy. This report shows that NAC may be a safe choice in treatment of pediatric trichotillomania. Pharmacologic modulation of the glutamate system may prove to be useful in the control of other obsessive compulsive and related behaviors.
Acknowledgements
None.
Conflict of interest
Author declare thier is no conflicts of interestowards the artilce.
References
- Diagnostic and Statistical Manual of Mental Disorders. 5th edn, Washington: American Psychiatric Association; 2013.
- Berk M, Malhi GS, Gray LJ, et al. The promise of N-acetylcysteine in neuropsychiatry. Trends Pharmacol Sci. 2013;34(3):167–177.
- Afshar H, Roohafza H, Mohammad-Beigi H, et al. N-acetylcysteine add-on treatment in refractory obsessive-compulsive disorder: a randomized, double-blind, placebo controlled trial. J Clin Psychopharmacol. 2012;32(6):797–803.
- Ghanizadeh A, Derakhshan N, Berk M. N-acetylcysteine versus placebo for treating nail biting, a double blind randomized placebo controlled clinical trial. Antiinflamm Antiallergy Agents Med Chem. 2013;12(3):223–228.
- Grant JE, Odlaug BL, KimSW. N-acetylcysteine, a glutamatemodulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009;66(7):756–763.
- Bloch MH, Panza KE, Grant JE, et al. N-Acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-on trial. J Am Acad Child Adolesc Psychiatry. 2013;52(3):231–240.
- Rodrigues-Barata AR, Tosti A, Rodríguez-Pichardo A, et al. N-acetylcysteine in the Treatment of Trichotillomania. Int J Trichology. 2012;4(3):176–178.
©2019 Yilmaz, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.