RESUMO
BACKGROUND: Trichotillomania (TTM) is a difficult-to-treat psychiatric condition with no first-line medications approved by the Food and Drug Administration. Individuals with TTM often feel that clinicians know little about this disorder. Here, we present an updated meta-analysis of randomized controlled trials (RCTs) examining treatments for TTM. METHODS: Pubmed, PsychINFO, Embase, and CENTRAL were searched with the terms "Trichotillomania OR Hair Pulling Disorder" to identify randomized controlled clinical trials evaluating treatments for TTM. RESULTS: Twenty-four trials involving 26 comparisons and 857 participants were included in this meta-analysis. Behavioral therapy with habit-reversal training components (BT-HRT) demonstrated a large benefit compared to control conditions (standardized mean difference [SMD] [95% CI] = -1.22 [-1.71, -0.73], p < .0001) for improving TTM symptoms. Clomipramine (SMD [95% CI] = -0.71 [-1.38, -0.05], p = .036), N-acetylcysteine (SMD [95% CI] = -0.75 [-1.36, -0.13], p = .017) and olanzapine (SMD [95% CI] = -0.94 [-1.77, -0.12], p = .025) demonstrated significant benefits compared to placebo in RCTs. CONCLUSIONS: BT-HRT has demonstrated the largest treatment effects and has the strongest evidence base for reducing TTM symptoms. In contrast, several pharmacological agents have demonstrated efficacy in single randomized clinical trials that would benefit from replication. Additional trials are needed to identify other effective medications for TTM and determine the relative efficacy of available agents.
Assuntos
Tricotilomania , Acetilcisteína , Terapia Comportamental , Clomipramina/uso terapêutico , Humanos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tricotilomania/tratamento farmacológicoRESUMO
The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.
Assuntos
Aconselhamento , Músculos da Mastigação/fisiopatologia , Mialgia/reabilitação , Autocuidado , Síndrome da Disfunção da Articulação Temporomandibular/reabilitação , Adolescente , Adulto , Idoso , Dor Facial/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Adulto JovemRESUMO
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.(AU)
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.(AU)
Assuntos
Humanos , Feminino , Adulto Jovem , Tricotilomania/psicologia , Terapia Comportamental/métodosRESUMO
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.