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Note:
June 24-25, 2019 | Philadelphia, USA
Mental Health 2019 Journal of Mental Health and Aging | Volume 3
Page 25
PSYCHIATRY DISORDERS, MENTAL
HEALTH ANDWELLNESS
World Summit on
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
HUNGRY AND STRESSED? TAKE A MOUTHFUL OF THIS AWFUL DELICACY
Durva Balkrishna Sail, Babhulkar S, Kadam K, Thakur S S, Umrajkar H and Kulkarni P S
B J Medical College and Sassoon General Hospital, India
Background: Trichotillomania has a prevalence of 0.6%–1.6% with a strong female predilection and typically
affecting patients in childhood and adolescence mainly. Approximately 30% of patients who suffer from tricho-
tillomania also engage in trichophagia. Some studies have reported a 25%-37.5% prevalence of trichobezoar
in those who engage in trichophagy. If trichobezoars may continue to grow past the pylorus, the situation is
called Rapunzel syndrome which was first described by Vaughan et. al in 1968. It is found that many of the pa-
tients have psychiatric pathology such as emotional problems, family discord and history of neglect or mental
retardation. Hence psychiatric intervention is an important part of management to prevent recurrence.
Case: A 13 years old female child referred to psychiatry from surgery in view of trichobezoar. On detailed eval-
uation, she reported that she experiences anxiety features in the form of worrying thoughts and palpitations
following stressor in the form of domestic violence and physical abuse at hostel. Following this she started
experiencing persistent pervasive low mood, anhedonia, irritability, decreased appetite and easy fatigability.
In response to her anxiety she started plucking her hair and used to eat them to relieve it. During course of
illness her school performance also deteriorated. Diagnosis of childhood depression was made and patient
was started on Tab. Sertraline 25mg which was up titrated to 37.5mg and she is maintained well on same. X-ray
abdomen, USG abdomen, CT abdomen was done S/O Rapunzel syndrome and was operated for same.
Conclusion: Childhood depression with concomitant anxiety may present as trichotillomania as an attempt to
alleviate the mounting anxiety by hair pulling. So, attempt should be made to rule out co morbid depression
in cases presenting as trichotillomania.
Durva Balkrishna Sail is a Resident Doctor in Department of Psychiatry at BJ Government Medical College and Sassoon General
Hospital, India. She was graduated from Topiwala National Medical College and BYL Nair Hospital Mumbai at the age of 23 years.
She has published her original research paper inJournal of Evidence BasedMedicine and presented poster at 44th Annual Conference
of Research Society BJGMC, Pune. She has presented the topic titled “Minor physical anomalies in depression” for A V Shah award
at Annual West Zone conference. She has presented the topic titled “Atypical Kliene Levin syndrome” for Professor M Murrugappan
award at Annual National conference of Indian Psychiatric Society. She was selected as ADMO at Indian Railways.
BIOGRAPHY
Durva Balkrishna Sail et al., J Ment Health Aging 2019, Volume 3