Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis.

Publisher: Wiley Country of Publication: United States NLM ID: 9708816 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1520-6394 (Electronic) Linking ISSN: 10914269 NLM ISO Abbreviation: Depress Anxiety Subsets: MEDLINE

Original Publication: New York, NY : Wiley, c1997-

Trichotillomania*/drug therapy; Acetylcysteine ; Behavior Therapy ; Clomipramine/therapeutic use ; Humans ; Selective Serotonin Reuptake Inhibitors/therapeutic use

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.
(© 2020 Wiley Periodicals LLC.)

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Keywords: N-acetylcysteine; TTM; clinical trials; habit-reversal training; meta-analysis; olanzapine; selective serotonin reuptake inhibitors

0 (Serotonin Uptake Inhibitors)
NUV44L116D (Clomipramine)
WYQ7N0BPYC (Acetylcysteine)

Date Created: 20200512 Date Completed: 20201231 Latest Revision: 20221207

20221213

10.1002/da.23028

32390221