Repetitive Skin Focused Disorders May Express a Functional Connectome
DOI:
https://doi.org/10.17140/SBRPOJ-4-114Keywords:
Onychophagia, Trichotillomania, Delusions of infestations, Human connectome project, Locus coeruleusAbstract
Background
Repetitive skin focused behaviors, such as nail biting, hair pulling, cutting, and others may involve brain regions that participate in visual and tactile awareness, contextual learning and anxiety.
Methods
Gender and age of onset were collected on 78 patients with a repetitive skin focused disorder from a general dermatology clinic between 2014-2018. The disorders included onychophagia (nail biting), trichotillomania (hair pulling), cutting, pathologic skin picking, acne excoriée (popping pimples) and delusions of infestations.
Results
Sixty/Seventy-eight, (77%) of the patients were female. Onychophagia, trichotillomania, and cutting emerged during key develop mental milestones, such as adrenarche and pubarche. The 17 patients with delusions of infestations were middle-aged, between 52-66. Five/Seventy-eight (6%) attempted suicide, all female, three successfully.
Conclusions
Repetitive skin focused behaviors may reflect potentiation in neural circuits that participate in contextual processing, tactile and visual awareness. Trends emerged in gender predominance and age of onset. These disorders may have clinical utility in two key areas, emotional regulation in teenagers and drug toxicity in adults.
Trial Registration
UMKC IRB 16-464.
References
Patel V, Flisher A, Hetrick S, McGorry P. Mental health of young people: A global public-health challenge. Lancet. 2007; 369(9569): 1302-1313. doi: 10.1016/S0140-6736(07)60368-7
Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Meas-urement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clin Psychol Rev. 2018; 62: 56-70. doi: 10.1016/j.cpr.2018.05.002
Horowitz LM, Wang PS, Koocher GP, et al. Detecting suicide risk in a pediatric emergency department: Development of a brief screening tool. Pediatrics. 2001; 107(5): 1133-1137.
Cappelli M, Gray C, Zemek R, et al. The HEADS-ED: A rapid mental health screening tool for pediatric patients in the emergen-cy department. Pediatrics. 2012; 130(2): e321-e327. doi: 10.1542/ peds.2011-3798
Ballard ED, Cwik M, Van Eck K, et al. Identification of at-risk youth by suicide screening in a pediatric emergency department. Prev Sci. 2017; 18(2): 174-182. doi: 10.1007/s11121-016-0717-5
Zbozinek T, Rose R, Wolitzky-Taylor K. Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a pri-mary care sample. Depress Anxiety. 2012; 29(12): 1065-1071. doi: 10.1002/da.22026
Masten AS. Adolescent Psychopathology and the Developing Brain. Inte-grating Brain and Prevention Science. Romer D, Walker EF (Eds). New York, USA: Oxford University Press. 2007.
Gershon RC, Cella D, Fox NA, Havlik RJ, Hendrie HC, Wag-ster MV. Assessment of neurological and behavioural function: the NIH Toolbox. Lancet Neurol. 2010; 9(2): 138-139. doi: 10.1016/ S1474-4422(09)70335-7
Sareen J, Cox B, Afifi T, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitu-dinal study of adults. Arch Gen Psychiatry. 2005; 62(11): 1249-1257. doi: 10.1001/archpsyc.62.11.1249
Singh H, Graber ML. Improving diagnosis in health care-the next imperative for patient safety. N Engl J Med. 2015; 373(26): 2493-2495. doi: 10.1056/NEJMp1512241
Lahti A, Harju A, Hakko H, Riala K, Räsänen P. Suicide in chil-dren and young adolescents: A 25-year database on suicides from Northern Finland. J Psychiatr Res. 2014; 58: 123-128. doi: 10.1016/j. jpsychires.2014.07.020
Kim H, Lim C, Kaang B. Neuronal mechanisms and circuits underlying repetitive behaviors in mouse models of autism spec-trum disorder. Behav Brain Funct. 2016; 12(1): 3. doi: 10.1186/ Original Research | Volume 4 | Number 1| Reisz CM s12993-016-0087-y
Zike I, Xu T, Hong N, Veenstra-VanderWeele J. Rodent mod-els of obsessive-compulsivedisorder: Evaluating validity to inter-pret emerging neurobiology. Neuroscience. 2017; 345: 256-273. doi: 10.1016/j.neuroscience.2016.09.012
Ricketts EJ, Snorrason Í, Kircanski K, et al. A latent profile analysis of age of onset in pathological skin picking. Compr Psychia-try. 2018; 87: 46-52. doi: 10.1016/j.comppsych.2018.08.011
Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: Neurobiology and treatment. Neu-rosci Biobehav Rev. 2009; 33(6): 831-842. doi: 10.1016/j.neubior-ev.2009.02.002
Zetterqvist M. The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child Adolesc Psychia-try Ment Health. 2015; 9: 31. doi: 10.1186%2Fs13034-015-0062-7
Flessner C, Knopik V, McGeary J. Hair pulling disorder (tricho-tillomania): Genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Res. 2012; 199(3): 151-158. doi: 10.1016/j.psychres.2012.03.039
Fox MD. Mapping symptoms to brain networks with the Human Connectome. N Engl J Med. 2018; 379: 2237-2245. doi: 10.1056/NEJMra1706158
Glasser MF, Coalson TS, Robinson EC, et al. A multi-mod-al parcellation of human cerebral cortex. Nature. 2016 Aug 11;536(7615):171-178. doi: 10.1038/nature18933
Gardner D, Akil H, Ascoli G, et al. The neuroscience informa-tion framework: A data and knowledge environment for neurosci-ence. Neuroinformatics. 2008; 6(3): 149-160. doi: 10.1007/s12021- 008-9024-z
Lijie Wang, Jinping Xu, Chao Wang,Jiaojian Wang. Whole brain functional connectivity pattern homogeneity mapping. Front Hum Neurosci. 2018; 12: 164. doi: 10.3389/fnhum.2018.00164
LeDoux JE. Emotion circuits in the brain. Annu Rev Neurosci. 2000; 23: 155-184. doi: 10.1146/annurev.neuro.23.1.155
Romer D, Reyna VF, Satterthwaite TD. Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in develop-mental context. Dev Cogn Neurosci. 2017; 27: 19-34. doi: 10.1016/j. dcn.2017.07.007
Consortium B, Anttila V, Bulik-Sullivan B, et al. Analysis of shared heritability in common disorders of the brain. Science. 2018; 360(6395). doi: 10.1126/science.aap8757
Frey U, Morris RG. Synaptic tagging and long-term potentia-tion. Nature. 1997; 385: 533-538. doi: 10.1038/385533a0
Douglas RM, Goddard GV. Long-term potentiation of the perforant path-granule cell synapse in the rat hippocampus. Brain Res. 1975; 86(2): 205-215.
Guo-li Ming, Hongjun Song. Adult neurogenesis in the mam-malian brain: Significant answers and significant questions. Neuron. 2011; 70(4): 687-702. doi: 10.1016/j.neuron.2011.05.001
Kay LM, Beshel J, Brea J, Martin C, Rojas-Líbano D, Kopell N. Olfactory oscillations: The what, how and what for. Trends Neurosci. 2009; 32(4): 207-214. doi: 10.1016/j.tins.2008.11.008
Malvaut S, Saghatelyan A. The role of adult-born neurons in the constantly changing olfactory bulb network. Neural Plasticity. 2016; 1614329. doi: 10.1155/2016/1614329
Fukunaga I, Berning M, Kollo M, Schmaltz A, Schaefer AJ. Two distinct channels of olfactory bulb output. Neuron. 2012; 75(2): 320-329. doi: 10.1016/j.neuron.2012.05.017
Schwarz LA, Luo L. Organization of the locus coeruleus-nor-epinephrine system. Curr. Biol. 2015; 25: R1051-R1056. doi: 10.1016/j.cub.2015.09.039
Carlson NR, Birkett MA. Physiology of Behavior. New Jersey, USA: Pearson Education, Inc. 2017; 559-576.
Vietl D. Interoception. Biological Psychology. 1996; 42(1-2): 1-27. doi: 10.1016/0301-0511(95)05144-9
Dalton KM, Nacewicz BM, Johnstone T, et al. Gaze fixation and the neural circuitry of face processing in autism. Nat Neurosci. 2005; 8(4): 519-526. doi: 10.1038/nn1421
Gilzenrat MS, Nieuwenhuis S, Jepma M, Cohen JD. Pupil diam-eter tracks changes in control state predicted by the adaptive gain theory of locus coeruleus function. Cogn Affect Behav Neurosci. 2010; 10(2): 252-269. doi: 10.3758/CABN.10.2.252
Thorell LH, Wolfersdorf M, Straub R, et al. Electrodermal hy-poreactivity as a trait marker for suicidal propensity in uni- and bipolar depression. J Psychiatr Res. 2013; 47(12): 1925-1931. doi: 10.1016/j.jpsychires.2013.08.017
Sarchiapone M, Gramaglia C, Iossue, et al. The association be-tween electrodermal activity (EDA), depression and suicidal be-haviour: A systematic review and narrative synthesis. BMC Psychia-try. 2018; 18(1): 22. doi: 10.1186/s12888-017-1551-4
Moretta T, Buodo G. Autonomic stress reactivity and craving in individuals with problematic internet use. PLoS One. 2018; 13(1): e0190951. doi: 10.1371/journal.pone.0190951 6 Reisz CM
Wang P, Gao Y, Isen J, Tuvblad C, Raine A, Baker LA. Genetic covariance between psychopathic traits and anticipatory skin con-ductance responses to threat: Evidence for a potential endopheno-type. Dev Psychopathol. 2015; 27(4 Pt 1): 1313- 1322. doi: 10.1017/ S0954579414001424
Sudol K, Mann JJ. Biomarkers of suicide attempt behavior: Towards a biological model of risk. Curr Psychiatry Rep. 2017; 19(6): 31. doi: 10.1007/s11920-017-0781-y
Eippert F, Veit R, Weiskopf N, Erb M, Birbaumer N, Anders S. Regulation of emotional responses elicited by threat-related stimu-li. Hum Brain Mapp. 2007; 28(5): 409-423. doi: 10.1002/hbm.20291
Suominen K, Isometsä E, Martunnen M, Ostamo A, Lönnqvist J. Health care contacts before and after attempted suicide among adolescent and young adult versus older suicide attempters. Psychol Med. 2004; 34(2): 313-321
Klebold S, Soloman A. A Mother’s Reckoning: Living in the After-math of Tragedy. New York, USA: Broadway Books. 2016.
Combi C, Keravnou-Papailiou E, Shahar Y. Temporal Information Systems in Medicine. New York, USA: Springer. 2010; 249-297.
Cahill L. Why sex matters for neuroscience. Nat Rev Neurosci. 2006; 7(6): 477-484. doi: 10.1038/nrn1909
Barth C, Villringer A, Sacher J. Sex hormones affect neuro-transmitters and shape the adult female brain during hormo-nal transition periods. Front Neurosci. 2015; 9:37. doi: 10.3389/ fnins.2015.00037
Nielsen SE, Ertman N, Lakhani YS, Cahill L. Hormonal con-traception usage is associated with altered memory for an emotion-al story. Neurobiology of learning and memory. 2011; 96(2): 378-384. doi: 10.1016/j.nlm.2011.06.013
van Wingen GA, van Broekhoven F, Verkes RJ, et al. Progester-one selectively increases amygdala reactivity in women. Mol Psychia-try. 2008; 13(3): 325-333. doi: 10.1038/sj.mp.4002030
Ingalhalikar M, Smith A, Parker D, et al. Sex differences in the structural connectome of the human brain. Proc Natl Acad Sci U S A. 2014; 111(2): 823-828. doi: 10.1073/pnas.1316909110
Bixo M, Johansson M, Timby E, Michalski L, Bäckström T. Ef-fects of GABA active steroids in the female brain with a focus on the premenstrual dysphoric disorder. J Neuroendocrinol. 2018; 30(2). doi: 10.1111/jne.12553
Karpinski M, Mattina G, Steiner M. Effect of gonadal hor-mones on neurotransmitters implicated in the pathophysiology of obsessive-compulsive disorder: A critical review. Neuroendocrinology. 2017; 105(1): 1-16. doi: 10.1159/000453664 Original Research | Volume 4 | Number 1|
Altemus M, Sarvaiya, N, Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014; 35(3): 320-330. doi: 10.1016/j.yfrne.2014.05.004
Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2009; 48(3): 143-157. doi: 10.2165/00003088-200948030-00001
Miller MA. Gender-Based Differences in the toxicity of phar-maceuticals—The food and drug administration's perspective. Int J Toxicol. 200; 20(3): 149-152. doi: 10.1080/109158101317097728
Reisz C. Recognizing off target drug effects at the gut and brain. Neurosci Commun. 2016; e1315. doi: 10.14800/nc.1315
Ropper AH, Brown RH. Chapter 4. Abnormalities of Move-ment and Posture Caused by Disease of the Basal Ganglia. Adam and Victor’s Principles of Neurology. New York, USA: McGraw Hill. 2005; 55-70.
Ropper AH, Brown RH. Chapter 43. Disorders of the Nervous System due to Drugs, Toxins and other Chemical Agents. Adam and Victor’s Principles of Neurology. New York, USA: McGraw Hill. 2005; 1016-1045.
Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events: Implications for preven-tion. JAMA. 1995; 274(1): 29-34.
Weingart SN, Gandhi TK, Seger AC, et al. Patient-report-ed medication symptoms in primary care. Arch Intern Med. 2005; 165(2): 234-240. doi: 10.1001/archinte.165.2.234
Qato DM, Ozenberger K, Olfson M. Prevalence of prescrip-tion medications with depression as a potential adverse effect among adults in the United States. JAMA. 2018; 319(22): 2289- Submit your article to this journal | https://openventio.org/submit-manuscript/ Original Research | Volume 4 | Number 1| Reisz CM 2298. doi: 10.1001/jama.2018.6741
Ioannidis JP, Lau J. Completeness of safety reporting in ran-domized trials: An evaluation of 7 medical areas. JAMA. 2001; 285(4): 437-443.
de Aguiar Vallim TQ, Tarling EJ, Edwards PA. Pleiotropic roles of bile acids in metabolism. Cell Metab. 2013; 17(5): 657-669. doi: 10.1016/j.cmet.2013.03.013
Cordon-Cardo C, O'Brien JP, Boccia J, Casals D, Bertino JR, Melamed MR. Expression of the multidrug resistance gene prod-uct (P-glycoprotein) in human normal and tumor tissues. J Histo-chem Cytochem. 1990; 38(9): 1277-1287. doi: 10.1177/38.9.1974900
Grall-Bronnec M, Victorri-Vigneau C, Donnio Y, et al. Dopa-mine agonists and impulse control disorders: A complex associa-tion. Drug Saf. 2018; 41(1): 19-75. doi: 10.1007/s40264-017-0590-
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17(1): 230. doi: 10.1186/s12877-017-0621-2
Insel T, Cuthbert B, Garvey M, et al. Research domain crite-ria (RDoC): Toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167(7): 748-751. doi: 10.1176/appi.ajp.2010.09091379
Lilienfeld S, Treadway M. Clashing diagnostic approaches: DSM-ICD Versus RDoC. Annu Rev Clin Psychol. 2016; 12: 435-463. doi: 10.1146/annurev-clinpsy-021815-093122
Szabadi E. Functional neuroanatomy of the central noradr-energic system. J Psychopharmacol. 2013; 27(8): 659-693. doi: 10.1177/0269881113490326
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