TLC has embarked on an ambitious international collaborative research project to collect clinical and genetic data from people with trichotillomania and related disorders, and their families. The goal of the Consortium is to better understand the underlying risk factors contributing to the expression of trichotillomania. The data collected by conducting in-person interviews with subjects will also validate the results of the TLC Trichotillomania Impact Project (TIP), which was conducted through an internet survey.
TLC believes fostering collaboration is the best way to promote progress in this field. The project will create a repository of genetic information (blood samples, DNA and cell lines) and clinical data (in-depth interviews) which can be used by researchers worldwide, now and in the future, to examine the underlying causes of trichotillomania and related disorders.
Dr. David Paul's laboratory in the Psychiatric and Neurodevelopmental Genetics Unit (PNGU) in the Center for Human Genetic Research at the Massachusetts General Hospital will be the coordinating site for data collection and management. Access to the data and DNA included in the Repository will be available to all contributors and other qualified investigators in the larger scientific community.
The Pilot Study for this Consortium was successfully led by Nancy Keuthen, Ph.D. and David Pauls, Ph.D. Our thanks to Drs. Keuthen and Pauls, all the members of our Scientific Advisory Board who advised on the process, and to all the members of the trich community who participated. TLCâ€™s Scientific Advisory Board has a long history of collegial, collaborative work, which set the stage for this new, much larger-scale project. We look forward to launching new blood & data collection sites in the coming year. (We will keep you posted!)
2012 Research Grant Program:
Funded Projects and Progress Reports
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2012 Grant Award Recipients
TLC grants have supported efforts to better understand the phenomenology of hair pulling and skin picking; to investigate the neurology and genetics of these disorders; and to develop new treatment options from Acceptance and Commitment Therapy to computerized cognitive training to N-acetylcysteine.
Our goal was to double the size of this program by 2013. I am delighted to announce that thanks to your support and a generous donation by a TLC member, we have reached that goal a year early and will be funding two important studies this year:
Translational Study of Cognition in Adults with Trichotillomania and Unaffected First-Degree Relatives using Functional Neuroimaging
Brian L. Odlaug, MPH
PhD Candidate, Visiting research at the University of Chicago
Samuel R. Chamberlain, MD, PhD
Senior Visiting Clinical Research, Research Fellow
Department of Psychiatry , University of Cambridge
TLC is pleased to award Mr. Brian Odlaug (University of Chicago) and Dr. Samuel Chamberlain (Cambridge University) a TLC Research Grant to study cognitive testing during brain imaging (known as functional imaging) in an effort to better understand the state versus trait nature of neurobiological changes in trichotillomania. There is an ongoing search in psychiatry for models of the neurobiological circuitry implicated in given disorders. Whether or not trichotillomania is associated with subtle changes in brain function (as opposed to structure) is not yet established and although functional imaging has been used, with considerable success, to identify biological markers in other impulsive-compulsive disorders (such as Obsessive Compulsive Disorder), there is a paucity of functional imaging studies in trichotillomania.
Furthermore, no studies to date have examined brain activation in unaffected first-degree relatives of individuals with trichotillomania â€“ a vital first step in the detection of trait biological markers that may shed important light on the genetic underpinnings of such behaviors. Understanding whether differences in brain functioning exist between individuals with TTM, first-degree relatives and a sample of healthy controls may aid in the development of new treatments for trichotillomania and other body-focused repetitive behaviors such as skin picking disorder.
The hypothesis to be tested is that trichotillomania subjects and unaffected first-degree relatives of trichotillomania subjects will show under-activation of brain regions during cognitive tests when compared to controls with no known family history of the condition. The study will examine a total of 36 individuals: twelve with trichotillomania, twelve unaffected first-degree relatives of those subjects with trichotillomania, and twelve matched healthy controls with no known family history of trichotillomania or body-focused repetitive behaviors.
Interested in Learning More?
This study will be conducted at the University of Chicago and will involve one 3-hour visit where the individual with TTM and the first-degree family member would come in together. Compensation will be provided for your time although travel to the study center from outside of the Chicago area will not. If you are interested in learning more, please contact Brian directly at firstname.lastname@example.org.
Tara S. Peris, PhD
Assistant Professor, Dept. of Psychiatry & Biobehavioral Sciences Child OCD, Anxiety and Tic Disorders Program
Semel Institute for Neuroscience & Human Behavior
University of California, Los Angeles
This study examines the effects of behavior therapy (BT) on the brains of children with TTM. Behavior therapy is a specific type of treatment that teaches children to become more aware of their hair pulling and the urges that surround it and to develop alternative strategies for responding. Studies show that BT can be very effective for youth with trichotillomania; however, many questions remain. Most importantly, although we know that BT works to reduce symptoms of TTM, we still don't know how or why it helps youngsters to get better. Understanding what happens to make treatment successful is important because it informs our understanding of TTM and tells us what can be done to address it most effectively.
This study uses magnetic resonance spectroscopy imaging (MRSI) to learn more about the regions of the brain that are involved in pediatric TTM and to examine whether these regions change following a course of behavior therapy. Our hope is that findings from this work will teach us about the underlying biology of pediatric TTM, how treatment works to get kids better, and what can be done to develop new and improved interventions.
Amy Lossie, PhD
Assistant Professor, Dept of Animal Science, Purdue University
Adjunct Assistant Professor, Department of Medicine
Indiana University School of Medicine
Dr. Lossie's study, in partnership with Dr. Joseph Garner, TLC Scientific Advisory Board member, and Giovana Vieira, a Fullbright Scholar PhD student, explores the â€˜how and whyâ€™ behind Dr. Jon Grantâ€™s exciting independent research studies demonstrating the efficacy of N-acetylcysteine (NAC) for treating the symptoms of Trichotillomania in adults.
Dr. Lossieâ€™s project focuses on two goals: 1) Identifying how NAC works in the brain to treat symptoms of TTM, and 2.) Developing potential blood - and urine - based tests, called biomarkers, that could lead to screens that predict risk for developing TTM, as well as help in the identification, diagnosis, and personalized treatment of individuals with TTM.
"It has been quite an exciting year for us, as our TLC-sponsored research has yielded promising new insights into the mechanisms of Trich," reports Lossie. The research team has made some preliminary breakthroughs that strongly suggest that oxidative stress plays a major role in the development of barbering (a model of trich) in mice.
Update: N-Acetylcysteine for the Treatment of TTM in Children
Principal Investigators: Michael H. Bloch MD, MS
Clinical Research Coordinator: Kaitlyn E. Panza, BA
Funded by 2009 Grant Cycle
Preliminary results of this study were presented at the 2012 TLC Conference. Thirty-nine children with trichotillomania were randomized to NAC or placebo. We found that NAC was not more effective than placebo in treating the symptoms of pediatric trichotillomania. However, we found that children in both the placebo and NAC groups significantly improved during the course of the 12-week trial. Additionally, side-effects from NAC treatment were similar to that observed in placebo. However, one child had an allergic reaction to the active NAC tablets.
This trial highlights the need to focus on understanding the developmental and clinical course of this condition in children. Specifically, longitudinal studies examining the likelihood of children remitting over time are critical to properly understanding, treating and researching this condition. It also emphasizes the importance of referring children with TTM to appropriate behavioral therapy, which has been shown to be effective in children, before initiating any pharmacological interventions.
Update: Computerized Cognitive Training Programs for TTM
Han Joo Lee, PhD
Assistant Professor, Department of Psychology
University of Wisconsin-Milwaukee
This study aims to examine the feasibility of a computerized treatment that specifically targets poor response inhibition, which is suspected to be an important cognitive deficit underlying trich. To this end, young individuals aged between 12 and 17 with TTM have been randomly assigned to the response inhibition training condition (RIT) vs. a waitlist condition (WLT). Participants in the RIT condition receive eight 30-min training sessions over a 4-week period and are assessed at three time points (baseline, post-treatment, and 1-month follow-up). Participants in the WLT condition are assessed at baseline and after a 1-month waiting period, and they are also invited to receive the RIT after completing the study procedure for replication purposes.
Upon establishing efficacy, the computerized treatment may be easily integrated into various contexts. For example, as an adjunctive intervention to existing behavioral and/or pharmacological treatments, an instrument to identify and help at-risk individuals for preventative training, a stand-alone short-term intervention, and/or a remote web-based self-help intervention.
Currently, a total of 13 participants have completed the study and there are four potential participants who are being evaluated for participation. Participants have responded to the RIT intervention without reports of any adverse events. Please contact the Han Joo Lee, PhD, with inquiries or referrals of potential participants: (414) 229-5858 or TrichStudy@gmail.com.
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