CLINICAL PERSPECTIVES. CLINICAL CASE ROUNDS IN CHILD AND ADOLESCENT PSYCHIATRY Trichotillomania, Bipolar Disorder and White Matter Hyperintensities in a Six-Year Old Girl

Olza-Fernández et al A six-year-old girl was referred to our child psychiatry outpatient clinic by the Pediatric Neurology Unit with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) and trichotillomania. She had neither eyebrows nor eyelashes. The clinical picture was of irritability, frequent tantrums, and aggressive behaviour. During the following year she presented several brief episodes of intense mood changes, which typically started with night-time onset trichotillomania and sleep disturbance. The episodes lasted no longer than five days and recurred within one or two months. A diagnosis of pediatric bipolar disorder (BD) was made after the first months of clinical follow-up. An MRI showed focal white matter hyperintensities (WMH) in T2. Key Words: Trichotillomania, pediatric bipolar disorder, white matter hyperintensities A six-year-old girl was referred to our child psychia-try outpatient clinic by the Pediatric Neurology Unit with a diagnosis of ADHD and trichotillomania. She had no family history of mental illness other than a maternal uncle who had suffered from alcoholism. The older of two siblings, she had a normal developmental history and lived with her parents and a four-year-old brother. Both parent