Onychotillomania in the course of depression: a case report.

Onychotillomania is a form of self-induced damage of nails which results from recurrent picking and manicuring (using different tools, e.g. scissors or toothpicks) of fingernails and/or toenails causing visual shortening and/ or distraction of nails (1–3). Onychotillomania should be distinguished from onychophagia which represents another form of self-induced damage of nails caused by nail-biting. The knowledge about onychotillomania is still only based on few case reports. Coexistence of onychotillomania with depression or delusional disorder has been already reported in the past (2, 4, 5). In such cases onychotillomania was described as a compulsion or a behaviour motivated by delusions (2, 4, 5). On the other hand, onychotillomania was also reported in subjects without any other comorbidity of mental disorders, suggesting that in selected individuals it could also be a sole psychiatric problem (6, 7). To the best of our knowledge, epidemiological data about onychotillomania are very limited. In our recent study including a group of 339 medical students in Poland we found onychotillomania in 3 participants (2 females and 1 male; prevalence: 0.9%) (8). In both women specific phobia was diagnosed (8). Comparing to onychophagia, onychotillomania occurred about 50 times less frequently. Due to its rarity, onychotillomania has not been studied in respect to comorbidities and treatment. To provide more data on this nail problem, we demonstrate a patient with onychotillomania occurring during depressive episodes. A 60-year-old man with the diagnosis of recurrent de-pressive disorder over the past 6 years was admitted to the psychiatric ward because of depressive symptoms with suicide thoughts. He had experienced 6 depressive episodes within the last 6 years. Depressive episodes had occurred every year, and usually lasted about 4 to 6 months. Previously he had been hospitalised 4 times and successfully treated with antidepressive medications. No alcohol or drug abuse was stated, as well as no family history of mental disorders found. Psychiatric examination confirmed the diagnosis of recurrent depressive disorder with the presence of a moderate depressive episode according to the ICD 10 diagnostic criteria (The ICD-10 Classification of Mental and Behavioural Disorders) (9). He had no psychotic symptoms, delusions or hallucinations. His initial 17-items Hamilton Depressive Scale total score was rated as 25. Current depressive episode started about 12 weeks prior to the admission to psychiatric ward and was unsuccessfully treated with mianserin 120 mg daily. Anamnesis as well as physical examination did not reveal any other relevant medical condition except of …