To evaluate the reason of major behavioral problems in patients with alopecia universalis, we tried to examine by way of the Millon's MCMI- III whether these signs are transient or ingrained.

Patients with alopecia universalis (279 consecutive) were studied before and 3 months after treatment with MCMI-III and scheduled psychiatric interview. They were stratified in regard to sex, age, socioeconomic class, age of onset of alopecia (before or after 18yrs.) and response. The results were compared with 3000 normal examinees.

There was significant preponderance of personality disorders among patients with early onset (p< 0.003) but not late onset (p=0.1) alopecia including schizotypal, schizoid, self defeating, borderline and avoidant personalities compared to the general population. This was not affected by treatment. (p< 0.004) All alopecia patients showed higher scales in axis II disorders including depression, anxiety, drug abuse, alcohol abuse in addition to major thought disorders. (Overall p< 0.02) These were ameliorated with treatment of alopecia. These data were confirmed by scheduled interviews.

This is the first report of severe personality disorder in the context of a medical condition. We conclude that childhood onset chronic illnesses can cause serious personality disorders that are a stronger predictor than genetics or learned behavior encompassed in previous theories on personality. Alopecia universalis has a more sustained effect due to jeopardizing the development of self image.

Mirtazapine is indicated in the treatment of major depressive disorder particularly in selective serotonin re-uptake inhibitors resistance. Its effect on hair loss is rare with no previous documented effect on hair colour.

Review of relevant literature and description of a case report of a 54-year-old male patient who developed alopecia and hair discoloration after initiation of mirtazapine treatment.

Upon cessation of mirtazapine treatment full restoration of hair colour and regrowth of hair was attained within 10 weeks.

There was clear temporal relationship between experiencing hair loss and commencing mirtazapine treatment. No other more likely medical reason to explain such experience was established. A noticeable restoration of the hair colour occurred following mirtazapine cessation.

Mirtazapine is associated with hair discoloration and hair loss. The possibility of such distressing adverse effects needs to be conveyed to patients by clinicians and to be further explored by researchers.