Prompt

A 22-year-old woman newly diagnosed with trichotillomania and mild facial skin-picking wants a plain-language explanation of the diagnosis, why habit reversal training (not just 'willpower') will help, how adult N-acetylcysteine might be considered, why olanzapine is not first-line, and what her partner should stop doing (pulling her hand away angrily and constant hair comments).

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [4]

Candidate instructions. Explain trichotillomania/skin-picking as treatable neurobehavioural BFRBs (not vanity or weak will), outline habit reversal training, discuss possible adult NAC, address partner criticism, safety-net trichophagia/infection, and check understanding. The examiner plays the patient. [3][4]

Psychiatry Fellowship Pro

You have read the opening of this CASC / OSCE. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References5Show ledger

[1]Grant JE, Odlaug BL, Kim SW N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study Arch Gen Psychiatry, 2009.PMID 19581567
[2]Grant JE, Chamberlain SR, Redden SA, et al. N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27007062
[3]Farhat LC, Olfson E, Nasir M, et al. Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis Depress Anxiety, 2020.PMID 32390221
[4]Grant JE, Chamberlain SR Trichotillomania and Skin-Picking Disorder: An Update Focus (Am Psychiatr Publ), 2021.PMID 35747295
[5]Woods DW, Wetterneck CT, Flessner CA A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania Behav Res Ther, 2006.PMID 16039603

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [4]

Psychiatry Fellowship Pro

You have read the opening of this CASC / OSCE. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References5Show ledger

[1]Grant JE, Odlaug BL, Kim SW N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study Arch Gen Psychiatry, 2009.PMID 19581567
[2]Grant JE, Chamberlain SR, Redden SA, et al. N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27007062
[3]Farhat LC, Olfson E, Nasir M, et al. Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis Depress Anxiety, 2020.PMID 32390221
[4]Grant JE, Chamberlain SR Trichotillomania and Skin-Picking Disorder: An Update Focus (Am Psychiatr Publ), 2021.PMID 35747295
[5]Woods DW, Wetterneck CT, Flessner CA A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania Behav Res Ther, 2006.PMID 16039603

Explain TTM, HRT and NAC to a patient — CASC communication station

Station brief

Explain TTM, HRT and NAC to a patient — CASC communication station

Station brief