Psych CASC / OSCE · General adult psychiatry — OCRD / BFRB
Explain TTM, HRT and NAC to a patient — CASC communication station
MRCPsych/FRANZCP-style communication station: BFRB explanation, HRT, NAC timeline, medical safety-net for trichophagia, family response coaching.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
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]
References5ShowHide
- [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