Trichotillomania — MCQs

10 questions

A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

Patchy hair loss with hyperhidrosis of skin points to the diagnosis of -

Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :

Contraindicated in Androgenic Alopecia –

An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?

Which of the following is not classified as OCD as per ICD 11?

Tics, hair pulling, and nail biting behaviors are best treated with?

Which of the following is the most prevalent psychiatric disorder in the general population?

Q10

A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Trichotillomania Indian Medical PG Practice Questions and MCQs

Question 1: A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

A. Alopecia areata
B. Tinea capitis (Correct Answer)
C. Pediculosis capitis
D. Pyoderma

Explanation: ***Tinea capitis*** - **Tinea capitis** presents with **patchy hair loss**, **scaling**, and **itching** on the scalp, which are classic signs of a fungal infection. - The fact that the sister also had similar lesions indicates a **contagious** condition, consistent with a **dermatophyte infection**. *Alopecia areata* - Characterized by **sudden, non-scarring hair loss** in circular or oval patches, often with no scaling or inflammation. - It is an **autoimmune condition** and typically not associated with itching or contagiousness amongst siblings. *Pediculosis capitis* - This condition involves an **infestation of head lice**, primarily causing **intense itching** of the scalp. - While it is contagious, it typically presents with **nits** (lice eggs) firmly attached to hair shafts and excoriations from scratching, rather than significant hair loss and scaling. *Pyoderma* - **Pyoderma** is a bacterial skin infection, often presenting as **pustules**, **crusts**, or **blisters** on the scalp. - While it can be contagious and cause discomfort, it is primarily characterized by purulent lesions and not the diffuse patchy hair loss and scaling seen in this case.

Question 2: Patchy hair loss with hyperhidrosis of skin points to the diagnosis of -

A. Alopecia areata
B. Trichotillomania
C. Hyperthyroidism (Correct Answer)
D. Adenoma sebaceum

Explanation: ***Hyperthyroidism*** - **Hyperthyroidism** can cause **diffuse hair thinning** or **patchy hair loss**, and increased **sweating (hyperhidrosis)** is a classic symptom due to increased metabolic rate [1]. - Other common symptoms include **heat intolerance**, **tachycardia**, **weight loss**, and **tremors**. *Alopecia areata* - Characterized by **well-demarcated, smooth non-scarring patches of hair loss**, often with **exclamation mark hairs** [1]. - It is an **autoimmune condition** and typically does not present with hyperhidrosis as a primary symptom. *Trichotillomania* - Defined by the **compulsive pulling out of one's hair**, leading to **irregular patches of hair loss** with hairs of varying lengths [1]. - It is a **psychiatric disorder** and does not cause hyperhidrosis. *Adenoma sebaceum* - This term is a misnomer for **facial angiofibromas**, which are small, red-to-flesh-colored papules typically found on the nose and cheeks. - These lesions are a common feature of **Tuberous Sclerosis Complex** and do not cause hair loss or hyperhidrosis.

Question 3: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

A. Cognitive behavioral therapy
B. SSRIs
C. Clomipramine
D. Systematic desensitisation (Correct Answer)

Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.

Question 4: An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :

A. Lichen planus
B. Tinea Capitis (Correct Answer)
C. Tinea Barbae
D. Alopecia areata

Explanation: ***Tinea Capitis*** - **Tinea capitis** typically presents as **localized, non-cicatricial alopecia** with features like **scaling**, **itching**, and broken hairs, which are consistent with the child's symptoms. - It's a common **dermatophyte infection** of the scalp, particularly in children, caused by fungi like *Trichophyton* or *Microsporum*. *Lichen planus* - **Lichen planus** can cause alopecia, but it is typically a **cicatricial (scarring)** alopecia, unlike the non-cicatricial finding described. - It is more commonly associated with **purplish, polygonal, pruritic papules** on the skin and mucous membranes. *Tinea Barbae* - **Tinea barbae** specifically affects the **beard and mustache area** in adult males and would not present as alopecia on the scalp in an 8-year-old child. - It usually involves deep follicular inflammation with **pustules and nodules**. *Alopecia areata* - **Alopecia areata** is characterized by **smooth, circular patches of non-scarring hair loss** without associated scaling or significant itching. - The presence of **scaling and itching** in this case makes alopecia areata less likely.

Question 5: Contraindicated in Androgenic Alopecia –

A. Minoxidil
B. Testosterone (Correct Answer)
C. Cyproterone
D. Finasteride

Explanation: ***Testosterone*** - Androgenic alopecia, or **male-pattern baldness**, is driven by **androgens**, particularly **dihydrotestosterone (DHT)**, which is derived from testosterone. - Administering exogenous **testosterone** would exacerbate hair loss in individuals with androgenic alopecia by increasing the substrate available for conversion to DHT. *Minoxidil* - **Minoxidil** is a vasodilator that is commonly used topically to treat androgenic alopecia. - It works by **prolonging the anagen phase** of hair growth and increasing follicular size, making it a treatment option, not a contraindication. *Cyproterone* - **Cyproterone** is an **anti-androgen** that blocks androgen receptors and inhibits androgen synthesis. - It is used in some cases of severe androgenic alopecia in women, making it a treatment, not a contraindication. *Finasteride* - **Finasteride** is a **5-alpha-reductase inhibitor** that blocks the conversion of testosterone to dihydrotestosterone (DHT). - By reducing DHT levels, it slows or reverses hair loss in androgenic alopecia, making it a common treatment and not a contraindication.

Question 6: An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?

A. Depression
B. OCD
C. Phobia
D. Trichotillomania (Hair-Pulling Disorder) (Correct Answer)

Explanation: ***Trichotillomania (Hair-Pulling Disorder)*** - This condition is characterized by the **recurrent pulling out of one's hair**, resulting in noticeable hair loss or **bald patches**. - The description of a **circumscribed bald patch** without evidence of organic disease in an 18-year-old girl is highly suggestive of trichotillomania, especially given that organic causes of hair loss have been ruled out. *Depression* - While depression can be a **comorbid condition** with trichotillomania, it does not directly cause a circumscribed bald patch. - Depression is a **mood disorder** primarily characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. *OCD* - **Obsessive-compulsive disorder** (OCD) involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - Although trichotillomania can share some characteristics with OCD (e.g., repetitive behavior), it is classified as a distinct **body-focused repetitive behavior disorder** in the DSM-5, not OCD itself. *Phobia* - A phobia is an **anxiety disorder** defined by an intense and irrational fear of a specific object or situation. - Phobias do not directly cause **physical symptoms** like bald patches; their primary manifestation is avoidance and panic in the presence of the feared stimulus.

Question 7: Which of the following is not classified as OCD as per ICD 11?

A. Hypochondriac disorder
B. Body dysmorphic disorder
C. PTSD (Correct Answer)
D. Trichotillomania

Explanation: ***PTSD*** - **Post-traumatic stress disorder (PTSD)** is classified under **disorders specifically associated with stress** in ICD-11, not as an OCD-related disorder. - PTSD involves symptoms like re-experiencing the traumatic event, avoidance, and hyperarousal following exposure to a **traumatic event**. *Hypochondriac disorder* - In ICD-11, **hypochondriac disorder (illness anxiety disorder)** is reclassified under **obsessive-compulsive or related disorders**, focusing on preoccupation with having a serious illness. - This reflects the **compulsive checking** and **obsessive fears** associated with the condition. *Body dysmorphic disorder* - **Body dysmorphic disorder** is classified under **obsessive-compulsive or related disorders** in ICD-11. - It is characterized by **preoccupation with perceived flaws in physical appearance** and repetitive behaviors (e.g., mirror checking) in response to these concerns. *Trichotillomania* - **Trichotillomania (hair-pulling disorder)** is classified as an **obsessive-compulsive or related disorder** in ICD-11. - It involves **recurrent pulling out of one's hair** resulting in hair loss, despite repeated attempts to stop.

Question 8: Tics, hair pulling, and nail biting behaviors are best treated with?

A. Behavior therapy (Correct Answer)
B. Psychodynamic therapy
C. ECT
D. Medications

Explanation: ***Behavior therapy*** - **Behavior therapy**, particularly **Habit Reversal Training (HRT)**, is the first-line and most effective treatment for tics, hair pulling (trichotillomania), and nail biting (onychophagia). - It involves teaching individuals to identify triggers and recognize urges, and then substituting the undesirable behavior with a competing response. *Psychodynamic therapy* - This therapy focuses on uncovering **unconscious conflicts** and past experiences that may contribute to symptoms. - While it can be helpful for some psychological issues, it is generally **less effective** for directly addressing specific behavioral symptoms like tics or body-focused repetitive behaviors. *ECT* - **Electroconvulsive therapy (ECT)** is a powerful somatic treatment primarily used for severe mental illnesses like **treatment-resistant depression** or catatonia. - It is **not indicated** for tics, hair pulling, or nail biting due to the high risks and lack of evidence for its efficacy in these conditions. *Medications* - While some medications (e.g., **antipsychotics** for severe tics, **SSRIs** for co-occurring anxiety/OCD) can be used as an adjunct, **behavioral therapy** is generally more effective and the first-line approach for these specific behaviors. - Medications alone rarely resolve these behaviors completely without behavioral intervention, and they often come with side effects.

Question 9: Which of the following is the most prevalent psychiatric disorder in the general population?

A. Schizophrenia
B. Mania
C. Anxiety disorder (Correct Answer)
D. Depression

Explanation: ***Anxiety disorder*** - **Anxiety disorders** are collectively the most prevalent psychiatric disorders in the general population, affecting approximately **10-30% of individuals** during their lifetime. - This category includes **specific phobias, social anxiety disorder, panic disorder, generalized anxiety disorder, and others**, which together have the highest prevalence among all psychiatric conditions. - Epidemiological studies consistently show that **anxiety disorders surpass depression** in terms of overall prevalence in community samples. *Depression* - **Major depressive disorder** is highly prevalent (lifetime prevalence approximately 10-15%) and is the **leading cause of disability worldwide**. - While extremely common and clinically significant, it is slightly less prevalent than anxiety disorders when considering community-based epidemiological data. - Depression often occurs **co-morbidly with anxiety disorders**, further emphasizing the importance of both conditions. *Schizophrenia* - **Schizophrenia** is a severe chronic mental illness with a much lower prevalence, affecting approximately **0.3-0.7%** of the general population. - Despite its significant impact on affected individuals and families, its overall prevalence is relatively low compared to mood and anxiety disorders. *Mania* - **Mania** is a mood state characteristic of **bipolar disorder**, which has a prevalence of approximately **1-2%** of the population. - This is considerably lower than the prevalence of both anxiety disorders and major depressive disorder.

Question 10: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

A. Behavior therapy (Correct Answer)
B. SSRI
C. Atypical antipsychotics
D. Allow her to have surgery

Explanation: ***Behavior therapy*** - This patient presents with **body dysmorphic disorder (BDD)**, characterized by preoccupation with a perceived defect in appearance that is not observable to others, leading to significant distress and impairment. - **Cognitive behavioral therapy (CBT)**, specifically **CBT-BDD with exposure and response prevention (ERP)**, is the **first-line treatment** with the strongest evidence base for BDD. - CBT-BDD addresses the core cognitive distortions, reduces checking behaviors, and provides sustained long-term improvement without medication side effects. - **Most appropriate management** involves CBT as primary treatment, often combined with pharmacotherapy for optimal outcomes. *SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line **pharmacotherapy** for BDD, often requiring higher doses than those used for major depressive disorder. - SSRIs are highly effective and can be used as monotherapy or preferably in combination with CBT. - While SSRIs are appropriate, CBT has superior evidence as the primary intervention for BDD. *Atypical antipsychotics* - **Atypical antipsychotics** may be considered as an augmentation strategy for BDD in cases that do not respond to SSRI monotherapy, especially with significant delusional features or severe functional impairment. - They are not first-line pharmacological treatment. *Allow her to have surgery* - Allowing plastic surgery is **contraindicated** in patients with BDD because it rarely alleviates distress and often leads to dissatisfaction with surgical outcomes, potentially worsening symptoms or causing further unnecessary procedures. - The core problem is distorted perception of self, not an actual physical defect that can be remedied surgically.

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