PSYCH EOR REVIEW ACTUAL 55 COMPLETE QUESTIONS AND 100% VERIFIED ANSWERS WITH DETAILED EXPLANATIONS ALREADY GRADED A+ NEW UPDATE

This comprehensive study guide is your ultimate resource for the Psychiatry End of Rotation (EOR) exam. Compiled from actual exam questions, this document contains 55 questions with correct answers and in-depth clinical rationales. Each question is designed to mirror the exact content, difficulty, and clinical reasoning required to excel on your PAEA or nursing psychiatry EOR exam and in clinical rotations. What's Inside – Complete Psychiatry EOR Blueprint Coverage: Sleep Disorders: Insomnia Disorder – nonpharmacologic interventions (hot bath near bedtime effective, NOT exercise, late meals, naps, or sleeping later on weekends); Circadian Rhythm Sleep Disorder – delayed sleep phase type (mismatch between internal clock and environmental demands, as seen when switching from bartending to office job); Differential diagnosis from breathing-related sleep disorder and major depression. Eating Disorders: Anorexia Nervosa – BMI calculation (BMI 19 first indicator, calculate before invasive labs), outpatient treatment (family therapy most effective in adolescents), positive prognostic factor (greater impulsivity), negative prognostic factors (self-induced vomiting, higher trait anxiety, lower BMI at treatment start); Bulimia Nervosa – later onset than anorexia, physical findings (dental caries from vomiting, round face from parotid enlargement, calluses on fingers), laboratory abnormalities (hypochloremic-hypokalemic alkalosis from repetitive emesis, hyperamylasemia, hypomagnesemia), contraindicated treatment (atypical antipsychotics – may increase appetite and binging), effective treatments (nutritional rehabilitation, CBT, SSRIs, group therapy). Substance Use Disorders & Withdrawal: Alcohol Use Disorder – laboratory findings (macrocytic anemia, elevated GGT, elevated AST with normal ALT), withdrawal timeline – tremulousness (6-8 hours), hallucinations with intact orientation (8-12 hours, alcoholic hallucinosis), withdrawal seizures (12-24 hours), delirium tremens (DTs – 24-72 hours, up to 96 hours); Delirium tremens treatment (benzodiazepines – first-line; lorazepam preferred in liver disease due to glucuronidation metabolism; phenobarbital or propofol for refractory DTs requires intubation; antipsychotics lower seizure threshold and should be avoided); CAGE questionnaire for screening. Autism Spectrum Disorder (ASD): Stereotyped/repetitive motor movements (criterion B, e.g., spinning objects); Etiology (complex heritable and in utero environmental influences – NOT MMR vaccine, NOT cold mother/absent father); DSM-5 grouping (previously distinct disorders were not discrete as once thought); Irritability treatment (aripiprazole shows benefit). Delirium & Dementia: Delirium – most important treatment (identify and treat precipitating factor, e.g., UTI with antibiotics), hallmark feature (decreased attention – distinguishes from early dementia where attention is typically maintained); Level of consciousness (coma = unresponsive to verbal stimuli, precludes delirium diagnosis); Dementia – Major NCD diagnosis requires loss of independence in IADLs; Cognitive testing (NCD patients put forth effort but have poor insight; depressed patients apathetic with little effort); Behavioral management (initial step = verbal de-escalation, NOT medications or restraints; low-dose high-potency antipsychotic haloperidol if acute risk of harm; avoid low-potency antipsychotics chlorpromazine due to anticholinergic effects; benzodiazepines may worsen agitation or increase fall risk). Borderline Personality Disorder (BPD): Defense mechanisms – splitting (alternating between all-good and all-bad views of others, e.g., "nurses are rude" then "nurse is best"), devaluation (defending against hurt/anger by minimizing therapist), idealization; Treatment – dialectical behavioral therapy (DBT) most effective; Comorbid major depression – treat with SSRI (paroxetine), use vegetative symptoms (sleep/appetite changes) as clues since BPD patients are "stably unstable"; Decreasing idealization before admission (explaining rules and unit expectations minimizes subsequent devaluation). Narcissistic Personality Disorder (NPD): Seeking treatment due to anger (not grandiosity or insight), precipitated by aging (loss of beauty/youth hurts fragile self-esteem); Therapeutic approach (appeal to narcissism with admiration – "You're articulate, teach me"); Defense mechanism – devaluation (when therapist late, patient criticizes therapist's competence). Major Depressive Disorder (MDD): Diagnosis requires depressed mood or anhedonia (NOT appetite, fatigue, insomnia, or SI alone); Treatment – SSRI (citalopram), continue same effective dose for 6-12 months after remission (dose that got you better will keep you well); Sexual dysfunction (anorgasmia) is common late side effect (weeks to months); Lifetime recurrence risk 85% if not maintained on medication. Post-Traumatic Stress Disorder (PTSD): Most efficacious treatment – cognitive behavioral therapy (CBT) and exposure therapy; Medication monotherapy for persistent symptoms – prazosin (alpha-1 antagonist) effective for nightmares, hypervigilance, emotional numbing; Avoid benzodiazepines (high substance abuse comorbidity). Somatic Symptom Disorder: Somatic symptom disorder with predominant pain (chronic headaches, no organic findings after extensive workup, onset coinciding with retirement/inability to visit grandchild, NOT intentionally produced as in factitious or malingering); Management – validate and reassure patient's experience of pain (empathic response strengthens therapeutic alliance, implying symptoms are "not real" worsens pain); Treatment – biofeedback and relaxation techniques (effective for headaches); Avoid narcotics (abuse potential, withdrawal) and benzodiazepines (addiction risk). Psychotic Disorders Due to Another Medical Condition: Temporal lobe seizure – olfactory hallucinations (smelling fire) most indicative; Interictal psychosis (develops in poorly controlled epilepsy since childhood, chronic paranoia, social isolation, not postictal which is episodic); Hypoparathyroidism – psychotic symptoms (irritability, aggression, paranoia, auditory hallucinations) correct underlying hypocalcemia first (calcium administration), then antipsychotic if needed; Avoid benzodiazepines in TBI patients (may be disinhibiting). Schizophrenia & Substance Use: Clozapine – reduces suicide attempts (only antipsychotic with this indication); Nicotine is most common substance abuse in schizophrenia (75-90% smoke, induces CYP1A2, lowers clozapine levels, can cause relapse). Additional High-Yield Topics: Alcoholic hallucinosis (hallucinations without clouded sensorium or abnormal vitals, occurs 8-12 hours); Lithium and antipsychotic monitoring; Serotonin syndrome recognition; Benzodiazepine selection in liver disease (lorazepam, oxazepam, temazepam – glucuronidated); SSRIs vs TCAs side effects. Every question includes a correct answer and a detailed clinical rationale explaining the diagnostic criteria, pharmacologic mechanism, and treatment approach – exactly what you need to pass the Psych EOR exam.