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Bonus Episode: Board Bombs: 3 High-Yield Psychiatric Questions to Prepare You for Your Board Exam · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back
• 0:06
  my
• 0:06
  friends
• 0:06
  to
• 0:06
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep
• 0:09
  npz.
• 0:10
  Here
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:12
  pocket.
• 0:13
  We
• 0:13
  are
• 0:13
  here
• 0:13
  for
• 0:14
  board
• 0:14
  bombs
• 0:15
  today.
• 0:15
  Board
• 0:15
  bombs
• 0:16
  are
• 0:16
  a
• 0:16
  great
• 0:16
  segment.
• 0:17
  There
• 0:17
  are
• 0:18
  three
• 0:18
  questions
• 0:18
  to
• 0:18
  help
• 0:19
  you
• 0:19
  prepare
• 0:19
  for
• 0:19
  boards.
• 0:20
  High
• 0:21
  yield,
• 0:21
  well
• 0:22
  rounded,
• 0:22
  Getting
• 0:22
  your
• 0:23
  appetite
• 0:23
  wet.
• 0:24
  To
• 0:24
  learn
• 0:24
  a
• 0:24
  little
• 0:25
  more,
• 0:25
  to
• 0:25
  think
• 0:25
  a
• 0:25
  little
• 0:26
  more.
• 0:26
  These
• 0:26
  are
• 0:26
  three
• 0:27
  very
• 0:27
  good
• 0:27
  ones
• 0:28
  for
• 0:28
  you
• 0:28
  to
• 0:29
  wrap
• 0:29
  your
• 0:29
  heads
• 0:29
  around.
• 0:30
  Before
• 0:30
  we
• 0:31
  begin,
• 0:31
  I
• 0:31
  highly
• 0:31
  encourage
• 0:32
  all
• 0:32
  of
• 0:32
  you
• 0:33
  to
• 0:33
  go
• 0:33
  over
• 0:33
  to
• 0:33
  our
• 0:34
  show
• 0:34
  notes
• 0:34
  and
• 0:34
  to
• 0:34
  become
• 0:35
  Patreon
• 0:35
  members.
• 0:36
  If
• 0:36
  you
• 0:36
  become
• 0:36
  a
• 0:36
  Patreon
• 0:37
  member,
• 0:37
  you
• 0:38
  get
• 0:38
  so
• 0:39
  many
• 0:39
  evidence
• 0:39
  based
• 0:40
  tools,
• 0:40
  exciting
• 0:41
  pearls
• 0:41
  to
• 0:41
  empower
• 0:42
  you
• 0:42
  in
• 0:43
  psych
• 0:43
  NP
• 0:43
  school,
• 0:44
  to
• 0:44
  empower
• 0:44
  you
• 0:44
  in
• 0:45
  your
• 0:45
  practice
• 0:45
  to
• 0:46
  pass
• 0:46
  boards,
• 0:47
  all
• 0:47
  kinds
• 0:47
  of
• 0:47
  nerdy
• 0:48
  reads
• 0:48
  and
• 0:49
  beautiful
• 0:49
  visual
• 0:50
  slide
• 0:50
  decks.
• 0:50
  I
• 0:51
  highly
• 0:51
  encourage
• 0:52
  it.
• 0:52
  You
• 0:52
  also
• 0:52
  get
• 0:53
  bonus
• 0:53
  episodes,
• 0:54
  early
• 0:54
  episode
• 0:55
  drops.
• 0:56
  Lot
• 0:56
  of
• 0:56
  fun
• 0:56
  for
• 0:56
  Patreon
• 0:57
  members.
• 0:57
  Without
• 0:58
  further
• 0:58
  ado,
• 0:58
  let's
• 0:58
  go
• 0:59
  here.
• 0:59
  Question
• 1:00
  1.
• 1:00
  Which
• 1:01
  medication
• 1:02
  listed
• 1:02
  below
• 1:03
  is
• 1:03
  FDA
• 1:04
  approved
• 1:04
  for
• 1:04
  bipolar
• 1:05
  I
• 1:05
  depression?
• 1:06
  Is
• 1:06
  it
• 1:06
  A,
• 1:06
  Risperdal,
• 1:07
  B
• 1:08
  Lituda,
• 1:09
  C
• 1:09
  Abilify
• 1:10
  or
• 1:10
  D
• 1:11
  Olanzapine,
• 1:12
  also
• 1:13
  known
• 1:13
  as
• 1:13
  Zyprexa?
• 1:14
  You
• 1:14
  can
• 1:15
  pause
• 1:15
  this
• 1:15
  if
• 1:15
  you'd
• 1:15
  like
• 1:17
  while
• 1:17
  you
• 1:17
  think
• 1:17
  about
• 1:17
  it.
• 1:18
  Now
• 1:19
  there's
• 1:19
  a
• 1:19
  lot
• 1:20
  of
• 1:20
  good
• 1:20
  choices
• 1:20
  here
• 1:21
  that
• 1:21
  you
• 1:21
  could
• 1:22
  think
• 1:22
  about
• 1:22
  potentially.
• 1:23
  We
• 1:23
  know
• 1:23
  that
• 1:24
  bilify
• 1:25
  is
• 1:25
  often
• 1:25
  used
• 1:26
  as
• 1:26
  an
• 1:26
  adjunct
• 1:27
  in
• 1:27
  depression,
• 1:29
  but
• 1:30
  the
• 1:30
  answer,
• 1:30
  my
• 1:31
  friends,
• 1:31
  is
• 1:32
  B.
• 1:33
  Latuda.
• 1:33
  That's
• 1:34
  right,
• 1:34
  Lurazidone
• 1:35
  or
• 1:35
  Latuda
• 1:36
  is
• 1:36
  FDA
• 1:36
  approved
• 1:36
  for
• 1:36
  bipolar
• 1:37
  1
• 1:38
  depression.
• 1:39
  And
• 1:39
  that's
• 1:39
  a
• 1:40
  very
• 1:40
  important
• 1:40
  pearl.
• 1:41
  And
• 1:41
  I
• 1:41
  highly
• 1:41
  encourage
• 1:42
  all
• 1:42
  of
• 1:42
  you
• 1:42
  to
• 1:43
  familiarize
• 1:44
  yourself
• 1:44
  with
• 1:44
  FDA
• 1:45
  approvals.
• 1:46
  They
• 1:46
  are
• 1:47
  pretty
• 1:47
  important
• 1:48
  and
• 1:48
  they
• 1:49
  might
• 1:49
  pop
• 1:49
  up
• 1:49
  on
• 1:49
  the
• 1:49
  test.
• 1:50
  Knowing
• 1:51
  what
• 1:51
  medications
• 1:52
  are
• 1:53
  specifically
• 1:53
  approved
• 1:54
  for
• 1:55
  which
• 1:56
  states
• 1:56
  of
• 1:57
  illness
• 1:57
  is
• 1:57
  very
• 1:58
  important.
• 1:58
  In
• 1:59
  practice,
• 2:00
  you're
• 2:00
  gonna
• 2:00
  have
• 2:00
  to
• 2:00
  defend
• 2:01
  some
• 2:01
  of
• 2:01
  your
• 2:01
  decisions.
• 2:02
  Latuda
• 2:02
  is
• 2:02
  a
• 2:02
  good
• 2:02
  call
• 2:03
  for
• 2:03
  bipolar
• 2:04
  one
• 2:05
  depression.
• 2:06
  Remember,
• 2:06
  there's
• 2:06
  bipolar
• 2:07
  two
• 2:08
  depression.
• 2:08
  We
• 2:08
  have
• 2:09
  FDA
• 2:09
  approvals
• 2:09
  for
• 2:10
  Lumateperone
• 2:11
  and
• 2:11
  Seroquel
• 2:12
  for
• 2:12
  bipolar
• 2:12
  ii.
• 2:13
  Depression
• 2:14
  can
• 2:14
  get
• 2:14
  kind
• 2:14
  of
• 2:14
  confusing.
• 2:15
  So
• 2:15
  now
• 2:15
  you
• 2:15
  have
• 2:15
  bipolar
• 2:16
  I
• 2:16
  depression,
• 2:16
  you
• 2:17
  have
• 2:17
  Latuda
• 2:18
  in
• 2:18
  particular.
• 2:18
  Then
• 2:19
  you
• 2:19
  have
• 2:19
  other
• 2:19
  meds
• 2:20
  that
• 2:20
  are
• 2:20
  used
• 2:20
  off
• 2:20
  label
• 2:21
  all
• 2:21
  the
• 2:21
  time
• 2:21
  and
• 2:21
  that
• 2:22
  can
• 2:22
  get
• 2:22
  confusing.
• 2:22
  But
• 2:22
  not
• 2:23
  all
• 2:23
  of
• 2:23
  them
• 2:23
  are
• 2:23
  FDA
• 2:24
  approved.
• 2:24
  And
• 2:24
  that
• 2:24
  doesn't
• 2:25
  necessarily
• 2:25
  mean
• 2:25
  they're
• 2:26
  ineffective.
• 2:27
  It
• 2:27
  just
• 2:27
  means
• 2:27
  that
• 2:28
  those
• 2:28
  companies
• 2:29
  did
• 2:29
  not
• 2:29
  pay
• 2:29
  the
• 2:29
  money
• 2:30
  to
• 2:30
  run
• 2:30
  the
• 2:31
  trial
• 2:31
  to
• 2:31
  prove
• 2:32
  in
• 2:32
  that
• 2:33
  particular
• 2:34
  cohort
• 2:34
  of
• 2:34
  individuals
• 2:35
  that
• 2:35
  it
• 2:35
  was
• 2:35
  effective.
• 2:36
  Spend
• 2:37
  an
• 2:37
  afternoon
• 2:37
  and
• 2:37
  nerd
• 2:38
  out
• 2:38
  on
• 2:38
  FDA
• 2:38
  approvals.
• 2:39
  That's
• 2:39
  my
• 2:39
  best
• 2:40
  advice
• 2:40
  for
• 2:41
  for
• 2:41
  you
• 2:41
  as
• 2:41
  you
• 2:42
  prepare
• 2:42
  for
• 2:42
  your
• 2:42
  boards.
• 2:43
  As
• 2:43
  you
• 2:43
  prepare
• 2:43
  for
• 2:43
  your
• 2:44
  final
• 2:44
  exams
• 2:44
  in
• 2:44
  school
• 2:45
  and
• 2:45
  know
• 2:45
  who's
• 2:46
  who
• 2:46
  in
• 2:46
  the
• 2:46
  zoo?
• 2:47
  As
• 2:47
  it
• 2:47
  relates
• 2:48
  to
• 2:48
  FDA
• 2:49
  approvals,
• 2:50
  there's
• 2:50
  a
• 2:50
  few.
• 2:51
  All
• 2:51
  of
• 2:51
  these
• 2:51
  medications
• 2:52
  look
• 2:52
  and
• 2:52
  sound
• 2:52
  alike.
• 2:53
  They
• 2:53
  all
• 2:54
  stabilize
• 2:54
  mood,
• 2:55
  but
• 2:55
  they're
• 2:56
  not
• 2:56
  always
• 2:56
  fine
• 2:57
  tuned
• 2:57
  for
• 2:57
  specifically
• 2:58
  what's
• 2:58
  in
• 2:58
  front
• 2:58
  of
• 2:58
  you.
• 2:59
  Latuda,
• 3:00
  for
• 3:00
  example,
• 3:01
  is
• 3:01
  not
• 3:01
  as
• 3:02
  well
• 3:03
  known
• 3:03
  to
• 3:03
  control
• 3:03
  mania.
• 3:04
  You
• 3:04
  have
• 3:04
  your
• 3:05
  mood
• 3:05
  stabilizers
• 3:05
  for
• 3:05
  that.
• 3:06
  You
• 3:06
  have
• 3:07
  your
• 3:07
  lithium,
• 3:07
  your
• 3:07
  Depakotes.
• 3:09
  You
• 3:09
  have
• 3:09
  Abilify
• 3:11
  for
• 3:11
  mania
• 3:12
  control
• 3:12
  or
• 3:12
  Zyprexa.
• 3:13
  You've
• 3:14
  got
• 3:14
  to
• 3:14
  really
• 3:14
  wrap
• 3:14
  your
• 3:15
  head
• 3:15
  around
• 3:15
  the
• 3:15
  distinctions
• 3:15
  here
• 3:16
  and
• 3:16
  make
• 3:16
  sure
• 3:16
  these
• 3:17
  are
• 3:17
  accurate.
• 3:17
  Now,
• 3:18
  board
• 3:18
  bomb
• 3:18
  number
• 3:19
  two.
• 3:19
  A
• 3:20
  17
• 3:20
  year
• 3:20
  old
• 3:21
  with
• 3:21
  sudden
• 3:21
  school
• 3:21
  refusal,
• 3:22
  intense
• 3:23
  fear
• 3:23
  of
• 3:23
  being
• 3:23
  called
• 3:23
  on,
• 3:24
  and
• 3:24
  crippling
• 3:24
  anxiety
• 3:25
  in
• 3:25
  performance
• 3:26
  situations
• 3:27
  most
• 3:27
  likely
• 3:28
  has
• 3:28
  which
• 3:28
  condition?
• 3:29
  A
• 3:29
  generalized
• 3:29
  anxiety
• 3:30
  disorder,
• 3:31
  B
• 3:31
  social
• 3:31
  anxiety
• 3:32
  disorder,
• 3:33
  C
• 3:33
  panic
• 3:33
  disorder,
• 3:34
  or
• 3:34
  D
• 3:35
  avoidant
• 3:35
  personality
• 3:36
  disorder?
• 3:37
  There
• 3:37
  are
• 3:37
  a
• 3:37
  few
• 3:38
  answers
• 3:38
  here
• 3:38
  that
• 3:38
  could
• 3:39
  potentially
• 3:39
  throw
• 3:39
  you
• 3:39
  off.
• 3:40
  Clearly
• 3:41
  he's
• 3:41
  avoidant,
• 3:42
  he's
• 3:42
  avoiding
• 3:42
  school.
• 3:43
  He
• 3:43
  has
• 3:43
  intense
• 3:44
  fear.
• 3:44
  In
• 3:45
  terms
• 3:45
  of
• 3:45
  panic
• 3:45
  disorder,
• 3:46
  it
• 3:46
  does
• 3:47
  say
• 3:47
  he
• 3:47
  has
• 3:47
  crippling
• 3:47
  anxiety,
• 3:48
  but
• 3:48
  I
• 3:48
  don't
• 3:48
  see
• 3:49
  any
• 3:49
  clues
• 3:49
  that
• 3:49
  he
• 3:49
  has
• 3:49
  panic
• 3:50
  disorder.
• 3:50
  I
• 3:50
  don't
• 3:50
  see
• 3:50
  shortness
• 3:51
  of
• 3:51
  breath,
• 3:51
  diaphoresis,
• 3:53
  trembling
• 3:54
  or
• 3:54
  feeling
• 3:55
  nauseous.
• 3:55
  There's
• 3:55
  not
• 3:55
  a
• 3:56
  lot
• 3:56
  of
• 3:56
  diagnostic
• 3:57
  DSM
• 3:57
  stuff
• 3:57
  here
• 3:58
  for
• 3:58
  panic
• 3:59
  attack
• 3:59
  or
• 3:59
  panic
• 3:59
  disorder.
• 4:00
  Now
• 4:00
  he
• 4:00
  is
• 4:00
  refusing
• 4:01
  school.
• 4:01
  So
• 4:01
  that's
• 4:03
  the
• 4:03
  avoidant
• 4:03
  behavior
• 4:04
  you
• 4:04
  might
• 4:04
  see
• 4:04
  in
• 4:04
  panic
• 4:05
  attacks.
• 4:05
  But
• 4:05
  is
• 4:05
  he
• 4:05
  avoiding
• 4:06
  school
• 4:07
  because
• 4:07
  he's
• 4:08
  afraid
• 4:08
  of
• 4:08
  experiencing
• 4:09
  panic
• 4:10
  attack
• 4:10
  there?
• 4:10
  Or
• 4:11
  he's
• 4:12
  specifically
• 4:13
  avoiding
• 4:13
  school
• 4:14
  so
• 4:14
  that
• 4:14
  he's
• 4:14
  not
• 4:14
  called
• 4:14
  upon
• 4:15
  because
• 4:15
  the
• 4:15
  social
• 4:16
  interaction
• 4:17
  is
• 4:17
  the
• 4:17
  focal
• 4:18
  point
• 4:18
  by
• 4:18
  which
• 4:19
  he
• 4:19
  is
• 4:20
  exhibiting
• 4:20
  his
• 4:20
  anxiety?
• 4:21
  You
• 4:21
  see
• 4:21
  the
• 4:21
  distinction
• 4:22
  there.
• 4:22
  One
• 4:22
  is
• 4:23
  avoidance
• 4:23
  of
• 4:23
  a
• 4:23
  place
• 4:23
  you
• 4:24
  fear
• 4:24
  you
• 4:24
  might
• 4:25
  experience
• 4:25
  a
• 4:25
  panic
• 4:26
  attack
• 4:26
  in.
• 4:27
  One
• 4:27
  is
• 4:27
  avoidance
• 4:27
  of
• 4:28
  a
• 4:28
  specific
• 4:29
  stimulus
• 4:29
  related
• 4:30
  to
• 4:30
  being
• 4:31
  judged
• 4:31
  or
• 4:31
  evaluated
• 4:32
  negatively,
• 4:33
  which
• 4:34
  is
• 4:34
  more
• 4:34
  like
• 4:34
  social
• 4:35
  anxiety
• 4:35
  and
• 4:35
  not
• 4:36
  panic.
• 4:36
  You
• 4:36
  see
• 4:37
  that?
• 4:37
  Now,
• 4:37
  avoidant
• 4:38
  personality
• 4:38
  disorder,
• 4:39
  not
• 4:39
  a
• 4:39
  terrible
• 4:40
  choice.
• 4:40
  But
• 4:40
  this
• 4:41
  is
• 4:41
  a
• 4:41
  sudden
• 4:41
  school
• 4:42
  refusal.
• 4:43
  It's
• 4:43
  very
• 4:43
  localized
• 4:44
  to
• 4:44
  being
• 4:44
  called
• 4:44
  on,
• 4:45
  crippling
• 4:46
  anxiety
• 4:46
  and
• 4:46
  performance
• 4:47
  related
• 4:47
  situations.
• 4:49
  Avoidant
• 4:49
  personality
• 4:50
  is
• 4:50
  more
• 4:50
  of
• 4:50
  a
• 4:50
  pervasive
• 4:51
  lifelong
• 4:51
  pattern.
• 4:52
  It's
• 4:52
  not
• 4:53
  as
• 4:53
  acute
• 4:53
  or
• 4:54
  situational
• 4:55
  in
• 4:55
  onset
• 4:56
  as
• 4:56
  this
• 4:56
  question
• 4:57
  is
• 4:57
  formulated.
• 4:58
  Not
• 4:58
  insane,
• 4:59
  not
• 4:59
  a
• 4:59
  terrible
• 5:00
  choice,
• 5:00
  but
• 5:00
  certainly
• 5:01
  not
• 5:01
  exactly
• 5:02
  what
• 5:02
  we're
• 5:02
  going
• 5:02
  for
• 5:03
  here.
• 5:03
  And
• 5:03
  generalized
• 5:04
  anxiety,
• 5:04
  generalized
• 5:05
  anxiety
• 5:05
  is
• 5:06
  very
• 5:06
  broad.
• 5:06
  You're
• 5:06
  worried
• 5:07
  that
• 5:07
  you
• 5:07
  might
• 5:07
  get
• 5:07
  fired
• 5:08
  even
• 5:08
  though
• 5:08
  you're
• 5:08
  doing
• 5:08
  very
• 5:09
  well
• 5:09
  in
• 5:09
  your
• 5:09
  job.
• 5:10
  You're
• 5:10
  worried
• 5:10
  about
• 5:11
  the
• 5:11
  safety
• 5:11
  of
• 5:11
  your
• 5:12
  friends
• 5:12
  and
• 5:12
  relatives.
• 5:13
  I
• 5:13
  don't
• 5:13
  get
• 5:14
  a
• 5:14
  lot
• 5:14
  of
• 5:14
  broad
• 5:14
  anxiety
• 5:15
  here.
• 5:15
  Right.
• 5:15
  This
• 5:15
  is
• 5:15
  a
• 5:15
  very
• 5:16
  specific
• 5:16
  school
• 5:17
  refusal,
• 5:18
  fear
• 5:18
  of
• 5:18
  being
• 5:18
  called
• 5:18
  on.
• 5:19
  That
• 5:19
  is
• 5:19
  not
• 5:20
  general
• 5:20
  at
• 5:20
  all.
• 5:20
  Remember
• 5:21
  the
• 5:21
  words
• 5:22
  mean
• 5:22
  what
• 5:22
  they
• 5:22
  mean
• 5:22
  and
• 5:23
  generalized
• 5:23
  means
• 5:24
  generally
• 5:25
  everything.
• 5:25
  This
• 5:25
  is
• 5:26
  very
• 5:26
  specific,
• 5:26
  so
• 5:27
  you
• 5:27
  can
• 5:27
  knock
• 5:27
  that
• 5:28
  out
• 5:28
  right
• 5:28
  away.
• 5:28
  This
• 5:29
  is
• 5:29
  a
• 5:29
  little
• 5:29
  bit
• 5:29
  of
• 5:29
  a
• 5:30
  tricky
• 5:30
  question
• 5:30
  if
• 5:30
  you
• 5:31
  don't
• 5:31
  look
• 5:31
  at
• 5:31
  it
• 5:31
  carefully.
• 5:32
  But
• 5:32
  always
• 5:32
  ask
• 5:33
  yourself,
• 5:33
  what
• 5:33
  is
• 5:33
  the
• 5:34
  core
• 5:34
  fear
• 5:34
  here?
• 5:35
  The
• 5:35
  core
• 5:36
  fear
• 5:36
  here
• 5:36
  is
• 5:36
  not
• 5:37
  experiencing
• 5:37
  a
• 5:37
  panic
• 5:38
  attack,
• 5:38
  it
• 5:38
  is
• 5:38
  being
• 5:39
  called
• 5:39
  on
• 5:39
  at
• 5:40
  school.
• 5:40
  Right?
• 5:41
  And
• 5:42
  so
• 5:42
  we
• 5:42
  have
• 5:42
  a
• 5:42
  very
• 5:43
  specific
• 5:43
  social
• 5:43
  situation
• 5:44
  that's
• 5:44
  triggering
• 5:45
  avoidance,
• 5:46
  although
• 5:47
  that
• 5:47
  is
• 5:47
  avoidant,
• 5:47
  and
• 5:48
  you
• 5:48
  could
• 5:48
  argue
• 5:48
  it's
• 5:48
  an
• 5:48
  avoidant
• 5:49
  personality
• 5:49
  disorder.
• 5:50
  This
• 5:50
  is
• 5:50
  specific
• 5:51
  and
• 5:51
  it's
• 5:51
  not
• 5:51
  part
• 5:51
  of
• 5:52
  a
• 5:52
  broader
• 5:53
  personality
• 5:53
  construct,
• 5:54
  at
• 5:54
  least
• 5:54
  the
• 5:54
  way
• 5:54
  the
• 5:55
  question
• 5:55
  is
• 5:55
  written.
• 5:55
  The
• 5:56
  answer,
• 5:56
  my
• 5:56
  friends,
• 5:56
  is
• 5:56
  B,
• 5:57
  social
• 5:57
  anxiety
• 5:58
  disorder.
• 6:54
  Fear
• 6:54
  of
• 6:54
  judgment,
• 6:55
  scrutiny,
• 6:01
  embarrassment
• 6:56
  and
• 6:56
  performance.
• 6:57
  Classic
• 6:58
  SAD
• 6:58
  or
• 6:59
  social
• 6:59
  anxiety
• 7:00
  disorder.
• 7:00
  All
• 7:01
  right,
• 7:01
  board
• 7:01
  bomb
• 7:01
  number
• 7:02
  three,
• 7:03
  here
• 7:04
  we
• 7:04
  go.
• 7:05
  A
• 7:05
  patient
• 7:05
  presents
• 7:06
  with
• 7:06
  excessive
• 7:07
  daytime
• 7:07
  sleepiness,
• 7:08
  refreshing
• 7:09
  naps,
• 7:10
  and
• 7:10
  two,
• 7:11
  sleep
• 7:11
  onset
• 7:13
  REM
• 7:13
  periods.
• 7:14
  On
• 7:14
  an
• 7:15
  mslt,
• 7:15
  what
• 7:16
  is
• 7:16
  the
• 7:16
  most
• 7:16
  likely
• 7:17
  diagnosis?
• 7:17
  Is
• 7:18
  it
• 7:18
  A,
• 7:18
  obstructive
• 7:19
  sleep
• 7:19
  apnea?
• 7:19
  Is
• 7:20
  it
• 7:20
  B,
• 7:20
  narcolepsy
• 7:21
  type
• 7:21
  2?
• 7:22
  Is
• 7:22
  it
• 7:22
  C,
• 7:22
  delayed
• 7:23
  sleep
• 7:23
  wake
• 7:24
  phase
• 7:24
  disorder,
• 7:25
  or
• 7:25
  is
• 7:25
  it
• 7:25
  D,
• 7:26
  hypersomnolence
• 7:27
  disorder?
• 7:28
  Kind
• 7:28
  of
• 7:28
  a
• 7:28
  tricky
• 7:28
  one.
• 7:29
  And
• 7:29
  I
• 7:30
  know
• 7:30
  a
• 7:30
  lot
• 7:30
  of
• 7:30
  these
• 7:30
  sleep
• 7:31
  diagnoses
• 7:32
  can
• 7:32
  throw
• 7:32
  people
• 7:32
  off.
• 7:33
  I
• 7:33
  know
• 7:33
  for
• 7:33
  me
• 7:34
  they
• 7:34
  were
• 7:34
  a
• 7:34
  little
• 7:34
  bit
• 7:34
  more
• 7:35
  challenging
• 7:35
  when
• 7:35
  I
• 7:35
  was
• 7:36
  in
• 7:36
  school.
• 7:37
  I
• 7:37
  encourage
• 7:37
  you,
• 7:38
  if
• 7:38
  you
• 7:38
  open
• 7:38
  the
• 7:39
  DSM
• 7:39
  and
• 7:40
  review
• 7:40
  them
• 7:41
  for
• 7:41
  one
• 7:41
  afternoon,
• 7:43
  you
• 7:43
  will
• 7:43
  feel
• 7:44
  much
• 7:44
  more
• 7:44
  confident
• 7:45
  because
• 7:45
  just
• 7:45
  like
• 7:46
  these
• 7:46
  other
• 7:46
  psychiatric
• 7:47
  diagnoses,
• 7:48
  each
• 7:48
  of
• 7:48
  these
• 7:49
  sleep
• 7:49
  wake
• 7:50
  diagnoses
• 7:52
  have
• 7:52
  their
• 7:52
  own
• 7:53
  core
• 7:54
  feature
• 7:54
  that
• 7:54
  distinguishes
• 7:55
  them
• 7:55
  from
• 7:55
  the
• 7:56
  other
• 7:56
  ones.
• 7:57
  So
• 7:58
  what's
• 7:58
  the
• 7:58
  answer
• 7:58
  here?
• 7:59
  This
• 7:59
  patient
• 7:59
  is
• 8:00
  sleepy
• 8:00
  throughout
• 8:00
  the
• 8:01
  day.
• 8:01
  They
• 8:02
  have
• 8:02
  two
• 8:02
  sleep
• 8:02
  onset
• 8:03
  REM
• 8:03
  periods,
• 8:04
  also
• 8:04
  called
• 8:04
  REMs,
• 8:05
  on
• 8:06
  an
• 8:06
  MSLT.
• 8:07
  This
• 8:07
  patient
• 8:07
  has
• 8:07
  been
• 8:08
  tested
• 8:08
  formally
• 8:09
  for
• 8:09
  a
• 8:09
  sleep
• 8:09
  related
• 8:10
  issue.
• 8:11
  And
• 8:11
  it's
• 8:11
  not
• 8:11
  a
• 8:11
  polystynography.
• 8:12
  So
• 8:13
  that
• 8:13
  could
• 8:13
  be
• 8:13
  your
• 8:13
  first
• 8:14
  flag
• 8:15
  that
• 8:15
  obstructive
• 8:16
  sleep
• 8:16
  apnea
• 8:16
  is
• 8:16
  not
• 8:17
  what
• 8:17
  we're
• 8:17
  going
• 8:17
  for
• 8:17
  here.
• 8:18
  Because
• 8:18
  obstructive
• 8:19
  sleep
• 8:19
  apnea
• 8:20
  has
• 8:20
  its
• 8:20
  own
• 8:20
  cluster
• 8:20
  of
• 8:21
  symptoms,
• 8:21
  right?
• 8:22
  You're
• 8:22
  gasping
• 8:22
  at
• 8:23
  night,
• 8:23
  you
• 8:23
  have
• 8:23
  unrefreshing
• 8:24
  sleep,
• 8:24
  you
• 8:24
  wake
• 8:25
  up,
• 8:25
  maybe
• 8:25
  you
• 8:25
  have
• 8:25
  headaches,
• 8:26
  you're
• 8:27
  snoring,
• 8:27
  you're
• 8:28
  fatigued
• 8:28
  throughout
• 8:29
  the
• 8:29
  day,
• 8:29
  maybe
• 8:30
  irritable.
• 8:31
  There's
• 8:31
  really
• 8:31
  none
• 8:31
  of
• 8:32
  that
• 8:32
  in
• 8:32
  the
• 8:32
  question
• 8:32
  we
• 8:32
  have.
• 8:34
  For
• 8:34
  some
• 8:34
  reason,
• 8:34
  we're
• 8:34
  measuring
• 8:35
  REM
• 8:36
  onset
• 8:36
  in
• 8:36
  this
• 8:37
  question
• 8:37
  and
• 8:37
  mslt.
• 8:38
  So
• 8:39
  this
• 8:39
  sounds
• 8:39
  like
• 8:40
  not
• 8:40
  a
• 8:40
  common
• 8:41
  obstructive
• 8:42
  sleep
• 8:42
  apnea
• 8:42
  type
• 8:43
  workup
• 8:43
  at
• 8:43
  all.
• 8:43
  I
• 8:43
  would
• 8:44
  strike
• 8:44
  that
• 8:44
  immediately
• 8:45
  from
• 8:45
  the
• 8:45
  question.
• 8:46
  If
• 8:46
  you're
• 8:46
  just
• 8:47
  vaguely
• 8:47
  familiar
• 8:47
  with
• 8:48
  OSA
• 8:48
  or
• 8:48
  obstructive
• 8:49
  sleep
• 8:49
  apnea,
• 8:49
  you
• 8:50
  will
• 8:50
  know
• 8:50
  to
• 8:50
  strike
• 8:50
  this
• 8:50
  from
• 8:51
  the
• 8:51
  Question.
• 8:51
  Because
• 8:52
  if
• 8:52
  you
• 8:52
  open
• 8:52
  the
• 8:52
  dsm,
• 8:53
  there's
• 8:53
  no
• 8:53
  criteria
• 8:54
  that
• 8:54
  is
• 8:55
  asking
• 8:55
  for
• 8:55
  an
• 8:55
  MSLT
• 8:56
  or
• 8:56
  so
• 8:56
  remp.
• 8:57
  And
• 8:57
  we'll
• 8:58
  talk
• 8:58
  about
• 8:58
  SORAMP
• 8:58
  and
• 8:58
  MSLT
• 8:59
  in
• 8:59
  a
• 8:59
  moment.
• 9:00
  Now,
• 9:00
  could
• 9:01
  it
• 9:01
  be
• 9:01
  narcolepsy
• 9:01
  type
• 9:02
  2?
• 9:02
  Maybe.
• 9:02
  Maybe.
• 9:03
  Let's
• 9:03
  not
• 9:03
  rule
• 9:03
  that
• 9:04
  out.
• 9:04
  That
• 9:04
  sounds
• 9:05
  like
• 9:05
  a
• 9:05
  pretty
• 9:05
  official
• 9:06
  sleep
• 9:07
  impairment
• 9:07
  diagnosis
• 9:08
  that
• 9:08
  might
• 9:09
  involve
• 9:09
  its
• 9:09
  own
• 9:09
  workup.
• 9:10
  Could
• 9:10
  it
• 9:10
  be
• 9:11
  delayed
• 9:11
  sleep
• 9:11
  wake
• 9:12
  phase
• 9:12
  disorder?
• 9:12
  I
• 9:13
  don't
• 9:13
  see
• 9:13
  a
• 9:13
  whole
• 9:13
  lot
• 9:13
  of
• 9:14
  evidence
• 9:14
  for
• 9:15
  that.
• 9:15
  There's
• 9:16
  nothing
• 9:16
  to
• 9:16
  indicate
• 9:16
  a
• 9:16
  circadian
• 9:17
  shift
• 9:17
  issue
• 9:18
  here
• 9:19
  for
• 9:19
  a
• 9:19
  delayed
• 9:19
  sleep
• 9:20
  wake
• 9:20
  phase
• 9:20
  disorder.
• 9:21
  If
• 9:21
  you
• 9:21
  read
• 9:21
  the
• 9:21
  DSM,
• 9:22
  there's
• 9:22
  no
• 9:22
  mention
• 9:23
  of
• 9:23
  MSLTs
• 9:24
  or
• 9:24
  so
• 9:24
  REMs.
• 9:25
  We're
• 9:25
  not
• 9:25
  doing
• 9:25
  a
• 9:25
  formal
• 9:26
  test
• 9:26
  for
• 9:26
  those
• 9:26
  things.
• 9:26
  That
• 9:27
  is
• 9:27
  measuring
• 9:27
  how
• 9:27
  quickly
• 9:28
  you
• 9:28
  get
• 9:28
  into
• 9:28
  the
• 9:29
  REM
• 9:29
  cycle
• 9:29
  of
• 9:29
  sleep.
• 9:30
  For
• 9:30
  most
• 9:30
  people
• 9:31
  it's
• 9:32
  70
• 9:33
  minutes
• 9:33
  plus
• 9:34
  you
• 9:34
  don't
• 9:34
  get
• 9:34
  into
• 9:35
  the
• 9:35
  REM
• 9:35
  cycle
• 9:36
  very
• 9:36
  quickly.
• 9:36
  For
• 9:37
  folks
• 9:37
  with
• 9:37
  narcolepsy,
• 9:38
  they
• 9:38
  get
• 9:38
  into
• 9:38
  rem
• 9:39
  cycles
• 9:39
  within
• 9:40
  15
• 9:40
  minutes
• 9:40
  of
• 9:40
  falling
• 9:41
  asleep.
• 9:41
  It's
• 9:41
  very
• 9:41
  unusual.
• 9:42
  If
• 9:42
  you
• 9:42
  have
• 9:43
  two
• 9:43
  of
• 9:43
  those
• 9:44
  in
• 9:44
  addition
• 9:44
  to
• 9:45
  some
• 9:45
  other
• 9:45
  symptoms,
• 9:46
  then
• 9:46
  you
• 9:46
  might
• 9:47
  have
• 9:47
  narcolepsy.
• 9:48
  Narcolepsy
• 9:48
  type
• 9:49
  2
• 9:49
  might
• 9:49
  be
• 9:49
  this
• 9:49
  answer.
• 9:50
  We
• 9:50
  just
• 9:50
  have
• 9:50
  to
• 9:51
  rule
• 9:51
  out
• 9:51
  hypersomnolence
• 9:52
  disorder.
• 9:53
  Hypersomnolence
• 9:53
  disorder
• 9:55
  in
• 9:55
  the
• 9:55
  DSM
• 9:55
  is
• 9:56
  really
• 9:56
  characterized
• 9:57
  by
• 9:58
  waking
• 9:59
  up
• 9:59
  with
• 9:59
  a
• 10:00
  lot
• 10:00
  of
• 10:00
  inertia.
• 10:00
  You
• 10:00
  just
• 10:01
  don't
• 10:01
  want
• 10:01
  to
• 10:01
  wake
• 10:01
  up.
• 10:01
  You
• 10:02
  sleep
• 10:02
  a
• 10:02
  lot,
• 10:02
  but
• 10:02
  it's
• 10:03
  not
• 10:04
  very
• 10:04
  refreshing
• 10:04
  sleep
• 10:05
  despite
• 10:05
  the
• 10:05
  fact
• 10:05
  that
• 10:06
  you
• 10:06
  have
• 10:06
  adequate
• 10:07
  time
• 10:07
  frame
• 10:08
  to
• 10:08
  sleep.
• 10:08
  So
• 10:08
  you
• 10:09
  have
• 10:09
  like
• 10:09
  12
• 10:09
  hours
• 10:10
  and
• 10:10
  you're
• 10:10
  sleeping
• 10:11
  so
• 10:11
  much,
• 10:11
  but
• 10:11
  you're
• 10:11
  just
• 10:11
  not
• 10:12
  refreshed.
• 10:13
  But
• 10:13
  in
• 10:13
  the
• 10:14
  DSM
• 10:15
  5
• 10:15
  TR
• 10:16
  in
• 10:16
  hypersomnolence,
• 10:17
  there's
• 10:17
  really
• 10:17
  no
• 10:17
  requirement
• 10:18
  to
• 10:19
  or
• 10:20
  specification
• 10:20
  about
• 10:20
  rem
• 10:21
  intrusions
• 10:22
  or
• 10:23
  MSLTs.
• 10:24
  And
• 10:24
  so
• 10:24
  REM
• 10:24
  this
• 10:25
  vocabulary
• 10:25
  is
• 10:25
  associated
• 10:26
  specifically
• 10:27
  with
• 10:27
  narcolepsy.
• 10:27
  If
• 10:28
  you
• 10:28
  know
• 10:28
  that
• 10:28
  narcolepsy
• 10:29
  workup
• 10:29
  is
• 10:30
  associated
• 10:30
  with
• 10:30
  how
• 10:30
  quickly
• 10:31
  you
• 10:32
  enter
• 10:32
  rem,
• 10:33
  that
• 10:33
  would
• 10:33
  be
• 10:33
  your
• 10:34
  sleep
• 10:34
  onset
• 10:34
  REM
• 10:35
  cycle.
• 10:35
  If
• 10:35
  you're
• 10:36
  entering
• 10:36
  REM
• 10:36
  too
• 10:36
  soon
• 10:37
  within
• 10:37
  15
• 10:37
  minutes
• 10:38
  and
• 10:38
  your
• 10:39
  multiple
• 10:39
  sleep
• 10:39
  latency
• 10:40
  test,
• 10:40
  which
• 10:41
  is
• 10:41
  basically
• 10:41
  a
• 10:41
  fancy
• 10:42
  way
• 10:42
  of
• 10:42
  saying
• 10:43
  how
• 10:43
  fast
• 10:43
  can
• 10:43
  you
• 10:43
  go
• 10:44
  to
• 10:44
  sleep?
• 10:44
  For
• 10:44
  folks
• 10:44
  with
• 10:45
  narcolepsy,
• 10:45
  they're
• 10:46
  falling
• 10:46
  asleep
• 10:46
  in
• 10:47
  under
• 10:47
  eight
• 10:47
  minutes.
• 10:47
  Typically
• 10:48
  if
• 10:48
  you're
• 10:49
  falling
• 10:49
  asleep
• 10:49
  in
• 10:49
  under
• 10:50
  eight
• 10:50
  minutes,
• 10:50
  that's
• 10:51
  pretty
• 10:51
  fast.
• 10:51
  And
• 10:52
  you're
• 10:52
  entering
• 10:52
  REM
• 10:53
  there
• 10:53
  you
• 10:53
  have
• 10:54
  two
• 10:54
  periods
• 10:54
  where
• 10:54
  you're
• 10:55
  entering
• 10:55
  REM
• 10:55
  or
• 10:56
  greater
• 10:56
  in
• 10:56
  under
• 10:57
  15
• 10:57
  minutes.
• 10:58
  You
• 10:58
  may
• 10:58
  have
• 10:58
  narcolepsy.
• 10:59
  It's
• 11:00
  type
• 11:00
  two
• 11:00
  if
• 11:00
  you
• 11:01
  don't
• 11:01
  have
• 11:01
  the
• 11:01
  cataplexy,
• 11:02
  if
• 11:02
  you
• 11:03
  don't
• 11:03
  have
• 11:03
  the
• 11:03
  sudden
• 11:03
  loss
• 11:04
  of
• 11:04
  muscle
• 11:05
  tone
• 11:05
  where
• 11:05
  you're
• 11:05
  just
• 11:05
  kind
• 11:06
  of
• 11:06
  collapsing,
• 11:07
  then
• 11:07
  that
• 11:07
  would
• 11:08
  be
• 11:08
  type
• 11:08
  2
• 11:08
  narcolepsy.
• 11:09
  If
• 11:09
  you
• 11:09
  are
• 11:10
  losing
• 11:10
  muscle
• 11:11
  tone
• 11:11
  and
• 11:11
  just
• 11:11
  collapsing
• 11:12
  suddenly,
• 11:12
  that
• 11:13
  would
• 11:13
  be
• 11:13
  type
• 11:13
  one
• 11:13
  narcolepsy.
• 11:14
  Either
• 11:15
  way,
• 11:15
  this
• 11:15
  question
• 11:15
  is
• 11:16
  not
• 11:16
  asking
• 11:16
  you
• 11:16
  to
• 11:16
  know
• 11:17
  every
• 11:17
  single
• 11:17
  detail
• 11:18
  about
• 11:18
  every
• 11:18
  single
• 11:18
  sleep
• 11:19
  disorder,
• 11:19
  but
• 11:20
  it
• 11:20
  is
• 11:20
  asking
• 11:21
  you
• 11:21
  to
• 11:21
  be
• 11:21
  able
• 11:22
  to
• 11:22
  parse
• 11:22
  out
• 11:22
  and
• 11:23
  have
• 11:23
  a
• 11:23
  conceptual
• 11:24
  appreciation
• 11:24
  for
• 11:24
  the
• 11:25
  differences
• 11:26
  between
• 11:26
  these
• 11:27
  disorders.
• 11:27
  Right.
• 11:27
  We
• 11:28
  talked
• 11:28
  about
• 11:28
  osa,
• 11:29
  obstructive
• 11:29
  sleep
• 11:29
  apnea.
• 11:30
  We're
• 11:30
  not
• 11:31
  gasping
• 11:31
  for
• 11:31
  air
• 11:31
  here.
• 11:32
  We're
• 11:32
  not
• 11:32
  snorting.
• 11:33
  It's
• 11:33
  asking
• 11:34
  about
• 11:35
  these
• 11:35
  two
• 11:35
  wild
• 11:36
  metrics,
• 11:36
  MSLT
• 11:37
  and
• 11:37
  SO
• 11:37
  REMs
• 11:38
  that
• 11:38
  should
• 11:38
  gravitate
• 11:39
  you
• 11:39
  towards
• 11:39
  a
• 11:39
  narcolepsy
• 11:41
  type
• 11:42
  disorder.
• 11:42
  It's
• 11:43
  not
• 11:43
  talking
• 11:43
  about
• 11:43
  delayed
• 11:44
  sleep
• 11:45
  wake
• 11:45
  cycles
• 11:46
  so
• 11:46
  we
• 11:46
  can
• 11:46
  get
• 11:47
  rid
• 11:47
  of
• 11:47
  that.
• 11:47
  Hypersomnolence
• 11:48
  disorder
• 11:49
  doesn't
• 11:49
  have
• 11:49
  these
• 11:49
  nitty
• 11:49
  gritty
• 11:50
  tests
• 11:50
  attached
• 11:50
  to
• 11:50
  it
• 11:51
  that
• 11:51
  have
• 11:51
  to
• 11:51
  be
• 11:52
  proven
• 11:52
  and
• 11:52
  hit
• 11:52
  a
• 11:52
  certain
• 11:53
  metric
• 11:53
  to
• 11:53
  diagnose
• 11:54
  them.
• 11:54
  I
• 11:54
  think
• 11:55
  that
• 11:55
  will
• 11:55
  give
• 11:55
  you
• 11:55
  a
• 11:56
  pretty
• 11:56
  good
• 11:56
  understanding,
• 11:57
  kind
• 11:57
  of
• 11:57
  whet
• 11:58
  your
• 11:58
  appetite
• 11:58
  for
• 11:59
  what
• 11:59
  you
• 11:59
  need
• 11:59
  to
• 11:59
  know.
• 11:59
  I
• 12:00
  love
• 12:00
  that
• 12:00
  third
• 12:00
  question
• 12:01
  because
• 12:01
  again,
• 12:01
  it's
• 12:01
  very
• 12:01
  nitty
• 12:02
  gritty.
• 12:02
  It's
• 12:02
  very
• 12:02
  interesting.
• 12:03
  It
• 12:03
  helps
• 12:04
  demystify
• 12:04
  some
• 12:04
  of
• 12:05
  these
• 12:05
  sleep
• 12:05
  issues
• 12:06
  and
• 12:06
  gives
• 12:06
  you
• 12:06
  a
• 12:07
  little
• 12:07
  more
• 12:07
  confidence
• 12:08
  to
• 12:08
  tackle
• 12:09
  your
• 12:09
  boards.
• 12:10
  Just
• 12:10
  to
• 12:11
  recap,
• 12:11
  go
• 12:11
  over
• 12:11
  those
• 12:12
  FDA
• 12:12
  approvals,
• 12:13
  make
• 12:13
  those
• 12:13
  distinctions
• 12:14
  within
• 12:14
  your
• 12:14
  anxiety
• 12:15
  disorders
• 12:16
  to
• 12:16
  understand
• 12:17
  what
• 12:17
  is
• 12:17
  the
• 12:18
  core
• 12:18
  impairment
• 12:19
  we're
• 12:19
  talking
• 12:19
  about
• 12:19
  here
• 12:20
  to
• 12:20
  help
• 12:20
  you
• 12:20
  answer
• 12:20
  anxiety
• 12:21
  disorder
• 12:21
  questions.
• 12:22
  And
• 12:22
  last
• 12:22
  but
• 12:23
  not
• 12:23
  least,
• 12:23
  open
• 12:23
  the
• 12:24
  DSM
• 12:24
  and
• 12:25
  look
• 12:25
  at
• 12:25
  those
• 12:26
  sleep
• 12:26
  disorders
• 12:27
  have
• 12:27
  familiarity
• 12:28
  with
• 12:28
  what
• 12:28
  they
• 12:29
  mean,
• 12:29
  how
• 12:29
  to
• 12:30
  diagnose
• 12:30
  them,
• 12:30
  and
• 12:31
  what
• 12:31
  markers
• 12:31
  are
• 12:32
  required
• 12:32
  to
• 12:32
  diagnose
• 12:33
  them.
• 12:33
  I
• 12:34
  definitely
• 12:34
  think
• 12:34
  you
• 12:35
  will
• 12:35
  feel
• 12:35
  way
• 12:35
  more
• 12:35
  confident
• 12:36
  if
• 12:36
  you
• 12:36
  get
• 12:36
  into
• 12:36
  that.
• 12:37
  I
• 12:37
  hope
• 12:37
  you
• 12:37
  enjoyed
• 12:38
  today's
• 12:39
  episode
• 12:39
  of
• 12:40
  Board
• 12:40
  Bombs.
• 12:41
  Again,
• 12:41
  the
• 12:41
  answers
• 12:42
  are
• 12:42
  lituda
• 12:44
  social
• 12:44
  anxiety
• 12:45
  disorder
• 12:45
  and
• 12:46
  narcolepsy
• 12:47
  type
• 12:47
  2.
• 12:48
  Very
• 12:48
  fun,
• 12:48
  very
• 12:49
  awesome.
• 12:49
  Can't
• 12:49
  wait
• 12:49
  to
• 12:50
  see
• 12:50
  you
• 12:50
  all
• 12:50
  next
• 12:50
  time
• 12:51
  here
• 12:51
  on
• 12:51
  Pearls
• 12:52
  and
• 12:52
  Prep.
• 12:52
  Take
• 12:53
  care.
• 12:57
  Of.