Latest / Pearls and Prep / Exploring the Nuances of ADHD vs. Bipolar Disorder in Outpatient Care

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Exploring the Nuances of ADHD vs. Bipolar Disorder in Outpatient Care · Pearls and Prep

• 0:00
  Foreign
• 0:04
  welcome
• 0:05
  back
• 0:05
  my
• 0:05
  friends
• 0:06
  to
• 0:06
  another
• 0:06
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:08
  I'm
• 0:09
  NPZ
• 0:11
  and
• 0:11
  this
• 0:12
  is
• 0:12
  your
• 0:12
  go
• 0:12
  to
• 0:13
  place
• 0:13
  for
• 0:13
  pearls
• 0:14
  that
• 0:14
  prep
• 0:14
  you
• 0:15
  to
• 0:15
  practice.
• 0:16
  I'd
• 0:17
  like
• 0:17
  you
• 0:17
  to
• 0:17
  meet
• 0:17
  our
• 0:18
  fake
• 0:18
  patient,
• 0:18
  Dale.
• 0:19
  I
• 0:19
  just
• 0:19
  mean
• 0:20
  he's
• 0:20
  a
• 0:20
  fake
• 0:20
  patient.
• 0:20
  He's
• 0:21
  a
• 0:21
  mock
• 0:21
  patient.
• 0:22
  We
• 0:22
  do
• 0:22
  that
• 0:22
  to
• 0:22
  protect
• 0:22
  patient
• 0:23
  privacy
• 0:23
  here.
• 0:24
  These
• 0:24
  are
• 0:24
  patients
• 0:25
  that
• 0:25
  you
• 0:25
  may
• 0:25
  see
• 0:26
  in
• 0:26
  the
• 0:26
  outpatient
• 0:27
  space
• 0:28
  and
• 0:28
  this
• 0:28
  is
• 0:28
  going
• 0:28
  to
• 0:29
  get
• 0:29
  you
• 0:29
  to
• 0:29
  think
• 0:29
  critically.
• 0:30
  The
• 0:30
  purpose
• 0:31
  here
• 0:31
  is
• 0:31
  to
• 0:31
  educate
• 0:32
  you
• 0:33
  on
• 0:33
  how
• 0:33
  best
• 0:34
  to
• 0:34
  approach
• 0:35
  complex
• 0:35
  patients
• 0:36
  or
• 0:36
  even
• 0:36
  simple
• 0:36
  patients.
• 0:37
  I
• 0:37
  would
• 0:37
  argue
• 0:37
  every
• 0:38
  patient
• 0:38
  is
• 0:39
  complex
• 0:39
  if
• 0:39
  you
• 0:40
  look
• 0:40
  at
• 0:40
  them
• 0:40
  carefully
• 0:41
  enough,
• 0:41
  but
• 0:41
  complex
• 0:42
  in
• 0:42
  a
• 0:42
  fun
• 0:42
  and
• 0:42
  playful
• 0:43
  way
• 0:43
  in
• 0:43
  a
• 0:43
  way
• 0:44
  that
• 0:44
  allows
• 0:44
  you
• 0:44
  to
• 0:45
  really
• 0:45
  understand
• 0:46
  them
• 0:46
  and
• 0:46
  the
• 0:46
  world
• 0:46
  a
• 0:47
  little
• 0:47
  better.
• 0:47
  So
• 0:47
  here's
• 0:48
  Dale.
• 0:49
  Dale
• 0:49
  is
• 0:49
  coming
• 0:49
  to
• 0:50
  you
• 0:50
  because
• 0:51
  he
• 0:52
  says
• 0:52
  he
• 0:52
  has
• 0:53
  mood
• 0:53
  swings.
• 0:54
  He's
• 0:55
  38
• 0:55
  years
• 0:56
  old.
• 0:57
  He
• 0:57
  loves
• 0:58
  to
• 0:59
  make
• 0:59
  artisanal
• 1:00
  cheese.
• 1:01
  He
• 1:01
  collects
• 1:02
  vintage
• 1:02
  sci
• 1:02
  fi
• 1:03
  comics.
• 1:04
  Last
• 1:05
  weekend
• 1:05
  he
• 1:06
  ripped
• 1:06
  out
• 1:06
  cabinets,
• 1:07
  ordered
• 1:07
  a
• 1:07
  bunch
• 1:07
  of
• 1:08
  obscure
• 1:08
  parts
• 1:08
  online
• 1:09
  and
• 1:10
  he
• 1:10
  lost
• 1:10
  interest
• 1:10
  midway.
• 1:11
  And
• 1:11
  he
• 1:11
  leaved
• 1:12
  a
• 1:12
  half
• 1:12
  demolished
• 1:13
  cooking
• 1:13
  space
• 1:14
  for
• 1:14
  weeks
• 1:14
  while
• 1:15
  he
• 1:15
  became
• 1:15
  completely
• 1:16
  absorbed
• 1:16
  in
• 1:17
  learning
• 1:17
  medieval
• 1:18
  siege
• 1:18
  weaponry.
• 1:19
  This
• 1:19
  is
• 1:19
  a
• 1:19
  patient
• 1:20
  that
• 1:21
  is
• 1:21
  clearly
• 1:22
  somewhat
• 1:22
  distractible,
• 1:23
  right?
• 1:24
  He's
• 1:24
  got
• 1:24
  a
• 1:24
  lot
• 1:24
  of
• 1:24
  projects
• 1:25
  going
• 1:25
  on.
• 1:25
  His
• 1:25
  wife
• 1:26
  is
• 1:26
  with
• 1:26
  him
• 1:27
  saying
• 1:27
  that
• 1:28
  she
• 1:28
  thinks
• 1:28
  he's
• 1:28
  bipolar
• 1:29
  because
• 1:30
  his
• 1:30
  moods
• 1:30
  and
• 1:31
  interests
• 1:31
  just
• 1:31
  switch
• 1:32
  very
• 1:32
  quickly.
• 1:32
  He's
• 1:33
  going
• 1:33
  from
• 1:33
  renovating
• 1:34
  the
• 1:34
  entire
• 1:34
  kitchen
• 1:35
  to
• 1:37
  researching
• 1:37
  medieval
• 1:38
  weapons
• 1:39
  to
• 1:39
  making
• 1:39
  cheese.
• 1:40
  So
• 1:40
  he's
• 1:40
  really
• 1:40
  all
• 1:40
  over
• 1:41
  the
• 1:41
  place.
• 1:42
  And
• 1:42
  she
• 1:42
  said
• 1:42
  she's
• 1:43
  just
• 1:43
  had
• 1:43
  it
• 1:43
  up
• 1:43
  to
• 1:44
  here
• 1:44
  with
• 1:44
  him.
• 1:44
  This
• 1:45
  has
• 1:45
  been
• 1:45
  going
• 1:45
  on
• 1:45
  a
• 1:45
  really
• 1:46
  long
• 1:46
  time
• 1:46
  and
• 1:46
  she
• 1:46
  can't
• 1:46
  take
• 1:47
  it
• 1:47
  anymore.
• 1:48
  A
• 1:48
  couple
• 1:48
  other
• 1:49
  details
• 1:49
  about
• 1:49
  Dale
• 1:50
  he's
• 1:51
  mentioned
• 1:51
  his
• 1:51
  thoughts
• 1:51
  are
• 1:52
  racing,
• 1:52
  that
• 1:53
  he
• 1:53
  often
• 1:53
  has
• 1:54
  crashing
• 1:54
  fatigue,
• 1:55
  and
• 1:56
  his
• 1:56
  girlfriend
• 1:56
  might
• 1:57
  leave
• 1:57
  him
• 1:57
  because
• 1:58
  she
• 1:58
  refers
• 1:58
  to
• 1:58
  him
• 1:58
  as
• 1:59
  the
• 1:59
  bipolar
• 1:59
  boyfriend.
• 2:00
  He
• 2:01
  is
• 2:01
  interested
• 2:02
  in
• 2:02
  a
• 2:02
  lot
• 2:02
  of
• 2:02
  different
• 2:02
  things
• 2:03
  at
• 2:03
  once.
• 2:03
  He
• 2:03
  admits
• 2:04
  he's
• 2:04
  a
• 2:04
  pretty
• 2:04
  passionate
• 2:05
  person.
• 2:05
  He's
• 2:06
  been
• 2:06
  diagnosed
• 2:06
  with
• 2:06
  generalized
• 2:07
  anxiety
• 2:07
  and
• 2:08
  depression
• 2:08
  in
• 2:08
  college.
• 2:09
  He's
• 2:10
  been
• 2:10
  in
• 2:10
  therapy
• 2:10
  for
• 2:11
  stress
• 2:11
  management
• 2:12
  and
• 2:12
  regulating
• 2:13
  some
• 2:13
  of
• 2:13
  his
• 2:13
  moods.
• 2:14
  But
• 2:15
  he
• 2:15
  also
• 2:15
  tells
• 2:16
  you
• 2:16
  he's
• 2:16
  changed
• 2:17
  jobs
• 2:17
  a
• 2:17
  lot
• 2:17
  in
• 2:17
  the
• 2:17
  past
• 2:18
  because
• 2:18
  he
• 2:18
  doesn't
• 2:19
  feel
• 2:19
  particularly
• 2:19
  challenged
• 2:20
  or
• 2:20
  engaged
• 2:21
  in
• 2:21
  his
• 2:22
  jobs
• 2:23
  now.
• 2:23
  He
• 2:24
  does
• 2:24
  drink
• 2:24
  energy
• 2:25
  drinks
• 2:25
  just
• 2:26
  to
• 2:26
  kind
• 2:26
  of
• 2:26
  feel
• 2:27
  a
• 2:27
  little
• 2:27
  more
• 2:27
  intense.
• 2:28
  He
• 2:28
  likes
• 2:28
  the
• 2:29
  caffeine
• 2:29
  rush.
• 2:30
  He
• 2:30
  occasionally
• 2:31
  uses
• 2:31
  marijuana
• 2:32
  to
• 2:32
  calm
• 2:32
  his
• 2:33
  thoughts.
• 2:34
  He
• 2:34
  has
• 2:35
  some
• 2:35
  complaints
• 2:35
  of
• 2:35
  insomnia
• 2:36
  and
• 2:36
  restless
• 2:37
  legs.
• 2:38
  He's
• 2:38
  tried
• 2:38
  SSRIs
• 2:39
  in
• 2:39
  the
• 2:39
  past
• 2:40
  and
• 2:41
  benzodiazepines
• 2:42
  for
• 2:42
  some
• 2:42
  anxiety.
• 2:43
  He
• 2:43
  lives
• 2:44
  with
• 2:44
  his
• 2:44
  parents.
• 2:44
  That
• 2:44
  might
• 2:45
  be
• 2:45
  one
• 2:45
  of
• 2:45
  the
• 2:45
  main
• 2:45
  reasons
• 2:46
  his
• 2:46
  girlfriend
• 2:47
  really
• 2:47
  wants
• 2:47
  to
• 2:47
  Leave
• 2:47
  him.
• 2:48
  We
• 2:48
  love
• 2:48
  all
• 2:48
  of
• 2:48
  our
• 2:48
  patients
• 2:49
  and
• 2:49
  we
• 2:49
  root
• 2:49
  for
• 2:50
  them.
• 2:50
  And
• 2:50
  their
• 2:50
  hobbies
• 2:51
  are
• 2:51
  our
• 2:51
  hobbies.
• 2:52
  So
• 2:52
  let's
• 2:53
  move
• 2:53
  on.
• 2:54
  Now
• 2:55
  the
• 2:55
  patient
• 2:55
  is
• 2:57
  saying
• 2:57
  that
• 2:57
  he
• 2:58
  hasn't
• 2:59
  really
• 2:59
  been
• 2:59
  depressed
• 3:00
  lately.
• 3:00
  He's
• 3:01
  been
• 3:01
  diagnosed
• 3:01
  with
• 3:01
  anxiety
• 3:02
  and
• 3:02
  depression
• 3:02
  in
• 3:02
  college,
• 3:03
  but
• 3:03
  he
• 3:03
  doesn't
• 3:03
  currently
• 3:04
  feel
• 3:04
  depressed.
• 3:05
  Now,
• 3:05
  what
• 3:05
  do
• 3:05
  you
• 3:05
  do
• 3:06
  with
• 3:06
  this?
• 3:06
  Right,
• 3:06
  let's
• 3:07
  zoom
• 3:07
  out
• 3:07
  and
• 3:07
  look
• 3:07
  at
• 3:08
  this
• 3:08
  and
• 3:08
  say,
• 3:08
  okay,
• 3:09
  here
• 3:09
  you
• 3:09
  clearly
• 3:10
  have
• 3:10
  a
• 3:10
  patient.
• 3:11
  His
• 3:12
  girlfriend
• 3:12
  is
• 3:12
  exasperated
• 3:13
  with
• 3:13
  him,
• 3:14
  he's
• 3:14
  interested
• 3:15
  in
• 3:15
  a
• 3:15
  lot
• 3:15
  of
• 3:15
  things,
• 3:16
  his
• 3:16
  interests
• 3:16
  will
• 3:17
  rapidly
• 3:17
  change,
• 3:17
  and
• 3:18
  his
• 3:18
  life
• 3:18
  looks
• 3:18
  kind
• 3:18
  of
• 3:19
  disorganized.
• 3:19
  Right?
• 3:20
  You're
• 3:20
  renovating
• 3:21
  a
• 3:21
  kitchen
• 3:21
  and
• 3:21
  you
• 3:21
  just
• 3:22
  lose
• 3:22
  interest.
• 3:23
  How
• 3:23
  are
• 3:23
  you
• 3:23
  supposed
• 3:23
  to
• 3:24
  make
• 3:24
  your
• 3:24
  Mac
• 3:25
  and
• 3:25
  cheese
• 3:25
  at
• 3:25
  night?
• 3:25
  Why
• 3:26
  are
• 3:26
  you
• 3:26
  renovating
• 3:26
  your
• 3:26
  parents
• 3:27
  kitchen?
• 3:27
  I
• 3:28
  don't
• 3:28
  know.
• 3:28
  I
• 3:28
  don't
• 3:28
  always
• 3:29
  understand
• 3:29
  these
• 3:29
  mock
• 3:30
  cases.
• 3:31
  But
• 3:31
  the
• 3:31
  greater
• 3:31
  point
• 3:32
  is
• 3:32
  he's
• 3:32
  kind
• 3:33
  of
• 3:33
  all
• 3:33
  over
• 3:33
  the
• 3:33
  place
• 3:34
  and
• 3:34
  his
• 3:34
  girlfriend's
• 3:35
  aware
• 3:35
  of
• 3:35
  that
• 3:35
  and
• 3:35
  is
• 3:36
  not
• 3:36
  pleased.
• 3:37
  So
• 3:37
  what
• 3:37
  do
• 3:37
  we
• 3:37
  do?
• 3:38
  What
• 3:38
  do
• 3:38
  we
• 3:38
  do
• 3:38
  with
• 3:39
  this?
• 3:39
  Pearl
• 3:40
  number
• 3:40
  one,
• 3:40
  My
• 3:40
  friends
• 3:41
  and
• 3:41
  I
• 3:41
  can't
• 3:41
  emphasize
• 3:42
  this
• 3:42
  enough.
• 3:43
  Your
• 3:43
  patients
• 3:43
  are
• 3:43
  going
• 3:43
  to
• 3:44
  come
• 3:44
  to
• 3:44
  you
• 3:44
  with
• 3:44
  their
• 3:44
  own
• 3:45
  verbiage
• 3:45
  and
• 3:46
  their
• 3:46
  own
• 3:46
  perspective
• 3:47
  on
• 3:47
  their
• 3:47
  issues.
• 3:47
  Whether
• 3:48
  that's
• 3:48
  verbiage
• 3:48
  acquired
• 3:49
  through
• 3:50
  Hollywood
• 3:50
  media,
• 3:51
  Instagram,
• 3:52
  or
• 3:52
  Google,
• 3:53
  they're
• 3:53
  going
• 3:53
  to
• 3:53
  have
• 3:54
  their
• 3:54
  own
• 3:54
  ways
• 3:54
  of
• 3:55
  characterizing
• 3:55
  their
• 3:55
  symptoms
• 3:56
  or
• 3:56
  their
• 3:56
  loved
• 3:57
  ones.
• 3:57
  In
• 3:57
  this
• 3:58
  case,
• 3:58
  his
• 3:58
  girlfriend's
• 3:59
  calling
• 3:59
  him
• 3:59
  bipolar.
• 4:00
  So
• 4:00
  you
• 4:00
  might
• 4:00
  be
• 4:01
  inclined
• 4:01
  to
• 4:02
  immediately
• 4:02
  think
• 4:02
  he's
• 4:03
  bipolar.
• 4:03
  We
• 4:03
  call
• 4:03
  it
• 4:04
  an
• 4:04
  anchoring
• 4:04
  bias
• 4:04
  to
• 4:05
  the
• 4:05
  first
• 4:05
  thing
• 4:05
  that
• 4:05
  you
• 4:06
  see,
• 4:06
  which
• 4:06
  is
• 4:06
  that
• 4:07
  he's
• 4:07
  bipolar.
• 4:08
  But
• 4:08
  we
• 4:08
  don't
• 4:08
  know
• 4:09
  he
• 4:09
  very
• 4:09
  well
• 4:09
  could
• 4:09
  be
• 4:10
  bipolar.
• 4:10
  We
• 4:10
  haven't
• 4:11
  gone
• 4:11
  through
• 4:11
  the
• 4:11
  questions
• 4:11
  yet.
• 4:12
  He
• 4:12
  very
• 4:12
  well
• 4:13
  might
• 4:13
  not
• 4:13
  be
• 4:13
  bipolar.
• 4:14
  He
• 4:14
  might
• 4:15
  be
• 4:15
  bipolar,
• 4:15
  and
• 4:15
  he
• 4:15
  might
• 4:16
  have
• 4:16
  five
• 4:16
  other
• 4:16
  things,
• 4:17
  too,
• 4:17
  that
• 4:17
  deserve
• 4:17
  our
• 4:18
  treatment,
• 4:18
  but
• 4:18
  we
• 4:19
  just
• 4:19
  don't
• 4:19
  really
• 4:19
  know
• 4:21
  what
• 4:22
  the
• 4:22
  issue
• 4:22
  is.
• 4:24
  So
• 4:25
  I
• 4:25
  urge
• 4:26
  you
• 4:26
  to
• 4:26
  have
• 4:26
  an
• 4:27
  open
• 4:27
  mind,
• 4:28
  to
• 4:28
  think
• 4:28
  about
• 4:29
  this
• 4:29
  carefully
• 4:30
  and
• 4:31
  to
• 4:31
  collect
• 4:31
  information
• 4:32
  first.
• 4:32
  Collect
• 4:33
  information
• 4:34
  before
• 4:34
  you
• 4:34
  make
• 4:34
  judgments.
• 4:35
  You
• 4:35
  may
• 4:36
  want
• 4:36
  to
• 4:36
  make
• 4:36
  a
• 4:36
  judgment,
• 4:37
  you
• 4:37
  might
• 4:37
  want
• 4:37
  to
• 4:37
  make
• 4:37
  it
• 4:38
  so
• 4:38
  fast.
• 4:39
  You
• 4:39
  might
• 4:39
  want
• 4:39
  to
• 4:40
  rubber
• 4:40
  stamp
• 4:40
  this,
• 4:41
  whip
• 4:41
  out
• 4:41
  the
• 4:41
  dsm,
• 4:42
  shove
• 4:43
  it
• 4:43
  in
• 4:43
  your
• 4:43
  patient's
• 4:44
  face,
• 4:45
  jump
• 4:45
  on
• 4:45
  the
• 4:45
  table
• 4:45
  and
• 4:46
  scream
• 4:46
  that
• 4:46
  you've
• 4:47
  diagnosed
• 4:47
  them
• 4:47
  properly.
• 4:48
  But
• 4:48
  no,
• 4:48
  no,
• 4:49
  no,
• 4:49
  no,
• 4:49
  no.
• 4:49
  Please
• 4:49
  don't
• 4:50
  do
• 4:50
  any
• 4:50
  of
• 4:50
  that.
• 4:51
  Please
• 4:51
  don't
• 4:51
  do
• 4:51
  any
• 4:52
  of
• 4:52
  that.
• 4:53
  Take
• 4:53
  your
• 4:53
  time,
• 4:54
  slow
• 4:54
  down,
• 4:55
  and
• 4:55
  try
• 4:56
  your
• 4:56
  best
• 4:56
  not
• 4:57
  to
• 4:57
  judge.
• 4:57
  I
• 4:57
  would
• 4:58
  also
• 4:58
  argue
• 4:58
  you
• 4:58
  will
• 4:58
  become
• 4:59
  a
• 4:59
  better
• 4:59
  person
• 4:59
  in
• 5:00
  life.
• 5:00
  I'm
• 5:01
  still
• 5:01
  working
• 5:01
  on
• 5:01
  this
• 5:02
  every
• 5:02
  day.
• 5:02
  I'm
• 5:02
  not
• 5:02
  going
• 5:02
  to
• 5:02
  pretend
• 5:03
  I'm
• 5:03
  perfect.
• 5:04
  But
• 5:04
  you
• 5:04
  will
• 5:04
  become
• 5:04
  a
• 5:05
  Better
• 5:05
  person
• 5:05
  in
• 5:05
  life
• 5:06
  if
• 5:06
  you
• 5:06
  just
• 5:06
  learn
• 5:07
  to
• 5:07
  slow
• 5:07
  down
• 5:07
  your
• 5:08
  judgment
• 5:08
  and
• 5:09
  collect
• 5:09
  information.
• 5:10
  Because
• 5:10
  people,
• 5:11
  turns
• 5:11
  out,
• 5:12
  are
• 5:12
  much
• 5:12
  more
• 5:12
  complicated
• 5:13
  than
• 5:13
  you
• 5:13
  think.
• 5:14
  They're
• 5:14
  even
• 5:14
  more
• 5:15
  complicated
• 5:15
  than
• 5:15
  your
• 5:15
  DSM
• 5:16
  textbook.
• 5:16
  It's.
• 5:17
  It
• 5:17
  simplifies
• 5:17
  the
• 5:17
  world
• 5:18
  down
• 5:18
  to
• 5:18
  categories.
• 5:19
  People
• 5:19
  are
• 5:20
  more
• 5:20
  complicated.
• 5:22
  So
• 5:23
  one
• 5:23
  of
• 5:23
  the
• 5:23
  biggest
• 5:24
  questions
• 5:24
  you
• 5:25
  could
• 5:25
  ask
• 5:25
  Dale
• 5:26
  would
• 5:27
  be
• 5:27
  to
• 5:28
  ask
• 5:28
  him
• 5:28
  when.
• 5:30
  When
• 5:30
  is
• 5:30
  a
• 5:30
  really
• 5:31
  important
• 5:31
  question
• 5:32
  here.
• 5:32
  When
• 5:33
  did
• 5:33
  you
• 5:33
  realize
• 5:34
  that
• 5:35
  you
• 5:35
  had
• 5:35
  some
• 5:36
  problems
• 5:37
  not
• 5:37
  finishing
• 5:38
  tasks
• 5:39
  and
• 5:39
  moving
• 5:39
  on
• 5:40
  to
• 5:40
  other
• 5:40
  ones?
• 5:41
  I
• 5:41
  would
• 5:42
  ask
• 5:42
  him,
• 5:44
  do
• 5:44
  these
• 5:44
  types
• 5:45
  of
• 5:45
  behaviors
• 5:46
  occur
• 5:47
  in
• 5:47
  episodes
• 5:48
  for,
• 5:49
  you
• 5:49
  know,
• 5:49
  four
• 5:50
  days,
• 5:51
  maybe
• 5:51
  a
• 5:51
  week
• 5:51
  at
• 5:52
  a
• 5:52
  time,
• 5:52
  and
• 5:52
  then
• 5:52
  they
• 5:52
  stop
• 5:53
  and
• 5:53
  you
• 5:53
  act
• 5:53
  totally
• 5:54
  different?
• 5:54
  Or
• 5:55
  is
• 5:55
  this
• 5:55
  just
• 5:55
  kind
• 5:56
  of
• 5:56
  the
• 5:56
  norm
• 5:56
  where
• 5:57
  you're
• 5:57
  passionate
• 5:57
  about
• 5:58
  cheese
• 5:58
  and
• 5:58
  sci
• 5:59
  fi
• 5:59
  comics
• 5:59
  and
• 6:00
  World
• 6:00
  of
• 6:00
  Warcraft
• 6:01
  and
• 6:01
  you
• 6:01
  just
• 6:02
  find
• 6:02
  that
• 6:02
  you're
• 6:02
  always
• 6:02
  jumping
• 6:03
  from
• 6:04
  one
• 6:04
  thing
• 6:04
  to
• 6:04
  the
• 6:04
  next,
• 6:05
  and
• 6:05
  that's
• 6:05
  just
• 6:06
  how
• 6:06
  it
• 6:06
  always
• 6:06
  has
• 6:07
  been.
• 6:07
  And
• 6:07
  I
• 6:08
  would
• 6:08
  also
• 6:08
  ask
• 6:08
  his
• 6:08
  girlfriend
• 6:09
  that.
• 6:10
  Now
• 6:11
  we
• 6:11
  ask
• 6:11
  them
• 6:11
  that
• 6:12
  and
• 6:12
  they
• 6:12
  tell
• 6:12
  us,
• 6:12
  yes,
• 6:12
  this
• 6:13
  is
• 6:13
  how
• 6:13
  I've
• 6:13
  always
• 6:14
  been.
• 6:14
  I'm
• 6:14
  very
• 6:14
  passionate.
• 6:15
  And
• 6:15
  his
• 6:15
  girlfriend
• 6:15
  goes,
• 6:16
  oh,
• 6:16
  yeah.
• 6:16
  Ever
• 6:16
  since
• 6:16
  I
• 6:17
  met
• 6:17
  him,
• 6:17
  he
• 6:18
  just
• 6:18
  can't
• 6:18
  stay
• 6:18
  on
• 6:18
  one
• 6:19
  topic.
• 6:19
  He
• 6:19
  just
• 6:19
  loves
• 6:20
  going
• 6:20
  to
• 6:20
  something
• 6:20
  else.
• 6:21
  And
• 6:21
  he
• 6:21
  just
• 6:21
  abandons
• 6:22
  what's
• 6:22
  in
• 6:22
  front
• 6:23
  of
• 6:23
  him.
• 6:23
  Now,
• 6:24
  that's
• 6:24
  critical
• 6:24
  information,
• 6:25
  my
• 6:25
  friends,
• 6:26
  because
• 6:26
  just
• 6:26
  off
• 6:27
  the
• 6:27
  bat,
• 6:27
  I'm
• 6:27
  not
• 6:28
  making
• 6:28
  judgments.
• 6:29
  I
• 6:29
  am
• 6:29
  not
• 6:29
  sitting
• 6:30
  there
• 6:31
  with
• 6:31
  a,
• 6:32
  you
• 6:32
  know,
• 6:33
  I'm
• 6:33
  not
• 6:33
  sitting
• 6:34
  there
• 6:34
  ready
• 6:34
  to
• 6:35
  declare
• 6:35
  that
• 6:35
  he's
• 6:36
  has
• 6:36
  ADHD
• 6:37
  or
• 6:37
  bipolar
• 6:37
  or
• 6:38
  depression.
• 6:39
  But
• 6:39
  I'm
• 6:40
  just
• 6:40
  saying
• 6:40
  that's.
• 6:40
  That
• 6:41
  smells
• 6:41
  more
• 6:41
  of
• 6:41
  ADHD
• 6:42
  right
• 6:42
  away,
• 6:42
  right?
• 6:43
  That
• 6:43
  this
• 6:43
  is
• 6:43
  longitudinal,
• 6:44
  that
• 6:44
  these
• 6:44
  are
• 6:44
  not
• 6:45
  discreet
• 6:45
  episodes
• 6:46
  where
• 6:46
  he's
• 6:46
  just
• 6:47
  moving
• 6:47
  from
• 6:47
  one
• 6:47
  thing
• 6:47
  to
• 6:48
  the
• 6:48
  next,
• 6:49
  that
• 6:49
  this
• 6:50
  is
• 6:50
  more
• 6:50
  longitudinal
• 6:51
  and
• 6:52
  that
• 6:52
  this
• 6:52
  is
• 6:52
  how
• 6:52
  he
• 6:52
  is?
• 6:53
  Right.
• 6:54
  I
• 6:54
  would
• 6:54
  ask
• 6:55
  him,
• 6:56
  okay,
• 6:57
  are
• 6:57
  you
• 6:57
  coming
• 6:57
  here
• 6:58
  because
• 6:58
  of
• 6:58
  something
• 6:59
  that
• 6:59
  happened
• 6:59
  recently
• 7:00
  that
• 7:00
  was
• 7:01
  over
• 7:01
  the
• 7:01
  top
• 7:02
  red
• 7:02
  line
• 7:03
  behavior,
• 7:03
  or
• 7:04
  is
• 7:04
  this
• 7:04
  a
• 7:04
  culmination
• 7:05
  of
• 7:06
  behaviors
• 7:07
  that
• 7:07
  you
• 7:08
  are
• 7:09
  more
• 7:09
  and
• 7:09
  more
• 7:09
  concerned
• 7:10
  about?
• 7:10
  And
• 7:11
  I
• 7:11
  know
• 7:11
  you
• 7:11
  might
• 7:11
  feel
• 7:12
  like
• 7:12
  that's
• 7:12
  a
• 7:12
  recapitulation
• 7:13
  of
• 7:13
  what
• 7:13
  I
• 7:13
  just
• 7:13
  asked,
• 7:14
  but
• 7:14
  I'm
• 7:15
  trying
• 7:15
  to
• 7:15
  understand,
• 7:15
  was
• 7:16
  there
• 7:16
  a
• 7:16
  precipitating
• 7:17
  factor
• 7:17
  that
• 7:17
  brought
• 7:17
  them
• 7:18
  here?
• 7:18
  Or
• 7:18
  again,
• 7:19
  is
• 7:19
  this
• 7:19
  a
• 7:19
  slow
• 7:19
  boil,
• 7:20
  happens
• 7:21
  every
• 7:21
  day,
• 7:21
  I'm
• 7:22
  sick
• 7:22
  of
• 7:22
  it
• 7:22
  type
• 7:22
  thing.
• 7:23
  Oftentimes
• 7:23
  with
• 7:23
  bipolar,
• 7:24
  especially
• 7:24
  bipolar
• 7:25
  2,
• 7:26
  they
• 7:26
  don't
• 7:26
  end
• 7:26
  up
• 7:26
  going
• 7:27
  in
• 7:27
  the
• 7:27
  hospital
• 7:27
  necessarily,
• 7:28
  but
• 7:28
  they're
• 7:28
  in
• 7:28
  a
• 7:29
  clinic.
• 7:29
  There
• 7:29
  will
• 7:30
  be
• 7:30
  this
• 7:30
  kind
• 7:30
  of
• 7:30
  extreme
• 7:31
  episodic
• 7:32
  thing
• 7:32
  that
• 7:32
  brings
• 7:33
  them
• 7:33
  into
• 7:34
  treatment.
• 7:35
  It
• 7:35
  could
• 7:35
  be
• 7:36
  right
• 7:36
  where
• 7:36
  they
• 7:37
  just.
• 7:37
  Something
• 7:37
  just
• 7:38
  went
• 7:38
  off
• 7:38
  the
• 7:38
  deep
• 7:38
  end.
• 7:38
  Or
• 7:39
  if
• 7:39
  it
• 7:39
  was
• 7:39
  a
• 7:39
  psychotic
• 7:39
  break,
• 7:40
  obviously
• 7:40
  they'd
• 7:41
  be
• 7:41
  in
• 7:41
  the
• 7:41
  hospital
• 7:41
  more
• 7:42
  often
• 7:42
  than
• 7:42
  not,
• 7:42
  not
• 7:43
  in
• 7:43
  your
• 7:43
  outpatient
• 7:43
  space.
• 7:44
  But
• 7:44
  I'm
• 7:45
  trying
• 7:45
  to
• 7:45
  understand,
• 7:46
  is
• 7:46
  this
• 7:46
  a
• 7:46
  mood
• 7:47
  episode?
• 7:47
  Is
• 7:47
  this
• 7:47
  episodic,
• 7:49
  or
• 7:50
  is
• 7:50
  this
• 7:51
  something
• 7:51
  that's
• 7:51
  a
• 7:51
  little
• 7:51
  bit
• 7:52
  different
• 7:52
  than
• 7:52
  that?
• 7:53
  Is
• 7:53
  this
• 7:53
  longitudinal?
• 7:54
  Is
• 7:54
  this
• 7:55
  something
• 7:55
  that
• 7:56
  has
• 7:56
  been
• 7:56
  a
• 7:57
  problem
• 7:57
  for
• 7:57
  a
• 7:57
  very
• 7:57
  long
• 7:58
  time
• 7:58
  and
• 7:58
  she's
• 7:58
  sick
• 7:58
  of
• 7:59
  it?
• 7:59
  Again,
• 7:59
  I'm
• 7:59
  trying
• 7:59
  to
• 8:00
  understand,
• 8:00
  I'm
• 8:01
  trying
• 8:01
  to
• 8:01
  orient
• 8:01
  more.
• 8:02
  Is
• 8:02
  this
• 8:02
  the
• 8:03
  bipolar
• 8:03
  or
• 8:04
  the
• 8:04
  ADHD
• 8:04
  kind
• 8:05
  of
• 8:05
  rabbit
• 8:05
  hole?
• 8:06
  Now
• 8:06
  I'll
• 8:06
  ask
• 8:07
  him.
• 8:07
  This
• 8:07
  is
• 8:08
  another
• 8:08
  important
• 8:08
  thing
• 8:08
  to
• 8:08
  ask
• 8:09
  Dale
• 8:09
  and
• 8:09
  say,
• 8:09
  Dale,
• 8:11
  when
• 8:11
  you
• 8:11
  abandoned
• 8:12
  your
• 8:13
  work
• 8:13
  in
• 8:14
  the
• 8:14
  kitchen,
• 8:14
  what
• 8:15
  would
• 8:15
  you
• 8:15
  say
• 8:15
  is
• 8:15
  the
• 8:15
  reason
• 8:16
  you
• 8:16
  moved
• 8:16
  on
• 8:16
  to
• 8:16
  something
• 8:17
  else?
• 8:18
  Right?
• 8:18
  And
• 8:18
  if
• 8:19
  this
• 8:19
  is
• 8:19
  bipolar,
• 8:20
  you're
• 8:20
  going
• 8:20
  to
• 8:20
  need
• 8:20
  his
• 8:21
  girlfriend
• 8:21
  to
• 8:21
  collaborate
• 8:22
  here.
• 8:22
  She
• 8:22
  might
• 8:22
  say,
• 8:23
  well,
• 8:24
  he
• 8:24
  moved
• 8:25
  on
• 8:25
  because
• 8:25
  he
• 8:25
  just
• 8:26
  couldn't
• 8:26
  sit
• 8:26
  still.
• 8:26
  He
• 8:26
  was
• 8:27
  frantic.
• 8:27
  He
• 8:27
  was
• 8:27
  talking
• 8:28
  so
• 8:28
  fast,
• 8:28
  and
• 8:28
  he
• 8:28
  wasn't
• 8:29
  making
• 8:29
  sense.
• 8:30
  Then
• 8:30
  you're
• 8:30
  really
• 8:30
  going
• 8:31
  down
• 8:31
  the
• 8:31
  bipolar
• 8:31
  rabbit
• 8:32
  hole
• 8:32
  there,
• 8:32
  right?
• 8:33
  Then
• 8:33
  your
• 8:33
  indexes
• 8:34
  of
• 8:34
  suspicion
• 8:35
  for
• 8:35
  bipolar
• 8:35
  is
• 8:36
  super
• 8:36
  high.
• 8:37
  Not
• 8:37
  quite
• 8:38
  there
• 8:38
  yet,
• 8:38
  but
• 8:38
  it's
• 8:38
  getting
• 8:38
  higher.
• 8:40
  So
• 8:40
  you
• 8:40
  want
• 8:40
  to
• 8:40
  ask
• 8:40
  that.
• 8:41
  Now
• 8:41
  if
• 8:41
  Dale
• 8:41
  just
• 8:42
  says,
• 8:42
  oh,
• 8:42
  you
• 8:42
  know,
• 8:43
  I
• 8:43
  was
• 8:43
  in
• 8:43
  the
• 8:43
  middle
• 8:43
  of
• 8:44
  remodeling
• 8:45
  a
• 8:45
  cabinet,
• 8:45
  and
• 8:45
  it's
• 8:46
  so
• 8:46
  tedious
• 8:46
  because
• 8:47
  we
• 8:47
  didn't
• 8:47
  really
• 8:47
  have
• 8:48
  the
• 8:48
  right
• 8:48
  materials,
• 8:48
  and
• 8:48
  I
• 8:49
  didn't
• 8:49
  feel
• 8:49
  like
• 8:49
  going
• 8:49
  to
• 8:49
  Home
• 8:50
  Depot
• 8:51
  and
• 8:51
  I
• 8:51
  just
• 8:52
  wanted
• 8:52
  to
• 8:52
  play
• 8:52
  a
• 8:52
  video
• 8:53
  game,
• 8:54
  it
• 8:54
  was
• 8:54
  time
• 8:54
  to
• 8:54
  eat
• 8:55
  dinner.
• 8:55
  I
• 8:55
  realized
• 8:55
  I
• 8:55
  didn't
• 8:56
  make
• 8:56
  dinner,
• 8:56
  and
• 8:57
  so
• 8:57
  I
• 8:57
  sat
• 8:57
  down
• 8:57
  and
• 8:57
  had
• 8:58
  a
• 8:58
  nice
• 8:58
  dinner
• 8:58
  with
• 8:59
  my
• 8:59
  girlfriend.
• 9:00
  So
• 9:01
  now,
• 9:01
  again,
• 9:02
  the.
• 9:02
  That
• 9:03
  sounds
• 9:03
  more
• 9:03
  like
• 9:03
  adhd,
• 9:04
  right?
• 9:04
  Where
• 9:05
  you're
• 9:05
  just
• 9:05
  not
• 9:05
  organized
• 9:06
  and
• 9:06
  prioritizing
• 9:07
  your
• 9:07
  day
• 9:07
  very
• 9:08
  well.
• 9:08
  You
• 9:09
  lose
• 9:09
  interest,
• 9:10
  right?
• 9:10
  That's
• 9:10
  the
• 9:10
  key
• 9:10
  with
• 9:11
  adhd.
• 9:11
  You
• 9:11
  lose
• 9:12
  interest
• 9:12
  in
• 9:12
  what
• 9:13
  you're
• 9:13
  currently
• 9:13
  doing,
• 9:14
  and
• 9:14
  you
• 9:14
  get.
• 9:15
  You
• 9:15
  gravitate
• 9:16
  towards
• 9:16
  something
• 9:16
  else
• 9:16
  that's
• 9:17
  more
• 9:17
  important
• 9:17
  or
• 9:17
  more
• 9:18
  salient
• 9:18
  in
• 9:18
  that
• 9:18
  moment,
• 9:19
  Right?
• 9:19
  And
• 9:20
  again,
• 9:20
  this
• 9:20
  is
• 9:20
  constant.
• 9:21
  This
• 9:21
  is
• 9:21
  not
• 9:22
  a
• 9:22
  state,
• 9:23
  it's
• 9:23
  a
• 9:23
  trait.
• 9:24
  In
• 9:24
  other
• 9:24
  words,
• 9:24
  it's
• 9:24
  not
• 9:25
  a
• 9:25
  state
• 9:25
  of
• 9:25
  mind
• 9:25
  in
• 9:26
  that
• 9:26
  moment.
• 9:26
  It's
• 9:26
  a
• 9:26
  trait
• 9:27
  where
• 9:27
  it's
• 9:28
  just
• 9:28
  sort
• 9:28
  of
• 9:28
  ingrained
• 9:29
  in
• 9:29
  that
• 9:29
  patient.
• 9:30
  So
• 9:31
  that's
• 9:31
  what
• 9:31
  I
• 9:31
  would
• 9:32
  be
• 9:32
  asking.
• 9:33
  I
• 9:33
  would
• 9:33
  be
• 9:33
  really
• 9:33
  getting
• 9:34
  to
• 9:34
  the
• 9:34
  bottom
• 9:34
  of
• 9:35
  that
• 9:35
  sort
• 9:35
  of
• 9:35
  behavior.
• 9:37
  Now,
• 9:39
  my
• 9:39
  friends,
• 9:40
  it's
• 9:41
  really
• 9:41
  important
• 9:42
  to
• 9:42
  also
• 9:42
  understand
• 9:43
  if
• 9:43
  you
• 9:43
  want
• 9:44
  to
• 9:44
  rule
• 9:44
  out
• 9:44
  bipolar
• 9:45
  quickly
• 9:45
  before
• 9:45
  you
• 9:46
  go
• 9:46
  down
• 9:47
  the
• 9:47
  ADHD
• 9:48
  diagnostic
• 9:49
  path,
• 9:50
  you
• 9:50
  could
• 9:51
  ask
• 9:51
  him,
• 9:51
  did
• 9:51
  you
• 9:52
  feel
• 9:52
  unusually
• 9:52
  irritable
• 9:53
  or
• 9:53
  confident
• 9:54
  while
• 9:55
  you
• 9:55
  were
• 9:55
  remodeling
• 9:56
  the
• 9:56
  kitchen?
• 9:57
  Were
• 9:57
  you
• 9:57
  talking
• 9:58
  quickly?
• 9:59
  And
• 9:59
  he
• 9:59
  might
• 9:59
  say,
• 9:59
  oh,
• 10:00
  absolutely
• 10:00
  not.
• 10:01
  Not
• 10:01
  like
• 10:01
  that.
• 10:01
  It
• 10:02
  was
• 10:02
  just
• 10:02
  A
• 10:02
  regular
• 10:02
  day.
• 10:03
  And
• 10:03
  his
• 10:03
  girlfriend
• 10:03
  might
• 10:04
  say,
• 10:04
  yeah,
• 10:04
  this
• 10:04
  is
• 10:04
  just
• 10:04
  how
• 10:04
  he
• 10:05
  always
• 10:05
  is.
• 10:05
  Again,
• 10:06
  we're
• 10:06
  moving
• 10:06
  into
• 10:06
  the
• 10:06
  ADHD
• 10:07
  column
• 10:07
  then.
• 10:08
  If
• 10:08
  this
• 10:08
  is
• 10:08
  not
• 10:08
  an
• 10:09
  episode,
• 10:09
  this
• 10:09
  is
• 10:09
  not
• 10:10
  a
• 10:10
  marked
• 10:10
  departure
• 10:11
  from
• 10:11
  how
• 10:11
  he
• 10:11
  normally
• 10:12
  behaves,
• 10:13
  then
• 10:13
  we're
• 10:13
  probably
• 10:14
  more
• 10:14
  in
• 10:14
  the
• 10:14
  ADHD
• 10:15
  column.
• 10:16
  Okay,
• 10:17
  I'm
• 10:17
  of
• 10:17
  course,
• 10:17
  radically
• 10:18
  simplifying
• 10:18
  this.
• 10:19
  It
• 10:19
  could
• 10:19
  be
• 10:20
  a
• 10:20
  hyperthyroid,
• 10:21
  it
• 10:21
  could
• 10:21
  be
• 10:21
  many
• 10:21
  other
• 10:21
  things,
• 10:22
  but
• 10:23
  at
• 10:23
  least
• 10:23
  in
• 10:23
  terms
• 10:24
  of
• 10:24
  the
• 10:24
  very
• 10:24
  moment
• 10:25
  you're
• 10:25
  seeing
• 10:25
  them,
• 10:26
  thought
• 10:26
  to
• 10:27
  thought,
• 10:27
  as
• 10:28
  this
• 10:28
  is
• 10:28
  going
• 10:28
  through
• 10:28
  your
• 10:29
  mind.
• 10:30
  So
• 10:30
  he's
• 10:30
  telling
• 10:30
  you
• 10:31
  he's
• 10:31
  just
• 10:31
  moving
• 10:31
  on
• 10:31
  to
• 10:32
  other
• 10:32
  tasks
• 10:32
  because
• 10:32
  he
• 10:32
  gets
• 10:33
  kind
• 10:33
  of
• 10:33
  bored.
• 10:34
  The
• 10:34
  measurements
• 10:34
  are
• 10:34
  tedious.
• 10:35
  He
• 10:35
  didn't
• 10:35
  feel
• 10:36
  like
• 10:36
  going
• 10:36
  to
• 10:36
  Home
• 10:36
  Depot.
• 10:37
  It's
• 10:37
  not
• 10:37
  like
• 10:38
  he
• 10:38
  abandoned
• 10:39
  the
• 10:39
  renovation
• 10:39
  of
• 10:39
  the
• 10:40
  kitchen.
• 10:40
  And
• 10:40
  because
• 10:41
  he
• 10:41
  wanted
• 10:41
  to
• 10:41
  go
• 10:41
  buy
• 10:42
  a
• 10:42
  thousand
• 10:42
  Powerball
• 10:43
  tickets
• 10:43
  and
• 10:43
  a
• 10:43
  grand
• 10:43
  piano.
• 10:44
  Right.
• 10:44
  That's
• 10:45
  more
• 10:45
  of
• 10:45
  the
• 10:45
  bipolar
• 10:46
  again,
• 10:46
  he's
• 10:46
  abandoning
• 10:47
  it
• 10:47
  because
• 10:47
  he
• 10:48
  doesn't
• 10:48
  feel
• 10:48
  like
• 10:48
  sustaining
• 10:49
  his
• 10:49
  attention.
• 10:49
  He
• 10:50
  didn't
• 10:50
  organize
• 10:50
  his
• 10:51
  day
• 10:51
  well,
• 10:51
  so
• 10:52
  he's
• 10:52
  got
• 10:52
  to
• 10:52
  catch
• 10:52
  up
• 10:52
  on
• 10:53
  other
• 10:53
  areas.
• 10:53
  That
• 10:54
  screams
• 10:54
  more
• 10:55
  adhd.
• 10:57
  Right.
• 10:57
  Although
• 10:58
  he
• 10:58
  has
• 10:58
  depression,
• 10:59
  you
• 10:59
  can
• 10:59
  ask
• 10:59
  him
• 10:59
  and
• 11:00
  zoom
• 11:00
  out
• 11:00
  even
• 11:00
  more
• 11:00
  and
• 11:01
  say,
• 11:01
  have
• 11:01
  you
• 11:01
  ever
• 11:01
  had
• 11:02
  four
• 11:02
  or
• 11:02
  more
• 11:02
  days
• 11:02
  in
• 11:02
  a
• 11:03
  row
• 11:03
  where
• 11:03
  you
• 11:03
  felt
• 11:04
  unusually
• 11:05
  confident
• 11:05
  or
• 11:05
  irritable?
• 11:06
  Maybe
• 11:07
  you
• 11:07
  were
• 11:07
  talking
• 11:07
  fast
• 11:08
  and
• 11:08
  felt
• 11:08
  like
• 11:08
  you
• 11:08
  didn't
• 11:09
  need
• 11:09
  to
• 11:09
  sleep
• 11:09
  at
• 11:09
  all
• 11:10
  because
• 11:10
  you
• 11:10
  had
• 11:10
  surges
• 11:11
  of
• 11:11
  energy?
• 11:12
  I
• 11:12
  know
• 11:12
  that's
• 11:12
  a
• 11:12
  mouthful.
• 11:13
  And
• 11:13
  you
• 11:14
  will
• 11:14
  master
• 11:15
  some
• 11:15
  of
• 11:15
  these
• 11:16
  questions
• 11:16
  as
• 11:16
  you
• 11:17
  progress.
• 11:17
  I
• 11:17
  don't
• 11:18
  really
• 11:18
  love
• 11:18
  lengthy
• 11:19
  compound
• 11:20
  questions
• 11:20
  like
• 11:20
  that
• 11:21
  as
• 11:21
  a
• 11:21
  rule,
• 11:21
  but
• 11:22
  I
• 11:22
  do
• 11:22
  find
• 11:23
  that
• 11:23
  it
• 11:23
  helps
• 11:24
  when
• 11:24
  you're
• 11:24
  approaching
• 11:25
  the
• 11:25
  high
• 11:25
  yield
• 11:25
  diagnostic
• 11:26
  type
• 11:27
  questions
• 11:27
  like
• 11:27
  bipolar
• 11:28
  or
• 11:28
  OCD.
• 11:30
  It
• 11:30
  can
• 11:30
  really
• 11:31
  help
• 11:31
  to
• 11:31
  jam.
• 11:31
  Pack
• 11:32
  very
• 11:33
  specific
• 11:34
  DSM
• 11:34
  5
• 11:35
  level
• 11:35
  information
• 11:36
  in
• 11:36
  there
• 11:37
  so
• 11:37
  that
• 11:37
  you
• 11:38
  can
• 11:39
  figure
• 11:40
  this
• 11:40
  out
• 11:40
  rather
• 11:41
  quickly
• 11:41
  and
• 11:41
  assertively
• 11:42
  rather
• 11:42
  than
• 11:43
  get
• 11:43
  a
• 11:43
  bunch
• 11:43
  of
• 11:43
  false
• 11:44
  positives
• 11:44
  and
• 11:44
  go
• 11:45
  down
• 11:45
  all
• 11:45
  these
• 11:45
  rabbit
• 11:45
  holes.
• 11:46
  Because
• 11:46
  if
• 11:46
  you
• 11:46
  just
• 11:46
  say,
• 11:46
  have
• 11:46
  your
• 11:47
  moods
• 11:47
  ever
• 11:47
  been
• 11:48
  kind
• 11:48
  of
• 11:48
  shaky
• 11:49
  and
• 11:49
  unpredictable?
• 11:50
  Well,
• 11:50
  all
• 11:50
  of
• 11:50
  us
• 11:50
  might
• 11:51
  say
• 11:51
  yes
• 11:51
  to
• 11:51
  that
• 11:51
  at
• 11:52
  some
• 11:52
  point.
• 11:52
  Yeah,
• 11:52
  my
• 11:52
  moods
• 11:53
  have
• 11:53
  been
• 11:53
  unpredictable.
• 11:53
  Ask
• 11:54
  my
• 11:54
  wife
• 11:54
  if
• 11:54
  my
• 11:54
  moods
• 11:55
  have
• 11:55
  been
• 11:55
  unpredictable.
• 11:56
  Right.
• 11:56
  If
• 11:56
  you
• 11:57
  asked
• 11:57
  everybody,
• 11:58
  spouse
• 11:59
  in
• 11:59
  America
• 12:00
  if
• 12:01
  their
• 12:01
  husbands
• 12:02
  or
• 12:02
  wives
• 12:02
  have
• 12:02
  moods
• 12:03
  that
• 12:03
  are
• 12:03
  unpredictable,
• 12:04
  we
• 12:04
  would
• 12:04
  all
• 12:04
  be
• 12:04
  diagnosed
• 12:05
  with
• 12:05
  bipolar
• 12:06
  one
• 12:06
  and
• 12:06
  we'd
• 12:07
  all
• 12:07
  be
• 12:07
  5150.
• 12:08
  So
• 12:08
  you
• 12:08
  really
• 12:09
  have
• 12:09
  to
• 12:09
  be
• 12:09
  careful
• 12:09
  with
• 12:09
  false
• 12:10
  positive
• 12:10
  questions.
• 12:11
  So
• 12:11
  when
• 12:12
  we're
• 12:12
  talking
• 12:12
  bipolar
• 12:12
  and
• 12:13
  we
• 12:13
  ask
• 12:13
  Dale
• 12:13
  that
• 12:13
  question
• 12:14
  about
• 12:14
  four
• 12:14
  or
• 12:14
  more
• 12:15
  nights
• 12:15
  being
• 12:16
  really
• 12:16
  energized
• 12:16
  where
• 12:17
  he
• 12:17
  doesn't
• 12:17
  feel
• 12:17
  like
• 12:17
  he
• 12:17
  even
• 12:17
  needs
• 12:18
  to
• 12:18
  sleep.
• 12:18
  Oh,
• 12:18
  no,
• 12:19
  no,
• 12:19
  no.
• 12:19
  Never
• 12:19
  like
• 12:19
  that.
• 12:20
  Well,
• 12:20
  look,
• 12:20
  at
• 12:20
  his
• 12:21
  family
• 12:21
  history.
• 12:21
  He
• 12:21
  has
• 12:22
  nobody
• 12:22
  in
• 12:22
  his
• 12:22
  family
• 12:23
  how
• 12:23
  has
• 12:23
  had
• 12:24
  bipolar.
• 12:24
  In
• 12:25
  fact,
• 12:25
  he
• 12:25
  tells
• 12:25
  you,
• 12:25
  mom
• 12:26
  was
• 12:26
  always
• 12:26
  busy
• 12:27
  doing
• 12:27
  10
• 12:27
  things
• 12:27
  at
• 12:28
  once.
• 12:28
  Dad
• 12:28
  was
• 12:29
  a
• 12:29
  bit
• 12:29
  of
• 12:29
  a
• 12:29
  scatterbrain,
• 12:30
  but
• 12:30
  no
• 12:30
  history
• 12:31
  of
• 12:31
  bipolar
• 12:32
  disorder
• 12:32
  or
• 12:32
  schizophrenia.
• 12:33
  Right.
• 12:34
  And
• 12:35
  so
• 12:35
  you
• 12:36
  do
• 12:36
  have
• 12:36
  to
• 12:36
  take
• 12:36
  that
• 12:36
  with
• 12:37
  the
• 12:37
  grain
• 12:37
  sometimes,
• 12:38
  because
• 12:38
  it's
• 12:39
  true.
• 12:40
  We
• 12:40
  don't
• 12:41
  always
• 12:41
  know
• 12:41
  if
• 12:41
  our
• 12:42
  patients
• 12:42
  know
• 12:42
  if
• 12:43
  their
• 12:43
  parents
• 12:43
  had
• 12:44
  bipolar.
• 12:45
  Different
• 12:45
  generations
• 12:46
  don't
• 12:46
  always
• 12:46
  diagnose
• 12:47
  as
• 12:47
  often
• 12:48
  it's
• 12:48
  more
• 12:48
  taboo
• 12:49
  to
• 12:49
  approach
• 12:49
  mental
• 12:50
  health.
• 12:50
  And
• 12:50
  we
• 12:50
  all
• 12:50
  have
• 12:50
  our
• 12:50
  own
• 12:51
  verbiage
• 12:51
  about
• 12:51
  how
• 12:52
  we
• 12:52
  characterize
• 12:52
  bipolar
• 12:54
  versus
• 12:54
  adhd.
• 12:55
  So
• 12:55
  it's,
• 12:55
  it's,
• 12:56
  it's
• 12:56
  patients
• 12:56
  are
• 12:56
  your
• 12:57
  best
• 12:57
  teachers
• 12:57
  and
• 12:57
  they
• 12:57
  can
• 12:58
  definitely
• 12:58
  help
• 12:58
  you,
• 12:59
  but
• 12:59
  you
• 12:59
  want
• 12:59
  to
• 12:59
  take
• 13:00
  their
• 13:00
  verbiage
• 13:00
  a
• 13:01
  bit
• 13:01
  with
• 13:01
  a
• 13:01
  grain
• 13:01
  of
• 13:01
  salt
• 13:02
  because
• 13:02
  again,
• 13:03
  we
• 13:03
  all
• 13:03
  have
• 13:03
  a
• 13:04
  different
• 13:04
  lingo
• 13:04
  of
• 13:05
  how
• 13:05
  we
• 13:05
  characterize
• 13:06
  these
• 13:06
  symptoms
• 13:07
  and,
• 13:07
  and
• 13:07
  these
• 13:08
  signals.
• 13:08
  Just
• 13:09
  be
• 13:09
  mindful
• 13:09
  of
• 13:09
  that.
• 13:10
  Mom
• 13:10
  always
• 13:10
  busy
• 13:11
  doing
• 13:11
  10
• 13:11
  things
• 13:11
  at
• 13:11
  once
• 13:12
  can
• 13:12
  look
• 13:12
  like
• 13:12
  bipolar.
• 13:13
  It
• 13:14
  could
• 13:14
  also
• 13:14
  look
• 13:14
  like
• 13:15
  adhd.
• 13:15
  It
• 13:16
  could
• 13:16
  also
• 13:16
  be
• 13:16
  nothing.
• 13:16
  Mom
• 13:17
  could
• 13:17
  just
• 13:17
  have
• 13:18
  that
• 13:18
  kind
• 13:18
  of
• 13:18
  a
• 13:18
  temperamental
• 13:19
  personality.
• 13:20
  It
• 13:20
  might
• 13:20
  not
• 13:21
  be
• 13:21
  anything.
• 13:21
  Right.
• 13:22
  But
• 13:22
  again,
• 13:22
  you're
• 13:22
  collecting
• 13:23
  clues.
• 13:23
  Not
• 13:24
  every
• 13:24
  single
• 13:25
  thing
• 13:25
  is
• 13:25
  going
• 13:26
  to
• 13:26
  be
• 13:26
  able
• 13:26
  to
• 13:26
  be
• 13:26
  this,
• 13:27
  you
• 13:28
  know,
• 13:29
  this,
• 13:29
  this
• 13:29
  triumphant
• 13:30
  moment
• 13:30
  where
• 13:31
  you
• 13:31
  get
• 13:31
  a
• 13:31
  diagnosis
• 13:32
  and
• 13:32
  understand
• 13:32
  things.
• 13:33
  You
• 13:33
  gotta
• 13:33
  kind
• 13:33
  of
• 13:33
  put
• 13:33
  this
• 13:34
  all
• 13:34
  together.
• 13:35
  Now,
• 13:36
  the
• 13:36
  patient
• 13:37
  also
• 13:37
  mentioned
• 13:37
  his
• 13:38
  energy
• 13:38
  drink
• 13:39
  consumption.
• 13:39
  You've
• 13:39
  gotta
• 13:40
  factor
• 13:40
  that
• 13:40
  in
• 13:41
  a
• 13:41
  little
• 13:41
  bit
• 13:41
  too.
• 13:42
  Does
• 13:42
  it
• 13:42
  make
• 13:42
  him
• 13:42
  really
• 13:43
  hyper
• 13:43
  and
• 13:43
  excitable?
• 13:44
  And
• 13:44
  that
• 13:44
  can
• 13:44
  also
• 13:45
  trigger
• 13:45
  an
• 13:45
  excessive
• 13:46
  interest
• 13:46
  in
• 13:46
  certain
• 13:46
  activities
• 13:47
  for
• 13:47
  the
• 13:47
  day.
• 13:48
  We
• 13:48
  all
• 13:48
  have
• 13:48
  that
• 13:48
  coffee
• 13:49
  high
• 13:49
  where
• 13:49
  eating
• 13:50
  even
• 13:50
  the
• 13:50
  office
• 13:50
  memo
• 13:51
  becomes
• 13:51
  super
• 13:51
  exciting.
• 13:52
  Right.
• 13:53
  In
• 13:53
  my
• 13:53
  experience,
• 13:54
  when
• 13:55
  issues
• 13:55
  are
• 13:55
  really
• 13:55
  chronic
• 13:56
  and
• 13:57
  disruptive,
• 13:57
  it's
• 13:57
  usually
• 13:58
  not
• 13:58
  caffeine.
• 13:59
  Caffeine
• 13:59
  could
• 14:00
  play
• 14:00
  a
• 14:00
  huge
• 14:00
  role
• 14:00
  if
• 14:01
  you're
• 14:01
  drinking
• 14:01
  like
• 14:01
  five
• 14:02
  death
• 14:02
  wish
• 14:02
  coffees
• 14:03
  a
• 14:03
  day.
• 14:58
  In
• 14:58
  my
• 14:59
  experience,
• 14:59
  it's
• 15:00
  very
• 15:00
  useful
• 15:01
  to
• 15:01
  categorize
• 15:02
  and
• 14:07
  quantify
• 15:02
  how
• 15:03
  much
• 15:03
  coffee.
• 15:05
  Tell
• 15:05
  me
• 15:05
  how
• 15:05
  many
• 15:05
  milligrams
• 15:06
  are
• 15:06
  in
• 15:06
  that.
• 15:07
  I
• 15:08
  would
• 15:08
  say,
• 15:08
  you
• 15:08
  know,
• 15:09
  what
• 15:09
  is
• 15:09
  your
• 15:09
  caffeine
• 15:10
  consumption
• 15:10
  consumption
• 15:10
  look
• 15:11
  like
• 15:11
  throughout
• 15:12
  the
• 15:12
  day?
• 15:13
  Do
• 15:13
  you
• 15:13
  know
• 15:13
  how
• 15:13
  many
• 15:13
  milligrams
• 15:14
  of
• 15:14
  caffeine
• 15:14
  are
• 15:15
  in
• 15:15
  that
• 15:15
  energy
• 15:16
  drink?
• 15:16
  If
• 15:17
  he
• 15:17
  doesn't,
• 15:17
  I
• 15:17
  would
• 15:17
  just
• 15:18
  look
• 15:18
  that
• 15:18
  up.
• 15:18
  It's
• 15:19
  no
• 15:19
  big
• 15:19
  deal.
• 15:19
  But
• 15:20
  don't
• 15:20
  ignore
• 15:20
  coffee
• 15:21
  is
• 15:21
  all
• 15:21
  I'm
• 15:21
  saying.
• 15:21
  If
• 15:22
  nothing
• 15:22
  else,
• 15:22
  it's
• 15:22
  a
• 15:22
  good
• 15:22
  psychoeducational
• 15:23
  tidbit
• 15:24
  to
• 15:24
  include
• 15:25
  because
• 15:26
  it
• 15:26
  can
• 15:26
  make
• 15:27
  you
• 15:27
  more
• 15:27
  irritable,
• 15:28
  hyper
• 15:28
  restless,
• 15:29
  things
• 15:29
  like
• 15:29
  that.
• 15:30
  Interestingly
• 15:30
  enough,
• 15:31
  the
• 15:31
  patient
• 15:31
  has
• 15:31
  never
• 15:32
  tried
• 15:32
  a
• 15:32
  stimulant
• 15:33
  before.
• 15:33
  They
• 15:34
  have
• 15:34
  tried
• 15:34
  SSRIs
• 15:35
  and
• 15:35
  there
• 15:36
  was
• 15:36
  not
• 15:36
  great
• 15:37
  improvement.
• 15:38
  You
• 15:38
  can.
• 15:38
  I
• 15:38
  would
• 15:38
  definitely
• 15:39
  ask
• 15:39
  your
• 15:39
  patient
• 15:40
  a
• 15:40
  little
• 15:40
  bit
• 15:40
  more
• 15:40
  about
• 15:40
  those
• 15:41
  SSRIs
• 15:41
  and
• 15:42
  say,
• 15:42
  you
• 15:42
  know,
• 15:42
  can
• 15:42
  you
• 15:43
  tell
• 15:43
  me
• 15:43
  about
• 15:43
  what
• 15:43
  was
• 15:43
  going
• 15:44
  on
• 15:44
  at
• 15:44
  that
• 15:44
  time
• 15:44
  and
• 15:45
  maybe
• 15:45
  sniff
• 15:45
  out
• 15:45
  if
• 15:46
  there's
• 15:46
  a
• 15:46
  bipolar
• 15:46
  diagnosis
• 15:47
  back
• 15:47
  then,
• 15:48
  and
• 15:48
  if
• 15:48
  he
• 15:49
  continues
• 15:49
  to
• 15:49
  deny
• 15:50
  any
• 15:50
  of
• 15:50
  those
• 15:50
  irritable,
• 15:52
  hyper
• 15:52
  confident,
• 15:53
  talkative,
• 15:53
  pressured
• 15:54
  moments
• 15:55
  and
• 15:55
  he
• 15:55
  just
• 15:55
  had
• 15:55
  depression
• 15:56
  or
• 15:57
  what
• 15:57
  have
• 15:57
  you,
• 15:58
  then
• 15:58
  you're
• 15:58
  starting
• 15:59
  to
• 15:59
  question
• 16:00
  one
• 16:00
  suspect
• 16:01
  more
• 16:01
  than
• 16:01
  the
• 16:01
  next.
• 16:02
  Don't
• 16:02
  let
• 16:02
  them
• 16:02
  leave
• 16:03
  the
• 16:03
  police
• 16:03
  station.
• 16:04
  Both
• 16:04
  suspects
• 16:05
  should
• 16:05
  be
• 16:05
  in
• 16:05
  handcuffs
• 16:06
  and
• 16:06
  questioned.
• 16:07
  But
• 16:08
  you
• 16:08
  might
• 16:08
  be
• 16:09
  talking
• 16:09
  to
• 16:09
  the
• 16:09
  HD
• 16:10
  suspect
• 16:10
  a
• 16:10
  little
• 16:10
  bit
• 16:11
  more,
• 16:11
  especially
• 16:12
  if
• 16:13
  he's
• 16:13
  been
• 16:13
  treated
• 16:13
  for
• 16:14
  these
• 16:14
  symptoms
• 16:14
  in
• 16:14
  the
• 16:14
  past
• 16:15
  or
• 16:15
  what
• 16:15
  he
• 16:16
  says
• 16:16
  he
• 16:16
  thought
• 16:16
  he
• 16:16
  was
• 16:17
  treated
• 16:17
  for,
• 16:17
  but
• 16:18
  he
• 16:18
  took
• 16:18
  an
• 16:18
  SSRI
• 16:19
  and
• 16:19
  it
• 16:19
  didn't
• 16:19
  work.
• 16:20
  If
• 16:20
  he
• 16:20
  says,
• 16:20
  yeah,
• 16:21
  we've
• 16:21
  been
• 16:21
  to
• 16:22
  an
• 16:22
  outpatient
• 16:22
  clinic
• 16:23
  like
• 16:23
  this
• 16:23
  before
• 16:23
  with
• 16:23
  the
• 16:24
  same
• 16:24
  problem.
• 16:24
  They
• 16:25
  put
• 16:25
  us
• 16:25
  on
• 16:25
  Zoloft
• 16:26
  and
• 16:26
  nothing
• 16:26
  happened,
• 16:28
  well,
• 16:28
  then,
• 16:29
  yeah,
• 16:29
  maybe
• 16:29
  we're
• 16:30
  going
• 16:30
  down
• 16:30
  the
• 16:31
  ADHD
• 16:32
  rabbit
• 16:32
  hole
• 16:33
  a
• 16:33
  little
• 16:33
  bit.
• 16:34
  Because
• 16:34
  if
• 16:34
  he's.
• 16:35
  Because
• 16:35
  if
• 16:35
  he's
• 16:36
  not
• 16:36
  treated.
• 16:37
  If
• 16:37
  he
• 16:37
  wasn't
• 16:38
  treated
• 16:38
  successfully
• 16:39
  and
• 16:39
  he
• 16:39
  was
• 16:39
  on
• 16:39
  an
• 16:39
  ssri,
• 16:40
  then
• 16:40
  your
• 16:40
  index
• 16:41
  of
• 16:41
  suspicion
• 16:41
  might
• 16:42
  increase
• 16:43
  in
• 16:43
  favor
• 16:43
  of
• 16:44
  an
• 16:44
  ADHD
• 16:44
  diagnosis.
• 16:45
  Now,
• 16:46
  as
• 16:46
  you
• 16:46
  get
• 16:46
  warmer
• 16:47
  to
• 16:47
  the
• 16:47
  ADHD
• 16:48
  stuff,
• 16:48
  you
• 16:48
  want
• 16:48
  to
• 16:49
  whip
• 16:49
  out
• 16:50
  your
• 16:50
  screening
• 16:51
  tools.
• 16:51
  And
• 16:51
  I
• 16:51
  highly
• 16:52
  recommend
• 16:52
  you
• 16:53
  become
• 16:53
  a
• 16:53
  Patreon
• 16:53
  member
• 16:54
  because
• 16:54
  you
• 16:55
  will
• 16:55
  have
• 16:55
  access
• 16:56
  to
• 16:56
  these
• 16:56
  screening
• 16:57
  tools
• 16:57
  with
• 16:57
  specific
• 16:58
  questions
• 16:58
  you
• 16:58
  could
• 16:59
  ask
• 16:59
  your
• 17:00
  patients
• 17:00
  to
• 17:00
  really
• 17:00
  power
• 17:01
  your
• 17:01
  practice.
• 17:02
  Get
• 17:02
  more
• 17:02
  specificity
• 17:03
  and
• 17:03
  sensitivity
• 17:04
  into
• 17:04
  your
• 17:04
  practice
• 17:05
  and
• 17:05
  care.
• 17:06
  I
• 17:06
  can't
• 17:06
  emphasize
• 17:06
  enough
• 17:07
  how
• 17:07
  important
• 17:07
  it
• 17:07
  is
• 17:08
  to
• 17:08
  join
• 17:08
  our
• 17:09
  Patreon
• 17:10
  membership.
• 17:10
  Go
• 17:10
  to
• 17:10
  our
• 17:11
  show
• 17:11
  notes
• 17:11
  after
• 17:11
  this
• 17:12
  and
• 17:12
  become
• 17:12
  a
• 17:13
  member.
• 17:13
  You'll
• 17:13
  have
• 17:14
  all
• 17:14
  of
• 17:14
  these
• 17:14
  lectures
• 17:15
  in
• 17:15
  beautiful
• 17:16
  slide
• 17:16
  deck
• 17:17
  form
• 17:17
  full
• 17:17
  of
• 17:17
  clinical
• 17:18
  screening
• 17:18
  tools,
• 17:19
  research
• 17:20
  evidence,
• 17:20
  these
• 17:21
  great
• 17:21
  research
• 17:21
  articles,
• 17:22
  and
• 17:23
  other
• 17:23
  pertinent
• 17:24
  clinical
• 17:24
  information.
• 17:25
  We
• 17:25
  really
• 17:25
  do
• 17:26
  deep
• 17:26
  dives
• 17:26
  in
• 17:26
  these
• 17:27
  cases.
• 17:27
  I'm
• 17:27
  a
• 17:28
  visual
• 17:28
  guy,
• 17:28
  so
• 17:29
  seeing
• 17:29
  this
• 17:30
  visually
• 17:30
  is
• 17:30
  really
• 17:30
  important.
• 17:31
  Now,
• 17:31
  if
• 17:31
  we
• 17:32
  get
• 17:32
  to
• 17:33
  the.
• 17:34
  The
• 17:34
  questions
• 17:35
  right,
• 17:35
  you
• 17:35
  want
• 17:35
  to
• 17:35
  incorporate
• 17:36
  those
• 17:36
  rich
• 17:37
  ADHD
• 17:38
  screening
• 17:38
  tools,
• 17:39
  those
• 17:39
  rich
• 17:39
  ADHD
• 17:40
  questions
• 17:41
  that.
• 17:41
  Ask
• 17:41
  them.
• 17:42
  Okay.
• 17:42
  When
• 17:43
  did
• 17:43
  you
• 17:43
  first
• 17:43
  notice
• 17:44
  that
• 17:44
  you
• 17:44
  had
• 17:44
  trouble
• 17:44
  organizing
• 17:45
  things
• 17:45
  or
• 17:46
  paying
• 17:46
  attention?
• 17:46
  Oh,
• 17:47
  my
• 17:47
  whole
• 17:47
  life.
• 17:48
  Since
• 17:48
  I
• 17:48
  was
• 17:48
  a
• 17:48
  kid.
• 17:49
  Patients
• 17:49
  say,
• 17:49
  my
• 17:49
  whole
• 17:50
  life.
• 17:50
  Okay,
• 17:50
  well,
• 17:50
  how
• 17:50
  old
• 17:50
  were
• 17:51
  you?
• 17:51
  Oh,
• 17:51
  I
• 17:51
  was
• 17:51
  8
• 17:52
  years
• 17:52
  old.
• 17:52
  And
• 17:52
  what
• 17:52
  kind
• 17:52
  of
• 17:53
  things
• 17:53
  were
• 17:53
  happening
• 17:53
  in
• 17:54
  school
• 17:54
  or
• 17:55
  at
• 17:55
  home
• 17:55
  that
• 17:55
  led
• 17:55
  you
• 17:56
  to
• 17:56
  believe
• 17:56
  or
• 17:57
  your
• 17:57
  family
• 17:57
  to
• 17:57
  believe
• 17:58
  that
• 17:58
  you
• 17:58
  had
• 17:58
  issues
• 17:59
  paying
• 17:59
  attention?
• 18:00
  Oh,
• 18:00
  I
• 18:00
  had
• 18:01
  my
• 18:01
  own
• 18:01
  individual
• 18:02
  education
• 18:02
  plan.
• 18:02
  I
• 18:03
  was
• 18:03
  in
• 18:03
  a
• 18:03
  certain
• 18:03
  class.
• 18:04
  Because
• 18:04
  I
• 18:04
  was
• 18:04
  so
• 18:05
  disruptive
• 18:05
  or
• 18:06
  I
• 18:06
  just
• 18:06
  couldn't
• 18:07
  pay
• 18:07
  Attention.
• 18:07
  My
• 18:07
  grades
• 18:08
  were
• 18:08
  terrible,
• 18:09
  and
• 18:09
  I
• 18:09
  couldn't
• 18:09
  sit
• 18:10
  still
• 18:10
  in
• 18:10
  my
• 18:10
  chair.
• 18:11
  And,
• 18:11
  you
• 18:11
  know,
• 18:11
  we
• 18:12
  were
• 18:12
  thinking
• 18:12
  about
• 18:12
  doing
• 18:12
  an
• 18:12
  ADHD
• 18:13
  workup,
• 18:13
  but
• 18:14
  my
• 18:14
  parents
• 18:14
  weren't
• 18:15
  really
• 18:15
  believers
• 18:16
  in
• 18:16
  ADHD
• 18:16
  meds.
• 18:17
  Right,
• 18:17
  so
• 18:17
  now
• 18:18
  you're
• 18:18
  getting
• 18:18
  an
• 18:18
  idea
• 18:19
  that
• 18:19
  this
• 18:19
  has
• 18:19
  been
• 18:20
  a
• 18:20
  problem
• 18:20
  for
• 18:21
  a
• 18:21
  very
• 18:21
  long
• 18:21
  time.
• 18:22
  The
• 18:23
  patient
• 18:23
  has
• 18:23
  tried
• 18:23
  to
• 18:23
  cope
• 18:24
  their
• 18:24
  whole
• 18:25
  lives
• 18:25
  with
• 18:25
  this,
• 18:25
  but
• 18:25
  they're
• 18:26
  running
• 18:26
  into
• 18:26
  a
• 18:27
  situation
• 18:27
  now
• 18:27
  where
• 18:28
  it's
• 18:28
  untenable.
• 18:29
  They
• 18:29
  have
• 18:29
  a
• 18:29
  girlfriend
• 18:30
  who
• 18:30
  said,
• 18:30
  no
• 18:30
  more.
• 18:31
  So
• 18:31
  we're
• 18:32
  really
• 18:32
  getting
• 18:32
  to
• 18:32
  that
• 18:32
  point.
• 18:33
  I
• 18:33
  would
• 18:33
  argue
• 18:35
  that
• 18:35
  we're
• 18:35
  really
• 18:35
  in
• 18:36
  the
• 18:36
  ADHD
• 18:36
  territory
• 18:37
  here.
• 18:38
  So
• 18:38
  you
• 18:39
  want
• 18:39
  to
• 18:39
  ask
• 18:39
  those
• 18:39
  questions.
• 18:40
  How
• 18:40
  hard
• 18:40
  is
• 18:40
  it
• 18:40
  for
• 18:41
  you
• 18:41
  to
• 18:41
  listen
• 18:41
  to
• 18:41
  someone
• 18:42
  when
• 18:42
  they're
• 18:43
  giving
• 18:43
  you
• 18:43
  instructions?
• 18:44
  Do
• 18:44
  you
• 18:44
  find
• 18:44
  that
• 18:44
  you
• 18:45
  lose
• 18:45
  or
• 18:45
  misplace
• 18:45
  things
• 18:46
  a
• 18:46
  lot?
• 18:47
  Do
• 18:47
  you
• 18:47
  talk
• 18:47
  over
• 18:47
  others?
• 18:48
  Do
• 18:48
  you
• 18:48
  interrupt
• 18:48
  other
• 18:48
  people?
• 18:49
  Is
• 18:49
  it
• 18:49
  difficult
• 18:50
  for
• 18:50
  you
• 18:50
  to
• 18:51
  await
• 18:51
  your
• 18:51
  turn?
• 18:53
  Walk
• 18:53
  me
• 18:53
  through
• 18:54
  your
• 18:54
  ability
• 18:55
  to
• 18:55
  organize
• 18:55
  things
• 18:56
  around
• 18:56
  the
• 18:56
  house
• 18:56
  or
• 18:56
  your
• 18:57
  schedule
• 18:57
  throughout
• 18:57
  the
• 18:57
  day.
• 18:58
  It
• 18:58
  really
• 18:58
  helps
• 18:59
  to
• 18:59
  ask
• 18:59
  questions
• 19:00
  like
• 19:00
  that.
• 19:00
  Walk
• 19:00
  me
• 19:01
  through
• 19:01
  how
• 19:01
  you
• 19:01
  organize
• 19:02
  your
• 19:02
  day,
• 19:02
  what
• 19:03
  your
• 19:03
  ordinary
• 19:03
  day
• 19:04
  looks
• 19:04
  like.
• 19:04
  You
• 19:05
  can
• 19:05
  collaborate
• 19:06
  with
• 19:06
  his
• 19:07
  girlfriend
• 19:07
  if
• 19:08
  she's
• 19:08
  with
• 19:08
  you
• 19:09
  in
• 19:09
  session
• 19:09
  to
• 19:10
  figure
• 19:10
  this
• 19:10
  out.
• 19:10
  She
• 19:11
  can
• 19:11
  say,
• 19:11
  oh,
• 19:11
  he's
• 19:11
  a
• 19:11
  mess.
• 19:11
  He
• 19:12
  brushes
• 19:12
  his
• 19:12
  teeth
• 19:12
  at
• 19:12
  different
• 19:13
  times
• 19:13
  every
• 19:13
  day.
• 19:14
  Sometimes
• 19:14
  he
• 19:14
  forgets.
• 19:15
  He
• 19:15
  always
• 19:15
  forgets
• 19:16
  the
• 19:16
  keys.
• 19:16
  We're
• 19:16
  always
• 19:17
  having
• 19:17
  to
• 19:18
  go
• 19:18
  back
• 19:18
  home
• 19:19
  because
• 19:20
  he
• 19:20
  forgot
• 19:21
  his
• 19:21
  keys
• 19:21
  or
• 19:22
  his
• 19:22
  wallet.
• 19:23
  And
• 19:23
  so
• 19:23
  you'll
• 19:23
  really
• 19:24
  get
• 19:24
  an
• 19:24
  idea.
• 19:24
  How
• 19:25
  pervasive
• 19:25
  is
• 19:26
  this?
• 19:26
  How
• 19:26
  impairing
• 19:27
  is
• 19:27
  this?
• 19:27
  How
• 19:28
  does
• 19:28
  this
• 19:28
  affect
• 19:28
  you
• 19:28
  academically,
• 19:29
  socially?
• 19:30
  It's
• 19:30
  always
• 19:30
  late
• 19:31
  to
• 19:31
  our
• 19:31
  dates.
• 19:32
  It's
• 19:33
  really
• 19:33
  disruptive.
• 19:33
  It's
• 19:34
  so
• 19:34
  embarrassing.
• 19:34
  Sometimes
• 19:35
  he
• 19:35
  doesn't
• 19:35
  bring
• 19:35
  his
• 19:36
  wallet,
• 19:36
  and
• 19:36
  I
• 19:37
  have
• 19:37
  to
• 19:37
  pay.
• 19:38
  He
• 19:38
  failed
• 19:38
  history
• 19:39
  last
• 19:39
  semester
• 19:40
  because
• 19:40
  he
• 19:40
  just
• 19:41
  never
• 19:42
  can
• 19:42
  study
• 19:42
  and
• 19:43
  sit
• 19:43
  down
• 19:43
  for
• 19:43
  more
• 19:43
  than
• 19:44
  five
• 19:44
  minutes
• 19:44
  without
• 19:44
  having
• 19:45
  to
• 19:45
  move
• 19:45
  to
• 19:45
  something
• 19:46
  else.
• 19:46
  Now,
• 19:47
  typically
• 19:47
  with
• 19:47
  adhd,
• 19:48
  people
• 19:48
  will
• 19:48
  move
• 19:48
  to
• 19:49
  something
• 19:49
  else
• 19:49
  that's
• 19:49
  more
• 19:50
  interesting.
• 19:50
  Right?
• 19:51
  And
• 19:51
  usually
• 19:52
  what
• 19:52
  they
• 19:52
  move
• 19:52
  to
• 19:53
  is
• 19:53
  a
• 19:53
  logical
• 19:54
  thing.
• 19:54
  Right?
• 19:54
  Oh,
• 19:54
  I
• 19:55
  was
• 19:55
  studying
• 19:55
  history,
• 19:55
  and
• 19:56
  then
• 19:56
  I
• 19:56
  decided
• 19:56
  I
• 19:56
  was
• 19:56
  gonna
• 19:57
  watch
• 19:57
  an
• 19:57
  episode
• 19:57
  of
• 19:57
  Friends.
• 19:58
  Well,
• 19:58
  that's
• 19:59
  more
• 19:59
  ADHD
• 20:00
  than
• 20:00
  bipolar,
• 20:01
  right?
• 20:01
  Because
• 20:02
  bipolar
• 20:02
  is
• 20:02
  like,
• 20:03
  oh,
• 20:03
  I'm
• 20:03
  not
• 20:03
  studying
• 20:04
  because
• 20:04
  I'm
• 20:04
  trying
• 20:05
  to
• 20:05
  run
• 20:06
  to
• 20:06
  be
• 20:06
  the
• 20:06
  next
• 20:06
  mayor
• 20:07
  of
• 20:07
  Phoenix.
• 20:08
  Well,
• 20:08
  that's
• 20:08
  weird.
• 20:08
  Are
• 20:08
  you
• 20:09
  involved
• 20:09
  in
• 20:09
  politics?
• 20:10
  No.
• 20:11
  Is
• 20:11
  your
• 20:11
  family
• 20:11
  involved
• 20:12
  in
• 20:12
  politics?
• 20:12
  No.
• 20:13
  How
• 20:13
  long
• 20:13
  did
• 20:13
  you
• 20:14
  want
• 20:14
  to
• 20:14
  be
• 20:14
  the
• 20:14
  mayor
• 20:14
  of
• 20:14
  Phoenix
• 20:15
  for?
• 20:15
  Since
• 20:16
  today
• 20:16
  at
• 20:17
  noon.
• 20:17
  Right.
• 20:18
  So
• 20:18
  that's
• 20:19
  a
• 20:19
  very
• 20:19
  bipolar
• 20:20
  thing.
• 20:20
  So
• 20:20
  the
• 20:20
  content,
• 20:21
  what
• 20:21
  they're
• 20:21
  specifically
• 20:23
  going
• 20:24
  towards
• 20:24
  is
• 20:25
  very
• 20:25
  important.
• 20:25
  What
• 20:26
  distracts
• 20:26
  them
• 20:27
  and
• 20:27
  the
• 20:27
  reason
• 20:28
  they're
• 20:28
  moving
• 20:28
  on
• 20:28
  to
• 20:29
  a
• 20:29
  different
• 20:29
  task
• 20:29
  or
• 20:30
  what
• 20:30
  that
• 20:30
  task
• 20:30
  is,
• 20:31
  is
• 20:31
  a
• 20:31
  very
• 20:32
  important
• 20:32
  diagnostic
• 20:33
  clue,
• 20:34
  right?
• 20:34
  And
• 20:35
  so.
• 20:35
  So
• 20:35
  that's
• 20:35
  very
• 20:35
  important.
• 20:36
  So
• 20:36
  start
• 20:36
  asking
• 20:37
  the
• 20:37
  ADHD
• 20:37
  questions.
• 20:38
  And
• 20:39
  lo
• 20:39
  and
• 20:39
  behold,
• 20:39
  we're
• 20:39
  really
• 20:40
  moving
• 20:40
  away
• 20:40
  from
• 20:40
  a
• 20:41
  mood
• 20:41
  disorder
• 20:42
  here
• 20:42
  and
• 20:42
  we're
• 20:43
  moving
• 20:43
  more
• 20:43
  towards
• 20:43
  adhd.
• 20:44
  Now,
• 20:44
  remember,
• 20:45
  in
• 20:45
  depression,
• 20:45
  he
• 20:45
  did
• 20:45
  say
• 20:46
  he
• 20:46
  was
• 20:46
  depressed.
• 20:46
  He
• 20:46
  did
• 20:47
  say
• 20:47
  he
• 20:47
  had
• 20:47
  generalized
• 20:48
  anxiety.
• 20:48
  Anxiety
• 20:49
  and
• 20:49
  depression
• 20:50
  also
• 20:50
  involve
• 20:51
  their
• 20:51
  own
• 20:52
  cognitive
• 20:52
  impairments.
• 20:53
  Right?
• 20:53
  The
• 20:53
  diagnostic
• 20:54
  criteria
• 20:55
  in
• 20:55
  generalized
• 20:56
  anxiety
• 20:56
  disorder,
• 20:57
  one
• 20:57
  of
• 20:57
  them
• 20:57
  is
• 20:57
  difficulty
• 20:58
  concentrating,
• 20:59
  right?
• 21:00
  It's
• 21:00
  very
• 21:01
  possible
• 21:01
  that
• 21:02
  he
• 21:03
  just
• 21:04
  can't
• 21:04
  concentrate
• 21:05
  because
• 21:05
  it's
• 21:05
  part
• 21:05
  of
• 21:05
  an
• 21:06
  anxiety
• 21:06
  disorder.
• 21:06
  Or
• 21:07
  maybe
• 21:07
  he's
• 21:07
  super
• 21:07
  depressed.
• 21:08
  Psychomotor
• 21:09
  slowing
• 21:09
  too,
• 21:09
  where
• 21:10
  he's
• 21:10
  moving
• 21:10
  slowly,
• 21:10
  he's
• 21:11
  thinking
• 21:11
  slowly,
• 21:11
  he
• 21:12
  just
• 21:12
  got
• 21:12
  kind
• 21:12
  of
• 21:12
  brain
• 21:13
  fog.
• 21:13
  That's
• 21:14
  also
• 21:14
  very
• 21:14
  possible.
• 21:15
  You
• 21:15
  have
• 21:15
  to
• 21:15
  think
• 21:15
  about
• 21:15
  that.
• 21:16
  You
• 21:16
  also
• 21:17
  really
• 21:17
  want
• 21:17
  to
• 21:17
  assess,
• 21:18
  did
• 21:18
  any
• 21:18
  major
• 21:18
  stressors
• 21:19
  happen
• 21:19
  recently
• 21:20
  that
• 21:20
  have
• 21:20
  maybe
• 21:21
  impaired
• 21:21
  his
• 21:21
  concentration?
• 21:22
  Again,
• 21:22
  he's
• 21:22
  telling
• 21:23
  you
• 21:23
  this
• 21:23
  is
• 21:23
  longitudinal.
• 21:24
  This
• 21:24
  is
• 21:24
  long
• 21:24
  time
• 21:25
  coming.
• 21:25
  You
• 21:26
  always
• 21:26
  want
• 21:26
  to
• 21:26
  ask
• 21:26
  about
• 21:27
  trauma.
• 21:27
  The
• 21:27
  purpose
• 21:28
  of
• 21:28
  this
• 21:28
  case
• 21:28
  study
• 21:28
  today
• 21:29
  is
• 21:29
  really
• 21:29
  to
• 21:29
  look
• 21:30
  at
• 21:30
  the
• 21:30
  differentiating
• 21:31
  factors
• 21:31
  between
• 21:32
  something
• 21:32
  like
• 21:32
  bipolar
• 21:33
  and
• 21:33
  adhd.
• 21:35
  Right?
• 21:35
  Something.
• 21:36
  And
• 21:36
  they
• 21:36
  are
• 21:36
  very
• 21:37
  different.
• 21:37
  When
• 21:37
  you
• 21:37
  look
• 21:37
  at
• 21:38
  them
• 21:38
  closely,
• 21:38
  they
• 21:39
  are
• 21:39
  very
• 21:39
  different.
• 21:40
  The
• 21:40
  hyperactivity
• 21:41
  in
• 21:41
  ADHD
• 21:42
  is
• 21:43
  constant
• 21:44
  before
• 21:44
  the
• 21:44
  age
• 21:44
  of
• 21:45
  12.
• 21:45
  Usually
• 21:46
  it's
• 21:46
  more
• 21:46
  episodic
• 21:47
  in
• 21:47
  bipolar.
• 21:48
  Right.
• 21:49
  Not
• 21:49
  to
• 21:50
  make
• 21:50
  things
• 21:50
  even
• 21:50
  more
• 21:50
  complicated,
• 21:51
  but
• 21:52
  5
• 21:52
  to
• 21:52
  10%
• 21:53
  of
• 21:53
  adults
• 21:53
  with
• 21:53
  ADHD
• 21:54
  also
• 21:54
  have
• 21:54
  bipolar.
• 21:55
  So
• 21:55
  it's
• 21:55
  not
• 21:56
  insane
• 21:56
  to
• 21:57
  think
• 21:57
  that
• 21:57
  he
• 21:57
  could
• 21:57
  have
• 21:58
  both.
• 21:58
  But
• 21:59
  again,
• 21:59
  he's
• 21:59
  not
• 21:59
  really
• 21:59
  endorsing
• 22:00
  the
• 22:00
  bipolar
• 22:01
  piece.
• 22:02
  Once
• 22:02
  you
• 22:02
  get
• 22:02
  through
• 22:03
  a
• 22:03
  lot
• 22:03
  of
• 22:03
  the
• 22:03
  ADHD
• 22:04
  questions,
• 22:04
  you
• 22:04
  know,
• 22:05
  do
• 22:05
  you
• 22:05
  fidget?
• 22:06
  Do
• 22:06
  you
• 22:06
  leave
• 22:06
  your
• 22:06
  seat
• 22:07
  a
• 22:07
  lot?
• 22:07
  Are
• 22:07
  you
• 22:07
  always
• 22:07
  on
• 22:08
  the
• 22:08
  go
• 22:08
  as
• 22:08
  if
• 22:08
  you're
• 22:08
  driven
• 22:09
  by
• 22:09
  a
• 22:09
  motor?
• 22:10
  Do
• 22:10
  you
• 22:10
  avoid
• 22:10
  tasks
• 22:11
  that
• 22:11
  typically
• 22:12
  involve
• 22:12
  a
• 22:12
  lot
• 22:12
  of
• 22:13
  paying
• 22:13
  attention?
• 22:14
  That's
• 22:14
  also
• 22:14
  very
• 22:14
  important,
• 22:15
  right?
• 22:15
  Do
• 22:16
  you
• 22:16
  do
• 22:16
  your
• 22:16
  taxes
• 22:17
  in
• 22:17
  February
• 22:17
  or
• 22:18
  do
• 22:18
  you
• 22:18
  do
• 22:18
  them
• 22:19
  in
• 22:19
  November?
• 22:19
  That's
• 22:20
  kind
• 22:20
  of
• 22:20
  a
• 22:20
  good
• 22:20
  tip
• 22:21
  off.
• 22:21
  I
• 22:21
  hate
• 22:21
  doing
• 22:22
  my
• 22:22
  taxes,
• 22:22
  so
• 22:22
  I
• 22:22
  wait
• 22:23
  until
• 22:23
  November
• 22:24
  every
• 22:24
  year.
• 22:24
  That's
• 22:25
  awful
• 22:25
  and
• 22:26
  expensive.
• 22:26
  And
• 22:27
  you
• 22:27
  probably
• 22:27
  can't
• 22:28
  even
• 22:28
  afford
• 22:28
  to
• 22:28
  take
• 22:28
  your
• 22:29
  girlfriend
• 22:29
  out
• 22:29
  to
• 22:29
  the
• 22:29
  Cheesecake
• 22:30
  Factory
• 22:30
  at
• 22:30
  that
• 22:31
  point.
• 22:31
  No
• 22:31
  wonder
• 22:31
  you're
• 22:32
  so
• 22:32
  depressed.
• 22:33
  Keep
• 22:33
  these
• 22:33
  things
• 22:33
  in
• 22:34
  mind,
• 22:34
  my
• 22:34
  friends.
• 22:35
  With
• 22:35
  bipolar,
• 22:36
  a
• 22:36
  good
• 22:36
  way
• 22:36
  to
• 22:36
  think
• 22:37
  of
• 22:37
  it
• 22:37
  is
• 22:38
  it's
• 22:38
  like
• 22:38
  a
• 22:38
  wave.
• 22:39
  It's
• 22:39
  like
• 22:39
  waves
• 22:40
  in
• 22:40
  the
• 22:40
  ocean,
• 22:40
  right?
• 22:41
  And
• 22:41
  ADHD
• 22:42
  is
• 22:42
  more
• 22:43
  like
• 22:43
  a
• 22:43
  whirlpool
• 22:44
  of
• 22:44
  choppy
• 22:45
  water.
• 22:46
  Right?
• 22:46
  Waves
• 22:46
  are
• 22:47
  distinct.
• 22:47
  They
• 22:48
  come,
• 22:48
  they
• 22:48
  crash,
• 22:48
  they
• 22:49
  recede.
• 22:49
  Gee's
• 22:50
  more
• 22:50
  of
• 22:50
  a
• 22:50
  whirlpool.
• 22:50
  There's
• 22:51
  Ripples.
• 22:51
  It's
• 22:51
  constant
• 22:52
  ripples
• 22:52
  in
• 22:53
  the
• 22:53
  water.
• 22:53
  There's
• 22:54
  irritability,
• 22:54
  impulsivity,
• 22:56
  emotional
• 22:56
  overreactions,
• 22:57
  but
• 22:57
  it's
• 22:57
  less
• 22:58
  extreme.
• 22:58
  It's
• 22:59
  normally
• 22:59
  confined
• 23:00
  to
• 23:00
  the
• 23:00
  situation,
• 23:01
  and
• 23:01
  it's
• 23:01
  more
• 23:01
  longitudinal
• 23:02
  in
• 23:02
  nature.
• 23:03
  Think
• 23:03
  of
• 23:03
  that
• 23:04
  as
• 23:04
  the
• 23:04
  difference
• 23:04
  between
• 23:05
  a
• 23:05
  wave
• 23:05
  and
• 23:05
  a
• 23:05
  ripple.
• 23:06
  Now,
• 23:06
  what
• 23:06
  would
• 23:07
  we
• 23:07
  do
• 23:07
  for
• 23:07
  adhd?
• 23:08
  Let's
• 23:08
  say
• 23:08
  we've
• 23:09
  diagnosed
• 23:09
  Dale.
• 23:10
  It's
• 23:10
  pretty
• 23:10
  clear
• 23:10
  he's
• 23:11
  got
• 23:11
  adhd.
• 23:13
  Combined
• 23:13
  type.
• 23:14
  Well,
• 23:14
  first
• 23:15
  line
• 23:15
  treatments
• 23:15
  are
• 23:16
  stimulants.
• 23:16
  They
• 23:16
  have
• 23:17
  large
• 23:17
  effect
• 23:17
  sizes.
• 23:18
  They
• 23:18
  are
• 23:19
  the
• 23:19
  first
• 23:19
  line
• 23:19
  treatments
• 23:20
  for
• 23:20
  adhd,
• 23:21
  pharmacologically
• 23:22
  speaking.
• 23:23
  And
• 23:23
  one
• 23:24
  way,
• 23:24
  one
• 23:25
  thing
• 23:25
  we
• 23:25
  could
• 23:25
  start
• 23:25
  em
• 23:26
  on
• 23:26
  would
• 23:26
  be,
• 23:26
  you
• 23:27
  know,
• 23:27
  Adderall,
• 23:27
  Adderall,
• 23:28
  10mg
• 23:28
  xr
• 23:30
  would
• 23:30
  be
• 23:30
  a
• 23:30
  good
• 23:31
  start
• 23:31
  for
• 23:31
  em,
• 23:31
  right?
• 23:31
  When
• 23:32
  Adderall,
• 23:32
  we
• 23:33
  have
• 23:34
  dextroamphetamine
• 23:35
  and
• 23:35
  amphetamine.
• 23:36
  It's
• 23:36
  a
• 23:36
  central
• 23:37
  nervous
• 23:37
  stimulant.
• 23:39
  It
• 23:39
  works
• 23:39
  by
• 23:39
  primarily
• 23:40
  increasing
• 23:40
  the
• 23:40
  availability
• 23:41
  of
• 23:41
  two
• 23:41
  key
• 23:42
  neurotransmitters
• 23:42
  in
• 23:43
  your
• 23:43
  brain.
• 23:43
  Dopamine
• 23:44
  and
• 23:44
  norepinephrine.
• 23:45
  Let's
• 23:45
  compare
• 23:46
  this
• 23:46
  to
• 23:46
  having
• 23:47
  to
• 23:48
  blow
• 23:48
  out
• 23:48
  our
• 23:49
  leaves
• 23:49
  in
• 23:50
  our
• 23:50
  backyard.
• 23:51
  Dopamine
• 23:51
  would
• 23:51
  be
• 23:52
  like
• 23:52
  the
• 23:52
  thing
• 23:52
  that
• 23:52
  gives
• 23:53
  you
• 23:53
  the
• 23:53
  motivation
• 23:54
  to
• 23:54
  go
• 23:54
  out
• 23:54
  there
• 23:55
  and
• 23:55
  blow
• 23:56
  the
• 23:56
  leaves.
• 23:56
  It
• 23:56
  gives
• 23:57
  you
• 23:57
  the
• 23:57
  motivation
• 23:57
  and
• 23:57
  energy
• 23:58
  to
• 23:58
  go
• 23:58
  out,
• 23:58
  pick
• 23:59
  up
• 23:59
  the
• 23:59
  leaf
• 23:59
  blower
• 24:00
  and
• 24:00
  decide
• 24:00
  to
• 24:00
  start
• 24:00
  clearing
• 24:01
  your
• 24:01
  yard.
• 24:02
  It's
• 24:02
  the
• 24:02
  get
• 24:02
  up
• 24:02
  and
• 24:02
  go.
• 24:03
  It
• 24:03
  helps
• 24:03
  initiate
• 24:04
  action,
• 24:04
  among
• 24:04
  many
• 24:05
  other
• 24:05
  things.
• 24:06
  Motivation
• 24:06
  and
• 24:06
  reward,
• 24:07
  anticipatory
• 24:08
  reward.
• 24:09
  But
• 24:09
  dopamine
• 24:10
  gets
• 24:10
  you
• 24:10
  out
• 24:10
  there
• 24:10
  to
• 24:11
  actually
• 24:11
  pick
• 24:12
  up
• 24:12
  the
• 24:12
  leaf
• 24:12
  blower
• 24:12
  and
• 24:13
  go.
• 24:13
  And
• 24:13
  the
• 24:13
  norepinephrine
• 24:14
  is
• 24:14
  the
• 24:15
  neurotransmitter
• 24:16
  that
• 24:16
  allows
• 24:17
  you
• 24:17
  to
• 24:18
  focus
• 24:18
  your
• 24:19
  aim
• 24:19
  clearly
• 24:19
  and
• 24:19
  be
• 24:20
  precise
• 24:21
  and
• 24:21
  actually
• 24:21
  blow
• 24:22
  out
• 24:22
  the
• 24:22
  leaves.
• 24:22
  So
• 24:23
  it
• 24:23
  helps
• 24:23
  you
• 24:23
  actually
• 24:24
  focus
• 24:24
  onto
• 24:25
  the
• 24:25
  task
• 24:25
  so
• 24:25
  you
• 24:25
  have
• 24:26
  the
• 24:26
  motivation
• 24:26
  and
• 24:26
  the
• 24:26
  focus
• 24:27
  to
• 24:27
  actually
• 24:28
  do
• 24:28
  that.
• 24:29
  Adderall
• 24:29
  XR
• 24:30
  boosts
• 24:30
  both
• 24:30
  dopamine
• 24:31
  and
• 24:31
  norepinephrine
• 24:32
  by
• 24:32
  promoting
• 24:32
  the
• 24:32
  release
• 24:33
  of
• 24:33
  and
• 24:33
  prevention
• 24:34
  of
• 24:34
  their
• 24:34
  reuptake.
• 24:36
  And
• 24:36
  so
• 24:37
  you
• 24:37
  become
• 24:37
  this
• 24:37
  super
• 24:38
  yard
• 24:39
  worker,
• 24:40
  major
• 24:40
  brain
• 24:41
  leaf
• 24:41
  blower
• 24:42
  here.
• 24:42
  And
• 24:42
  it's
• 24:42
  super
• 24:43
  powerful
• 24:43
  and
• 24:43
  efficient,
• 24:43
  can
• 24:44
  very
• 24:44
  much
• 24:44
  help.
• 24:45
  So
• 24:45
  that's
• 24:45
  what
• 24:45
  I
• 24:45
  would
• 24:45
  typically
• 24:46
  start
• 24:46
  Dale
• 24:46
  on,
• 24:47
  10mg
• 24:47
  Adderall
• 24:48
  XR.
• 24:48
  I
• 24:49
  would
• 24:49
  see
• 24:49
  him
• 24:49
  in
• 24:49
  a
• 24:49
  couple
• 24:49
  weeks
• 24:50
  to
• 24:50
  see
• 24:50
  how
• 24:50
  he's
• 24:51
  tolerating
• 24:51
  the
• 24:52
  10
• 24:52
  milligram
• 24:52
  dose.
• 24:53
  I
• 24:53
  would
• 24:53
  adjust
• 24:53
  accordingly
• 24:54
  to
• 24:55
  make
• 24:55
  sure
• 24:56
  it's
• 24:56
  efficacious
• 24:57
  for
• 24:57
  him.
• 24:58
  And
• 24:58
  I
• 24:58
  would
• 24:58
  warn
• 24:59
  him
• 24:59
  that
• 24:59
  it
• 24:59
  controls
• 25:00
  his
• 25:00
  symptoms
• 25:00
  for
• 25:01
  up
• 25:01
  to
• 25:01
  10
• 25:01
  to
• 25:01
  12
• 25:01
  hours.
• 25:02
  It
• 25:02
  might
• 25:03
  involve
• 25:03
  a
• 25:04
  reduction
• 25:04
  in
• 25:04
  appetite,
• 25:05
  some
• 25:05
  insomnia,
• 25:06
  dry
• 25:06
  mouth,
• 25:07
  headaches.
• 25:07
  It
• 25:07
  kind
• 25:07
  of
• 25:07
  depends
• 25:08
  Everybody's
• 25:08
  a
• 25:08
  little
• 25:09
  different,
• 25:09
  but
• 25:09
  he
• 25:10
  can
• 25:10
  stop
• 25:10
  taking
• 25:10
  it
• 25:10
  immediately
• 25:11
  if
• 25:11
  it
• 25:11
  is
• 25:12
  bothering
• 25:12
  him
• 25:13
  and
• 25:13
  we
• 25:13
  can
• 25:13
  reconvene
• 25:14
  shortly.
• 25:15
  We
• 25:15
  really
• 25:16
  want
• 25:16
  to
• 25:16
  tackle
• 25:16
  his
• 25:16
  core
• 25:17
  ADHD
• 25:17
  symptoms
• 25:18
  to
• 25:18
  allow
• 25:19
  him
• 25:19
  to
• 25:19
  thrive
• 25:19
  a
• 25:20
  little
• 25:20
  bit
• 25:20
  better.
• 25:21
  Keep
• 25:21
  in
• 25:21
  mind
• 25:21
  his
• 25:21
  appetite
• 25:22
  may
• 25:22
  go
• 25:22
  down
• 25:23
  on
• 25:23
  stimulants
• 25:24
  and
• 25:24
  make
• 25:24
  sure
• 25:24
  he's
• 25:24
  aware
• 25:25
  of
• 25:25
  that
• 25:25
  and
• 25:26
  make
• 25:26
  sure
• 25:27
  that
• 25:27
  you
• 25:28
  if
• 25:28
  he
• 25:28
  has
• 25:28
  any
• 25:28
  pre
• 25:29
  existing
• 25:29
  cardiovascular
• 25:30
  issues,
• 25:30
  you're
• 25:30
  doing
• 25:31
  a
• 25:31
  full
• 25:31
  workup
• 25:32
  and
• 25:32
  we'll
• 25:32
  go
• 25:32
  over
• 25:32
  that
• 25:33
  in
• 25:33
  future
• 25:33
  sessions.
• 25:34
  But
• 25:35
  that's
• 25:35
  also
• 25:35
  very
• 25:36
  important,
• 25:36
  right?
• 25:37
  To
• 25:37
  get
• 25:37
  an
• 25:37
  EKG
• 25:38
  and
• 25:38
  a
• 25:39
  full
• 25:39
  cardiovascular
• 25:39
  workup,
• 25:40
  especially
• 25:40
  if
• 25:40
  he
• 25:41
  has
• 25:41
  first
• 25:41
  degree
• 25:41
  family
• 25:42
  members
• 25:42
  with
• 25:43
  sudden
• 25:43
  cardiovascular
• 25:44
  death.
• 25:45
  Make
• 25:45
  sure
• 25:46
  you
• 25:46
  know
• 25:46
  about
• 25:46
  his
• 25:47
  blood
• 25:47
  pressure
• 25:48
  and
• 25:48
  those
• 25:48
  baseline
• 25:49
  vitals
• 25:49
  before
• 25:50
  you
• 25:50
  start
• 25:50
  and
• 25:50
  give
• 25:50
  him
• 25:51
  his
• 25:51
  informed
• 25:51
  consent.
• 25:52
  That's
• 25:52
  a
• 25:52
  little
• 25:52
  beyond
• 25:53
  the
• 25:53
  scope
• 25:53
  of
• 25:53
  this
• 25:53
  podcast,
• 25:54
  so
• 25:54
  make
• 25:54
  sure
• 25:54
  you're
• 25:55
  doing
• 25:55
  your
• 25:55
  due
• 25:55
  diligence
• 25:56
  when
• 25:56
  you
• 25:56
  prescribe
• 25:56
  a
• 25:56
  medication.
• 25:57
  But
• 25:58
  we're
• 25:58
  going
• 25:58
  to
• 25:58
  zoom,
• 25:59
  zoom
• 25:59
  out
• 25:59
  here
• 25:59
  and
• 26:00
  close
• 26:00
  out
• 26:00
  here.
• 26:00
  Our
• 26:01
  power
• 26:01
  pearls
• 26:01
  today
• 26:02
  are
• 26:02
  to
• 26:03
  focus
• 26:03
  on
• 26:04
  chronicity
• 26:05
  versus
• 26:06
  cyclicis.
• 26:07
  Is
• 26:07
  this
• 26:07
  chronic
• 26:08
  or
• 26:08
  is
• 26:08
  this
• 26:08
  cyclical
• 26:09
  when
• 26:09
  it
• 26:09
  comes
• 26:09
  to
• 26:10
  ADHD
• 26:10
  or
• 26:10
  bipolar?
• 26:11
  Right.
• 26:11
  One
• 26:12
  of
• 26:12
  them's
• 26:12
  more
• 26:12
  chronic,
• 26:13
  that's
• 26:13
  the
• 26:13
  adhd.
• 26:14
  One
• 26:14
  of
• 26:15
  them's
• 26:15
  more
• 26:15
  cyclical,
• 26:16
  that
• 26:16
  would
• 26:16
  be
• 26:16
  bipolar.
• 26:17
  It's
• 26:17
  more
• 26:17
  episodic.
• 26:18
  The
• 26:19
  quality
• 26:19
  of
• 26:19
  the
• 26:19
  high
• 26:20
  energy
• 26:20
  is
• 26:20
  very
• 26:20
  different
• 26:21
  in
• 26:21
  adhd.
• 26:21
  It's
• 26:22
  more
• 26:22
  like
• 26:22
  restlessness,
• 26:23
  impulsivity,
• 26:23
  difficult,
• 26:24
  multi,
• 26:24
  sitting
• 26:24
  still.
• 26:25
  In
• 26:25
  bipolar
• 26:26
  mania,
• 26:26
  there's
• 26:27
  usually
• 26:27
  a
• 26:27
  cluster
• 26:28
  of
• 26:28
  symptoms
• 26:28
  all
• 26:28
  happening
• 26:29
  together.
• 26:29
  The
• 26:30
  patient's
• 26:30
  grandiose,
• 26:31
  they're
• 26:31
  talking
• 26:32
  fast,
• 26:32
  they're
• 26:33
  pursuing
• 26:33
  goals
• 26:34
  that
• 26:34
  are
• 26:34
  pretty
• 26:34
  extravagant
• 26:35
  and
• 26:35
  unusual
• 26:37
  and
• 26:37
  then
• 26:37
  they
• 26:37
  return
• 26:37
  to
• 26:38
  a
• 26:38
  totally
• 26:38
  different
• 26:38
  baseline.
• 26:39
  So
• 26:39
  it's
• 26:40
  very
• 26:40
  different.
• 26:40
  Right.
• 26:41
  These
• 26:41
  are
• 26:41
  lifelong
• 26:42
  patterns
• 26:42
  versus
• 26:42
  episodic
• 26:43
  shifts.
• 26:44
  Right.
• 26:44
  And
• 26:45
  you
• 26:45
  really
• 26:45
  want
• 26:45
  to
• 26:46
  make
• 26:46
  sure
• 26:46
  you
• 26:47
  know
• 26:47
  the
• 26:47
  difference
• 26:47
  and
• 26:47
  they
• 26:48
  can
• 26:48
  co
• 26:48
  occur.
• 26:49
  Right.
• 26:49
  So
• 26:49
  we
• 26:49
  treated
• 26:50
  Dale,
• 26:50
  he
• 26:50
  came
• 26:51
  back
• 26:51
  in
• 26:51
  a
• 26:51
  couple
• 26:51
  weeks.
• 26:51
  He
• 26:52
  said
• 26:52
  10mg
• 26:53
  is
• 26:53
  helps
• 26:54
  with
• 26:54
  the
• 26:54
  majority
• 26:54
  of
• 26:54
  his
• 26:55
  symptoms,
• 26:55
  but
• 26:55
  he
• 26:56
  would
• 26:56
  like
• 26:56
  to
• 26:56
  increase
• 26:56
  the
• 26:57
  dose
• 26:57
  potentially
• 26:58
  because
• 26:58
  it
• 26:58
  tends
• 26:59
  to
• 26:59
  wear
• 26:59
  off
• 26:59
  and
• 27:00
  he
• 27:00
  feels
• 27:01
  like
• 27:01
  maybe
• 27:02
  15
• 27:02
  or
• 27:02
  20
• 27:02
  would
• 27:03
  be
• 27:03
  better
• 27:03
  fit
• 27:04
  for
• 27:04
  him.
• 27:04
  So
• 27:04
  we
• 27:05
  raise
• 27:05
  it
• 27:05
  to
• 27:05
  15mg
• 27:06
  xr
• 27:06
  for
• 27:07
  another
• 27:07
  two
• 27:07
  weeks
• 27:07
  to
• 27:07
  see
• 27:07
  how
• 27:08
  he's
• 27:08
  doing.
• 27:08
  Sure
• 27:09
  enough,
• 27:09
  he
• 27:09
  says
• 27:09
  absolutely,
• 27:10
  that
• 27:10
  is
• 27:10
  the
• 27:10
  best
• 27:11
  dose
• 27:12
  for
• 27:12
  him.
• 27:12
  He
• 27:13
  wants
• 27:13
  to
• 27:13
  stay
• 27:13
  at
• 27:13
  15
• 27:14
  and
• 27:14
  he
• 27:14
  does.
• 27:15
  And
• 27:15
  he
• 27:15
  does
• 27:15
  pretty
• 27:16
  well.
• 27:16
  His
• 27:16
  girlfriend
• 27:16
  is
• 27:17
  excited.
• 27:17
  She
• 27:18
  says
• 27:18
  he's
• 27:18
  doing
• 27:18
  a
• 27:18
  lot
• 27:19
  better.
• 27:19
  He's
• 27:19
  more
• 27:19
  focused,
• 27:20
  the
• 27:20
  kitchen
• 27:20
  is
• 27:21
  renovated,
• 27:21
  he's
• 27:22
  happy.
• 27:22
  He
• 27:23
  is
• 27:23
  less
• 27:23
  disruptive
• 27:24
  around
• 27:24
  the
• 27:24
  house.
• 27:25
  He's
• 27:25
  also
• 27:25
  a
• 27:26
  little
• 27:26
  bit
• 27:26
  less
• 27:26
  irritable.
• 27:27
  He
• 27:28
  still
• 27:28
  has
• 27:28
  that
• 27:29
  generalized
• 27:29
  anxiety
• 27:29
  disorder
• 27:30
  and
• 27:30
  depressive
• 27:31
  disorder
• 27:31
  diagnosis
• 27:32
  in
• 27:32
  the
• 27:32
  past
• 27:32
  because
• 27:33
  that
• 27:33
  was
• 27:33
  not
• 27:33
  his
• 27:34
  chief
• 27:34
  concern.
• 27:35
  It's
• 27:35
  not
• 27:35
  something
• 27:36
  that
• 27:36
  you
• 27:36
  focused
• 27:37
  on
• 27:37
  today.
• 27:37
  He's
• 27:38
  coming
• 27:38
  to
• 27:38
  you
• 27:38
  for
• 27:38
  executive
• 27:39
  functioning
• 27:39
  issues.
• 27:40
  He
• 27:40
  did
• 27:40
  not
• 27:40
  tell
• 27:41
  you
• 27:41
  he's
• 27:41
  down
• 27:41
  and
• 27:42
  sad.
• 27:42
  He
• 27:42
  did
• 27:43
  not
• 27:43
  tell
• 27:43
  you
• 27:43
  he's
• 27:43
  hopeless.
• 27:44
  It's
• 27:44
  important
• 27:44
  to
• 27:45
  make
• 27:45
  sure
• 27:45
  that
• 27:45
  he's
• 27:46
  not
• 27:46
  down,
• 27:46
  sad
• 27:46
  and
• 27:46
  hopeless
• 27:47
  and
• 27:47
  that's
• 27:48
  not
• 27:48
  one
• 27:48
  of
• 27:48
  the
• 27:48
  reasons
• 27:48
  he's
• 27:49
  here.
• 27:49
  But
• 27:50
  no,
• 27:50
  he
• 27:50
  was
• 27:50
  here
• 27:51
  for
• 27:51
  adhd.
• 27:51
  We
• 27:52
  treated
• 27:52
  ADHD
• 27:53
  and
• 27:53
  we
• 27:53
  definitely
• 27:53
  want
• 27:53
  to
• 27:53
  be
• 27:54
  vigilant
• 27:54
  of
• 27:54
  any
• 27:54
  depression
• 27:55
  or
• 27:55
  anxiety.
• 27:55
  For
• 27:56
  now
• 27:56
  through
• 27:56
  your
• 27:56
  questions,
• 27:57
  that
• 27:57
  is
• 27:57
  not
• 27:57
  his
• 27:58
  chief
• 27:58
  concern.
• 27:59
  We
• 27:59
  will
• 27:59
  keep
• 27:59
  our
• 27:59
  eyes
• 28:00
  on
• 28:00
  that
• 28:01
  and
• 28:01
  consider
• 28:02
  Wellbutrin
• 28:03
  in
• 28:03
  the
• 28:03
  future.
• 28:04
  If
• 28:04
  he
• 28:04
  does
• 28:04
  get
• 28:04
  depressed
• 28:05
  and
• 28:05
  he
• 28:05
  does
• 28:05
  also
• 28:06
  have
• 28:06
  this
• 28:06
  ADHD
• 28:07
  comorbid,
• 28:07
  we
• 28:08
  can
• 28:08
  think
• 28:08
  about
• 28:08
  Wellbutrin
• 28:10
  and
• 28:10
  definitely
• 28:10
  monitor
• 28:11
  how
• 28:11
  he's
• 28:11
  doing
• 28:11
  on
• 28:12
  his
• 28:12
  stimulants.
• 28:13
  I
• 28:13
  am
• 28:13
  very
• 28:13
  appreciative
• 28:14
  of
• 28:14
  each
• 28:15
  and
• 28:15
  every
• 28:15
  one
• 28:15
  of
• 28:15
  you
• 28:15
  being
• 28:15
  here.
• 28:16
  This
• 28:16
  podcast
• 28:16
  is
• 28:17
  getting
• 28:17
  really
• 28:17
  popular
• 28:18
  in
• 28:18
  Psych
• 28:18
  NP
• 28:19
  circles.
• 28:19
  People
• 28:20
  studying
• 28:20
  for
• 28:20
  boards
• 28:21
  are
• 28:21
  finding
• 28:21
  that
• 28:21
  it's
• 28:22
  very
• 28:22
  useful,
• 28:22
  so
• 28:22
  we
• 28:23
  really
• 28:23
  appreciate
• 28:23
  you.
• 28:24
  Keep
• 28:24
  spreading
• 28:24
  the
• 28:24
  word.
• 28:25
  Send
• 28:25
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• 28:25
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• 28:25
  anybody
• 28:26
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• 28:26
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• 28:26
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• 28:27
  NP
• 28:27
  curriculum.
• 28:28
  Please
• 28:28
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• 28:28
  our
• 28:29
  Patreon.
• 28:30
  It's
• 28:30
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• 28:30
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• 28:30
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• 28:30
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• 28:31
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• 28:31
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• 28:31
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• 28:31
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• 28:31
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• 28:32
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• 28:32
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• 28:33
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  Yield
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  Slide
• 28:38
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• 28:39
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• 28:39
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• 28:40
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• 28:40
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  Chock
• 28:41
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• 28:42
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• 28:42
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• 28:43
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  that
• 28:44
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• 28:44
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• 28:45
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• 28:45
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• 28:45
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• 28:46
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• 28:46
  reads
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  must
• 28:48
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• 28:48
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• 28:48
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• 28:49
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• 28:49
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• 28:49
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• 28:49
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• 28:50
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• 28:50
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• 28:50
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• 28:51
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• 28:51
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• 28:51
  or
• 28:51
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• 28:52
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• 28:52
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• 28:52
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• 28:52
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• 28:53
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• 28:53
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• 28:53
  sharper,
• 28:54
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• 28:54
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• 28:54
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• 28:55
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• 28:56
  Head
• 28:56
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• 28:57
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• 28:58
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• 29:00
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• 29:00
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• 29:00
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• 29:01
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• 29:01
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• 29:01
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  Thank
• 29:02
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• 29:02
  all
• 29:02
  very
• 29:02
  much
• 29:03
  and
• 29:03
  have
• 29:03
  a
• 29:03
  wonderful
• 29:04
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• 29:05
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• 29:05
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• 29:05
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