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Board Bombs: 3 Great Practice Psychiatric Nurse Practitioner Board Prep Questions · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  My
• 0:06
  friends,
• 0:06
  welcome
• 0:07
  back
• 0:08
  to
• 0:08
  a
• 0:08
  bonus
• 0:08
  episode
• 0:09
  of
• 0:10
  Pearls
• 0:10
  and
• 0:10
  Prep.
• 0:10
  This
• 0:11
  is
• 0:11
  called
• 0:11
  Board
• 0:12
  Bombs
• 0:13
  and
• 0:13
  we
• 0:14
  are
• 0:14
  bringing
• 0:14
  you
• 0:14
  Board
• 0:15
  Bombs,
• 0:15
  which
• 0:15
  are
• 0:16
  essentially
• 0:16
  three
• 0:16
  questions
• 0:17
  to
• 0:17
  better
• 0:17
  prepare
• 0:18
  you
• 0:18
  for
• 0:18
  your
• 0:18
  psych
• 0:19
  NP
• 0:19
  boards.
• 0:20
  Questions
• 0:20
  that
• 0:21
  are
• 0:21
  highly
• 0:21
  relevant
• 0:22
  in
• 0:22
  practice
• 0:23
  or
• 0:23
  just
• 0:24
  highly
• 0:24
  relevant
• 0:24
  potentially
• 0:25
  for
• 0:25
  board
• 0:26
  studying.
• 0:26
  And.
• 0:27
  And
• 0:27
  today
• 0:27
  we're
• 0:27
  going
• 0:27
  to
• 0:28
  go
• 0:28
  over
• 0:28
  three
• 0:28
  questions
• 0:29
  and
• 0:29
  I
• 0:29
  hope
• 0:29
  you
• 0:30
  enjoy
• 0:30
  this.
• 0:30
  I
• 0:30
  think
• 0:31
  it's
• 0:31
  going
• 0:31
  to
• 0:31
  be
• 0:31
  a
• 0:32
  lot
• 0:32
  of
• 0:32
  fun
• 0:32
  to
• 0:32
  connect
• 0:33
  and
• 0:34
  make
• 0:34
  sense
• 0:35
  of
• 0:35
  three
• 0:35
  different
• 0:36
  topics
• 0:36
  in
• 0:36
  psychiatry
• 0:38
  that
• 0:38
  may
• 0:39
  be
• 0:39
  pertinent
• 0:39
  to
• 0:39
  you.
• 0:39
  If
• 0:40
  nothing
• 0:40
  else,
• 0:40
  we'll
• 0:40
  give
• 0:40
  you
• 0:41
  some
• 0:41
  good
• 0:41
  pearls
• 0:42
  moving
• 0:43
  forward.
• 0:44
  All
• 0:44
  right,
• 0:44
  my
• 0:44
  friends.
• 0:45
  So
• 0:45
  question
• 0:46
  1.
• 0:46
  A
• 0:46
  38
• 0:46
  year
• 0:47
  old
• 0:47
  man
• 0:47
  presents
• 0:48
  for
• 0:48
  evaluation,
• 0:49
  stating,
• 0:49
  I
• 0:50
  just
• 0:50
  know
• 0:50
  I'm
• 0:51
  going
• 0:51
  to
• 0:51
  develop
• 0:51
  pancreatic
• 0:52
  cancer.
• 0:53
  He
• 0:53
  reports
• 0:53
  no
• 0:54
  current
• 0:55
  symptoms,
• 0:55
  but
• 0:56
  spends
• 0:56
  several
• 0:57
  hours
• 0:57
  daily
• 0:57
  researching
• 0:58
  rare
• 0:58
  cancers
• 0:59
  online
• 0:59
  and
• 0:59
  avoids
• 1:00
  social
• 1:00
  events
• 1:01
  due
• 1:01
  to
• 1:01
  fear
• 1:02
  of
• 1:02
  exposure
• 1:02
  to
• 1:03
  environmental
• 1:03
  toxins.
• 1:04
  His
• 1:04
  wife
• 1:05
  says
• 1:05
  he
• 1:05
  has
• 1:05
  seen
• 1:05
  multiple
• 1:06
  specialists,
• 1:07
  all
• 1:07
  of
• 1:07
  whom
• 1:07
  found
• 1:08
  no
• 1:08
  physical
• 1:08
  illness.
• 1:09
  He
• 1:10
  becomes
• 1:10
  frustrated
• 1:11
  when
• 1:11
  he's
• 1:11
  reassured
• 1:12
  that
• 1:12
  he's
• 1:12
  healthy,
• 1:13
  stating
• 1:13
  they
• 1:13
  just
• 1:13
  haven't
• 1:14
  found
• 1:14
  it
• 1:14
  yet.
• 1:15
  He
• 1:15
  has
• 1:15
  no
• 1:15
  notable
• 1:16
  physical
• 1:16
  complaints
• 1:17
  at
• 1:17
  this
• 1:17
  time.
• 1:18
  What
• 1:18
  is
• 1:18
  his
• 1:19
  most
• 1:19
  likely
• 1:19
  diagnosis?
• 1:20
  Is
• 1:20
  it
• 1:20
  A
• 1:21
  somatic
• 1:22
  symptom
• 1:22
  disorder,
• 1:23
  generalized
• 1:24
  anxiety
• 1:24
  disorder,
• 1:25
  C,
• 1:25
  illness
• 1:26
  anxiety
• 1:26
  disorder,
• 1:27
  or
• 1:28
  D,
• 1:28
  conversion
• 1:29
  disorder?
• 1:30
  Okay,
• 1:31
  so
• 1:31
  that's
• 1:31
  our
• 1:31
  first
• 1:31
  question,
• 1:32
  and
• 1:33
  when
• 1:33
  you
• 1:33
  look
• 1:33
  at
• 1:33
  this,
• 1:35
  you
• 1:36
  definitely
• 1:37
  understand
• 1:37
  there
• 1:37
  is
• 1:37
  some
• 1:38
  kind
• 1:38
  of
• 1:38
  anxiety
• 1:39
  disorder
• 1:39
  going
• 1:39
  on
• 1:40
  here.
• 1:40
  Two
• 1:41
  answers
• 1:42
  likely
• 1:42
  jump
• 1:43
  out
• 1:43
  at
• 1:43
  you,
• 1:43
  and
• 1:44
  I
• 1:44
  wish
• 1:44
  I
• 1:44
  could
• 1:45
  reach
• 1:45
  through
• 1:45
  the
• 1:45
  podcast
• 1:46
  app
• 1:46
  and
• 1:47
  pick
• 1:47
  your
• 1:47
  brain
• 1:47
  and
• 1:48
  figure
• 1:48
  out
• 1:48
  what
• 1:48
  the
• 1:48
  heck
• 1:48
  you're
• 1:49
  thinking
• 1:49
  right
• 1:49
  now.
• 1:50
  But
• 1:50
  I
• 1:50
  bet
• 1:50
  you're
• 1:50
  thinking
• 1:51
  this
• 1:51
  has
• 1:51
  to
• 1:51
  do
• 1:52
  with
• 1:52
  either
• 1:53
  somatic
• 1:53
  symptom
• 1:54
  or
• 1:54
  illness.
• 1:55
  Anxiety
• 1:55
  disorder.
• 1:56
  Maybe
• 1:56
  that
• 1:56
  distinction's
• 1:57
  a
• 1:57
  little
• 1:58
  fuzzy
• 1:58
  for
• 1:58
  you.
• 1:59
  Maybe
• 1:59
  you're
• 1:59
  even
• 2:00
  thinking
• 2:00
  generalized
• 2:01
  anxiety.
• 2:01
  And
• 2:01
  that's
• 2:02
  okay
• 2:02
  if
• 2:02
  you
• 2:02
  are
• 2:03
  conversion
• 2:04
  disorder.
• 2:04
  Eh,
• 2:05
  doesn't
• 2:05
  really
• 2:05
  scream
• 2:06
  conversion
• 2:06
  disorder
• 2:07
  where
• 2:08
  you
• 2:08
  have
• 2:08
  physical
• 2:09
  manifestations
• 2:10
  of
• 2:10
  anxious
• 2:11
  thoughts
• 2:12
  or
• 2:12
  feelings.
• 2:12
  I
• 2:12
  don't
• 2:12
  see
• 2:13
  a
• 2:13
  lot
• 2:13
  of
• 2:13
  physical
• 2:14
  problems,
• 2:14
  you
• 2:15
  know,
• 2:15
  twitching
• 2:15
  or
• 2:16
  spasms
• 2:17
  or
• 2:17
  any
• 2:18
  other
• 2:18
  kind
• 2:18
  of
• 2:18
  physical
• 2:19
  complaints
• 2:19
  that
• 2:19
  correlate
• 2:20
  to
• 2:21
  emotional
• 2:21
  states
• 2:22
  here.
• 2:22
  So
• 2:22
  conversion
• 2:23
  disorder,
• 2:23
  I
• 2:24
  think
• 2:24
  we
• 2:24
  can
• 2:24
  probably
• 2:24
  strike
• 2:25
  that
• 2:25
  out
• 2:25
  right
• 2:26
  now.
• 2:27
  The
• 2:27
  next
• 2:27
  suspect
• 2:28
  we
• 2:28
  can
• 2:28
  look
• 2:28
  at
• 2:28
  is
• 2:29
  generalized
• 2:29
  anxiety
• 2:30
  disorder.
• 2:30
  Well,
• 2:31
  remember,
• 2:31
  generalized
• 2:32
  anxiety
• 2:32
  is
• 2:33
  as
• 2:33
  simple
• 2:33
  as
• 2:34
  the
• 2:34
  definition
• 2:34
  states.
• 2:35
  It's
• 2:35
  general.
• 2:36
  This
• 2:36
  doesn't
• 2:36
  sound
• 2:37
  that
• 2:37
  general,
• 2:37
  does
• 2:38
  it?
• 2:38
  He's
• 2:38
  very
• 2:39
  much
• 2:39
  focused
• 2:39
  on
• 2:40
  acquiring
• 2:40
  a
• 2:40
  specific
• 2:41
  illness,
• 2:42
  pancreatic
• 2:43
  cancer
• 2:43
  or
• 2:44
  maybe
• 2:44
  rare
• 2:45
  cancers,
• 2:45
  environmental
• 2:46
  toxins.
• 2:46
  In
• 2:46
  other
• 2:47
  words,
• 2:47
  it's
• 2:47
  not
• 2:47
  really
• 2:47
  generalized.
• 2:49
  Right.
• 2:49
  He's
• 2:50
  worried
• 2:51
  about
• 2:51
  acquiring
• 2:52
  a
• 2:53
  fatal
• 2:53
  cancer
• 2:54
  or
• 2:54
  cancers.
• 2:55
  And
• 2:55
  this
• 2:56
  is
• 2:56
  more
• 2:56
  specific.
• 2:57
  General
• 2:57
  worry
• 2:57
  is
• 2:58
  you're
• 2:58
  just
• 2:58
  on
• 2:58
  Edge,
• 2:59
  you
• 2:59
  see
• 2:59
  everything
• 3:00
  through
• 3:00
  kind
• 3:00
  of
• 3:00
  a
• 3:00
  fear
• 3:01
  filter.
• 3:02
  You're
• 3:02
  worried
• 3:02
  about
• 3:03
  your
• 3:03
  family
• 3:03
  getting
• 3:04
  hurt
• 3:04
  when
• 3:04
  there's
• 3:04
  no
• 3:05
  basis
• 3:05
  for
• 3:05
  your
• 3:05
  family
• 3:05
  getting
• 3:06
  hurt
• 3:06
  that
• 3:06
  day
• 3:06
  necessarily.
• 3:07
  Or
• 3:07
  you're
• 3:08
  going
• 3:08
  to
• 3:08
  lose
• 3:08
  your
• 3:08
  job
• 3:08
  and
• 3:09
  get
• 3:09
  fired
• 3:09
  even
• 3:09
  though
• 3:10
  you
• 3:10
  haven't
• 3:10
  even
• 3:11
  been
• 3:11
  written
• 3:11
  up
• 3:12
  and
• 3:12
  there's
• 3:12
  no
• 3:12
  basis
• 3:13
  to
• 3:13
  think
• 3:13
  your
• 3:13
  performance
• 3:14
  is
• 3:14
  in
• 3:14
  decline.
• 3:14
  Right.
• 3:15
  General
• 3:15
  worry
• 3:16
  is
• 3:16
  as
• 3:16
  it's
• 3:17
  stated.
• 3:18
  And
• 3:18
  although
• 3:19
  you
• 3:19
  could
• 3:19
  make
• 3:20
  the
• 3:20
  case
• 3:20
  that
• 3:20
  he's
• 3:21
  worried
• 3:21
  about
• 3:21
  many
• 3:22
  things
• 3:22
  and
• 3:22
  we
• 3:22
  can't
• 3:22
  rule
• 3:23
  out
• 3:23
  generalized
• 3:23
  anxiety,
• 3:24
  it
• 3:24
  doesn't
• 3:24
  scream
• 3:25
  to
• 3:25
  the
• 3:25
  core
• 3:25
  of
• 3:26
  his
• 3:26
  symptoms
• 3:26
  here.
• 3:27
  And
• 3:27
  so
• 3:28
  this
• 3:28
  brings
• 3:28
  us
• 3:28
  to
• 3:28
  either
• 3:29
  somatic
• 3:29
  symptom
• 3:29
  or
• 3:30
  illness
• 3:30
  anxiety
• 3:31
  disorder.
• 3:31
  When
• 3:31
  I
• 3:32
  was
• 3:32
  in
• 3:32
  psych
• 3:32
  and
• 3:32
  P
• 3:32
  school,
• 3:32
  this
• 3:33
  drove
• 3:33
  me
• 3:33
  nuts.
• 3:33
  I
• 3:33
  think
• 3:34
  I
• 3:34
  even
• 3:34
  argued
• 3:34
  with
• 3:34
  one
• 3:35
  of
• 3:35
  my
• 3:35
  professors
• 3:35
  once
• 3:36
  about
• 3:36
  this.
• 3:36
  I
• 3:36
  just
• 3:37
  got
• 3:37
  so
• 3:37
  angry
• 3:37
  at
• 3:37
  these
• 3:38
  questions
• 3:38
  because
• 3:38
  I
• 3:38
  was
• 3:39
  convinced
• 3:39
  it
• 3:39
  was
• 3:39
  either
• 3:39
  somatic
• 3:40
  or
• 3:40
  illness.
• 3:41
  I
• 3:41
  did
• 3:41
  very
• 3:41
  well
• 3:42
  on
• 3:42
  my
• 3:42
  DSM
• 3:43
  5
• 3:43
  exams,
• 3:44
  but
• 3:45
  this
• 3:45
  was
• 3:45
  always
• 3:46
  the
• 3:46
  kind
• 3:46
  of
• 3:46
  question
• 3:47
  that
• 3:47
  I
• 3:47
  got
• 3:47
  wrong.
• 3:47
  It
• 3:48
  was
• 3:48
  one
• 3:48
  of
• 3:48
  the
• 3:48
  rare
• 3:48
  ones
• 3:48
  that
• 3:49
  I
• 3:49
  would
• 3:49
  get
• 3:49
  wrong.
• 3:50
  And
• 3:50
  the
• 3:50
  difference
• 3:51
  between
• 3:51
  somatic
• 3:52
  symptom
• 3:52
  and
• 3:53
  illness
• 3:53
  anxiety
• 3:53
  disorder
• 3:54
  is
• 3:55
  that
• 3:55
  illness
• 3:55
  anxiety
• 3:56
  involves
• 3:56
  the
• 3:57
  preoccupation
• 3:58
  with
• 3:58
  having
• 3:58
  or
• 3:58
  acquiring
• 3:59
  a
• 3:59
  serious
• 3:59
  illness,
• 4:00
  but
• 4:00
  it
• 4:00
  has
• 4:00
  minimal
• 4:01
  or
• 4:01
  no
• 4:02
  somatic
• 4:03
  symptoms.
• 4:03
  Somatic
• 4:04
  symptom
• 4:04
  disorder
• 4:04
  requires
• 4:05
  actual
• 4:06
  physical
• 4:06
  symptoms
• 4:07
  that
• 4:07
  are
• 4:07
  distressing
• 4:08
  or
• 4:08
  disruptive
• 4:09
  plus
• 4:10
  excessive
• 4:10
  thoughts
• 4:11
  or
• 4:11
  feelings
• 4:11
  about
• 4:12
  them.
• 4:12
  Notice
• 4:13
  in
• 4:13
  this
• 4:13
  case,
• 4:14
  our
• 4:14
  38
• 4:15
  year
• 4:15
  old
• 4:15
  man
• 4:15
  didn't
• 4:16
  have
• 4:16
  any
• 4:16
  physical
• 4:17
  symptoms.
• 4:17
  And
• 4:17
  there
• 4:18
  was
• 4:18
  a
• 4:18
  clue
• 4:18
  in
• 4:18
  the
• 4:18
  question
• 4:19
  when
• 4:19
  it
• 4:19
  even
• 4:20
  stated
• 4:20
  that
• 4:21
  he
• 4:21
  had
• 4:21
  no
• 4:21
  physical
• 4:22
  illness.
• 4:22
  And
• 4:22
  we
• 4:23
  didn't
• 4:23
  talk
• 4:23
  about
• 4:23
  any
• 4:24
  symptoms
• 4:24
  at
• 4:24
  all
• 4:24
  in
• 4:24
  that
• 4:25
  paragraph.
• 4:25
  We
• 4:25
  talked
• 4:26
  about
• 4:26
  his
• 4:26
  fear
• 4:26
  of
• 4:26
  developing
• 4:27
  cancer.
• 4:28
  We
• 4:28
  talked
• 4:28
  about
• 4:28
  how
• 4:29
  he
• 4:29
  has
• 4:29
  avoidant
• 4:29
  behaviors
• 4:30
  where
• 4:30
  he
• 4:30
  doesn't
• 4:30
  want
• 4:31
  to
• 4:31
  get
• 4:31
  exposed
• 4:31
  to
• 4:31
  environmental
• 4:32
  toxins.
• 4:33
  We
• 4:33
  talked
• 4:33
  about
• 4:33
  how
• 4:33
  he
• 4:34
  was
• 4:34
  frustrated
• 4:35
  when
• 4:35
  he
• 4:35
  was
• 4:35
  reassured
• 4:36
  and
• 4:36
  he
• 4:36
  kept
• 4:37
  looking,
• 4:37
  but
• 4:38
  he
• 4:38
  didn't
• 4:38
  have
• 4:38
  physical
• 4:39
  complaints.
• 4:39
  And
• 4:39
  that
• 4:39
  was
• 4:39
  the
• 4:40
  clue
• 4:40
  within
• 4:41
  the
• 4:41
  question
• 4:42
  that
• 4:42
  can
• 4:42
  steer
• 4:43
  you
• 4:43
  away
• 4:43
  from
• 4:44
  somatic
• 4:44
  symptom
• 4:44
  disorder.
• 4:45
  Because
• 4:45
  the
• 4:45
  purpose
• 4:46
  of
• 4:46
  a
• 4:46
  question
• 4:47
  like
• 4:47
  this
• 4:47
  is
• 4:47
  to
• 4:48
  see
• 4:48
  if
• 4:48
  you
• 4:48
  understand
• 4:49
  the
• 4:49
  distinction.
• 4:50
  And
• 4:50
  it's
• 4:50
  the
• 4:50
  absence
• 4:51
  of
• 4:51
  physical
• 4:51
  symptoms.
• 4:52
  And
• 4:52
  again,
• 4:53
  somatic
• 4:54
  symptom
• 4:54
  is
• 4:54
  in
• 4:54
  the
• 4:55
  name.
• 4:55
  That's
• 4:55
  why
• 4:55
  I
• 4:55
  think
• 4:56
  I
• 4:56
  did
• 4:56
  so
• 4:56
  well
• 4:57
  on
• 4:57
  some
• 4:57
  of
• 4:57
  these
• 4:57
  tests.
• 4:58
  And
• 4:58
  trust
• 4:58
  me,
• 4:59
  I'm
• 4:59
  not
• 4:59
  bragging.
• 4:59
  I
• 5:00
  was
• 5:00
  never
• 5:00
  a
• 5:00
  great
• 5:00
  student.
• 5:01
  I,
• 5:01
  I
• 5:01
  failed
• 5:02
  physics
• 5:02
  growing
• 5:03
  up.
• 5:03
  Pre
• 5:04
  calculus
• 5:04
  was
• 5:05
  a
• 5:05
  monster.
• 5:06
  I
• 5:06
  am
• 5:06
  not
• 5:06
  like
• 5:06
  a
• 5:07
  model
• 5:07
  student,
• 5:07
  but
• 5:07
  I
• 5:08
  did
• 5:08
  so
• 5:08
  well
• 5:08
  in
• 5:08
  these
• 5:09
  diagnostic
• 5:09
  classes
• 5:10
  because
• 5:10
  I
• 5:10
  just
• 5:11
  felt
• 5:11
  the
• 5:11
  names
• 5:11
  were
• 5:12
  so
• 5:12
  fair.
• 5:12
  Right.
• 5:13
  Somatic
• 5:13
  symptom
• 5:14
  is
• 5:14
  what
• 5:14
  it
• 5:14
  says.
• 5:15
  You're
• 5:15
  focused
• 5:15
  on
• 5:16
  A
• 5:16
  somatic
• 5:16
  symptom.
• 5:17
  This
• 5:17
  guy
• 5:17
  was
• 5:18
  not
• 5:18
  focused
• 5:18
  on
• 5:18
  a
• 5:18
  symptom.
• 5:19
  Illness,
• 5:20
  anxiety.
• 5:20
  You're
• 5:21
  focused
• 5:21
  on
• 5:21
  potentially
• 5:22
  having
• 5:22
  an
• 5:23
  illness.
• 5:23
  You
• 5:23
  have
• 5:23
  anxiety
• 5:24
  about
• 5:24
  acquiring
• 5:25
  an
• 5:25
  illness.
• 5:25
  You're
• 5:25
  not
• 5:26
  talking
• 5:26
  about
• 5:26
  a
• 5:26
  symptom.
• 5:27
  You're
• 5:27
  not
• 5:27
  focused
• 5:27
  on
• 5:27
  a
• 5:28
  symptom.
• 5:28
  So,
• 5:28
  my
• 5:29
  friends,
• 5:29
  without
• 5:29
  beating
• 5:30
  the
• 5:30
  dead
• 5:30
  horse
• 5:30
  any
• 5:31
  more
• 5:31
  than
• 5:31
  I
• 5:31
  beat
• 5:31
  it
• 5:32
  to
• 5:32
  death,
• 5:32
  maybe
• 5:33
  I'm
• 5:33
  already
• 5:33
  kicking
• 5:34
  its
• 5:34
  corpse.
• 5:35
  But
• 5:35
  the
• 5:35
  answer
• 5:36
  here
• 5:36
  is
• 5:36
  C,
• 5:36
  Illness,
• 5:37
  anxiety
• 5:37
  disorder.
• 5:38
  All
• 5:38
  right,
• 5:39
  so
• 5:40
  Moving
• 5:40
  on.
• 5:41
  Question
• 5:41
  2.
• 5:41
  Lamotrigine.
• 5:43
  A
• 5:43
  29
• 5:44
  year
• 5:44
  old
• 5:44
  female
• 5:44
  with
• 5:45
  bipolar
• 5:45
  2
• 5:45
  has
• 5:46
  been
• 5:46
  stable
• 5:46
  on
• 5:46
  lamotrigine
• 5:47
  200mg
• 5:48
  daily
• 5:48
  for
• 5:48
  several
• 5:49
  months.
• 5:49
  At
• 5:50
  today's
• 5:50
  visit,
• 5:50
  she
• 5:50
  reports
• 5:51
  that
• 5:51
  her
• 5:51
  depressive
• 5:52
  symptoms
• 5:52
  have
• 5:52
  gradually
• 5:53
  returned
• 5:53
  over
• 5:53
  the
• 5:53
  past
• 5:54
  few
• 5:54
  weeks.
• 5:55
  She
• 5:55
  recently
• 5:55
  began
• 5:56
  taking
• 5:56
  a
• 5:56
  combined
• 5:57
  oral
• 5:57
  contraceptive
• 5:58
  pill.
• 5:58
  Lab
• 5:58
  idols
• 5:59
  are
• 5:59
  unremarkable.
• 6:00
  What
• 6:00
  is
• 6:00
  the
• 6:01
  most
• 6:01
  likely
• 6:01
  cause
• 6:01
  of
• 6:02
  her
• 6:02
  mood
• 6:02
  worsening?
• 6:03
  Is
• 6:03
  it,
• 6:03
  A,
• 6:03
  the
• 6:03
  oral
• 6:04
  contraceptive
• 6:05
  increased
• 6:05
  lamictal
• 6:06
  levels
• 6:07
  causing
• 6:07
  toxicity?
• 7:02
  B,
• 7:03
  estrogen
• 7:03
  induced
• 7:04
  metabolism
• 7:04
  of
• 7:04
  lamotrigine,
• 7:06
  lowering
• 7:06
  its
• 6:12
  effectiveness?
• 7:08
  C,
• 7:08
  the
• 7:08
  combination
• 7:08
  of
• 7:09
  lamotrigine
• 7:09
  and
• 7:10
  estrogen
• 7:10
  has
• 7:11
  no
• 7:11
  known
• 7:11
  interaction.
• 7:12
  Or
• 7:12
  is
• 7:12
  it
• 7:13
  lamotrigine
• 7:14
  decreased
• 7:14
  estrogen
• 7:15
  levels,
• 7:15
  reducing
• 7:15
  mood
• 7:16
  stabilizing
• 7:16
  effects?
• 7:17
  Aha.
• 7:18
  Well,
• 7:18
  this
• 7:18
  is
• 7:18
  a
• 7:18
  very
• 7:19
  interesting
• 7:19
  question,
• 7:20
  and
• 7:20
  this
• 7:21
  is
• 7:21
  one
• 7:21
  of
• 7:21
  those
• 7:21
  questions
• 7:22
  that
• 7:22
  really
• 7:22
  requires
• 7:23
  you
• 7:23
  to
• 7:24
  know
• 7:24
  your
• 7:24
  stuff,
• 7:25
  right?
• 7:25
  You
• 7:26
  don't
• 7:26
  have
• 7:26
  to
• 7:26
  know
• 7:27
  the
• 7:27
  history
• 7:27
  of
• 7:28
  oral
• 7:28
  contraceptives
• 7:29
  in
• 7:29
  detail
• 7:29
  and
• 7:30
  all
• 7:30
  of
• 7:30
  the
• 7:30
  different
• 7:30
  kinds
• 7:31
  of
• 7:31
  oral
• 7:31
  contraceptives
• 7:32
  necessarily,
• 7:33
  but
• 7:33
  it's
• 7:34
  asking
• 7:34
  if
• 7:35
  you
• 7:35
  have
• 7:35
  some
• 7:35
  familiarity
• 7:36
  between
• 7:36
  this
• 7:36
  common
• 7:37
  interaction
• 7:38
  with
• 7:38
  lamotrigine
• 7:39
  and
• 7:39
  oral
• 7:40
  contraceptives.
• 7:41
  And
• 7:42
  so
• 7:43
  we
• 7:43
  look
• 7:43
  at
• 7:43
  these
• 7:44
  potential
• 7:44
  answers.
• 7:45
  The
• 7:45
  oral
• 7:45
  contraceptive
• 7:46
  increased
• 7:47
  lamictal
• 7:47
  levels
• 7:48
  causing
• 7:48
  toxicity.
• 7:49
  Oral
• 7:50
  contraceptives
• 7:51
  don't
• 7:51
  increase
• 7:52
  lamictal
• 7:53
  levels
• 7:54
  actually,
• 7:54
  so
• 7:55
  that's
• 7:55
  not
• 7:55
  likely.
• 7:56
  And
• 7:56
  even
• 7:56
  if
• 7:56
  you
• 7:57
  didn't
• 7:57
  know
• 7:57
  that,
• 7:57
  could
• 7:57
  it
• 7:58
  cause
• 7:58
  toxicity?
• 7:59
  Well,
• 7:59
  we're
• 8:00
  talking
• 8:00
  about
• 8:01
  the,
• 8:01
  the
• 8:01
  question
• 8:02
  saying
• 8:02
  that
• 8:02
  her
• 8:02
  depressive
• 8:03
  symptoms
• 8:03
  have
• 8:04
  returned.
• 8:04
  It's
• 8:05
  not
• 8:05
  really
• 8:05
  talking
• 8:05
  about
• 8:06
  toxicity,
• 8:06
  it's
• 8:07
  talking
• 8:07
  about
• 8:07
  her
• 8:07
  depression
• 8:08
  has
• 8:08
  returned.
• 8:09
  So
• 8:09
  you
• 8:09
  can
• 8:09
  eliminate
• 8:10
  that
• 8:10
  even
• 8:10
  if
• 8:10
  you
• 8:10
  don't
• 8:11
  know
• 8:11
  what.
• 8:12
  Whether
• 8:12
  oral
• 8:12
  contraceptives
• 8:13
  increase
• 8:13
  lamictal
• 8:14
  levels.
• 8:14
  The
• 8:14
  core
• 8:15
  of
• 8:15
  the
• 8:15
  question
• 8:15
  is
• 8:15
  a
• 8:16
  patient
• 8:16
  whose
• 8:16
  depressive
• 8:17
  symptoms
• 8:17
  have
• 8:17
  returned.
• 8:18
  Estrogen
• 8:19
  induced
• 8:19
  metabolism
• 8:20
  of
• 8:21
  lamotrigine
• 8:21
  lowering
• 8:22
  its
• 8:22
  effectiveness.
• 8:23
  That's
• 8:23
  possible.
• 8:23
  The
• 8:24
  combination
• 8:24
  of
• 8:24
  lamotrigine
• 8:25
  and
• 8:25
  estrogen
• 8:26
  has
• 8:26
  no
• 8:26
  known
• 8:26
  interaction.
• 8:27
  You
• 8:28
  all
• 8:28
  have
• 8:28
  been
• 8:28
  taking
• 8:28
  tests
• 8:28
  your
• 8:29
  whole
• 8:29
  life.
• 8:29
  It's
• 8:30
  pretty
• 8:30
  rare
• 8:31
  that
• 8:31
  an
• 8:31
  answer
• 8:32
  just
• 8:32
  kind
• 8:33
  of
• 8:33
  is
• 8:33
  a
• 8:33
  dead
• 8:33
  end
• 8:33
  where
• 8:34
  it's
• 8:34
  like,
• 8:34
  hey,
• 8:34
  the
• 8:34
  point
• 8:35
  of
• 8:35
  this
• 8:35
  question
• 8:35
  is
• 8:36
  that
• 8:36
  there
• 8:36
  is
• 8:36
  no
• 8:36
  point
• 8:37
  Right.
• 8:37
  It's
• 8:38
  kind
• 8:38
  of
• 8:38
  rare.
• 8:39
  It's
• 8:39
  sort
• 8:39
  of
• 8:39
  like
• 8:39
  asking
• 8:41
  what
• 8:41
  do
• 8:41
  you
• 8:41
  do
• 8:42
  at
• 8:42
  a
• 8:42
  purple
• 8:43
  light?
• 8:44
  Do
• 8:44
  you
• 8:44
  stop,
• 8:44
  do
• 8:45
  you
• 8:45
  go
• 8:45
  or
• 8:45
  do
• 8:45
  you
• 8:46
  proceed
• 8:46
  with
• 8:46
  caution?
• 8:46
  And
• 8:47
  the
• 8:47
  answer
• 8:47
  is
• 8:47
  there
• 8:48
  are
• 8:48
  no
• 8:48
  purple
• 8:48
  lights.
• 8:49
  Well,
• 8:49
  what's
• 8:49
  the
• 8:50
  point
• 8:50
  of
• 8:50
  that
• 8:50
  question?
• 8:50
  Why
• 8:51
  would
• 8:51
  anyone
• 8:51
  have
• 8:51
  a
• 8:51
  question
• 8:52
  like
• 8:52
  that
• 8:52
  on
• 8:52
  a
• 8:52
  test?
• 8:53
  So
• 8:53
  yeah,
• 8:54
  even
• 8:54
  if
• 8:54
  you
• 8:54
  don't
• 8:54
  know,
• 8:55
  even
• 8:55
  if
• 8:55
  you
• 8:55
  think
• 8:55
  that
• 8:56
  C
• 8:56
  is
• 8:56
  the
• 8:56
  right
• 8:57
  answer,
• 8:57
  the
• 8:57
  combination
• 8:57
  of
• 8:58
  lamictal
• 8:58
  and
• 8:58
  estrogen
• 8:59
  has
• 8:59
  no
• 8:59
  known
• 8:59
  interaction.
• 9:00
  Answer
• 9:00
  D.
• 9:01
  Lamotrigine
• 9:02
  decreased
• 9:02
  estrogen
• 9:02
  levels,
• 9:03
  reducing
• 9:04
  mood
• 9:04
  stabilizing
• 9:04
  effects.
• 9:05
  Could
• 9:05
  really
• 9:05
  throw
• 9:06
  you
• 9:06
  off.
• 9:06
  You
• 9:06
  could
• 9:06
  believe
• 9:07
  that
• 9:07
  maybe
• 9:07
  estrogen
• 9:08
  is
• 9:08
  protective
• 9:09
  and
• 9:09
  lamotrigine
• 9:10
  decreased
• 9:11
  it
• 9:11
  and
• 9:11
  now
• 9:12
  she's
• 9:12
  has
• 9:12
  a
• 9:12
  return
• 9:12
  of
• 9:13
  depression.
• 9:13
  So
• 9:13
  that
• 9:14
  could
• 9:14
  really
• 9:15
  make
• 9:15
  you
• 9:15
  wonder
• 9:16
  what
• 9:16
  the
• 9:16
  right
• 9:16
  answer
• 9:17
  is.
• 9:18
  But
• 9:18
  the
• 9:18
  answer
• 9:18
  is
• 9:18
  B
• 9:19
  estrogen
• 9:19
  induced
• 9:20
  metabolism
• 9:20
  of
• 9:20
  lamotrigine
• 9:21
  lowering
• 9:21
  its
• 9:22
  effectiveness.
• 9:22
  You
• 9:22
  gotta
• 9:23
  watch
• 9:23
  this.
• 9:23
  Because
• 9:24
  estrogen
• 9:24
  containing
• 9:25
  contraceptives
• 9:25
  induce
• 9:26
  UGT1A4.
• 9:27
  It's
• 9:28
  an
• 9:28
  enzyme
• 9:28
  involved
• 9:29
  in
• 9:29
  glucocoor
• 9:30
  which
• 9:30
  is
• 9:30
  how
• 9:30
  the
• 9:30
  liver
• 9:31
  metabolizes
• 9:32
  and
• 9:32
  clears
• 9:32
  certain
• 9:32
  drugs
• 9:33
  including
• 9:33
  lamotrigine.
• 9:35
  So
• 9:35
  when
• 9:35
  that
• 9:36
  activity
• 9:36
  increases,
• 9:37
  lamotrigine
• 9:37
  is
• 9:38
  actually
• 9:38
  broken
• 9:38
  down
• 9:38
  faster
• 9:39
  leading
• 9:39
  to
• 9:39
  lower
• 9:40
  blood
• 9:40
  levels
• 9:40
  and
• 9:40
  reduced
• 9:41
  mood
• 9:41
  stabilizing
• 9:42
  effects,
• 9:43
  particularly
• 9:43
  for
• 9:43
  bipolar
• 9:44
  depression.
• 9:45
  Watch
• 9:45
  out
• 9:45
  for
• 9:45
  that
• 9:46
  interaction.
• 9:46
  The
• 9:47
  last
• 9:47
  question
• 9:47
  is
• 9:48
  about
• 9:49
  a
• 9:49
  44
• 9:50
  year
• 9:50
  old
• 9:50
  male
• 9:50
  with
• 9:51
  treatment
• 9:51
  resistant
• 9:51
  MDD.
• 9:52
  Major
• 9:53
  depressive
• 9:53
  disorder
• 9:53
  is
• 9:54
  switched,
• 9:54
  is
• 9:55
  being
• 9:55
  switched
• 9:55
  From
• 9:56
  Per
• 9:56
  Paxil
• 9:57
  40
• 9:57
  milligrams,
• 9:57
  he's
• 9:58
  been
• 9:58
  taking
• 9:58
  it
• 9:58
  for
• 9:58
  12
• 9:59
  weeks
• 9:59
  to
• 9:59
  phenylzine.
• 10:00
  What
• 10:01
  is
• 10:01
  the
• 10:01
  minimum
• 10:01
  washout
• 10:02
  period
• 10:02
  required
• 10:03
  before
• 10:03
  initiating
• 10:04
  phenylzine
• 10:04
  to
• 10:04
  avoid
• 10:05
  a
• 10:05
  potentially
• 10:05
  life
• 10:05
  threatening
• 10:06
  drug
• 10:06
  interaction?
• 10:07
  Is
• 10:07
  it
• 10:07
  24
• 10:08
  hours,
• 10:08
  3
• 10:09
  days,
• 10:09
  5
• 10:09
  days
• 10:10
  or
• 10:10
  14
• 10:10
  days?
• 10:11
  Now
• 10:11
  the
• 10:12
  answer
• 10:12
  here
• 10:12
  is
• 10:12
  14
• 10:12
  days.
• 10:13
  And
• 10:14
  this
• 10:14
  is
• 10:14
  one
• 10:14
  of
• 10:15
  those
• 10:15
  questions
• 10:15
  my
• 10:16
  friends,
• 10:16
  that
• 10:17
  can
• 10:18
  kind
• 10:18
  of
• 10:18
  trip
• 10:18
  people
• 10:18
  up
• 10:19
  because
• 10:19
  you
• 10:19
  look
• 10:19
  at
• 10:19
  phenylzine
• 10:20
  and
• 10:20
  you
• 10:20
  scratch
• 10:20
  your
• 10:21
  head
• 10:21
  for
• 10:21
  a
• 10:21
  minute,
• 10:21
  right?
• 10:21
  It's
• 10:22
  not
• 10:22
  a
• 10:22
  medication
• 10:22
  that's
• 10:23
  prescribed
• 10:23
  very
• 10:23
  commonly
• 10:24
  anymore.
• 10:25
  It's
• 10:25
  an
• 10:25
  MAOI
• 10:26
  inhibitor.
• 10:27
  It's
• 10:27
  kind
• 10:27
  of
• 10:27
  old
• 10:27
  school.
• 10:28
  And
• 10:28
  so,
• 10:29
  so
• 10:29
  I
• 10:29
  know
• 10:29
  this
• 10:29
  always
• 10:29
  would
• 10:30
  trip
• 10:30
  me
• 10:30
  up
• 10:30
  these
• 10:30
  types
• 10:31
  of
• 10:31
  questions
• 10:31
  because
• 10:31
  I
• 10:31
  always
• 10:32
  got
• 10:32
  confused
• 10:32
  about
• 10:33
  maois
• 10:34
  and
• 10:34
  first
• 10:34
  generation
• 10:35
  antipsychotics
• 10:36
  because
• 10:36
  sometimes
• 10:36
  the
• 10:36
  names
• 10:37
  sound
• 10:38
  similar
• 10:38
  and
• 10:38
  you're
• 10:38
  like
• 10:38
  wait,
• 10:39
  what
• 10:39
  am
• 10:39
  I
• 10:39
  looking
• 10:39
  at
• 10:39
  here?
• 10:40
  So
• 10:40
  it's
• 10:40
  advantageous
• 10:41
  if
• 10:41
  you
• 10:41
  get
• 10:42
  very
• 10:42
  familiar
• 10:43
  with
• 10:43
  the
• 10:44
  first
• 10:44
  generation
• 10:44
  antipsychotics,
• 10:45
  the
• 10:45
  TCAs
• 10:46
  and
• 10:46
  the
• 10:46
  Maois.
• 10:47
  You
• 10:47
  should
• 10:47
  have
• 10:47
  a
• 10:47
  good
• 10:47
  familiarity
• 10:48
  about
• 10:49
  who's
• 10:49
  who
• 10:49
  in
• 10:49
  the
• 10:49
  zoo
• 10:50
  in
• 10:50
  all
• 10:50
  three
• 10:51
  drug
• 10:51
  categories
• 10:51
  because
• 10:52
  in
• 10:52
  the
• 10:52
  event
• 10:52
  you,
• 10:53
  you're
• 10:53
  confronted
• 10:54
  with
• 10:54
  A
• 10:54
  board
• 10:54
  question
• 10:55
  about
• 10:55
  some
• 10:55
  med
• 10:56
  that
• 10:56
  doesn't
• 10:56
  sound
• 10:57
  like
• 10:57
  Prozac
• 10:57
  or
• 10:57
  Zoloft,
• 10:58
  you're
• 10:58
  going
• 10:58
  to
• 10:58
  want
• 10:59
  to
• 10:59
  really
• 10:59
  understand,
• 10:59
  like,
• 11:00
  what
• 11:00
  the
• 11:00
  hell
• 11:00
  am
• 11:00
  I
• 11:01
  looking
• 11:01
  at
• 11:01
  here?
• 11:01
  You
• 11:01
  got
• 11:02
  to
• 11:02
  at
• 11:02
  least
• 11:02
  know
• 11:02
  what
• 11:03
  kind
• 11:03
  of
• 11:03
  drug
• 11:03
  category
• 11:04
  we're
• 11:04
  looking
• 11:05
  at
• 11:05
  to
• 11:05
  answer
• 11:06
  the
• 11:06
  question.
• 11:06
  Just
• 11:07
  remember
• 11:07
  that
• 11:07
  we
• 11:08
  need
• 11:08
  a
• 11:08
  washout
• 11:09
  period
• 11:09
  if
• 11:09
  we're
• 11:09
  going
• 11:09
  to
• 11:09
  be
• 11:09
  discontinuing
• 11:10
  paxil
• 11:11
  for
• 11:11
  about
• 11:12
  14
• 11:12
  days
• 11:12
  before
• 11:13
  we
• 11:13
  start
• 11:13
  an
• 11:13
  MAOI
• 11:14
  to
• 11:14
  avoid
• 11:15
  serotonin
• 11:15
  syndrome.
• 11:16
  That's
• 11:16
  the
• 11:16
  core
• 11:16
  issue
• 11:17
  of
• 11:17
  this
• 11:17
  question.
• 11:17
  To
• 11:18
  make
• 11:18
  sure
• 11:18
  you're
• 11:18
  safe,
• 11:19
  to
• 11:19
  make
• 11:19
  sure
• 11:19
  you
• 11:19
  understand
• 11:20
  the
• 11:20
  importance
• 11:20
  of
• 11:21
  washout,
• 11:21
  you've
• 11:22
  got
• 11:22
  to
• 11:22
  monitor
• 11:22
  these
• 11:23
  half
• 11:23
  lives.
• 11:23
  You've
• 11:24
  got
• 11:24
  to
• 11:24
  make
• 11:24
  sure
• 11:24
  that
• 11:25
  these
• 11:25
  half
• 11:26
  lives
• 11:26
  have
• 11:26
  run
• 11:26
  their
• 11:27
  course
• 11:27
  and
• 11:28
  we've
• 11:28
  washed
• 11:28
  out
• 11:28
  medications.
• 11:29
  Now
• 11:30
  remember,
• 11:30
  Prozac
• 11:31
  is
• 11:31
  an
• 11:31
  exception.
• 11:31
  It
• 11:32
  requires
• 11:32
  five
• 11:32
  weeks
• 11:33
  or
• 11:33
  more
• 11:34
  because
• 11:34
  it
• 11:34
  has
• 11:34
  a
• 11:34
  much
• 11:34
  longer
• 11:35
  half
• 11:35
  life.
• 11:36
  We
• 11:36
  really
• 11:36
  want
• 11:36
  to
• 11:36
  avoid
• 11:37
  serotonin
• 11:37
  syndrome,
• 11:38
  that
• 11:38
  hyperthermia,
• 11:38
  that
• 11:39
  delirium
• 11:39
  clonus
• 11:40
  that
• 11:40
  can
• 11:40
  be
• 11:40
  fatal.
• 11:41
  This
• 11:41
  is
• 11:41
  a
• 11:41
  high
• 11:41
  stakes
• 11:42
  question.
• 11:42
  They
• 11:42
  want
• 11:43
  you
• 11:43
  to
• 11:43
  be
• 11:44
  safe
• 11:45
  and
• 11:45
  competent
• 11:46
  when
• 11:46
  you
• 11:47
  practice.
• 11:47
  They
• 11:47
  tease
• 11:48
  out
• 11:48
  that
• 11:48
  competence
• 11:49
  with
• 11:49
  questions
• 11:50
  like
• 11:50
  this.
• 11:51
  And
• 11:51
  so
• 11:51
  the
• 11:51
  big
• 11:52
  takeaway
• 11:52
  from
• 11:52
  question
• 11:52
  three,
• 11:53
  of
• 11:53
  course,
• 11:53
  is
• 11:53
  let's
• 11:54
  avoid
• 11:54
  serotonin
• 11:54
  syndrome.
• 11:55
  The
• 11:55
  second
• 11:55
  big
• 11:56
  takeaway
• 11:56
  is
• 11:57
  be
• 11:57
  familiar
• 11:57
  with
• 11:58
  all
• 11:58
  of
• 11:58
  the
• 11:59
  tools
• 11:59
  in
• 12:00
  your
• 12:00
  arsenal.
• 12:01
  Make
• 12:01
  sure
• 12:01
  you
• 12:02
  understand
• 12:02
  who's
• 12:03
  who
• 12:03
  because
• 12:03
  you
• 12:04
  don't
• 12:04
  want
• 12:04
  questions
• 12:05
  to
• 12:05
  like,
• 12:05
  trip
• 12:06
  you
• 12:06
  up
• 12:06
  and
• 12:07
  you
• 12:07
  don't
• 12:07
  even
• 12:07
  know
• 12:07
  what
• 12:08
  meds
• 12:08
  they're
• 12:08
  talking
• 12:09
  about.
• 12:09
  I
• 12:09
  hope
• 12:09
  you
• 12:09
  enjoyed
• 12:10
  this
• 12:10
  segment
• 12:10
  of
• 12:10
  Bored
• 12:11
  Bombs.
• 12:11
  It's
• 12:11
  a
• 12:11
  little
• 12:12
  bonus
• 12:12
  episode
• 12:12
  to
• 12:13
  keep
• 12:13
  you
• 12:13
  on
• 12:13
  your
• 12:13
  toes.
• 12:14
  The
• 12:14
  these
• 12:14
  are
• 12:14
  three
• 12:14
  great
• 12:15
  pearls
• 12:15
  you
• 12:15
  can
• 12:15
  share
• 12:16
  with
• 12:16
  your
• 12:16
  cohort
• 12:16
  today.
• 12:17
  This
• 12:17
  podcast
• 12:17
  has
• 12:17
  gotten
• 12:18
  really
• 12:18
  big
• 12:19
  fast.
• 12:19
  We're
• 12:19
  so
• 12:20
  impressed
• 12:21
  and
• 12:21
  grateful
• 12:22
  with
• 12:22
  all
• 12:22
  the
• 12:22
  people
• 12:23
  who
• 12:23
  have
• 12:23
  reached
• 12:24
  out
• 12:24
  to
• 12:24
  us
• 12:24
  have
• 12:24
  become
• 12:24
  Patreon
• 12:25
  members.
• 12:26
  Patreon
• 12:26
  membership
• 12:27
  is
• 12:27
  so
• 12:27
  vital,
• 12:28
  I
• 12:28
  can't
• 12:28
  emphasize
• 12:28
  it
• 12:29
  enough.
• 12:29
  With
• 12:29
  Patreon,
• 12:30
  you
• 12:30
  get
• 12:30
  access
• 12:31
  to
• 12:31
  beautiful
• 12:32
  slide
• 12:32
  decks
• 12:33
  where
• 12:33
  you
• 12:33
  have
• 12:33
  tons
• 12:34
  of
• 12:34
  great
• 12:34
  clinical
• 12:35
  information
• 12:35
  at
• 12:36
  your
• 12:36
  fingertips,
• 12:37
  evidence
• 12:37
  based
• 12:38
  literature
• 12:39
  and
• 12:39
  tools
• 12:39
  for
• 12:39
  your
• 12:40
  practice.
• 12:40
  There's
• 12:40
  also
• 12:41
  private
• 12:41
  podcast
• 12:42
  feeds
• 12:42
  that
• 12:43
  you
• 12:43
  have
• 12:43
  access
• 12:43
  to
• 12:44
  with
• 12:44
  more
• 12:44
  of
• 12:44
  this
• 12:45
  good
• 12:45
  stuff
• 12:45
  to
• 12:45
  empower
• 12:46
  yourselves
• 12:47
  as
• 12:47
  students.
• 12:48
  If
• 12:48
  nothing
• 12:49
  else,
• 12:49
  please
• 12:49
  give
• 12:49
  us
• 12:49
  five
• 12:50
  stars
• 12:50
  on
• 12:50
  Apple.
• 12:50
  That
• 12:51
  really
• 12:51
  helps.
• 12:51
  And
• 12:52
  go
• 12:52
  to
• 12:52
  the
• 12:52
  Show
• 12:52
  Notes.
• 12:53
  That's
• 12:53
  where
• 12:53
  you
• 12:53
  can
• 12:53
  become
• 12:53
  a
• 12:54
  Patreon
• 12:54
  member.
• 12:54
  You
• 12:54
  can
• 12:55
  email
• 12:55
  me
• 12:55
  with
• 12:56
  episode
• 12:56
  recommendations.
• 12:57
  Another
• 12:57
  cool
• 12:58
  thing
• 12:58
  about
• 12:58
  becoming
• 12:59
  a
• 12:59
  Patreon
• 12:59
  member
• 13:00
  is
• 13:00
  you
• 13:00
  have
• 13:00
  direct
• 13:00
  access
• 13:01
  to
• 13:01
  me
• 13:01
  where
• 13:01
  you
• 13:01
  and
• 13:02
  I
• 13:02
  can
• 13:02
  chat
• 13:02
  about
• 13:03
  what
• 13:03
  you
• 13:03
  need
• 13:03
  help
• 13:04
  with.
• 13:04
  We
• 13:04
  can
• 13:04
  dedicate
• 13:04
  whole
• 13:05
  podcast
• 13:05
  episodes
• 13:06
  to
• 13:06
  what
• 13:06
  you
• 13:07
  need
• 13:07
  help
• 13:07
  with
• 13:07
  in
• 13:07
  school
• 13:08
  grateful
• 13:09
  for
• 13:09
  each
• 13:09
  and
• 13:09
  every
• 13:09
  one
• 13:09
  of
• 13:10
  you.
• 13:10
  Spread
• 13:10
  this
• 13:10
  to
• 13:10
  all
• 13:10
  your
• 13:11
  psych
• 13:11
  and
• 13:11
  P
• 13:11
  cohort
• 13:12
  friends,
• 13:12
  and
• 13:13
  let's
• 13:13
  have
• 13:13
  fun
• 13:13
  together.
• 13:14
  Take
• 13:14
  care.
• 13:14
  Thank
• 13:15
  you.
• 13:15
  Signing
• 13:15
  off.
• 13:15
  Bye.
• 13:15
  Bye.