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Pearl of the Week: The Bipolar Blind Spot · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:05
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:06
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:09
  Prep.
• 0:09
  This
• 0:09
  is
• 0:10
  npz,
• 0:11
  your
• 0:11
  preceptor
• 0:12
  in
• 0:12
  your
• 0:12
  pocket.
• 0:13
  We
• 0:13
  have
• 0:14
  our
• 0:14
  pearl
• 0:14
  of
• 0:15
  the
• 0:15
  week.
• 0:15
  But
• 0:15
  before
• 0:16
  we
• 0:16
  begin
• 0:16
  with
• 0:17
  Pearls
• 0:17
  of
• 0:17
  the
• 0:18
  Week,
• 0:18
  I
• 0:18
  urge
• 0:19
  all
• 0:19
  of
• 0:19
  you,
• 0:19
  my
• 0:20
  friends,
• 0:20
  to
• 0:20
  jump
• 0:21
  over
• 0:21
  to
• 0:21
  Patreon
• 0:22
  via
• 0:22
  our
• 0:23
  show
• 0:23
  notes
• 0:23
  and
• 0:23
  become
• 0:24
  Patreon
• 0:24
  members.
• 0:25
  You
• 0:25
  get
• 0:26
  awesome
• 0:26
  slide
• 0:27
  decks
• 0:27
  full
• 0:28
  of
• 0:28
  evidence
• 0:29
  based
• 0:29
  information,
• 0:30
  ways
• 0:30
  to
• 0:31
  think
• 0:31
  about
• 0:31
  and
• 0:32
  learn
• 0:32
  about
• 0:32
  these
• 0:33
  amazing
• 0:33
  concepts
• 0:34
  to
• 0:34
  help
• 0:34
  you
• 0:35
  become
• 0:35
  a
• 0:35
  better
• 0:35
  prescriber,
• 0:36
  a
• 0:36
  better
• 0:36
  clinician,
• 0:37
  to
• 0:37
  help
• 0:37
  you
• 0:37
  pass
• 0:37
  your
• 0:38
  boards
• 0:38
  and
• 0:38
  just
• 0:38
  do
• 0:39
  better
• 0:39
  with
• 0:39
  your
• 0:39
  patients.
• 0:40
  Definitely
• 0:41
  urge
• 0:41
  you
• 0:41
  all
• 0:41
  to
• 0:41
  become
• 0:41
  Patreon
• 0:42
  members.
• 0:43
  We're
• 0:43
  building
• 0:43
  a
• 0:43
  library
• 0:44
  of
• 0:44
  super
• 0:45
  beautiful,
• 0:46
  useful
• 0:46
  information.
• 0:47
  I
• 0:47
  nerded
• 0:48
  out
• 0:48
  on
• 0:48
  everything
• 0:48
  I
• 0:49
  could
• 0:49
  and
• 0:49
  I'm
• 0:49
  trying
• 0:50
  to
• 0:50
  build
• 0:50
  that
• 0:50
  for
• 0:51
  all
• 0:51
  of
• 0:51
  you
• 0:52
  so
• 0:52
  you
• 0:52
  can
• 0:52
  appreciate
• 0:53
  a
• 0:53
  library
• 0:53
  full
• 0:54
  of
• 0:54
  really
• 0:54
  useful
• 0:54
  information.
• 0:55
  Great
• 0:56
  mnemonic
• 0:56
  devices
• 0:57
  to
• 0:57
  remember
• 0:58
  your
• 0:58
  diagnosis
• 0:58
  season,
• 0:59
  all
• 0:59
  those
• 0:59
  great
• 1:00
  things.
• 1:00
  We're
• 1:00
  building
• 1:01
  a
• 1:01
  massive
• 1:02
  study
• 1:02
  hall
• 1:03
  together
• 1:03
  of
• 1:04
  great
• 1:04
  resources.
• 1:05
  Now,
• 1:05
  without
• 1:05
  further
• 1:05
  ado,
• 1:06
  our
• 1:06
  pearl
• 1:07
  of
• 1:07
  the
• 1:07
  week.
• 1:07
  This
• 1:08
  one
• 1:08
  is
• 1:08
  going
• 1:08
  to
• 1:08
  blow
• 1:08
  your
• 1:09
  mind.
• 1:09
  I
• 1:09
  know.
• 1:10
  It
• 1:10
  blew
• 1:10
  my
• 1:10
  mind
• 1:10
  when
• 1:11
  I
• 1:11
  first
• 1:11
  heard
• 1:11
  this.
• 1:12
  Now,
• 1:12
  if
• 1:12
  you
• 1:13
  all
• 1:13
  had
• 1:13
  to
• 1:13
  guess
• 1:14
  before
• 1:14
  I
• 1:14
  even
• 1:15
  give
• 1:15
  you
• 1:15
  the
• 1:15
  pearl,
• 1:15
  if
• 1:16
  you
• 1:16
  all
• 1:16
  had
• 1:16
  to
• 1:16
  guess,
• 1:17
  what
• 1:17
  is
• 1:17
  the
• 1:18
  average
• 1:18
  time
• 1:18
  it
• 1:19
  takes
• 1:19
  to
• 1:19
  correctly
• 1:19
  diagnose
• 1:20
  bipolar
• 1:21
  disorder?
• 1:22
  What's
• 1:22
  the
• 1:23
  average
• 1:23
  amount
• 1:23
  of
• 1:23
  time
• 1:23
  you
• 1:24
  think
• 1:24
  it
• 1:24
  takes
• 1:25
  to
• 1:25
  accurately
• 1:26
  diagnose
• 1:26
  bipolar
• 1:27
  disorder?
• 1:28
  You
• 1:28
  might
• 1:28
  think,
• 1:28
  well,
• 1:28
  that
• 1:28
  only
• 1:29
  takes
• 1:29
  90
• 1:29
  minutes.
• 1:30
  I
• 1:30
  can
• 1:30
  do
• 1:30
  an
• 1:30
  intake,
• 1:31
  I
• 1:31
  can
• 1:31
  give
• 1:32
  my
• 1:32
  patient
• 1:32
  some
• 1:33
  metrics,
• 1:34
  have
• 1:34
  them
• 1:34
  fill
• 1:35
  out
• 1:35
  some
• 1:35
  forms,
• 1:35
  look
• 1:36
  at
• 1:36
  their
• 1:36
  history,
• 1:36
  get
• 1:36
  some
• 1:37
  collateral.
• 1:38
  Okay,
• 1:39
  fine,
• 1:40
  Mr.
• 1:40
  Hotshot.
• 1:42
  90
• 1:42
  minute
• 1:42
  diagnosis.
• 1:44
  Some
• 1:44
  of
• 1:44
  you
• 1:44
  might
• 1:45
  say,
• 1:45
  well,
• 1:45
  that
• 1:45
  might
• 1:45
  take
• 1:46
  a
• 1:46
  little
• 1:46
  longer,
• 1:46
  I
• 1:46
  don't
• 1:46
  know,
• 1:47
  a
• 1:47
  few
• 1:47
  sessions.
• 1:47
  You've
• 1:48
  got
• 1:48
  to
• 1:48
  ask
• 1:48
  some
• 1:49
  questions,
• 1:49
  you've
• 1:49
  got
• 1:49
  to
• 1:49
  rule
• 1:50
  other
• 1:50
  things
• 1:50
  out.
• 1:50
  Maybe
• 1:51
  do
• 1:51
  psychometric
• 1:52
  testing,
• 1:53
  maybe
• 1:53
  rule
• 1:53
  out
• 1:54
  medical
• 1:54
  problems.
• 1:55
  Okay,
• 1:55
  maybe
• 1:55
  I'm
• 1:55
  thinking
• 1:56
  three
• 1:56
  months.
• 1:56
  Nine
• 1:57
  months.
• 1:57
  My
• 1:57
  friends,
• 1:58
  according
• 1:58
  to
• 1:59
  jama,
• 1:59
  the
• 1:59
  mean
• 2:00
  delay
• 2:01
  in
• 2:01
  correctly
• 2:01
  diagnosing
• 2:02
  bipolar
• 2:02
  disorder
• 2:03
  is.
• 2:04
  Drumroll.
• 2:05
  Nine
• 2:06
  years
• 2:06
  after
• 2:07
  a
• 2:07
  patient's
• 2:08
  first
• 2:08
  depressive
• 2:09
  episode.
• 2:10
  Now
• 2:10
  that,
• 2:11
  my
• 2:11
  friends,
• 2:12
  completely
• 2:12
  blew
• 2:13
  me
• 2:13
  away
• 2:13
  when
• 2:13
  I
• 2:14
  first
• 2:14
  read
• 2:14
  it.
• 2:15
  Couldn't
• 2:15
  believe
• 2:16
  my
• 2:16
  eyes.
• 2:17
  It's
• 2:19
  really
• 2:20
  amazing
• 2:20
  and
• 2:21
  sad
• 2:21
  in
• 2:22
  a
• 2:22
  horrible
• 2:22
  way,
• 2:23
  because
• 2:23
  nine
• 2:24
  years
• 2:24
  is
• 2:24
  a
• 2:24
  very
• 2:24
  long
• 2:25
  time
• 2:25
  for
• 2:26
  such
• 2:26
  a
• 2:26
  debilitating
• 2:28
  mental
• 2:28
  illness
• 2:28
  to
• 2:29
  go
• 2:30
  misdiagnosed
• 2:31
  or
• 2:31
  not
• 2:32
  looked
• 2:32
  at
• 2:32
  at
• 2:32
  all.
• 2:32
  Now,
• 2:33
  there's
• 2:33
  a
• 2:33
  reason
• 2:33
  for
• 2:34
  this,
• 2:34
  though,
• 2:34
  and
• 2:35
  I
• 2:35
  think
• 2:35
  that's
• 2:35
  why
• 2:35
  I
• 2:35
  think
• 2:36
  this
• 2:36
  pearl
• 2:36
  is
• 2:37
  so
• 2:37
  useful
• 2:37
  and
• 2:38
  it's
• 2:38
  so
• 2:38
  worth
• 2:38
  talking
• 2:39
  about
• 2:39
  and
• 2:39
  sharing
• 2:40
  this
• 2:40
  with
• 2:41
  your
• 2:41
  friends
• 2:41
  and
• 2:42
  your
• 2:42
  cohorts
• 2:42
  and
• 2:42
  everything.
• 2:43
  Because
• 2:44
  there's
• 2:44
  a
• 2:45
  reason
• 2:45
  behind
• 2:45
  this
• 2:45
  now,
• 2:46
  my
• 2:46
  friends,
• 2:48
  of
• 2:48
  the
• 2:49
  symptomatic
• 2:50
  times
• 2:50
  that
• 2:51
  somebody
• 2:52
  is,
• 2:52
  is
• 2:52
  bipolar.
• 2:53
  And
• 2:53
  remember,
• 2:53
  bipolar
• 2:54
  doesn't
• 2:54
  just
• 2:54
  mean
• 2:55
  mania
• 2:56
  or
• 2:56
  hypomania.
• 2:56
  It
• 2:57
  also
• 2:57
  means
• 2:57
  depression.
• 2:58
  And
• 2:58
  that's
• 2:58
  key
• 2:58
  to
• 2:58
  remember
• 2:59
  here
• 2:59
  of
• 3:00
  their
• 3:00
  symptomatic
• 3:01
  state.
• 3:01
  70%
• 3:02
  of
• 3:02
  that
• 3:02
  time
• 3:03
  is
• 3:03
  spent
• 3:03
  in
• 3:03
  a
• 3:04
  depressed
• 3:04
  mood
• 3:04
  state.
• 3:05
  So
• 3:05
  think
• 3:06
  about
• 3:06
  that
• 3:06
  for
• 3:06
  a
• 3:06
  second.
• 3:06
  Think
• 3:07
  about
• 3:07
  how
• 3:07
  complicated
• 3:08
  that
• 3:08
  is
• 3:09
  where
• 3:10
  70%
• 3:11
  of
• 3:11
  the
• 3:11
  time
• 3:11
  they're
• 3:12
  experiencing
• 3:12
  symptoms,
• 3:13
  they're
• 3:13
  depressed.
• 3:13
  Well,
• 3:14
  what
• 3:14
  do
• 3:14
  a
• 3:14
  lot
• 3:14
  of
• 3:15
  depressed
• 3:15
  people
• 3:15
  do?
• 3:15
  They
• 3:15
  sit
• 3:16
  at
• 3:16
  home.
• 3:16
  They
• 3:16
  don't
• 3:16
  always
• 3:17
  volunteer
• 3:17
  themselves
• 3:18
  to
• 3:18
  go
• 3:18
  to
• 3:18
  a
• 3:18
  clinic
• 3:19
  right
• 3:19
  away
• 3:20
  and
• 3:20
  get
• 3:20
  seen.
• 3:20
  Right?
• 3:21
  There's
• 3:21
  a
• 3:21
  huge,
• 3:22
  to
• 3:22
  say
• 3:22
  nothing
• 3:23
  of
• 3:23
  lack
• 3:23
  of
• 3:23
  access.
• 3:24
  There's
• 3:24
  also
• 3:24
  just
• 3:25
  lack
• 3:25
  of
• 3:25
  willpower
• 3:26
  because
• 3:26
  people
• 3:26
  are
• 3:26
  depressed.
• 3:27
  It's
• 3:27
  baked
• 3:27
  into
• 3:28
  the
• 3:28
  cake
• 3:28
  of
• 3:28
  the
• 3:28
  illness.
• 3:29
  It's
• 3:29
  very
• 3:29
  hard
• 3:29
  to
• 3:29
  even
• 3:29
  pick
• 3:30
  up
• 3:30
  and
• 3:30
  grab
• 3:31
  the
• 3:31
  remote
• 3:31
  control.
• 3:32
  I've
• 3:32
  had
• 3:32
  patients
• 3:33
  compare
• 3:33
  that
• 3:33
  to,
• 3:34
  like
• 3:34
  climbing
• 3:34
  Mount
• 3:35
  Everest,
• 3:35
  just
• 3:35
  grabbing
• 3:36
  a
• 3:36
  remote
• 3:36
  control.
• 3:37
  So
• 3:37
  not
• 3:37
  only
• 3:38
  is
• 3:38
  70%
• 3:39
  experienced
• 3:40
  in
• 3:40
  a
• 3:40
  depressed
• 3:40
  mood
• 3:41
  state,
• 3:41
  but
• 3:42
  patients
• 3:42
  stay
• 3:42
  home
• 3:42
  or
• 3:43
  they
• 3:43
  don't
• 3:43
  even
• 3:43
  have
• 3:43
  access.
• 3:44
  So
• 3:44
  that
• 3:44
  really
• 3:44
  complicates
• 3:45
  care.
• 3:46
  But
• 3:46
  let's
• 3:46
  say
• 3:46
  they
• 3:46
  do
• 3:47
  have
• 3:47
  access.
• 3:47
  Let's
• 3:48
  say
• 3:48
  they
• 3:48
  do
• 3:48
  leave
• 3:48
  their
• 3:49
  home
• 3:49
  and
• 3:49
  it's
• 3:49
  like,
• 3:50
  well,
• 3:50
  here
• 3:50
  I
• 3:50
  am,
• 3:51
  I'm
• 3:51
  depressed,
• 3:52
  right?
• 3:53
  When
• 3:53
  the
• 3:53
  primary
• 3:54
  care
• 3:54
  doc
• 3:54
  or
• 3:54
  the
• 3:55
  therapist
• 3:55
  or
• 3:55
  the
• 3:55
  psychiatrist
• 3:56
  interviews
• 3:57
  the
• 3:57
  patient,
• 3:58
  well,
• 3:58
  how
• 3:58
  do
• 3:58
  you
• 3:58
  feel?
• 3:59
  I
• 3:59
  have
• 3:59
  no
• 3:59
  motivation,
• 4:00
  I
• 4:00
  have
• 4:00
  no
• 4:00
  energy.
• 4:00
  I'm
• 4:01
  sad,
• 4:01
  I'm
• 4:01
  down,
• 4:01
  yada,
• 4:02
  yada.
• 4:03
  Okay,
• 4:04
  well,
• 4:05
  anchoring
• 4:05
  bias,
• 4:06
  right?
• 4:06
  We
• 4:06
  tend
• 4:07
  to
• 4:07
  anchor
• 4:07
  our
• 4:07
  opinions
• 4:08
  to
• 4:08
  the
• 4:08
  first
• 4:08
  things
• 4:08
  that
• 4:09
  we
• 4:09
  typically
• 4:09
  see.
• 4:10
  If
• 4:10
  you
• 4:10
  shake
• 4:10
  somebody's
• 4:11
  hand
• 4:11
  and
• 4:11
  they
• 4:12
  spit
• 4:12
  in
• 4:13
  your
• 4:13
  face,
• 4:14
  you
• 4:14
  might
• 4:14
  think
• 4:14
  that
• 4:15
  person
• 4:15
  is
• 4:15
  a
• 4:15
  terrible
• 4:16
  person,
• 4:17
  even
• 4:17
  though
• 4:17
  they
• 4:17
  might
• 4:17
  have
• 4:18
  accidentally
• 4:18
  spit
• 4:18
  in
• 4:19
  your
• 4:19
  face,
• 4:19
  they
• 4:20
  thought
• 4:20
  you
• 4:20
  were
• 4:20
  somebody
• 4:21
  else.
• 4:21
  But
• 4:21
  it's
• 4:21
  really
• 4:21
  hard
• 4:22
  to
• 4:22
  undo
• 4:22
  that
• 4:23
  first
• 4:23
  impression.
• 4:23
  You're
• 4:23
  going
• 4:23
  to
• 4:23
  be
• 4:24
  like,
• 4:24
  that's
• 4:24
  the
• 4:24
  guy
• 4:24
  who
• 4:24
  spatted
• 4:25
  my
• 4:25
  face.
• 4:25
  What
• 4:26
  the
• 4:26
  hell?
• 4:26
  I
• 4:26
  don't
• 4:27
  like
• 4:27
  that
• 4:27
  guy.
• 4:28
  Same
• 4:28
  thing
• 4:29
  goes
• 4:29
  in,
• 4:30
  in
• 4:31
  mental
• 4:31
  health.
• 4:31
  When
• 4:32
  we
• 4:32
  meet
• 4:32
  a
• 4:32
  patient
• 4:33
  and
• 4:33
  the
• 4:33
  first
• 4:34
  thing
• 4:34
  we
• 4:34
  see
• 4:34
  is
• 4:35
  depression,
• 4:35
  Depression,
• 4:36
  depression,
• 4:36
  depression.
• 4:36
  The
• 4:37
  patient's
• 4:37
  sullen,
• 4:37
  the
• 4:38
  patient's
• 4:38
  downcast.
• 4:39
  They're
• 4:39
  not
• 4:39
  looking
• 4:39
  at
• 4:39
  you
• 4:40
  in
• 4:40
  the
• 4:40
  eyes.
• 4:40
  They're
• 4:41
  a
• 4:41
  little
• 4:41
  disheveled.
• 4:42
  They're
• 4:42
  speaking
• 4:42
  and
• 4:42
  thinking
• 4:43
  slowly.
• 4:43
  Well,
• 4:44
  our
• 4:44
  anchoring
• 4:44
  bias,
• 4:45
  it's
• 4:45
  very
• 4:45
  hard
• 4:45
  to
• 4:45
  get
• 4:46
  out
• 4:46
  of
• 4:46
  our
• 4:46
  minds
• 4:47
  unless
• 4:47
  we
• 4:47
  directly
• 4:48
  challenge
• 4:48
  it.
• 4:48
  We're
• 4:49
  going
• 4:49
  to
• 4:49
  think
• 4:49
  to
• 4:49
  ourselves,
• 4:50
  well,
• 4:50
  this
• 4:50
  person
• 4:50
  is
• 4:51
  depressed.
• 4:52
  And
• 4:53
  as
• 4:54
  psychiatric
• 4:55
  clinicians,
• 4:55
  we
• 4:55
  have
• 4:55
  to
• 4:55
  challenge
• 4:56
  ourselves
• 4:56
  and
• 4:57
  know
• 4:57
  the
• 4:57
  data
• 4:58
  and
• 4:58
  read
• 4:58
  through
• 4:58
  the
• 4:59
  research
• 5:00
  and
• 5:00
  learn
• 5:00
  from
• 5:00
  our
• 5:01
  experience
• 5:01
  and
• 5:01
  say
• 5:02
  to
• 5:02
  ourselves,
• 5:02
  well,
• 5:03
  wait
• 5:03
  a
• 5:03
  Minute.
• 5:04
  This
• 5:04
  could
• 5:04
  very
• 5:05
  well
• 5:05
  be
• 5:05
  depression.
• 5:05
  This
• 5:06
  could
• 5:06
  also
• 5:06
  be
• 5:07
  someone
• 5:07
  on
• 5:07
  a
• 5:07
  bipolar
• 5:08
  spectrum.
• 5:08
  I
• 5:09
  have
• 5:10
  no
• 5:10
  reason
• 5:10
  to
• 5:10
  suspect
• 5:11
  otherwise.
• 5:11
  Actually,
• 5:13
  depression
• 5:13
  is
• 5:13
  very
• 5:13
  much
• 5:14
  part
• 5:14
  of
• 5:14
  the
• 5:14
  bipolar
• 5:15
  spectrum
• 5:15
  too.
• 5:16
  Right.
• 5:16
  It
• 5:17
  takes
• 5:17
  two
• 5:18
  of
• 5:18
  those
• 5:18
  to
• 5:18
  tango.
• 5:19
  Okay,
• 5:20
  except
• 5:20
  for
• 5:20
  mania.
• 5:20
  You
• 5:21
  can
• 5:21
  actually
• 5:21
  be
• 5:21
  manic
• 5:22
  and
• 5:22
  have
• 5:22
  a
• 5:23
  bipolar
• 5:23
  1
• 5:23
  diagnosis
• 5:24
  without
• 5:24
  ever
• 5:25
  experiencing
• 5:25
  depression.
• 5:26
  But
• 5:26
  for
• 5:26
  simplicity's
• 5:27
  sake,
• 5:28
  you
• 5:28
  can
• 5:28
  see
• 5:28
  how
• 5:28
  deceptive
• 5:29
  this
• 5:29
  can
• 5:29
  be.
• 5:29
  If
• 5:30
  all
• 5:30
  you're
• 5:30
  seeing
• 5:30
  is
• 5:30
  depression,
• 5:31
  70%
• 5:31
  of
• 5:32
  the
• 5:32
  time
• 5:32
  they're
• 5:32
  depressed,
• 5:32
  they're
• 5:33
  coming
• 5:33
  in
• 5:33
  and
• 5:34
  they
• 5:34
  are
• 5:35
  telling
• 5:35
  you
• 5:35
  even
• 5:35
  that
• 5:36
  they
• 5:36
  feel
• 5:36
  depressed.
• 5:37
  And
• 5:37
  maybe
• 5:38
  they're
• 5:38
  not
• 5:38
  telling
• 5:39
  you
• 5:40
  about
• 5:40
  that
• 5:40
  time
• 5:41
  four
• 5:41
  years
• 5:41
  ago
• 5:41
  that
• 5:42
  they
• 5:42
  were
• 5:42
  really
• 5:42
  energized
• 5:43
  and
• 5:44
  they
• 5:44
  weren't
• 5:44
  sleeping,
• 5:44
  or
• 5:45
  they
• 5:45
  felt
• 5:45
  really
• 5:45
  irritable,
• 5:46
  they
• 5:46
  were
• 5:46
  doing
• 5:46
  impulsive
• 5:47
  things
• 5:47
  and
• 5:47
  they
• 5:48
  don't
• 5:48
  volunteer
• 5:48
  that
• 5:49
  information.
• 5:49
  Maybe
• 5:50
  you
• 5:50
  didn't
• 5:50
  really
• 5:50
  ask
• 5:51
  about
• 5:51
  that
• 5:51
  information
• 5:52
  carefully
• 5:52
  enough.
• 5:53
  This
• 5:53
  is
• 5:53
  an
• 5:53
  ongoing
• 5:54
  process
• 5:54
  of
• 5:55
  asking
• 5:55
  the
• 5:55
  right
• 5:55
  questions,
• 5:56
  excavating
• 5:57
  the
• 5:57
  past
• 5:58
  to
• 5:58
  try
• 5:58
  and
• 5:58
  get
• 5:58
  the
• 5:58
  most
• 5:59
  high
• 5:59
  yield
• 5:59
  diagnostic
• 6:00
  information
• 6:01
  for
• 6:01
  a
• 6:01
  treatment
• 6:02
  plan
• 6:03
  that
• 6:03
  works
• 6:03
  for
• 6:03
  the
• 6:04
  patient.
• 6:04
  So
• 6:05
  again,
• 6:05
  you've
• 6:05
  got
• 6:05
  to
• 6:05
  really
• 6:05
  dig
• 6:06
  this
• 6:06
  out
• 6:06
  and
• 6:06
  it's
• 6:07
  not
• 6:07
  always
• 6:07
  easy.
• 6:07
  Oh,
• 6:08
  and
• 6:08
  on
• 6:08
  top
• 6:08
  of
• 6:09
  that,
• 6:09
  you're
• 6:09
  competing
• 6:10
  with
• 6:10
  a
• 6:10
  patient
• 6:11
  who
• 6:11
  doesn't
• 6:11
  process
• 6:12
  information
• 6:12
  as
• 6:13
  easily
• 6:13
  when
• 6:13
  they're
• 6:13
  depressed.
• 6:14
  So
• 6:14
  now
• 6:14
  you're
• 6:14
  asking
• 6:14
  them
• 6:15
  to
• 6:15
  dig
• 6:15
  out
• 6:16
  information
• 6:16
  about
• 6:17
  their
• 6:17
  past
• 6:17
  that
• 6:17
  might
• 6:18
  have
• 6:18
  to
• 6:18
  do
• 6:18
  with
• 6:18
  bipolarity.
• 6:19
  And
• 6:19
  they
• 6:20
  can't
• 6:20
  even
• 6:20
  think
• 6:20
  about
• 6:20
  what
• 6:21
  they
• 6:21
  eat
• 6:21
  for
• 6:21
  breakfast
• 6:22
  this
• 6:22
  morning
• 6:22
  half
• 6:22
  the
• 6:22
  time
• 6:23
  because
• 6:23
  they're
• 6:23
  just
• 6:23
  going
• 6:23
  through
• 6:24
  a
• 6:24
  hard
• 6:24
  time.
• 6:25
  So
• 6:25
  you
• 6:25
  can
• 6:25
  see
• 6:25
  how
• 6:25
  this
• 6:25
  is
• 6:26
  missed
• 6:26
  easily.
• 6:26
  Now,
• 6:27
  my
• 6:27
  friends,
• 6:27
  there's
• 6:28
  another
• 6:28
  reason
• 6:28
  why
• 6:29
  this
• 6:29
  is
• 6:29
  missed
• 6:30
  pretty
• 6:30
  easily.
• 7:26
  And
• 7:26
  it's
• 7:26
  for
• 7:26
  the
• 7:26
  simple
• 7:27
  fact
• 7:27
  that
• 6:33
  hypomania
• 7:28
  can
• 7:28
  feel
• 7:29
  really
• 7:29
  good
• 7:29
  to
• 7:29
  people.
• 7:30
  And
• 7:30
  I
• 7:30
  can't
• 7:30
  tell
• 7:31
  you
• 7:31
  how
• 7:31
  many
• 7:31
  times
• 7:32
  I
• 7:32
  have
• 7:32
  seen
• 7:33
  folks
• 7:33
  in
• 7:34
  practice
• 7:34
  who
• 7:35
  equate
• 7:36
  their
• 7:36
  hypomania
• 7:37
  with
• 7:37
  like,
• 7:38
  their
• 7:38
  normal
• 7:38
  selves.
• 7:39
  And
• 7:39
  you
• 7:40
  have
• 7:40
  to
• 7:40
  really
• 7:41
  dig
• 7:41
  and
• 7:41
  ask.
• 7:42
  And
• 7:43
  it
• 7:43
  can
• 7:43
  be
• 7:44
  very
• 7:45
  difficult
• 7:45
  actually,
• 7:46
  even
• 7:46
  in
• 7:46
  session,
• 7:47
  to
• 7:47
  distinguish
• 7:48
  between
• 7:49
  euthymia
• 7:50
  or
• 7:50
  just
• 7:50
  these
• 7:51
  kind
• 7:51
  of
• 7:52
  our
• 7:53
  everyday
• 7:53
  baseline
• 7:55
  non
• 7:55
  hypomanic,
• 7:56
  non
• 7:56
  depressed
• 7:57
  selves
• 7:57
  and
• 7:58
  hypomania,
• 7:58
  right?
• 7:59
  It
• 7:59
  can
• 7:59
  be
• 7:59
  very
• 7:59
  hard
• 8:00
  to
• 8:00
  distinguish
• 8:00
  just
• 8:01
  my
• 8:01
  depression
• 8:02
  is
• 8:02
  resolved
• 8:02
  versus
• 8:03
  I'm
• 8:03
  hypomanic.
• 8:04
  And
• 8:04
  so
• 8:04
  when
• 8:04
  patients
• 8:05
  are
• 8:05
  hypomanic,
• 8:06
  it's
• 8:06
  usually
• 8:07
  not
• 8:07
  the
• 8:07
  kind
• 8:07
  of
• 8:07
  mania
• 8:08
  that
• 8:08
  lands
• 8:08
  them
• 8:08
  in
• 8:08
  the
• 8:09
  hospital
• 8:09
  or
• 8:09
  the
• 8:09
  cemetery
• 8:10
  or
• 8:10
  in
• 8:11
  jail.
• 8:11
  It's
• 8:11
  the
• 8:11
  kind
• 8:12
  of
• 8:12
  like
• 8:13
  the
• 8:13
  foot's
• 8:13
  on
• 8:13
  the
• 8:13
  gas
• 8:14
  a
• 8:14
  little
• 8:14
  too
• 8:14
  much,
• 8:15
  but
• 8:15
  they
• 8:15
  feel
• 8:16
  good
• 8:16
  a
• 8:16
  lot
• 8:16
  of
• 8:16
  times.
• 8:17
  Right?
• 8:17
  They
• 8:17
  feel
• 8:17
  like
• 8:17
  they're
• 8:18
  making
• 8:18
  decisions
• 8:18
  and
• 8:19
  they're
• 8:19
  excited
• 8:19
  about
• 8:19
  those
• 8:20
  decisions,
• 8:20
  and
• 8:20
  they're
• 8:20
  confident
• 8:21
  and
• 8:21
  they're
• 8:21
  working
• 8:22
  into
• 8:22
  the
• 8:22
  wee
• 8:22
  hours
• 8:23
  of
• 8:23
  the
• 8:23
  night.
• 8:23
  And
• 8:24
  it's
• 8:24
  not
• 8:24
  immediately
• 8:25
  obvious
• 8:25
  to
• 8:25
  those
• 8:25
  folks
• 8:26
  that
• 8:26
  they're
• 8:26
  experiencing
• 8:27
  hypomania
• 8:28
  unless
• 8:29
  they
• 8:29
  fill
• 8:29
  out
• 8:29
  the
• 8:30
  metrics,
• 8:30
  unless
• 8:30
  they're
• 8:31
  a
• 8:31
  little
• 8:31
  more
• 8:31
  educated
• 8:32
  about
• 8:32
  what
• 8:33
  that
• 8:33
  is
• 8:33
  and
• 8:33
  what
• 8:34
  it
• 8:34
  looks
• 8:34
  like
• 8:34
  relative
• 8:35
  to
• 8:35
  what
• 8:35
  their
• 8:35
  normal
• 8:36
  baseline
• 8:36
  is.
• 8:37
  So
• 8:37
  when
• 8:37
  people
• 8:38
  feel
• 8:38
  hypomanic,
• 8:39
  they
• 8:39
  don't
• 8:39
  always
• 8:39
  volunteer
• 8:40
  you
• 8:40
  that
• 8:40
  information.
• 8:41
  They're
• 8:41
  not
• 8:42
  even
• 8:42
  able
• 8:42
  to
• 8:42
  reflect
• 8:43
  on
• 8:43
  it
• 8:43
  all
• 8:43
  the
• 8:43
  time,
• 8:43
  that
• 8:43
  it
• 8:44
  was
• 8:44
  dysfunctional.
• 8:44
  And
• 8:45
  they
• 8:45
  sure
• 8:45
  as
• 8:45
  heck
• 8:45
  don't
• 8:46
  always
• 8:46
  volunteer
• 8:47
  themselves
• 8:47
  to
• 8:48
  the
• 8:48
  nearest
• 8:48
  clinic
• 8:49
  and
• 8:49
  say,
• 8:49
  hey,
• 8:49
  there's
• 8:49
  something
• 8:50
  wrong
• 8:50
  with
• 8:50
  me.
• 8:50
  Before
• 8:51
  that
• 8:51
  nine
• 8:51
  year
• 8:51
  mark,
• 8:52
  I
• 8:52
  would
• 8:52
  challenge
• 8:52
  all
• 8:53
  of
• 8:53
  you
• 8:53
  to
• 8:53
  get
• 8:53
  this
• 8:53
  diagnosis
• 8:54
  right
• 8:54
  on
• 8:54
  the
• 8:55
  very
• 8:55
  first
• 8:55
  appointment
• 8:56
  you
• 8:56
  have
• 8:56
  the
• 8:56
  patient.
• 8:57
  But
• 8:57
  I
• 8:57
  recognize
• 8:58
  life
• 8:58
  is
• 8:58
  not
• 8:58
  always
• 8:59
  as
• 8:59
  simple.
• 8:59
  Right.
• 9:00
  Sometimes
• 9:00
  we
• 9:00
  have
• 9:00
  30
• 9:01
  or
• 9:01
  45
• 9:01
  minute
• 9:02
  intakes,
• 9:02
  we're
• 9:02
  crunched
• 9:03
  for
• 9:03
  time,
• 9:04
  our
• 9:04
  resources
• 9:05
  aren't
• 9:05
  great
• 9:05
  or
• 9:06
  the
• 9:06
  metrics
• 9:06
  aren't
• 9:06
  there,
• 9:07
  or
• 9:07
  whatever
• 9:07
  have
• 9:08
  you,
• 9:08
  life
• 9:08
  happens.
• 9:10
  But
• 9:10
  I
• 9:10
  would
• 9:10
  challenge
• 9:11
  you
• 9:11
  to
• 9:11
  shoot
• 9:11
  for
• 9:12
  the
• 9:12
  stars
• 9:12
  here
• 9:13
  and
• 9:13
  definitely
• 9:14
  beat
• 9:14
  the
• 9:14
  heck
• 9:15
  out
• 9:15
  of
• 9:15
  that
• 9:15
  nine
• 9:15
  year
• 9:16
  diagnosis,
• 9:17
  because
• 9:17
  that
• 9:17
  is
• 9:17
  unacceptable
• 9:18
  from
• 9:18
  all
• 9:19
  angles.
• 9:20
  Now,
• 9:20
  we
• 9:21
  talked
• 9:21
  a
• 9:21
  little
• 9:21
  bit
• 9:21
  about
• 9:22
  how
• 9:22
  hypomania
• 9:23
  might
• 9:23
  feel
• 9:23
  good.
• 9:24
  We
• 9:24
  talked
• 9:24
  about
• 9:24
  how
• 9:24
  most
• 9:24
  of
• 9:25
  this
• 9:25
  is
• 9:25
  experienced
• 9:26
  in
• 9:26
  depression,
• 9:26
  which
• 9:27
  can
• 9:27
  throw
• 9:27
  off
• 9:27
  a
• 9:27
  lot
• 9:27
  of
• 9:27
  clinicians.
• 9:28
  Now
• 9:28
  you
• 9:28
  give
• 9:28
  an
• 9:28
  antidepressant,
• 9:30
  the
• 9:30
  patient's
• 9:30
  kind
• 9:30
  of
• 9:30
  cycling
• 9:31
  in
• 9:31
  and
• 9:31
  out,
• 9:32
  maybe
• 9:32
  they're
• 9:32
  getting
• 9:33
  activated
• 9:33
  from
• 9:33
  the
• 9:33
  antidepressant.
• 9:34
  That
• 9:34
  feels
• 9:35
  really
• 9:35
  good.
• 9:35
  And
• 9:36
  they're
• 9:36
  like,
• 9:36
  well,
• 9:36
  you
• 9:37
  know,
• 9:37
  no,
• 9:37
  the
• 9:37
  antidepressants
• 9:38
  actually
• 9:38
  helpful.
• 9:38
  I
• 9:39
  feel
• 9:39
  pretty
• 9:39
  good.
• 9:40
  But
• 9:40
  lo
• 9:40
  and
• 9:40
  behold,
• 9:41
  they're
• 9:41
  good,
• 9:41
  but
• 9:41
  they're
• 9:42
  also
• 9:42
  irritable.
• 9:42
  But
• 9:43
  again,
• 9:43
  not
• 9:43
  every
• 9:43
  patient
• 9:44
  really
• 9:44
  knows
• 9:44
  that.
• 9:45
  How,
• 9:45
  how
• 9:45
  hard
• 9:46
  is
• 9:46
  it
• 9:46
  for
• 9:47
  any
• 9:47
  one
• 9:47
  of
• 9:47
  us
• 9:48
  to
• 9:48
  take
• 9:48
  an
• 9:48
  antidepressant
• 9:49
  and
• 9:49
  distinguish
• 9:50
  between,
• 9:50
  oh,
• 9:51
  this
• 9:51
  feels
• 9:52
  good,
• 9:52
  but
• 9:52
  I'm
• 9:53
  also
• 9:53
  agitated.
• 9:54
  Oh,
• 9:54
  I
• 9:54
  must
• 9:55
  have
• 9:55
  hypomania
• 9:56
  versus
• 9:57
  this
• 9:57
  feels
• 9:57
  good,
• 9:57
  I'm
• 9:58
  agitated.
• 9:58
  Oh,
• 9:58
  my
• 9:59
  cat
• 9:59
  just
• 9:59
  died.
• 10:00
  Right.
• 10:00
  The
• 10:00
  distinctions
• 10:01
  here
• 10:01
  are
• 10:01
  very
• 10:02
  difficult.
• 10:03
  Remember
• 10:03
  also,
• 10:04
  my
• 10:04
  friends,
• 10:05
  that
• 10:05
  hypomania
• 10:06
  can
• 10:07
  look
• 10:07
  like
• 10:07
  a
• 10:07
  lot
• 10:07
  of
• 10:07
  different
• 10:08
  things
• 10:08
  in
• 10:08
  session.
• 10:09
  Right.
• 10:10
  Impulsivity.
• 10:10
  Well,
• 10:11
  that
• 10:11
  can
• 10:11
  look
• 10:11
  like
• 10:11
  adhd.
• 10:12
  That
• 10:13
  can
• 10:13
  look
• 10:13
  like
• 10:13
  borderline
• 10:14
  personality
• 10:15
  disorder.
• 10:15
  Even
• 10:16
  caffeine
• 10:16
  intoxication
• 10:17
  or
• 10:17
  withdrawal
• 10:18
  can
• 10:18
  mimic
• 10:18
  a
• 10:19
  lot
• 10:19
  of
• 10:19
  the
• 10:19
  states
• 10:19
  that
• 10:19
  we
• 10:20
  see
• 10:20
  in
• 10:20
  depression
• 10:21
  or
• 10:21
  bipolarity.
• 10:23
  And
• 10:23
  so
• 10:23
  it
• 10:24
  makes
• 10:24
  things
• 10:24
  really
• 10:24
  complicated.
• 10:25
  Right.
• 10:25
  Talking
• 10:26
  fast.
• 10:26
  Well,
• 10:26
  people
• 10:27
  who
• 10:27
  are
• 10:27
  intoxicated
• 10:27
  with
• 10:28
  caffeine
• 10:28
  talk
• 10:28
  fast.
• 10:29
  People
• 10:29
  with
• 10:29
  ADHD
• 10:30
  tend
• 10:30
  to
• 10:30
  talk
• 10:31
  fast
• 10:31
  at
• 10:32
  times
• 10:32
  in
• 10:32
  certain
• 10:33
  presentations.
• 10:34
  So
• 10:35
  the
• 10:35
  diagnostic
• 10:36
  overlap
• 10:37
  between
• 10:37
  a
• 10:37
  lot
• 10:38
  of
• 10:38
  these
• 10:38
  symptoms
• 10:39
  can
• 10:39
  also
• 10:40
  make
• 10:40
  it
• 10:40
  hard
• 10:41
  for
• 10:41
  a
• 10:41
  clinician
• 10:42
  to
• 10:42
  understand.
• 10:44
  Not
• 10:44
  only
• 10:44
  is
• 10:44
  this
• 10:44
  not
• 10:45
  depression,
• 10:45
  there's
• 10:45
  hypomania.
• 10:46
  And
• 10:46
  these
• 10:46
  other
• 10:46
  symptoms
• 10:47
  are
• 10:47
  not
• 10:47
  part
• 10:48
  of
• 10:48
  of
• 10:48
  ADHD.
• 10:49
  They're
• 10:50
  part
• 10:50
  of
• 10:50
  a
• 10:51
  bipolar
• 10:52
  2
• 10:52
  construct.
• 10:53
  Very
• 10:54
  difficult.
• 10:55
  So
• 10:55
  the
• 10:55
  point
• 10:56
  of
• 10:56
  this
• 10:56
  is
• 10:56
  also
• 10:56
  not
• 10:57
  to
• 10:57
  beat
• 10:57
  up
• 10:57
  on
• 10:57
  the
• 10:57
  mental
• 10:58
  health
• 10:58
  field
• 10:58
  completely
• 10:59
  and
• 10:59
  say
• 10:59
  we're
• 11:00
  beyond
• 11:00
  repair
• 11:01
  for
• 11:01
  this
• 11:01
  nine
• 11:02
  year
• 11:02
  statistic.
• 11:03
  But
• 11:03
  it
• 11:03
  does
• 11:04
  open
• 11:04
  up
• 11:05
  some
• 11:05
  questions
• 11:06
  and
• 11:06
  opportunities
• 11:07
  for
• 11:07
  growth
• 11:08
  and
• 11:09
  highlights
• 11:10
  kind
• 11:10
  of
• 11:10
  the
• 11:10
  nature
• 11:11
  of
• 11:11
  our
• 11:11
  field,
• 11:11
  how
• 11:11
  this
• 11:12
  field
• 11:12
  is
• 11:12
  very
• 11:12
  complex.
• 11:13
  We
• 11:13
  have
• 11:13
  to
• 11:14
  be
• 11:14
  really
• 11:14
  lasered
• 11:14
  in.
• 11:15
  We
• 11:15
  have
• 11:15
  to
• 11:15
  make
• 11:16
  sure
• 11:16
  we
• 11:16
  ask
• 11:16
  the
• 11:17
  right
• 11:17
  questions.
• 11:17
  I
• 11:17
  think
• 11:17
  asking
• 11:18
  the
• 11:18
  right
• 11:18
  questions
• 11:19
  is
• 11:19
  one
• 11:19
  of
• 11:19
  the
• 11:20
  greatest
• 11:21
  skill
• 11:21
  sets
• 11:22
  we
• 11:22
  can
• 11:22
  develop
• 11:23
  as
• 11:23
  nurse
• 11:24
  practitioners
• 11:25
  because
• 11:25
  asking
• 11:26
  the
• 11:26
  right
• 11:26
  questions
• 11:26
  in
• 11:27
  the
• 11:27
  right
• 11:27
  sequence
• 11:28
  in
• 11:28
  the
• 11:28
  right
• 11:29
  way
• 11:29
  can
• 11:29
  help
• 11:30
  open
• 11:30
  up
• 11:30
  your
• 11:30
  patient
• 11:31
  to
• 11:31
  maximize
• 11:32
  the
• 11:32
  information
• 11:32
  coming
• 11:33
  to
• 11:33
  you
• 11:33
  so
• 11:33
  you
• 11:33
  can
• 11:33
  make
• 11:33
  a
• 11:34
  great
• 11:34
  diagnosis
• 11:35
  and
• 11:35
  subsequently
• 11:36
  generate
• 11:37
  a
• 11:37
  great
• 11:37
  treatment
• 11:38
  plan.
• 11:38
  I
• 11:38
  hope
• 11:39
  you
• 11:39
  enjoyed
• 11:39
  this.
• 11:39
  I
• 11:40
  highly
• 11:40
  encourage
• 11:40
  you
• 11:40
  to
• 11:41
  spread
• 11:41
  this
• 11:41
  like
• 11:41
  wildfire
• 11:42
  because
• 11:43
  it's
• 11:43
  a
• 11:43
  very
• 11:43
  important
• 11:44
  statistic.
• 11:44
  Maybe
• 11:44
  quiz
• 11:45
  your
• 11:45
  friends
• 11:46
  in
• 11:46
  between
• 11:46
  and
• 11:46
  say
• 11:47
  what
• 11:47
  do
• 11:47
  you
• 11:47
  think
• 11:47
  is
• 11:47
  the
• 11:48
  average
• 11:48
  delay
• 11:49
  in
• 11:49
  diagnosing
• 11:49
  bipolar
• 11:50
  disorder?
• 11:50
  And
• 11:51
  just
• 11:51
  see
• 11:51
  if
• 11:51
  they're
• 11:51
  even
• 11:51
  close.
• 11:52
  You
• 11:52
  know,
• 11:53
  kudos
• 11:53
  to
• 11:54
  the
• 11:54
  person
• 11:54
  who
• 11:54
  says
• 11:54
  nine
• 11:54
  years,
• 11:55
  but
• 11:56
  most
• 11:56
  people
• 11:56
  think
• 11:57
  it's
• 11:57
  five
• 11:57
  months
• 11:57
  or
• 11:58
  one
• 11:58
  year.
• 11:58
  It's
• 11:59
  interesting
• 11:59
  to
• 11:59
  hear
• 12:00
  people's
• 12:00
  answers.
• 12:00
  And
• 12:01
  then
• 12:01
  my
• 12:01
  friends
• 12:02
  would
• 12:02
  love
• 12:02
  if
• 12:02
  you
• 12:02
  became
• 12:03
  Patreon
• 12:03
  members.
• 12:04
  And
• 12:04
  remember,
• 12:04
  you
• 12:04
  can
• 12:04
  become
• 12:05
  free
• 12:05
  Patreon
• 12:06
  members
• 12:06
  too.
• 12:06
  I
• 12:07
  encourage
• 12:07
  that.
• 12:07
  The
• 12:08
  point
• 12:08
  is
• 12:08
  we
• 12:09
  really
• 12:09
  want
• 12:10
  to
• 12:10
  keep
• 12:10
  building
• 12:11
  this
• 12:11
  awesome
• 12:11
  study
• 12:12
  hall
• 12:12
  of
• 12:12
  resources
• 12:13
  so
• 12:13
  that
• 12:13
  you
• 12:13
  all
• 12:14
  have
• 12:14
  a
• 12:14
  one
• 12:14
  stop
• 12:14
  shop
• 12:15
  to
• 12:15
  study
• 12:15
  and
• 12:16
  and
• 12:16
  to
• 12:16
  nerd
• 12:16
  out
• 12:16
  on
• 12:17
  case
• 12:17
  cases,
• 12:17
  on
• 12:18
  mock
• 12:18
  cases.
• 12:19
  That's
• 12:19
  what
• 12:19
  we
• 12:19
  really
• 12:20
  want.
• 12:20
  And
• 12:20
  we're
• 12:21
  building
• 12:21
  a
• 12:21
  beautiful
• 12:21
  community.
• 12:22
  We're
• 12:22
  building
• 12:22
  mnemonic
• 12:23
  devices
• 12:24
  and
• 12:24
  spreadsheets
• 12:25
  and
• 12:26
  slide
• 12:26
  decks
• 12:27
  and
• 12:27
  beautiful
• 12:27
  one
• 12:28
  stop
• 12:28
  shop
• 12:28
  for
• 12:28
  you
• 12:29
  to
• 12:29
  really
• 12:29
  study
• 12:29
  and
• 12:29
  get
• 12:30
  all
• 12:30
  this
• 12:30
  under
• 12:30
  your
• 12:30
  belt
• 12:31
  and
• 12:31
  feel
• 12:31
  confident
• 12:32
  as
• 12:32
  you
• 12:32
  graduate
• 12:33
  Psych
• 12:33
  NP
• 12:33
  school.
• 12:34
  Good
• 12:34
  luck
• 12:34
  to
• 12:34
  all
• 12:34
  of
• 12:34
  you.
• 12:35
  I'm
• 12:35
  so
• 12:35
  jealous
• 12:36
  of
• 12:36
  all
• 12:36
  of
• 12:36
  you
• 12:36
  in
• 12:36
  school.
• 12:37
  It's
• 12:37
  such
• 12:37
  a
• 12:38
  fun
• 12:38
  time.
• 12:38
  I
• 12:38
  loved
• 12:39
  school.
• 12:39
  I
• 12:39
  really
• 12:40
  did
• 12:40
  love
• 12:40
  every
• 12:40
  minute
• 12:41
  of
• 12:41
  it.
• 12:42
  And
• 12:42
  you
• 12:42
  know,
• 12:42
  I
• 12:42
  didn't
• 12:42
  love
• 12:43
  school.
• 12:44
  Leading
• 12:44
  up
• 12:44
  to
• 12:45
  Psych
• 12:45
  NP
• 12:45
  school,
• 12:45
  I
• 12:46
  hated
• 12:46
  geometry.
• 12:47
  I
• 12:47
  had
• 12:47
  a
• 12:48
  music
• 12:48
  class
• 12:48
  once
• 12:49
  I
• 12:49
  had
• 12:49
  to
• 12:49
  sing
• 12:49
  in.
• 12:50
  I
• 12:50
  was
• 12:51
  petrified.
• 12:51
  I
• 12:51
  almost
• 12:52
  felt
• 12:52
  like
• 12:52
  fainting
• 12:52
  every
• 12:53
  time
• 12:53
  I
• 12:53
  was
• 12:53
  called
• 12:53
  on
• 12:54
  to
• 12:54
  sing.
• 12:54
  I
• 12:54
  mean,
• 12:55
  that's
• 12:55
  probably
• 12:55
  the
• 12:55
  scariest
• 12:56
  thing
• 12:56
  to
• 12:56
  do
• 12:56
  is
• 12:56
  sing
• 12:57
  in
• 12:57
  front
• 12:57
  of
• 12:58
  people
• 12:58
  who
• 12:58
  already
• 12:58
  don't
• 12:59
  like
• 12:59
  you.
• 12:59
  And
• 13:00
  anyway,
• 13:01
  when
• 13:01
  I
• 13:01
  finally
• 13:01
  got
• 13:01
  to
• 13:02
  study
• 13:02
  the
• 13:02
  thing
• 13:03
  I
• 13:03
  loved
• 13:03
  psychiatry
• 13:04
  in
• 13:04
  psych
• 13:05
  and
• 13:05
  Peace
• 13:05
  School.
• 13:05
  I
• 13:05
  was
• 13:06
  on
• 13:06
  the
• 13:06
  moon.
• 13:06
  I
• 13:07
  was
• 13:07
  so
• 13:07
  happy.
• 13:08
  And
• 13:08
  so
• 13:08
  I'm
• 13:09
  just
• 13:09
  jealous
• 13:09
  of
• 13:09
  all
• 13:09
  of
• 13:09
  you.
• 13:10
  You're
• 13:10
  going
• 13:10
  through
• 13:10
  a
• 13:10
  really
• 13:11
  exciting
• 13:11
  time,
• 13:12
  and
• 13:12
  you
• 13:12
  should
• 13:12
  absorb
• 13:13
  all
• 13:13
  the
• 13:13
  information
• 13:13
  you
• 13:13
  can,
• 13:14
  like
• 13:14
  a
• 13:14
  sponge.
• 13:15
  And
• 13:15
  that's
• 13:15
  really
• 13:15
  why
• 13:16
  we
• 13:16
  built
• 13:16
  our
• 13:16
  Patreon
• 13:17
  page,
• 13:17
  because
• 13:17
  you're
• 13:18
  going
• 13:18
  to
• 13:18
  get
• 13:18
  tons
• 13:18
  of
• 13:18
  little
• 13:19
  nuggets
• 13:19
  you'll
• 13:19
  never
• 13:19
  forget
• 13:20
  and
• 13:20
  fun
• 13:21
  ways
• 13:21
  to
• 13:21
  remember
• 13:22
  them.
• 13:22
  So
• 13:22
  hope
• 13:22
  you
• 13:23
  enjoy
• 13:23
  that.
• 13:23
  And,
• 13:23
  you
• 13:23
  know
• 13:24
  my
• 13:24
  goal
• 13:24
  here,
• 13:24
  too.
• 13:24
  I
• 13:24
  never
• 13:25
  give
• 13:25
  you
• 13:25
  guys
• 13:25
  pearls
• 13:26
  that
• 13:26
  are
• 13:26
  irrelevant.
• 13:26
  Right?
• 13:27
  I
• 13:27
  never,
• 13:27
  like,
• 13:27
  tell
• 13:28
  you
• 13:28
  the
• 13:28
  capital
• 13:28
  of
• 13:29
  South
• 13:29
  Dakota
• 13:29
  is
• 13:29
  Pierre.
• 13:30
  Like,
• 13:31
  who
• 13:31
  cares?
• 13:31
  Like,
• 13:31
  that's
• 13:32
  not.
• 13:32
  That's
• 13:32
  not
• 13:32
  relevant
• 13:33
  to
• 13:33
  you.
• 13:35
  The
• 13:35
  importance
• 13:36
  here
• 13:36
  is
• 13:36
  that
• 13:37
  every
• 13:37
  little
• 13:38
  pearl
• 13:38
  can
• 13:38
  empower
• 13:39
  you
• 13:39
  to
• 13:39
  be
• 13:39
  a
• 13:39
  better
• 13:40
  clinician
• 13:40
  and
• 13:41
  change
• 13:41
  somebody's
• 13:42
  life
• 13:42
  for
• 13:42
  the
• 13:43
  better.
• 13:43
  One
• 13:44
  little
• 13:44
  pearl
• 13:44
  can
• 13:45
  really
• 13:45
  change
• 13:45
  somebody's
• 13:46
  day
• 13:46
  or
• 13:46
  life
• 13:46
  or
• 13:47
  relationship,
• 13:48
  and
• 13:48
  that's
• 13:48
  the
• 13:48
  power
• 13:48
  of
• 13:49
  these
• 13:49
  pearls
• 13:49
  and
• 13:50
  of
• 13:50
  this
• 13:50
  podcast.
• 13:51
  And
• 13:51
  we
• 13:51
  want
• 13:51
  you
• 13:51
  to
• 13:52
  join
• 13:52
  us.
• 13:52
  Thank
• 13:52
  you
• 13:52
  all
• 13:53
  for
• 13:53
  being
• 13:53
  here,
• 13:53
  and
• 13:53
  we'll
• 13:53
  see
• 13:54
  you
• 13:54
  next
• 13:54
  time
• 13:54
  here
• 13:54
  on
• 13:54
  Pearls
• 13:55
  and
• 13:55
  Prep.