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PEARL OF THE WEEK: What is the only DSM diagnosis that requires a rating of symptoms? · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:05
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:09
  Today
• 0:10
  we
• 0:10
  have
• 0:10
  a
• 0:10
  Pearl
• 0:11
  of
• 0:11
  the
• 0:11
  Week
• 0:11
  pow.
• 0:13
  And
• 0:13
  it
• 0:13
  is
• 0:14
  going
• 0:14
  to
• 0:14
  be
• 0:15
  a
• 0:15
  good
• 0:15
  one
• 0:15
  for
• 0:15
  you.
• 0:16
  Here's
• 0:16
  your
• 0:16
  question.
• 0:17
  It's
• 0:17
  a
• 0:17
  multiple
• 0:17
  choice
• 0:18
  question.
• 0:18
  You
• 0:19
  can
• 0:19
  mull
• 0:19
  it
• 0:19
  over,
• 0:19
  press,
• 0:20
  pause,
• 0:20
  huddle
• 0:21
  with
• 0:21
  your
• 0:21
  team
• 0:22
  and
• 0:22
  debate
• 0:22
  it
• 0:23
  before
• 0:23
  you
• 0:24
  know
• 0:24
  the
• 0:24
  answer.
• 0:25
  So
• 0:25
  I
• 0:25
  encourage
• 0:25
  you
• 0:26
  to
• 0:26
  pause
• 0:26
  this
• 0:26
  if
• 0:26
  needed.
• 0:27
  You
• 0:27
  here
• 0:27
  we
• 0:27
  go.
• 0:28
  Which
• 0:28
  DSM
• 0:29
  5tr
• 0:29
  diagnosis
• 0:30
  actually
• 0:31
  requires
• 0:32
  a
• 0:32
  rating
• 0:32
  scale
• 0:33
  to
• 0:33
  confirm
• 0:34
  it?
• 0:34
  It
• 0:35
  is
• 0:35
  the
• 0:35
  only
• 0:35
  DSM
• 0:36
  5tr
• 0:37
  diagnosis
• 0:37
  that
• 0:38
  requires
• 0:38
  a
• 0:38
  rating
• 0:39
  scale
• 0:39
  to
• 0:40
  confirm
• 0:40
  it.
• 0:40
  Is
• 0:40
  it
• 0:41
  Autism
• 0:41
  Spectrum
• 0:42
  disorder,
• 0:43
  where
• 0:43
  structured
• 0:43
  tools
• 0:44
  like
• 0:44
  ADOS
• 0:45
  or
• 0:45
  ADIR
• 0:46
  would
• 0:47
  help
• 0:47
  confirm
• 0:47
  social
• 0:48
  and
• 0:48
  communication
• 0:49
  deficits?
• 0:49
  Is
• 0:50
  it
• 0:50
  B,
• 0:50
  adhd?
• 0:51
  Is
• 0:51
  it
• 0:52
  C,
• 0:53
  Major
• 0:53
  neurocognitive
• 0:54
  disorders?
• 0:55
  Or
• 0:56
  is
• 0:56
  it
• 0:56
  D
• 0:56
  premenstrual
• 0:57
  Dysphoric
• 0:58
  disorder?
• 0:59
  Take
• 1:00
  a
• 1:00
  little
• 1:00
  time
• 1:01
  to
• 1:02
  think
• 1:02
  about
• 1:02
  that
• 1:03
  for
• 1:03
  a
• 1:03
  second.
• 1:04
  Just
• 1:04
  right
• 1:04
  off
• 1:05
  the
• 1:05
  bat,
• 1:06
  these
• 1:06
  all
• 1:07
  seem
• 1:07
  like
• 1:07
  really
• 1:07
  good
• 1:08
  diagnoses
• 1:10
  to
• 1:10
  whip
• 1:10
  out
• 1:10
  a
• 1:11
  rating
• 1:11
  scale
• 1:11
  and
• 1:12
  be
• 1:13
  more
• 1:13
  precise.
• 1:14
  But
• 1:14
  the
• 1:15
  question
• 1:15
  wasn't
• 1:16
  which
• 1:16
  one
• 1:17
  of
• 1:17
  these
• 1:17
  diagnoses
• 1:19
  is
• 1:19
  best
• 1:20
  captured
• 1:20
  on
• 1:20
  a
• 1:20
  rating
• 1:21
  scale?
• 1:21
  That's
• 1:22
  not
• 1:22
  the
• 1:22
  question,
• 1:22
  right?
• 1:22
  The
• 1:23
  question
• 1:23
  is
• 1:24
  which
• 1:24
  DSM
• 1:25
  5
• 1:25
  TR
• 1:25
  diagnosis
• 1:26
  actually
• 1:26
  requires
• 1:28
  a
• 1:28
  rating
• 1:28
  scale
• 1:29
  to
• 1:29
  confirm
• 1:30
  said
• 1:31
  diagnosis?
• 1:31
  Without
• 1:32
  further
• 1:32
  ado,
• 1:33
  the
• 1:33
  answer
• 1:34
  is
• 1:35
  pmdd.
• 1:36
  Premenstrual
• 1:37
  Dysphoric
• 1:38
  Disorder.
• 1:38
  It
• 1:39
  actually
• 1:39
  requires
• 1:40
  a
• 1:41
  prospective
• 1:43
  rating
• 1:43
  scale
• 1:44
  daily
• 1:44
  prospective
• 1:45
  ratings
• 1:45
  for
• 1:45
  at
• 1:45
  least
• 1:46
  two
• 1:46
  symptomatic
• 1:47
  cycles
• 1:48
  of
• 1:49
  pmdd.
• 1:50
  Now,
• 1:51
  for
• 1:51
  those
• 1:51
  of
• 1:51
  you
• 1:51
  unfamiliar,
• 1:52
  PMDD
• 1:54
  is
• 1:54
  a
• 1:55
  cyclical
• 1:56
  disorder,
• 1:57
  essentially
• 1:57
  a
• 1:58
  cyclical
• 1:58
  mood
• 1:58
  disorder
• 1:59
  where
• 2:00
  there
• 2:00
  is
• 2:00
  only
• 2:01
  a
• 2:01
  given
• 2:01
  time
• 2:02
  of
• 2:02
  the
• 2:03
  month
• 2:03
  when
• 2:04
  females
• 2:05
  endorse
• 2:06
  wildly
• 2:07
  disruptive
• 2:08
  physical
• 2:09
  and
• 2:09
  emotional
• 2:10
  symptoms
• 2:11
  that
• 2:12
  resolve
• 2:13
  at
• 2:13
  the
• 2:13
  onset
• 2:14
  of
• 2:14
  their
• 2:15
  menstrual
• 2:15
  cycle.
• 2:17
  It
• 2:17
  has
• 2:17
  a
• 2:17
  very
• 2:18
  specific
• 2:19
  severity
• 2:19
  that
• 2:20
  is
• 2:20
  quite
• 2:20
  difficult
• 2:21
  to
• 2:21
  capture
• 2:22
  in
• 2:22
  practice
• 2:23
  just
• 2:24
  by
• 2:24
  the
• 2:24
  virtue
• 2:25
  of
• 2:25
  a
• 2:25
  clinical
• 2:25
  interview.
• 2:26
  And
• 2:26
  I
• 2:26
  think
• 2:26
  that's
• 2:26
  why
• 2:27
  the
• 2:27
  DSM
• 2:28
  5
• 2:28
  folks
• 2:29
  wanted
• 2:29
  this
• 2:29
  to
• 2:30
  be
• 2:30
  very
• 2:30
  precise
• 2:30
  and
• 2:31
  involve
• 2:31
  prospective
• 2:32
  rating
• 2:32
  scales.
• 2:33
  A
• 2:33
  prospective
• 2:34
  rating
• 2:34
  scale
• 2:34
  is
• 2:35
  the
• 2:35
  opposite
• 2:35
  of
• 2:35
  a
• 2:36
  retrospective
• 2:36
  one.
• 2:37
  In
• 2:37
  retrospect,
• 2:38
  it's
• 2:38
  a
• 2:38
  lot
• 2:38
  harder
• 2:39
  to
• 2:39
  recall
• 2:39
  your
• 2:39
  symptoms.
• 2:40
  If
• 2:40
  I
• 2:40
  ask
• 2:40
  you
• 2:41
  what
• 2:41
  did
• 2:41
  the
• 2:41
  flu
• 2:42
  look
• 2:42
  like
• 2:42
  for
• 2:42
  you
• 2:42
  last
• 2:43
  year
• 2:43
  or
• 2:43
  last
• 2:44
  month,
• 2:44
  you
• 2:44
  might
• 2:45
  say,
• 2:45
  oh,
• 2:45
  I
• 2:45
  felt
• 2:45
  terrible,
• 2:46
  I
• 2:47
  had
• 2:47
  a
• 2:47
  cough.
• 2:48
  But
• 2:48
  if
• 2:48
  I
• 2:48
  really
• 2:49
  asked
• 2:49
  you
• 2:49
  nitty
• 2:49
  gritty
• 2:50
  details
• 2:50
  of
• 2:50
  how
• 2:51
  weak
• 2:51
  you
• 2:51
  were
• 2:51
  on
• 2:52
  a
• 2:52
  scale
• 2:52
  of
• 2:52
  0
• 2:53
  to
• 2:53
  10,
• 2:53
  how
• 2:53
  many
• 2:54
  days
• 2:54
  did
• 2:54
  it
• 2:54
  last?
• 2:54
  When
• 2:55
  did
• 2:55
  it
• 2:55
  start?
• 2:55
  When
• 2:55
  was
• 2:56
  the
• 2:56
  first
• 2:56
  day
• 2:56
  you
• 2:56
  started
• 2:57
  feeling
• 2:57
  better,
• 2:58
  that
• 2:58
  would
• 2:58
  get
• 2:58
  a
• 2:58
  lot
• 2:59
  more
• 2:59
  hazy
• 2:59
  and
• 2:59
  difficult
• 3:00
  for
• 3:00
  you.
• 3:00
  A
• 3:00
  retrospective
• 3:01
  scale
• 3:02
  is
• 3:02
  not
• 3:02
  always
• 3:02
  as
• 3:03
  reliable.
• 3:04
  You
• 3:04
  got
• 3:04
  to
• 3:04
  remember
• 3:04
  a
• 3:05
  lot
• 3:05
  of
• 3:05
  your
• 3:05
  patients
• 3:05
  come
• 3:06
  in
• 3:06
  with
• 3:06
  difficulty,
• 3:07
  difficulty
• 3:07
  concentrating
• 3:08
  and
• 3:08
  mood
• 3:08
  swings
• 3:09
  and
• 3:09
  Irritability,
• 3:09
  and
• 3:10
  they're
• 3:10
  also
• 3:10
  just
• 3:10
  living
• 3:11
  their
• 3:11
  lives.
• 3:11
  It's
• 3:12
  not
• 3:12
  always
• 3:12
  easy
• 3:12
  for
• 3:13
  them
• 3:13
  to
• 3:13
  retrospectively
• 3:14
  declare
• 3:15
  all
• 3:15
  of
• 3:15
  their
• 3:16
  symptoms
• 3:16
  with
• 3:17
  perfect
• 3:17
  accuracy.
• 3:18
  So
• 3:18
  the
• 3:19
  prospective
• 3:19
  rating,
• 3:20
  you
• 3:20
  give
• 3:20
  them
• 3:21
  a
• 3:21
  rating
• 3:22
  scale
• 3:23
  that
• 3:23
  they
• 3:23
  fill
• 3:23
  out
• 3:24
  every
• 3:24
  day
• 3:25
  for
• 3:26
  31
• 3:26
  calendar
• 3:27
  days.
• 3:28
  I'm
• 3:28
  going
• 3:28
  to
• 3:28
  tuck
• 3:28
  it
• 3:29
  in
• 3:29
  the
• 3:29
  show
• 3:29
  notes
• 3:30
  for
• 3:30
  you
• 3:30
  to
• 3:30
  click.
• 3:30
  It's
• 3:31
  a
• 3:31
  free
• 3:31
  PDF,
• 3:31
  free
• 3:32
  access
• 3:32
  to
• 3:32
  all
• 3:32
  of
• 3:33
  you.
• 3:33
  It's
• 3:33
  the
• 3:34
  daily
• 3:34
  record
• 3:34
  of
• 3:35
  severity
• 3:36
  of
• 3:36
  problems,
• 3:37
  the
• 3:37
  DRSP
• 3:39
  gold
• 3:40
  standard
• 3:40
  approach
• 3:41
  for
• 3:41
  PMDD.
• 3:42
  It's
• 3:42
  a
• 3:42
  cool
• 3:43
  questionnaire
• 3:44
  where
• 3:45
  every
• 3:45
  day
• 3:46
  for
• 3:46
  31
• 3:46
  calendar
• 3:47
  days,
• 3:47
  it's
• 3:48
  spaced
• 3:48
  out
• 3:48
  for
• 3:48
  the
• 3:49
  patient.
• 3:49
  She
• 3:50
  can
• 3:50
  monitor
• 3:51
  her
• 3:51
  symptoms
• 3:52
  of
• 3:52
  sadness,
• 3:53
  anxiety,
• 3:53
  mood
• 3:54
  swings,
• 3:54
  irritability,
• 3:55
  loss
• 3:55
  of
• 3:55
  interest,
• 3:56
  concentration,
• 3:57
  lethargy,
• 3:58
  appetite
• 3:59
  fluctuation,
• 3:59
  sleep,
• 4:00
  breast
• 4:01
  tenderness,
• 4:01
  feeling
• 4:02
  overwhelmed
• 4:02
  or
• 4:03
  out
• 4:03
  of
• 4:03
  control.
• 4:04
  And
• 4:04
  then
• 4:04
  she
• 4:05
  can
• 4:05
  also
• 4:05
  indicate
• 4:06
  where
• 4:07
  she's
• 4:07
  impaired,
• 4:08
  if
• 4:08
  it's
• 4:08
  reduced
• 4:09
  her
• 4:09
  productivity
• 4:09
  or
• 4:10
  inefficiency,
• 4:11
  or
• 4:11
  it's
• 4:12
  made
• 4:12
  her
• 4:12
  feel
• 4:13
  less
• 4:14
  actively
• 4:14
  participating
• 4:15
  in
• 4:15
  her
• 4:15
  activities,
• 4:16
  or
• 4:16
  she's
• 4:16
  avoiding
• 4:17
  things.
• 4:17
  She
• 4:17
  has
• 4:17
  31
• 4:18
  days
• 4:18
  to
• 4:18
  rate
• 4:18
  these
• 4:19
  symptoms.
• 4:19
  One
• 4:20
  example
• 4:20
  is
• 4:20
  how
• 4:20
  angry
• 4:21
  or
• 4:21
  irritable
• 4:21
  she
• 4:22
  is.
• 4:22
  She
• 4:22
  can
• 4:22
  rate
• 4:22
  that
• 4:22
  on
• 4:23
  a
• 4:23
  scale
• 4:23
  of
• 4:23
  1,
• 4:24
  meaning
• 4:24
  not
• 4:25
  at
• 4:25
  all,
• 4:25
  to
• 4:26
  6,
• 4:26
  meaning
• 4:27
  extreme.
• 4:27
  In
• 4:28
  all
• 4:28
  of
• 4:28
  those
• 4:28
  categories,
• 4:29
  every
• 4:29
  day
• 4:30
  between
• 4:30
  one
• 4:30
  and
• 4:30
  six,
• 4:31
  you
• 4:31
  give
• 4:31
  a
• 4:31
  rating
• 4:32
  and
• 4:32
  then
• 4:32
  compile
• 4:33
  the
• 4:33
  score
• 4:33
  thereafter.
• 4:34
  In
• 4:35
  order
• 4:35
  to
• 4:35
  confirm
• 4:36
  a
• 4:36
  diagnosis
• 4:37
  of
• 4:37
  pmdd,
• 4:38
  you
• 4:38
  need
• 4:39
  this
• 4:39
  prospective
• 4:40
  charting
• 4:40
  for
• 4:41
  at
• 4:41
  least
• 4:42
  two
• 4:42
  full
• 4:42
  months
• 4:43
  of
• 4:43
  ratings.
• 4:44
  And
• 4:44
  where
• 4:44
  it
• 4:44
  gets
• 4:45
  interesting,
• 4:45
  my
• 4:45
  friends
• 4:46
  and
• 4:46
  you
• 4:46
  will
• 4:47
  see
• 4:47
  this
• 4:47
  in
• 4:47
  practice
• 4:48
  is
• 4:48
  it's
• 4:49
  never
• 4:49
  as
• 4:49
  simple
• 4:50
  as
• 4:50
  the
• 4:50
  textbook
• 4:51
  makes
• 4:51
  it
• 4:52
  out
• 4:52
  to
• 4:52
  look
• 4:53
  like,
• 4:53
  right?
• 4:53
  It's
• 4:54
  not
• 4:54
  like
• 4:54
  you're
• 4:54
  going
• 4:54
  to
• 4:54
  have
• 4:55
  someone
• 4:55
  walk
• 4:55
  into
• 4:55
  your
• 4:55
  office
• 4:56
  who's
• 4:56
  a
• 4:56
  perfect
• 4:56
  PMDD
• 4:58
  textbook
• 4:58
  case
• 4:59
  and
• 5:00
  everything's
• 5:00
  perfectly
• 5:01
  fine
• 5:01
  for
• 5:02
  most
• 5:02
  of
• 5:02
  the
• 5:02
  month.
• 5:03
  And
• 5:04
  then
• 5:04
  just
• 5:04
  two
• 5:04
  weeks
• 5:05
  before
• 5:05
  the
• 5:05
  onset
• 5:05
  of
• 5:06
  menses,
• 5:06
  it's
• 5:06
  really
• 5:07
  difficult.
• 5:07
  And
• 5:08
  then
• 5:08
  it
• 5:08
  resolves,
• 5:09
  right?
• 5:09
  No,
• 5:10
  it's
• 5:10
  not
• 5:10
  that
• 5:10
  simple.
• 5:11
  You
• 5:11
  might
• 5:11
  have
• 5:11
  some
• 5:11
  comorbid
• 5:12
  anxiety,
• 5:12
  you
• 5:13
  might
• 5:13
  have
• 5:13
  some
• 5:13
  developmental
• 5:14
  core
• 5:15
  traumas
• 5:15
  that
• 5:16
  make
• 5:16
  it
• 5:16
  even
• 5:16
  more
• 5:17
  difficult
• 5:17
  to
• 5:17
  understand.
• 5:18
  Well,
• 5:18
  do
• 5:18
  you
• 5:18
  have
• 5:19
  these
• 5:19
  symptoms
• 5:19
  all
• 5:19
  the
• 5:19
  time?
• 5:20
  Or.
• 5:20
  Or
• 5:20
  did
• 5:20
  you
• 5:20
  have
• 5:21
  these
• 5:21
  symptoms
• 5:22
  only
• 5:23
  14
• 5:23
  days,
• 5:24
  10
• 5:24
  days,
• 5:24
  or
• 5:25
  7
• 5:25
  to
• 5:25
  10
• 5:25
  days
• 5:25
  before
• 5:26
  the
• 5:26
  onset
• 5:27
  of
• 5:27
  your
• 5:27
  menstrual
• 5:28
  cycle?
• 5:28
  That's
• 5:29
  why
• 5:29
  this
• 5:30
  rating
• 5:30
  scale
• 5:30
  is
• 5:31
  so
• 5:31
  important
• 5:32
  and
• 5:32
  valuable.
• 5:32
  It's
• 5:33
  the
• 5:33
  drsp.
• 5:34
  You
• 5:34
  can
• 5:34
  Google
• 5:35
  D
• 5:35
  as
• 5:35
  in
• 5:35
  Dave,
• 5:36
  R
• 5:36
  as
• 5:36
  in
• 5:37
  Romeo,
• 5:38
  S
• 5:38
  as
• 5:38
  in
• 5:39
  Skittles,
• 5:39
  P
• 5:40
  as
• 5:40
  in
• 5:40
  problem
• 5:41
  child,
• 5:42
  D
• 5:42
  R,
• 5:42
  S
• 5:43
  P.
• 5:44
  And
• 5:44
  it's
• 5:44
  a
• 5:45
  cool
• 5:45
  scale.
• 5:45
  I
• 5:45
  would
• 5:46
  have
• 5:46
  it
• 5:46
  handy
• 5:46
  because
• 5:47
  PMDD
• 5:47
  will
• 5:48
  walk
• 5:48
  into
• 5:48
  your
• 5:48
  office
• 5:49
  at
• 5:49
  some
• 5:49
  point.
• 6:44
  The
• 6:46
  statistics
• 6:47
  show
• 6:47
  that
• 5:53
  PMDD
• 6:48
  can
• 6:48
  affect
• 6:49
  roughly
• 6:49
  3
• 6:50
  to
• 6:50
  8%
• 6:50
  of
• 6:51
  menstruating
• 6:51
  women.
• 6:52
  That's
• 6:52
  about
• 6:52
  1
• 6:53
  in
• 6:53
  12.
• 6:53
  So
• 6:53
  if
• 6:54
  you
• 6:54
  have
• 6:54
  a
• 6:54
  panel
• 6:54
  of
• 6:54
  35,
• 6:55
  40
• 6:55
  patients
• 6:56
  a
• 6:56
  week,
• 6:56
  think
• 6:57
  about
• 6:57
  that
• 6:57
  for
• 6:57
  a
• 6:57
  second,
• 6:58
  you're
• 6:58
  bound
• 6:58
  to
• 6:58
  see
• 6:58
  this
• 6:59
  every
• 6:59
  week,
• 6:59
  at
• 6:59
  least
• 6:59
  from
• 7:00
  a
• 7:00
  statistical
• 7:00
  standpoint.
• 7:01
  Technically
• 7:02
  speaking,
• 7:02
  you
• 7:03
  ought
• 7:03
  to
• 7:03
  be
• 7:03
  prepared
• 7:03
  for
• 7:04
  this,
• 7:04
  my
• 7:04
  friends.
• 7:04
  What
• 7:05
  are
• 7:05
  we
• 7:05
  looking
• 7:05
  for
• 7:05
  in
• 7:06
  this
• 7:06
  drsp?
• 7:07
  A
• 7:08
  textbook
• 7:08
  case
• 7:08
  of
• 7:09
  PMDD
• 7:10
  would
• 7:10
  mean
• 7:10
  very
• 7:11
  extreme
• 7:11
  scores,
• 7:13
  again,
• 7:13
  seven
• 7:14
  to
• 7:14
  14
• 7:15
  or
• 7:15
  seven
• 7:15
  to
• 7:15
  10
• 7:16
  days
• 7:16
  before
• 7:16
  the
• 7:17
  onset
• 7:17
  of
• 7:17
  menses.
• 7:18
  And
• 7:18
  you
• 7:18
  would
• 7:18
  see
• 7:18
  a
• 7:18
  dramatic
• 7:19
  drop
• 7:19
  or
• 7:20
  elimination
• 7:21
  of
• 7:21
  those
• 7:21
  extreme
• 7:22
  scores
• 7:22
  when
• 7:23
  the
• 7:23
  cycle
• 7:24
  commences,
• 7:25
  and
• 7:25
  that
• 7:25
  would
• 7:25
  be
• 7:26
  more
• 7:26
  definitional
• 7:27
  of
• 7:28
  pmdd.
• 7:29
  Now,
• 7:30
  what
• 7:30
  happens
• 7:31
  if
• 7:31
  the
• 7:31
  patient
• 7:32
  also
• 7:33
  has
• 7:34
  other
• 7:34
  issues
• 7:35
  going
• 7:35
  on
• 7:35
  throughout
• 7:36
  the
• 7:36
  rest
• 7:36
  of
• 7:36
  the
• 7:36
  month?
• 7:37
  That's
• 7:37
  why
• 7:38
  we
• 7:38
  have
• 7:38
  to
• 7:38
  really
• 7:38
  look
• 7:39
  at
• 7:39
  the
• 7:39
  pattern
• 7:39
  and.
• 7:40
  And
• 7:40
  the
• 7:40
  severity.
• 7:41
  So
• 7:42
  if
• 7:42
  there
• 7:42
  are
• 7:43
  symptoms
• 7:43
  throughout
• 7:43
  the
• 7:44
  month,
• 7:44
  but
• 7:44
  they're
• 7:44
  way
• 7:45
  worse
• 7:45
  in
• 7:45
  the
• 7:45
  luteal
• 7:46
  phase,
• 7:46
  that's
• 7:47
  the
• 7:47
  phase
• 7:48
  prior
• 7:48
  to
• 7:48
  the
• 7:48
  onset
• 7:49
  of
• 7:49
  the
• 7:49
  cycle.
• 7:49
  That
• 7:50
  patient
• 7:50
  likely
• 7:51
  has
• 7:51
  a
• 7:51
  premenstrual
• 7:52
  exacerbation
• 7:53
  of
• 7:53
  another
• 7:54
  mood
• 7:54
  disorder
• 7:55
  because
• 7:55
  she
• 7:56
  has
• 7:56
  symptoms
• 7:56
  throughout
• 7:57
  the
• 7:57
  month.
• 7:57
  But
• 7:58
  if
• 7:58
  there
• 7:58
  are
• 7:58
  symptoms
• 7:59
  only
• 7:59
  in
• 7:59
  the
• 7:59
  luteal
• 8:00
  phase
• 8:00
  and
• 8:00
  not
• 8:01
  any
• 8:01
  other
• 8:01
  time,
• 8:02
  this
• 8:02
  is
• 8:02
  either
• 8:03
  PMS
• 8:03
  or
• 8:04
  pmdd,
• 8:05
  and
• 8:05
  the
• 8:05
  severity
• 8:05
  of
• 8:06
  symptoms
• 8:06
  will
• 8:06
  determine
• 8:07
  which
• 8:07
  one.
• 8:08
  If
• 8:08
  you
• 8:08
  get
• 8:08
  31
• 8:09
  days
• 8:09
  of
• 8:09
  this
• 8:09
  all
• 8:10
  filled
• 8:10
  out
• 8:10
  and
• 8:11
  you're
• 8:11
  just
• 8:11
  seeing
• 8:11
  severe
• 8:12
  scores
• 8:12
  everywhere,
• 8:13
  that
• 8:13
  would
• 8:14
  drop
• 8:14
  the
• 8:14
  index
• 8:15
  of
• 8:15
  suspicion
• 8:15
  that
• 8:15
  you're
• 8:16
  looking
• 8:16
  at
• 8:16
  a
• 8:16
  PMDD
• 8:17
  in
• 8:18
  pure
• 8:18
  form,
• 8:18
  because
• 8:19
  obviously
• 8:20
  it's
• 8:20
  not
• 8:20
  as
• 8:21
  temporally
• 8:22
  associated
• 8:22
  with
• 8:22
  the
• 8:23
  luteal
• 8:23
  phase
• 8:24
  and
• 8:24
  the
• 8:24
  hormonal
• 8:25
  cycle.
• 8:25
  There's
• 8:26
  a
• 8:26
  lot
• 8:26
  more
• 8:27
  going
• 8:27
  on
• 8:28
  more
• 8:28
  pervasively
• 8:29
  that's
• 8:29
  independent
• 8:30
  of
• 8:30
  the
• 8:30
  cycle.
• 8:31
  So
• 8:31
  that
• 8:31
  would
• 8:31
  gravitate
• 8:32
  me
• 8:32
  more
• 8:32
  towards
• 8:33
  personality
• 8:33
  diagnosis.
• 8:34
  Depression,
• 8:35
  a
• 8:36
  bipolar.
• 8:36
  You
• 8:37
  know,
• 8:37
  go
• 8:37
  down
• 8:37
  that
• 8:37
  rabbit
• 8:38
  hole
• 8:38
  and
• 8:38
  do
• 8:38
  your
• 8:38
  assessments.
• 8:39
  But
• 8:40
  again,
• 8:40
  it's
• 8:40
  very
• 8:40
  important
• 8:41
  that
• 8:42
  the
• 8:42
  DRSP
• 8:43
  is
• 8:43
  provided
• 8:44
  to
• 8:45
  the
• 8:45
  patient,
• 8:45
  that
• 8:46
  it's
• 8:46
  explained
• 8:46
  why
• 8:47
  this
• 8:47
  is
• 8:47
  so
• 8:47
  important.
• 8:48
  And
• 8:48
  a
• 8:48
  lot
• 8:48
  of
• 8:48
  times
• 8:49
  patients
• 8:49
  will
• 8:49
  be
• 8:50
  relieved.
• 8:50
  It
• 8:50
  gives
• 8:51
  them
• 8:51
  a
• 8:51
  sense
• 8:51
  of
• 8:51
  control
• 8:52
  and
• 8:52
  a
• 8:52
  precision
• 8:53
  about
• 8:53
  their
• 8:53
  symptoms.
• 8:54
  It
• 8:54
  doesn't
• 8:54
  feel
• 8:54
  like
• 8:54
  they're
• 8:55
  being
• 8:55
  hijacked
• 8:55
  randomly
• 8:56
  without
• 8:57
  their
• 8:57
  willpower
• 8:58
  every
• 8:58
  month.
• 8:59
  I
• 8:59
  found
• 9:00
  that
• 9:00
  a
• 9:00
  lot
• 9:00
  of
• 9:00
  times
• 9:00
  patients
• 9:01
  will
• 9:01
  be
• 9:01
  relieved
• 9:02
  when
• 9:02
  we
• 9:02
  can
• 9:02
  pinpoint
• 9:03
  precisely
• 9:04
  when
• 9:04
  this
• 9:04
  happens,
• 9:04
  how
• 9:05
  severe
• 9:05
  it
• 9:05
  is,
• 9:05
  and
• 9:06
  then
• 9:06
  treat
• 9:06
  accordingly.
• 9:07
  That
• 9:07
  will
• 9:07
  be
• 9:07
  a
• 9:07
  different
• 9:07
  podcast
• 9:08
  episode,
• 9:08
  but
• 9:09
  we
• 9:09
  can
• 9:09
  typically
• 9:10
  treat
• 9:10
  with
• 9:10
  SSRIs.
• 9:11
  It's
• 9:12
  a
• 9:12
  really
• 9:12
  cool
• 9:13
  mechanism
• 9:13
  of
• 9:13
  action
• 9:14
  and
• 9:14
  influence
• 9:15
  as
• 9:15
  to
• 9:15
  how
• 9:15
  that
• 9:15
  works
• 9:16
  in
• 9:16
  pmdd.
• 9:16
  It's
• 9:17
  not
• 9:17
  exactly
• 9:17
  the
• 9:17
  same
• 9:17
  as
• 9:18
  we
• 9:18
  would
• 9:19
  treat
• 9:19
  with
• 9:19
  depression.
• 9:20
  There's
• 9:20
  some
• 9:21
  subtle
• 9:21
  differences
• 9:21
  and
• 9:22
  pretty
• 9:22
  interesting
• 9:23
  pharmacological
• 9:24
  factors
• 9:25
  that
• 9:25
  play
• 9:25
  into
• 9:26
  that,
• 9:26
  that'll
• 9:26
  be
• 9:26
  an
• 9:27
  exciting
• 9:27
  episode.
• 9:28
  But
• 9:28
  again,
• 9:29
  deliver
• 9:29
  this
• 9:30
  scale
• 9:30
  to
• 9:30
  your
• 9:31
  patients.
• 9:31
  It
• 9:32
  isn't
• 9:32
  necessarily
• 9:33
  easy.
• 9:33
  If
• 9:33
  somebody
• 9:33
  asked
• 9:34
  me
• 9:34
  to
• 9:34
  take
• 9:34
  a
• 9:34
  multivitam
• 9:36
  times
• 9:36
  a
• 9:36
  day
• 9:36
  or
• 9:36
  even
• 9:36
  one
• 9:37
  time
• 9:37
  a
• 9:37
  day,
• 9:37
  may
• 9:38
  forget
• 9:38
  in
• 9:38
  31
• 9:39
  days
• 9:39
  to
• 9:39
  take
• 9:39
  it,
• 9:40
  let
• 9:40
  alone
• 9:41
  now.
• 9:41
  You're
• 9:41
  asking
• 9:41
  her
• 9:42
  to
• 9:42
  fill
• 9:43
  out
• 9:43
  11
• 9:43
  different
• 9:44
  categories
• 9:44
  of
• 9:45
  physical
• 9:45
  and
• 9:45
  behavioral
• 9:46
  symptoms
• 9:46
  on
• 9:47
  a
• 9:47
  scale
• 9:47
  of
• 9:47
  one
• 9:47
  to
• 9:48
  six
• 9:48
  every
• 9:48
  single
• 9:49
  day.
• 9:49
  So
• 9:50
  is
• 9:51
  it
• 9:51
  going
• 9:51
  to
• 9:51
  be
• 9:51
  perfect?
• 9:51
  Is
• 9:52
  it
• 9:52
  going
• 9:52
  to
• 9:52
  be
• 9:52
  completely
• 9:53
  precise?
• 9:53
  Maybe
• 9:53
  not.
• 9:54
  You
• 9:54
  might
• 9:54
  have
• 9:54
  to
• 9:54
  pair
• 9:54
  this
• 9:55
  with
• 9:55
  an
• 9:55
  app
• 9:55
  out
• 9:55
  there
• 9:56
  that
• 9:56
  she
• 9:57
  might
• 9:57
  already
• 9:57
  be
• 9:57
  using
• 9:58
  to
• 9:58
  detect
• 9:58
  her
• 9:58
  mood
• 9:59
  symptoms
• 9:59
  and
• 10:00
  hormonal
• 10:00
  cycles
• 10:01
  and
• 10:01
  that
• 10:01
  can
• 10:01
  be
• 10:01
  beneficial
• 10:02
  to
• 10:02
  sort
• 10:02
  of
• 10:02
  pair
• 10:03
  that
• 10:03
  data.
• 10:03
  But
• 10:04
  again,
• 10:04
  I
• 10:05
  think
• 10:05
  this
• 10:05
  is
• 10:05
  pretty
• 10:05
  cool
• 10:06
  and
• 10:06
  it's
• 10:07
  just
• 10:07
  really
• 10:07
  unique
• 10:07
  to
• 10:08
  me
• 10:08
  that
• 10:08
  the
• 10:08
  DSM
• 10:09
  5
• 10:09
  is
• 10:10
  requiring
• 10:10
  a
• 10:11
  rating
• 10:11
  scale
• 10:11
  to
• 10:12
  confirm
• 10:12
  it.
• 10:12
  They
• 10:12
  ask
• 10:12
  you
• 10:13
  that
• 10:13
  you
• 10:13
  only
• 10:14
  provide
• 10:14
  a
• 10:14
  provisional
• 10:15
  diagnosis
• 10:16
  before
• 10:16
  an
• 10:17
  official
• 10:17
  diagnosis
• 10:18
  if
• 10:18
  you
• 10:18
  have
• 10:18
  not
• 10:19
  paired
• 10:19
  this
• 10:19
  with
• 10:20
  the
• 10:20
  dsrp.
• 10:21
  So
• 10:21
  I
• 10:21
  think,
• 10:22
  again,
• 10:22
  I
• 10:22
  think
• 10:22
  that's
• 10:23
  really
• 10:23
  neat
• 10:24
  and
• 10:25
  very
• 10:25
  technical.
• 10:26
  These
• 10:26
  measurement
• 10:26
  based
• 10:27
  interventions
• 10:28
  are
• 10:28
  very
• 10:28
  important
• 10:29
  in
• 10:29
  psychiatry
• 10:30
  more
• 10:30
  broadly.
• 10:31
  Sure,
• 10:31
  you
• 10:31
  have
• 10:31
  a
• 10:31
  person
• 10:32
  in
• 10:32
  front
• 10:32
  of
• 10:32
  you,
• 10:32
  you
• 10:32
  need
• 10:33
  to
• 10:33
  do
• 10:33
  a
• 10:33
  good
• 10:33
  clinical
• 10:33
  interview,
• 10:35
  but
• 10:35
  these
• 10:35
  things
• 10:36
  are
• 10:36
  pretty
• 10:36
  cool
• 10:36
  too.
• 10:37
  So
• 10:38
  I
• 10:38
  hope
• 10:38
  you
• 10:38
  enjoyed
• 10:38
  that
• 10:39
  Pearl
• 10:39
  of
• 10:39
  the
• 10:39
  week.
• 10:39
  I
• 10:40
  hope
• 10:40
  that
• 10:40
  kind
• 10:40
  of
• 10:40
  whet
• 10:40
  your
• 10:41
  appetite
• 10:41
  to
• 10:41
  do
• 10:41
  a
• 10:42
  deeper
• 10:42
  dive
• 10:42
  into
• 10:42
  pmdd.
• 10:43
  What
• 10:43
  it
• 10:43
  is,
• 10:44
  how
• 10:44
  it
• 10:44
  happens,
• 10:45
  what
• 10:45
  the
• 10:45
  treatment
• 10:46
  looks
• 10:46
  like.
• 10:47
  And
• 10:47
  go
• 10:47
  ahead
• 10:47
  into
• 10:48
  the
• 10:48
  show
• 10:48
  notes
• 10:48
  and
• 10:49
  grab
• 10:49
  this
• 10:49
  PDF.
• 10:50
  And
• 10:51
  while
• 10:51
  you're
• 10:51
  at
• 10:51
  it,
• 10:51
  my
• 10:51
  friends,
• 10:52
  it
• 10:52
  would
• 10:52
  be
• 10:52
  really
• 10:53
  cool
• 10:53
  if
• 10:53
  you
• 10:53
  became
• 10:53
  a
• 10:54
  Patreon
• 10:54
  member
• 10:55
  because
• 10:55
  we
• 10:56
  have
• 10:56
  so
• 10:56
  many
• 10:57
  amazing
• 10:57
  resources
• 10:58
  to
• 10:58
  empower
• 10:58
  you
• 10:59
  to
• 10:59
  pass
• 10:59
  your
• 10:59
  boards
• 11:00
  for
• 11:00
  in
• 11:01
  your
• 11:01
  clinical
• 11:01
  practice,
• 11:02
  evidence
• 11:02
  based
• 11:03
  research,
• 11:03
  beautiful
• 11:04
  slide
• 11:04
  decks,
• 11:05
  fun
• 11:05
  explanations
• 11:06
  about
• 11:07
  receptors
• 11:07
  and
• 11:07
  affinity
• 11:08
  and
• 11:08
  psychopharm.
• 11:09
  Nerd
• 11:09
  out
• 11:10
  and
• 11:10
  become
• 11:10
  a
• 11:10
  Patreon
• 11:10
  member.
• 11:11
  I
• 11:11
  definitely
• 11:11
  recommend
• 11:12
  you
• 11:12
  do
• 11:12
  that.
• 11:13
  And
• 11:13
  if
• 11:13
  not,
• 11:13
  just
• 11:14
  please
• 11:14
  go
• 11:14
  over
• 11:14
  to
• 11:15
  Apple
• 11:15
  podcast,
• 11:15
  give
• 11:16
  us
• 11:16
  a
• 11:16
  five
• 11:16
  star
• 11:16
  rating
• 11:17
  and
• 11:17
  a
• 11:17
  little
• 11:17
  comment
• 11:17
  if
• 11:17
  we've
• 11:18
  helped
• 11:18
  you
• 11:18
  out.
• 11:19
  I
• 11:19
  try
• 11:19
  to
• 11:19
  be
• 11:19
  your
• 11:19
  little
• 11:20
  preceptor
• 11:20
  in
• 11:20
  your
• 11:20
  pocket,
• 11:21
  right?
• 11:21
  It's
• 11:21
  a
• 11:21
  long
• 11:22
  process
• 11:22
  to
• 11:22
  become
• 11:23
  an
• 11:23
  np
• 11:23
  and
• 11:24
  I
• 11:24
  try
• 11:24
  to
• 11:24
  fill
• 11:24
  the
• 11:25
  gaps.
• 11:25
  For
• 11:25
  some
• 11:25
  of
• 11:25
  you
• 11:25
  folks
• 11:26
  who
• 11:26
  may
• 11:26
  not
• 11:27
  have
• 11:27
  ideal
• 11:27
  preceptorships,
• 11:28
  you
• 11:28
  want
• 11:28
  to
• 11:28
  just
• 11:29
  hear
• 11:29
  someone
• 11:29
  chat
• 11:30
  about
• 11:30
  what
• 11:30
  real
• 11:31
  life
• 11:31
  NP
• 11:32
  stuff
• 11:33
  is
• 11:33
  about
• 11:34
  and
• 11:34
  that's
• 11:34
  where
• 11:34
  I
• 11:34
  try
• 11:35
  to
• 11:35
  fill
• 11:35
  the
• 11:35
  gaps
• 11:35
  and
• 11:35
  I
• 11:36
  try
• 11:36
  to
• 11:36
  do
• 11:36
  it
• 11:36
  in
• 11:36
  a
• 11:36
  fun
• 11:37
  way.
• 11:37
  I
• 11:37
  think
• 11:37
  their
• 11:38
  field
• 11:38
  is
• 11:38
  endlessly
• 11:39
  entertaining
• 11:39
  and
• 11:40
  fun
• 11:40
  and
• 11:40
  rewarding.
• 11:40
  You
• 11:41
  get
• 11:41
  to
• 11:41
  help
• 11:41
  people
• 11:42
  and
• 11:42
  intellectually
• 11:43
  stimulating
• 11:44
  too.
• 11:44
  And
• 11:44
  so
• 11:45
  this
• 11:45
  was
• 11:45
  another
• 11:45
  example
• 11:46
  of
• 11:46
  this
• 11:46
  little
• 11:47
  pearl
• 11:47
  out
• 11:47
  in
• 11:47
  the
• 11:47
  ocean
• 11:48
  on
• 11:48
  the
• 11:48
  seabed
• 11:49
  of
• 11:49
  the
• 11:49
  ocean
• 11:49
  and
• 11:50
  it's
• 11:50
  just
• 11:50
  shining
• 11:50
  there
• 11:51
  and
• 11:51
  we
• 11:51
  don't
• 11:51
  always
• 11:51
  pick
• 11:51
  it
• 11:52
  up
• 11:52
  and
• 11:52
  it's
• 11:52
  such
• 11:52
  an
• 11:52
  important
• 11:53
  one
• 11:53
  right
• 11:54
  because
• 11:54
  here
• 11:54
  we
• 11:55
  are
• 11:55
  not
• 11:55
  even
• 11:55
  realizing
• 11:56
  maybe
• 11:57
  while
• 11:57
  we're
• 11:57
  in
• 11:57
  school
• 11:58
  that
• 11:59
  a
• 11:59
  rating
• 11:59
  scale
• 12:00
  is
• 12:00
  actually
• 12:00
  required
• 12:01
  to
• 12:01
  confirm
• 12:01
  a
• 12:01
  very
• 12:02
  important
• 12:02
  and
• 12:02
  a
• 12:02
  pretty
• 12:03
  pervasive
• 12:03
  diagnosis
• 12:04
  that
• 12:04
  can
• 12:04
  wreak
• 12:04
  havoc
• 12:05
  on
• 12:05
  females
• 12:06
  and
• 12:06
  their
• 12:06
  families.
• 12:07
  It's
• 12:07
  a
• 12:07
  very
• 12:07
  disruptive
• 12:08
  diagnosis.
• 12:09
  Definitely
• 12:09
  encourage
• 12:10
  you
• 12:10
  to
• 12:10
  look
• 12:10
  at
• 12:10
  it
• 12:11
  a
• 12:11
  lot
• 12:11
  more
• 12:12
  and
• 12:13
  appreciate
• 12:13
  it
• 12:14
  because
• 12:14
  it's
• 12:15
  just
• 12:15
  very
• 12:15
  fascinating.
• 12:16
  That's
• 12:16
  all
• 12:16
  I
• 12:16
  got
• 12:17
  today
• 12:17
  my
• 12:17
  friends.
• 12:17
  That
• 12:17
  was
• 12:18
  your
• 12:18
  pearl
• 12:18
  of
• 12:18
  the
• 12:19
  week.
• 12:19
  Share
• 12:19
  it
• 12:20
  with
• 12:20
  your
• 12:20
  fellow
• 12:21
  students
• 12:22
  talk
• 12:22
  about
• 12:22
  it
• 12:23
  do
• 12:23
  a
• 12:23
  deep
• 12:23
  dive
• 12:23
  on
• 12:23
  it
• 12:24
  and
• 12:24
  see
• 12:24
  if
• 12:25
  they
• 12:25
  can
• 12:25
  get
• 12:25
  the
• 12:26
  multiple
• 12:26
  choice
• 12:26
  question.
• 12:27
  I
• 12:27
  know
• 12:27
  it's
• 12:28
  kind
• 12:28
  of
• 12:28
  a
• 12:28
  tough
• 12:28
  one
• 12:28
  I
• 12:28
  think
• 12:28
  in
• 12:29
  NP
• 12:29
  school
• 12:29
  I
• 12:29
  probably
• 12:30
  would
• 12:30
  not
• 12:30
  have
• 12:30
  gotten
• 12:30
  that
• 12:31
  right.
• 12:31
  Test
• 12:31
  it
• 12:32
  out
• 12:32
  and
• 12:32
  it's
• 12:32
  always
• 12:32
  a
• 12:33
  pleasure
• 12:33
  my
• 12:33
  friends.
• 12:33
  Don't
• 12:34
  forget
• 12:34
  to
• 12:34
  subscribe
• 12:35
  and
• 12:35
  we
• 12:35
  will
• 12:35
  see
• 12:35
  you
• 12:35
  next
• 12:36
  time.
• 12:36
  Bye
• 12:36
  bye.