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Bonus Episode: One Detail That Can Derail Your Diagnosis · Pearls and Prep

• 0:00
  Foreign.
• 0:04
  Welcome
• 0:05
  back,
• 0:05
  my
• 0:05
  friends,
• 0:06
  to
• 0:06
  a
• 0:06
  bonus
• 0:07
  episode
• 0:08
  of
• 0:08
  Pearls
• 0:09
  and
• 0:09
  Prep.
• 0:09
  Npz
• 0:10
  Here,
• 0:10
  your
• 0:11
  preceptor
• 0:11
  in
• 0:11
  your
• 0:12
  pocket,
• 0:13
  the
• 0:13
  place
• 0:13
  to
• 0:13
  go
• 0:14
  for
• 0:14
  pearls
• 0:15
  that
• 0:15
  prep
• 0:15
  you
• 0:16
  to
• 0:16
  practice.
• 0:17
  Today's
• 0:17
  going
• 0:17
  to
• 0:17
  be
• 0:18
  a
• 0:18
  doozy.
• 0:18
  There's
• 0:19
  a
• 0:19
  blizzard
• 0:19
  outside.
• 0:20
  It's.
• 0:21
  Everybody's
• 0:22
  hunkered,
• 0:22
  hunkered
• 0:23
  in
• 0:24
  wanting
• 0:24
  to
• 0:24
  learn
• 0:24
  about
• 0:25
  psychiatry.
• 0:26
  That's
• 0:26
  what
• 0:26
  everybody's
• 0:27
  doing
• 0:27
  right
• 0:27
  now.
• 0:27
  They're,
• 0:28
  they're
• 0:28
  bored.
• 0:29
  They're
• 0:29
  saying
• 0:29
  to
• 0:29
  themselves,
• 0:30
  you
• 0:30
  know,
• 0:30
  screw
• 0:31
  Netflix,
• 0:31
  screw
• 0:32
  Hulu.
• 0:32
  I've
• 0:33
  already
• 0:33
  watched
• 0:33
  Breaking
• 0:34
  Bad
• 0:34
  nine
• 0:34
  times
• 0:35
  on
• 0:35
  repeat.
• 0:35
  I've
• 0:36
  already
• 0:36
  seen
• 0:36
  the
• 0:36
  Office.
• 0:37
  I
• 0:37
  want
• 0:38
  to
• 0:38
  learn
• 0:38
  about
• 0:40
  psychiatry.
• 0:41
  And
• 0:41
  so
• 0:42
  that's
• 0:42
  what
• 0:42
  I'm
• 0:42
  bringing
• 0:42
  you
• 0:43
  today,
• 0:43
  bonus
• 0:43
  episode.
• 0:44
  And
• 0:44
  I
• 0:44
  hope
• 0:44
  you
• 0:44
  all
• 0:45
  really
• 0:45
  enjoy
• 0:46
  this.
• 0:46
  So
• 0:47
  I'm
• 0:48
  going
• 0:48
  to
• 0:48
  begin
• 0:48
  with
• 0:48
  a
• 0:48
  bit
• 0:48
  of
• 0:48
  a
• 0:49
  case
• 0:49
  study
• 0:50
  and
• 0:50
  a
• 0:50
  multiple
• 0:51
  choice
• 0:51
  question.
• 0:52
  I
• 0:52
  think
• 0:52
  this
• 0:52
  will
• 0:53
  blow
• 0:53
  your
• 0:53
  minds.
• 0:54
  I
• 0:54
  certainly
• 0:55
  feel
• 0:55
  like
• 0:55
  it's
• 0:56
  a
• 0:56
  very
• 0:57
  compelling
• 0:57
  case
• 0:58
  study
• 0:58
  to
• 0:58
  think
• 0:58
  about.
• 0:59
  All
• 0:59
  right,
• 1:00
  without
• 1:01
  further
• 1:01
  ado,
• 1:01
  let's
• 1:02
  do
• 1:02
  this.
• 1:03
  So
• 1:03
  you
• 1:03
  have
• 1:03
  a
• 1:03
  35
• 1:04
  year
• 1:04
  old
• 1:05
  woman
• 1:06
  who
• 1:06
  presents
• 1:07
  to
• 1:07
  your
• 1:07
  outpatient
• 1:07
  clinic
• 1:08
  eight
• 1:08
  weeks
• 1:09
  after
• 1:09
  she
• 1:09
  was
• 1:10
  laid
• 1:10
  off
• 1:11
  from
• 1:12
  her
• 1:12
  job
• 1:12
  at
• 1:12
  Dunkin
• 1:13
  Donuts.
• 1:13
  She
• 1:14
  worked
• 1:14
  there
• 1:14
  for
• 1:15
  10
• 1:15
  years,
• 1:15
  but
• 1:16
  they
• 1:16
  did
• 1:16
  some
• 1:16
  company
• 1:17
  restructuring
• 1:18
  and
• 1:18
  she's
• 1:19
  laid
• 1:19
  off.
• 1:20
  She's
• 1:20
  devastated.
• 1:21
  She
• 1:21
  can't
• 1:21
  stop
• 1:22
  thinking
• 1:22
  about
• 1:22
  losing
• 1:23
  her
• 1:23
  job.
• 1:23
  She
• 1:23
  says
• 1:24
  she
• 1:24
  feels
• 1:24
  like
• 1:24
  such
• 1:25
  a
• 1:25
  failure.
• 1:25
  Her
• 1:26
  mood
• 1:26
  is
• 1:26
  super
• 1:26
  depressed
• 1:27
  most
• 1:27
  days.
• 1:28
  Very
• 1:28
  difficult
• 1:29
  for
• 1:29
  her
• 1:29
  to
• 1:29
  fall
• 1:29
  asleep.
• 1:30
  She
• 1:31
  sometimes
• 1:31
  takes
• 1:32
  two
• 1:32
  to
• 1:32
  three
• 1:32
  hours
• 1:32
  to
• 1:33
  fall
• 1:33
  asleep.
• 1:33
  She
• 1:34
  has
• 1:34
  a
• 1:34
  decreased
• 1:34
  Appetite
• 1:35
  with
• 1:35
  a
• 1:35
  10
• 1:35
  pound
• 1:36
  weight
• 1:36
  loss,
• 1:37
  fatigue,
• 1:37
  difficulty
• 1:38
  concentrating
• 1:39
  at
• 1:39
  home,
• 1:40
  loss
• 1:40
  of
• 1:40
  interest
• 1:41
  in
• 1:41
  her
• 1:41
  usual
• 1:41
  hobbies,
• 1:42
  and
• 1:43
  she
• 1:43
  spends
• 1:43
  most
• 1:44
  days
• 1:44
  on
• 1:44
  the
• 1:44
  couch.
• 1:45
  She
• 1:45
  doesn't
• 1:46
  exercise
• 1:46
  and
• 1:46
  feels
• 1:47
  pretty
• 1:47
  darn
• 1:47
  worthless.
• 1:48
  Denies
• 1:48
  any
• 1:49
  si,
• 1:49
  but
• 1:50
  states
• 1:50
  that
• 1:50
  she
• 1:50
  doesn't
• 1:51
  really
• 1:51
  see
• 1:51
  the
• 1:51
  point
• 1:51
  of
• 1:52
  anything
• 1:52
  right
• 1:52
  now.
• 1:53
  Now
• 1:54
  her
• 1:54
  mental
• 1:54
  status
• 1:55
  exam.
• 1:55
  She
• 1:55
  has
• 1:56
  some
• 1:56
  psychomotor
• 1:56
  retardation,
• 1:57
  some
• 1:57
  constricted
• 1:58
  affect.
• 1:59
  She
• 1:59
  appears
• 2:00
  visibly
• 2:00
  slowed
• 2:01
  in
• 2:01
  her
• 2:01
  movements
• 2:01
  and
• 2:01
  her
• 2:02
  speech.
• 2:02
  It's
• 2:02
  like
• 2:03
  in
• 2:03
  depression
• 2:03
  when
• 2:03
  everything
• 2:04
  is
• 2:04
  kind
• 2:04
  of
• 2:04
  in
• 2:04
  slow
• 2:05
  motion.
• 2:05
  Your
• 2:06
  patient
• 2:06
  in
• 2:06
  front
• 2:06
  of
• 2:06
  you
• 2:07
  is
• 2:07
  sometimes
• 2:08
  disheveled,
• 2:08
  talking
• 2:09
  slowly,
• 2:10
  responding
• 2:10
  very
• 2:11
  slowly
• 2:11
  to
• 2:11
  your
• 2:11
  questions.
• 2:13
  She
• 2:13
  has
• 2:13
  no
• 2:13
  prior
• 2:13
  psychiatric
• 2:14
  history
• 2:15
  and
• 2:15
  was
• 2:15
  functioning
• 2:16
  well
• 2:16
  in
• 2:16
  all
• 2:16
  domains
• 2:17
  before
• 2:18
  the
• 2:18
  job
• 2:18
  loss.
• 2:19
  When
• 2:19
  asked
• 2:19
  about
• 2:20
  her
• 2:20
  mood
• 2:20
  in
• 2:20
  relation
• 2:21
  to
• 2:21
  daily
• 2:21
  events,
• 2:21
  she
• 2:22
  states,
• 2:22
  nothing
• 2:22
  makes
• 2:22
  me
• 2:23
  feel
• 2:23
  better.
• 2:23
  Even
• 2:24
  when
• 2:24
  my
• 2:24
  kids
• 2:25
  try
• 2:25
  to
• 2:25
  cheer
• 2:25
  me
• 2:25
  up,
• 2:26
  I'm
• 2:26
  just
• 2:26
  numb.
• 2:27
  So
• 2:27
  which
• 2:28
  diagnosis
• 2:28
  best
• 2:29
  fits
• 2:29
  this
• 2:30
  clinical
• 2:30
  presentation?
• 2:31
  Is
• 2:32
  it
• 2:32
  A,
• 2:33
  adjustment
• 2:34
  disorder
• 2:34
  with
• 2:34
  depressed
• 2:35
  mood?
• 2:35
  Is
• 2:36
  it
• 2:36
  B,
• 2:36
  major
• 2:37
  depressive
• 2:37
  disorder,
• 2:38
  single
• 2:38
  episode?
• 2:39
  Is
• 2:39
  it
• 2:39
  C,
• 2:40
  persistent
• 2:41
  depressive
• 2:41
  disorder,
• 2:42
  also
• 2:42
  known
• 2:42
  as
• 2:43
  dysthymia?
• 2:44
  Is
• 2:45
  it
• 2:45
  D,
• 2:46
  unspecified
• 2:47
  depressive
• 2:47
  disorder?
• 2:48
  Now
• 2:48
  I'LL
• 2:49
  let
• 2:49
  you
• 2:49
  pause
• 2:49
  this
• 2:49
  and
• 2:49
  I'll
• 2:50
  discuss.
• 2:50
  We
• 2:50
  can
• 2:50
  definitely
• 2:51
  talk
• 2:51
  about
• 2:52
  this
• 2:52
  because
• 2:52
  it's
• 2:53
  a
• 2:53
  very
• 2:54
  interesting
• 2:55
  one.
• 2:55
  So
• 2:56
  this
• 2:56
  patient,
• 2:57
  Dunkin
• 2:58
  Donuts,
• 2:58
  Layoff,
• 3:00
  Stressful.
• 3:02
  Absolutely.
• 3:02
  There's
• 3:03
  an
• 3:03
  identifiable
• 3:04
  stressor.
• 3:05
  She
• 3:05
  has
• 3:05
  no
• 3:05
  prior
• 3:06
  psychiatric
• 3:06
  history.
• 3:07
  Her
• 3:07
  symptoms
• 3:08
  begin
• 3:08
  to
• 3:09
  surface
• 3:09
  at
• 3:10
  the
• 3:10
  onset
• 3:10
  of
• 3:10
  this
• 3:11
  stressor.
• 3:11
  Within
• 3:12
  eight
• 3:12
  weeks
• 3:13
  of
• 3:13
  the
• 3:13
  onset
• 3:14
  of
• 3:14
  her
• 3:14
  decline
• 3:14
  is
• 3:15
  very
• 3:15
  clear.
• 3:15
  Right?
• 3:16
  It's
• 3:16
  broad
• 3:16
  declines,
• 3:17
  weight
• 3:17
  loss,
• 3:18
  fatigue,
• 3:19
  depressed
• 3:19
  mood,
• 3:20
  passive
• 3:21
  si
• 3:21
  essentially.
• 3:22
  Right.
• 3:23
  It's
• 3:23
  really
• 3:24
  not
• 3:25
  a
• 3:25
  good
• 3:25
  situation.
• 3:26
  I'm
• 3:27
  gonna
• 3:27
  give
• 3:27
  you
• 3:27
  the
• 3:27
  answer.
• 3:27
  And
• 3:28
  the
• 3:28
  answer
• 3:28
  is
• 3:30
  major
• 3:30
  depressive
• 3:31
  disorder,
• 3:32
  single
• 3:32
  episode.
• 3:33
  My
• 3:34
  prior
• 3:34
  friends
• 3:35
  and
• 3:35
  students
• 3:35
  who
• 3:36
  talk
• 3:36
  to
• 3:36
  me,
• 3:37
  they
• 3:38
  think
• 3:38
  the
• 3:38
  answer
• 3:39
  is
• 3:39
  a
• 3:39
  adjustment
• 3:40
  disorder
• 3:41
  with
• 3:41
  depressed
• 3:41
  mood.
• 3:42
  And
• 3:42
  their
• 3:42
  rationale
• 3:43
  is
• 3:44
  listen,
• 3:45
  npz.
• 3:46
  This
• 3:46
  is
• 3:47
  a
• 3:47
  clearly
• 3:47
  identifiable
• 3:48
  stressor.
• 3:48
  The
• 3:49
  patient
• 3:49
  had
• 3:49
  no
• 3:49
  prior
• 3:50
  psychiatric
• 3:50
  history.
• 3:51
  They've
• 3:52
  never
• 3:52
  been
• 3:52
  depressed
• 3:53
  before.
• 3:53
  Of
• 3:53
  course
• 3:53
  it's
• 3:54
  an
• 3:54
  adjustment
• 3:54
  related
• 3:55
  disorder
• 3:55
  because
• 3:55
  it's
• 3:56
  an
• 3:56
  adjustment
• 3:56
  related
• 3:57
  stressor.
• 3:58
  However,
• 3:58
  my
• 3:59
  friends,
• 3:59
  the
• 3:59
  devil
• 4:00
  is
• 4:00
  in
• 4:00
  the
• 4:00
  dsm.
• 4:01
  Five
• 4:02
  criteria
• 4:03
  details
• 4:04
  and
• 4:05
  the
• 4:05
  rule,
• 4:05
  the
• 4:06
  iron
• 4:07
  rule
• 4:07
  in
• 4:08
  the
• 4:08
  DSM
• 4:09
  is
• 4:10
  that
• 4:12
  if
• 4:12
  the
• 4:13
  full
• 4:13
  criteria
• 4:13
  for
• 4:14
  a
• 4:14
  major
• 4:14
  depressive
• 4:14
  disorder
• 4:15
  is
• 4:15
  met,
• 4:16
  that
• 4:16
  diagnosis
• 4:17
  takes
• 4:17
  precedence
• 4:18
  over
• 4:18
  an
• 4:18
  adjustment
• 4:18
  disorder,
• 4:19
  regardless
• 4:20
  of
• 4:20
  whether
• 4:20
  a
• 4:20
  stressor
• 4:21
  is
• 4:21
  present.
• 4:22
  Those
• 4:23
  are
• 4:23
  fighting
• 4:23
  words,
• 4:24
  my
• 4:24
  friends.
• 4:25
  I
• 4:25
  love
• 4:25
  the
• 4:25
  dsm.
• 4:26
  I
• 4:26
  also
• 4:26
  hate
• 4:26
  the
• 4:26
  dsm.
• 4:27
  I
• 4:27
  think
• 4:27
  we
• 4:27
  all
• 4:28
  have
• 4:28
  the
• 4:28
  same
• 4:28
  relationship
• 4:29
  with
• 4:29
  it.
• 4:30
  This
• 4:30
  is
• 4:30
  a
• 4:31
  particularly
• 4:31
  devious
• 4:32
  curveball.
• 4:33
  This
• 4:34
  is
• 4:34
  one
• 4:35
  that
• 4:35
  is
• 4:35
  meant
• 4:36
  to
• 4:36
  have
• 4:36
  students
• 4:37
  tearing
• 4:37
  all
• 4:37
  of
• 4:38
  their
• 4:38
  hairs
• 4:38
  out
• 4:39
  because
• 4:39
  it
• 4:39
  sets
• 4:40
  you
• 4:40
  up
• 4:40
  so
• 4:40
  beautifully.
• 4:41
  This
• 4:42
  beautiful
• 4:42
  ball
• 4:43
  coming
• 4:43
  right
• 4:43
  down
• 4:44
  the
• 4:44
  middle
• 4:44
  of
• 4:44
  the
• 4:44
  plate
• 4:44
  for
• 4:45
  you
• 4:45
  to
• 4:45
  swing
• 4:45
  a
• 4:45
  grand
• 4:45
  slam.
• 4:46
  It
• 4:47
  looks
• 4:47
  so
• 4:47
  much
• 4:47
  like
• 4:48
  an
• 4:48
  adjustment
• 4:48
  disorder
• 4:49
  and
• 4:49
  it's
• 4:49
  like
• 4:50
  a
• 4:50
  Greg
• 4:50
  Maddox
• 4:51
  slider
• 4:52
  for
• 4:52
  you
• 4:52
  baseball
• 4:53
  fans
• 4:54
  or
• 4:54
  like
• 4:54
  a
• 4:54
  sinker.
• 4:55
  It
• 4:55
  just
• 4:55
  drops
• 4:56
  when
• 4:56
  you
• 4:56
  think
• 4:56
  you're
• 4:56
  getting
• 4:57
  a
• 4:57
  fastball,
• 4:58
  it
• 4:58
  drops
• 4:58
  and
• 4:59
  you
• 4:59
  swing
• 4:59
  and
• 4:59
  you
• 5:00
  miss.
• 5:00
  Because
• 5:02
  the
• 5:02
  key
• 5:02
  here
• 5:03
  is
• 5:03
  that
• 5:04
  we'll
• 5:05
  call
• 5:05
  this
• 5:05
  mock
• 5:05
  patient
• 5:06
  Greta
• 5:07
  meets
• 5:08
  all
• 5:08
  the
• 5:08
  criteria
• 5:09
  for
• 5:09
  a
• 5:09
  major
• 5:09
  depressive
• 5:10
  disorder
• 5:10
  here.
• 5:11
  I
• 5:11
  don't
• 5:11
  expect
• 5:12
  you
• 5:12
  or
• 5:12
  me
• 5:13
  or
• 5:13
  anyone
• 5:14
  to
• 5:14
  register,
• 5:15
  just
• 5:15
  off
• 5:15
  the
• 5:15
  audio
• 5:16
  that
• 5:16
  she
• 5:16
  met
• 5:16
  all
• 5:17
  the
• 5:17
  criteria.
• 5:18
  She
• 5:18
  needs
• 5:18
  five
• 5:18
  out
• 5:18
  of
• 5:19
  the
• 5:19
  nine
• 5:19
  symptoms
• 5:19
  for
• 5:20
  two
• 5:20
  or
• 5:20
  more
• 5:20
  weeks,
• 5:21
  right?
• 5:22
  But
• 5:22
  it's
• 5:23
  pretty
• 5:23
  clear
• 5:25
  that
• 5:26
  she
• 5:27
  has
• 5:27
  all
• 5:28
  of
• 5:28
  the
• 5:28
  wickets
• 5:28
  here,
• 5:29
  right?
• 5:29
  The
• 5:29
  sleep
• 5:30
  and
• 5:30
  appetite
• 5:30
  changes,
• 5:31
  fatigue,
• 5:31
  difficulty
• 5:32
  concentrating,
• 5:33
  loss
• 5:33
  of
• 5:33
  interest
• 5:33
  in
• 5:34
  her
• 5:34
  usual
• 5:34
  hobbies.
• 5:35
  One
• 5:36
  little
• 5:36
  tip
• 5:36
  off,
• 5:37
  my
• 5:37
  friends
• 5:38
  is
• 5:39
  that
• 5:40
  the
• 5:41
  quality
• 5:41
  of
• 5:41
  her
• 5:42
  symptoms
• 5:42
  are
• 5:42
  pretty
• 5:43
  pervasive
• 5:43
  here.
• 5:44
  Now,
• 5:44
  I'm
• 5:44
  not
• 5:45
  trying
• 5:45
  to
• 5:45
  say
• 5:45
  that
• 5:45
  losing
• 5:46
  your
• 5:46
  job
• 5:47
  is
• 5:47
  a
• 5:47
  picnic
• 5:48
  and
• 5:48
  that
• 5:49
  everything
• 5:49
  should
• 5:49
  be
• 5:49
  hunky
• 5:50
  dory,
• 5:51
  but
• 5:51
  this
• 5:51
  is
• 5:52
  very
• 5:52
  much
• 5:52
  a
• 5:52
  syndromal
• 5:54
  response
• 5:54
  or
• 5:54
  a
• 5:55
  syndromal
• 5:55
  presentation.
• 5:56
  With
• 5:57
  adjustment
• 5:57
  disorders.
• 5:58
  And
• 5:58
  here's
• 5:58
  a
• 5:58
  key
• 5:59
  pearl
• 5:59
  for
• 5:59
  y'
• 5:59
  all
• 5:59
  to
• 5:59
  remember.
• 6:00
  Adjustment
• 6:01
  disorders
• 6:02
  typically
• 6:03
  involve
• 6:04
  some
• 6:04
  variability
• 6:05
  in
• 6:05
  your
• 6:06
  patient's
• 6:06
  temperament.
• 6:07
  In
• 6:07
  other
• 6:07
  words,
• 6:08
  not
• 6:08
  everything
• 6:09
  is
• 6:10
  put
• 6:10
  through
• 6:10
  this
• 6:11
  sad
• 6:11
  filter.
• 6:11
  They're
• 6:12
  able
• 6:12
  to
• 6:12
  experience
• 6:13
  some
• 6:13
  pockets
• 6:14
  of
• 6:14
  joy
• 6:15
  and
• 6:15
  initiative
• 6:16
  and
• 6:16
  motivation.
• 6:17
  Maybe
• 6:17
  they
• 6:17
  still
• 6:17
  order
• 6:18
  pizza
• 6:18
  and
• 6:18
  enjoy
• 6:19
  it.
• 6:19
  Maybe
• 6:19
  they
• 6:19
  still
• 6:20
  go
• 6:20
  out
• 6:20
  to
• 6:20
  the
• 6:20
  movies
• 6:21
  or
• 6:21
  out
• 6:22
  to
• 6:22
  dinner
• 6:22
  with
• 6:23
  their
• 6:23
  wife
• 6:23
  and
• 6:23
  enjoy
• 6:24
  it.
• 6:24
  Depression
• 6:25
  is
• 6:25
  sort
• 6:26
  of
• 6:26
  this
• 6:26
  blanket
• 6:27
  everything
• 6:28
  is
• 6:28
  kind
• 6:28
  of
• 6:28
  bleak
• 6:28
  and
• 6:29
  empty
• 6:29
  and
• 6:29
  sad.
• 7:24
  And
• 7:25
  you
• 7:25
  could
• 7:25
  win
• 7:25
  the
• 7:25
  lottery
• 7:26
  and
• 7:26
  you'll
• 7:27
  just
• 7:27
  focus
• 7:27
  on
• 7:27
  paying
• 7:28
  the
• 7:28
  taxes
• 7:28
  and
• 7:29
  you
• 7:29
  won't
• 7:29
  really
• 7:29
  be
• 7:30
  excited
• 7:31
  about
• 7:31
  the
• 7:31
  fact
• 7:31
  that
• 7:32
  you
• 7:32
  won
• 6:37
  $5
• 7:32
  million
• 7:34
  as
• 7:34
  opposed
• 7:34
  to
• 7:34
  an
• 7:34
  adjustment
• 7:35
  disorder.
• 7:36
  Chances
• 7:36
  are
• 7:37
  that
• 7:37
  person
• 7:38
  is
• 7:38
  going
• 7:38
  to
• 7:38
  be
• 7:39
  very
• 7:39
  excited
• 7:39
  they
• 7:39
  won
• 7:40
  the
• 7:40
  Powerball.
• 7:40
  Now,
• 7:41
  that's
• 7:41
  not
• 7:41
  to
• 7:41
  minimize
• 7:42
  adjustment
• 7:42
  disorders
• 7:43
  because
• 7:43
  we
• 7:44
  tie
• 7:44
  up
• 7:44
  our
• 7:44
  sense
• 7:45
  of
• 7:45
  identity
• 7:46
  to
• 7:46
  our
• 7:46
  jobs.
• 7:47
  Life
• 7:47
  is
• 7:47
  kind
• 7:47
  of
• 7:47
  gray
• 7:48
  and
• 7:48
  in
• 7:48
  between,
• 7:49
  maybe
• 7:50
  it
• 7:50
  wouldn't
• 7:50
  erase
• 7:50
  their
• 7:51
  adjustment
• 7:51
  disorder.
• 7:51
  But
• 7:51
  you
• 7:52
  get
• 7:52
  my
• 7:52
  point.
• 7:52
  Depression
• 7:54
  is
• 7:54
  more
• 7:54
  of
• 7:54
  a
• 7:54
  syndromal
• 7:55
  experience.
• 7:56
  I
• 7:57
  would
• 7:57
  challenge
• 7:57
  you
• 7:58
  when
• 7:58
  you're
• 7:58
  stuck
• 7:59
  between
• 8:00
  an
• 8:00
  adjustment
• 8:00
  disorder
• 8:01
  or
• 8:01
  a
• 8:01
  major
• 8:01
  depressive
• 8:02
  disorder.
• 8:03
  Start
• 8:03
  counting.
• 8:04
  That's
• 8:04
  a
• 8:04
  huge
• 8:05
  pearl
• 8:05
  for
• 8:05
  today's
• 8:06
  episode.
• 8:07
  Start
• 8:08
  counting.
• 8:08
  The
• 8:08
  symptoms
• 8:09
  don't
• 8:09
  get
• 8:10
  bogged
• 8:10
  down
• 8:10
  in
• 8:11
  the
• 8:11
  well,
• 8:11
  this
• 8:11
  is
• 8:11
  an
• 8:11
  identifiable
• 8:12
  stressor.
• 8:12
  It
• 8:13
  sounds
• 8:13
  like
• 8:13
  an
• 8:13
  adjustment
• 8:14
  disorder.
• 8:14
  The
• 8:14
  DSM
• 8:15
  doesn't
• 8:15
  care
• 8:16
  that
• 8:16
  it's
• 8:16
  a
• 8:17
  perfect
• 8:17
  storybook.
• 8:18
  They
• 8:18
  care
• 8:19
  about
• 8:19
  the
• 8:20
  actual
• 8:20
  diagnostic
• 8:21
  validity.
• 8:22
  It
• 8:22
  seems
• 8:22
  their
• 8:23
  approach
• 8:23
  is
• 8:23
  that
• 8:24
  they're
• 8:25
  really
• 8:25
  chasing
• 8:25
  symptom
• 8:26
  clusters
• 8:27
  and
• 8:27
  not
• 8:27
  etiology.
• 8:28
  In
• 8:28
  other
• 8:28
  words,
• 8:29
  they
• 8:29
  find
• 8:29
  that
• 8:30
  the
• 8:30
  identification
• 8:31
  and
• 8:32
  the
• 8:32
  number
• 8:32
  and
• 8:33
  severity
• 8:33
  of
• 8:33
  symptoms
• 8:34
  is
• 8:34
  more
• 8:35
  important
• 8:35
  than
• 8:36
  the
• 8:36
  actual
• 8:37
  precipitating
• 8:38
  factor
• 8:39
  of
• 8:39
  why
• 8:40
  the
• 8:40
  patient
• 8:40
  is
• 8:40
  seeing
• 8:41
  you.
• 8:41
  And
• 8:42
  if
• 8:42
  you
• 8:42
  think
• 8:42
  about
• 8:42
  it,
• 8:42
  that
• 8:43
  makes
• 8:43
  some
• 8:43
  kind
• 8:43
  of
• 8:44
  sense,
• 8:44
  because
• 8:45
  patients
• 8:45
  are
• 8:45
  going
• 8:45
  to
• 8:45
  come
• 8:45
  to
• 8:46
  you
• 8:46
  for
• 8:46
  all
• 8:46
  kinds
• 8:46
  of
• 8:46
  reasons.
• 8:47
  And
• 8:47
  if
• 8:47
  we
• 8:48
  base
• 8:48
  their
• 8:49
  presentation
• 8:50
  or
• 8:50
  the
• 8:50
  reasons
• 8:51
  they
• 8:51
  say
• 8:51
  they're
• 8:51
  coming
• 8:51
  to
• 8:52
  us
• 8:52
  on
• 8:52
  the
• 8:52
  diagnostic
• 8:53
  outcome,
• 8:53
  that
• 8:53
  gets
• 8:54
  kind
• 8:54
  of
• 8:54
  slippery.
• 8:54
  Because
• 8:54
  who's
• 8:55
  to
• 8:55
  say
• 8:55
  a
• 8:55
  job
• 8:55
  loss
• 8:56
  for
• 8:56
  this
• 8:56
  person
• 8:57
  is
• 8:58
  going
• 8:58
  to
• 8:58
  meet
• 8:59
  major
• 8:59
  depressive
• 8:59
  criteria
• 9:00
  or
• 9:00
  not?
• 9:01
  It
• 9:01
  could
• 9:01
  be
• 9:01
  different
• 9:02
  in
• 9:02
  the
• 9:02
  other
• 9:02
  person.
• 9:02
  The
• 9:03
  other
• 9:03
  person
• 9:03
  could
• 9:03
  lose
• 9:03
  their
• 9:04
  job
• 9:04
  and
• 9:04
  be
• 9:04
  relieved
• 9:05
  and
• 9:06
  not
• 9:06
  at
• 9:06
  all
• 9:06
  have
• 9:06
  depression.
• 9:07
  So
• 9:08
  it
• 9:08
  does
• 9:08
  make
• 9:09
  sense
• 9:09
  that
• 9:09
  to
• 9:09
  maintain
• 9:10
  some
• 9:10
  kind
• 9:10
  of
• 9:10
  consistent
• 9:11
  standard,
• 9:12
  we
• 9:12
  still
• 9:13
  have
• 9:14
  this
• 9:14
  bar
• 9:15
  that
• 9:15
  you
• 9:15
  have
• 9:15
  to
• 9:15
  jump
• 9:16
  over
• 9:16
  to
• 9:16
  achieve
• 9:17
  major
• 9:17
  depressive
• 9:18
  disorder.
• 9:19
  And
• 9:20
  you
• 9:20
  know
• 9:20
  when
• 9:21
  you're
• 9:21
  not
• 9:21
  eating
• 9:22
  or
• 9:22
  you're
• 9:23
  sleeping
• 9:23
  in
• 9:23
  three
• 9:24
  hours
• 9:24
  past
• 9:25
  the
• 9:25
  time
• 9:26
  when
• 9:26
  all
• 9:26
  of
• 9:26
  life
• 9:27
  just
• 9:27
  seems
• 9:27
  kind
• 9:27
  of
• 9:27
  worthless
• 9:28
  and
• 9:28
  empty
• 9:29
  and
• 9:29
  now
• 9:30
  you're
• 9:30
  not
• 9:30
  really
• 9:30
  talking
• 9:31
  about
• 9:31
  an
• 9:31
  isolated
• 9:32
  stressor
• 9:32
  anymore.
• 9:32
  And
• 9:33
  that's
• 9:33
  another
• 9:33
  tip
• 9:33
  for
• 9:33
  you,
• 9:34
  when
• 9:34
  you
• 9:34
  start
• 9:34
  to
• 9:34
  get
• 9:35
  into
• 9:35
  the
• 9:35
  appetite
• 9:36
  and
• 9:36
  the
• 9:36
  sleep
• 9:37
  and
• 9:37
  you're
• 9:37
  not
• 9:37
  reactive
• 9:38
  to
• 9:38
  any
• 9:38
  kind
• 9:39
  of
• 9:39
  pleasurable
• 9:39
  stimuli
• 9:40
  anymore,
• 9:41
  you
• 9:41
  win
• 9:41
  the
• 9:41
  lottery
• 9:41
  and
• 9:41
  you
• 9:42
  just
• 9:42
  focus
• 9:42
  on
• 9:42
  the
• 9:42
  taxes.
• 9:44
  It
• 9:44
  doesn't
• 9:45
  fit
• 9:45
  with
• 9:45
  an
• 9:45
  adjustment
• 9:46
  disorder
• 9:46
  because
• 9:47
  you're
• 9:47
  not
• 9:47
  reacting
• 9:48
  to
• 9:48
  that
• 9:48
  stressor
• 9:49
  anymore.
• 9:49
  You're,
• 9:50
  you're,
• 9:50
  you're
• 9:51
  struggles
• 9:52
  or
• 9:52
  your
• 9:53
  distress.
• 9:54
  It
• 9:54
  seems
• 9:55
  deeper
• 9:55
  than
• 9:55
  just
• 9:56
  one
• 9:56
  identifiable
• 9:57
  stressor
• 9:57
  at
• 9:57
  that
• 9:58
  point.
• 9:58
  Right.
• 9:59
  So
• 9:59
  it
• 9:59
  kind
• 9:59
  of
• 10:00
  makes
• 10:00
  sense
• 10:00
  that
• 10:00
  the
• 10:00
  DSM
• 10:01
  5
• 10:01
  is
• 10:02
  mandating
• 10:03
  that
• 10:03
  you
• 10:03
  have
• 10:03
  to
• 10:04
  meet
• 10:04
  criteria.
• 10:05
  And
• 10:05
  if
• 10:05
  you
• 10:05
  do,
• 10:06
  it's
• 10:06
  not
• 10:06
  an
• 10:06
  adjustment
• 10:07
  disorder,
• 10:08
  regardless
• 10:08
  of
• 10:08
  the
• 10:08
  fact
• 10:09
  that
• 10:09
  it
• 10:09
  looks
• 10:09
  completely
• 10:10
  on
• 10:10
  paper
• 10:11
  like
• 10:11
  an
• 10:11
  adjustment
• 10:12
  disorder.
• 10:12
  I
• 10:13
  will
• 10:13
  say
• 10:13
  too,
• 10:13
  for
• 10:14
  those
• 10:14
  who
• 10:14
  wanted
• 10:14
  me
• 10:14
  to
• 10:15
  elaborate,
• 10:15
  don't
• 10:16
  be
• 10:16
  intimidated
• 10:16
  by
• 10:17
  pdd.
• 10:18
  We'll
• 10:18
  do
• 10:18
  this
• 10:19
  in
• 10:19
  a
• 10:19
  separate
• 10:19
  episode.
• 10:19
  It's
• 10:20
  actually
• 10:21
  kind
• 10:21
  of
• 10:21
  easy
• 10:22
  to
• 10:22
  diagnose
• 10:22
  in
• 10:23
  a
• 10:23
  way.
• 10:23
  I've
• 10:24
  seen
• 10:24
  it
• 10:24
  quite
• 10:24
  a
• 10:25
  bunch
• 10:25
  of
• 10:26
  times.
• 10:26
  It's
• 10:26
  not
• 10:26
  that
• 10:26
  you
• 10:26
  see
• 10:27
  it
• 10:27
  every
• 10:27
  day
• 10:27
  either.
• 10:29
  However,
• 10:29
  it's
• 10:30
  pretty
• 10:30
  easy
• 10:31
  to
• 10:31
  sniff
• 10:31
  out.
• 10:32
  And
• 10:32
  we
• 10:32
  didn't
• 10:33
  get
• 10:33
  any
• 10:33
  of
• 10:33
  that
• 10:33
  here.
• 10:34
  We
• 10:34
  didn't
• 10:34
  get
• 10:34
  any
• 10:35
  of
• 10:35
  the
• 10:35
  dysthymia
• 10:36
  or
• 10:36
  persistent
• 10:36
  depressive
• 10:37
  disorder
• 10:37
  vibes
• 10:38
  because
• 10:38
  persistent
• 10:39
  depressive
• 10:39
  disorder
• 10:40
  usually
• 10:40
  lasts
• 10:40
  for
• 10:41
  at
• 10:41
  least
• 10:41
  two
• 10:41
  years
• 10:42
  more
• 10:42
  days
• 10:42
  than
• 10:42
  not.
• 10:43
  And
• 10:43
  there's
• 10:43
  not
• 10:44
  one
• 10:44
  two
• 10:44
  week
• 10:44
  period
• 10:45
  where
• 10:45
  the
• 10:46
  patient
• 10:46
  is
• 10:46
  not
• 10:46
  feeling
• 10:47
  depressed.
• 10:48
  Okay,
• 10:49
  we
• 10:50
  clearly
• 10:50
  have
• 10:51
  eight
• 10:51
  weeks
• 10:51
  of
• 10:52
  misery
• 10:52
  here
• 10:53
  from,
• 10:53
  from
• 10:53
  Greta
• 10:54
  being
• 10:54
  laid
• 10:54
  off
• 10:54
  from
• 10:54
  Dunkin
• 10:55
  Donuts.
• 10:56
  And
• 10:56
  so
• 10:56
  you
• 10:56
  don't
• 10:56
  have
• 10:56
  two
• 10:57
  years
• 10:57
  to
• 10:57
  justify
• 10:58
  persistent
• 10:58
  depressive
• 10:58
  disorder.
• 10:59
  If
• 10:59
  you're
• 10:59
  just
• 10:59
  vaguely
• 11:00
  familiar
• 11:01
  with
• 11:01
  the
• 11:01
  diagnostic
• 11:02
  criteria
• 11:03
  for
• 11:03
  some
• 11:03
  of
• 11:03
  these,
• 11:04
  for
• 11:04
  some
• 11:04
  of
• 11:05
  these
• 11:05
  syndromes,
• 11:05
  they'll
• 11:06
  be
• 11:06
  pretty
• 11:06
  easy
• 11:07
  for
• 11:07
  you
• 11:07
  to
• 11:07
  rule
• 11:07
  out
• 11:07
  on
• 11:08
  a,
• 11:08
  on
• 11:08
  a
• 11:08
  test
• 11:08
  question
• 11:09
  because
• 11:09
  you
• 11:10
  don't
• 11:10
  have
• 11:10
  two
• 11:10
  years
• 11:10
  here.
• 11:11
  Right.
• 11:11
  You
• 11:11
  might
• 11:12
  be
• 11:12
  confused
• 11:12
  like,
• 11:12
  well,
• 11:12
  wait
• 11:13
  a
• 11:13
  minute,
• 11:13
  what,
• 11:14
  what
• 11:14
  symptom,
• 11:14
  what
• 11:15
  symptoms
• 11:15
  are
• 11:15
  different
• 11:15
  in
• 11:16
  persistent
• 11:16
  depressive
• 11:17
  disorder
• 11:17
  versus
• 11:17
  major
• 11:18
  depressive
• 11:18
  disorder?
• 11:19
  Well,
• 11:19
  there's
• 11:19
  a
• 11:19
  lot
• 11:19
  of
• 11:19
  overlap
• 11:20
  there,
• 11:20
  of
• 11:20
  course.
• 11:21
  Right.
• 11:21
  Low
• 11:22
  energy,
• 11:23
  sleep
• 11:23
  and
• 11:23
  appetite
• 11:24
  fluctuations.
• 11:25
  However,
• 11:26
  the
• 11:26
  biggest
• 11:27
  distinguisher
• 11:28
  between
• 11:29
  PDD
• 11:29
  and
• 11:30
  MDD
• 11:31
  is
• 11:31
  the
• 11:32
  time.
• 11:32
  Right.
• 11:33
  The
• 11:33
  two
• 11:33
  year
• 11:33
  mark
• 11:34
  and
• 11:34
  not
• 11:35
  having
• 11:35
  two
• 11:35
  weeks
• 11:36
  or
• 11:36
  more
• 11:37
  where
• 11:38
  you
• 11:38
  were
• 11:39
  in
• 11:39
  the
• 11:39
  absence
• 11:39
  of
• 11:40
  depressive
• 11:40
  symptoms.
• 11:41
  So
• 11:42
  we
• 11:42
  can
• 11:42
  get
• 11:42
  rid
• 11:42
  of
• 11:42
  that
• 11:42
  one
• 11:43
  and
• 11:43
  then
• 11:43
  unspecified
• 11:44
  depressive
• 11:44
  disorders.
• 11:45
  Incorrect.
• 11:45
  That
• 11:46
  would
• 11:46
  be
• 11:46
  option
• 11:46
  D,
• 11:46
  because
• 11:46
  we
• 11:47
  have
• 11:47
  met
• 11:47
  criteria
• 11:48
  here
• 11:48
  for
• 11:48
  a
• 11:48
  major
• 11:48
  depressive
• 11:49
  disorder
• 11:49
  single
• 11:50
  episode,
• 11:50
  because
• 11:50
  it's
• 11:51
  her
• 11:51
  first
• 11:51
  episode
• 11:52
  that
• 11:52
  we're
• 11:52
  aware
• 11:52
  of.
• 11:53
  So
• 11:54
  I
• 11:54
  thought
• 11:54
  this
• 11:54
  was
• 11:55
  kind
• 11:55
  of
• 11:55
  an
• 11:55
  interesting
• 11:56
  case
• 11:56
  study,
• 11:56
  to
• 11:57
  be
• 11:57
  perfectly
• 11:57
  honest
• 11:57
  with
• 11:58
  you,
• 11:58
  only
• 11:59
  because
• 12:00
  it
• 12:00
  just
• 12:00
  screams
• 12:01
  adjustment
• 12:02
  disorder.
• 12:02
  And
• 12:02
  I
• 12:02
  think
• 12:03
  that
• 12:03
  in
• 12:03
  a
• 12:04
  lot
• 12:04
  of
• 12:04
  settings
• 12:04
  the
• 12:05
  tendency
• 12:05
  would
• 12:05
  absolutely
• 12:06
  be
• 12:07
  to
• 12:07
  chalk
• 12:07
  this
• 12:08
  up
• 12:08
  as
• 12:08
  a
• 12:08
  significant
• 12:09
  life
• 12:09
  stressor
• 12:10
  that
• 12:11
  is
• 12:12
  worthy
• 12:12
  of
• 12:12
  an
• 12:12
  adjustment
• 12:13
  diagnosis
• 12:14
  and
• 12:14
  not
• 12:14
  a
• 12:14
  major
• 12:14
  depressive
• 12:15
  disorder.
• 12:16
  Especially
• 12:17
  given
• 12:17
  the
• 12:17
  fact
• 12:18
  that
• 12:18
  this
• 12:18
  patient
• 12:18
  has
• 12:19
  never
• 12:19
  been
• 12:19
  depressed
• 12:20
  before
• 12:20
  and
• 12:20
  she's
• 12:20
  35
• 12:21
  too,
• 12:21
  right?
• 12:22
  So
• 12:23
  that's
• 12:23
  kind
• 12:23
  of
• 12:23
  unusual.
• 12:24
  Normally
• 12:24
  if
• 12:24
  someone's
• 12:25
  coming
• 12:25
  to
• 12:25
  you
• 12:25
  and
• 12:25
  they're
• 12:26
  depressed
• 12:26
  and
• 12:27
  they're
• 12:27
  35,
• 12:28
  at
• 12:28
  least
• 12:28
  in
• 12:28
  my
• 12:29
  experience
• 12:29
  they've
• 12:29
  had
• 12:30
  some
• 12:30
  exposure
• 12:31
  to
• 12:31
  depressive
• 12:31
  symptoms
• 12:32
  in
• 12:32
  the
• 12:32
  past.
• 12:32
  So
• 12:33
  this
• 12:33
  would
• 12:33
  more
• 12:33
  likely
• 12:33
  be
• 12:34
  a
• 12:34
  recurrent
• 12:34
  moderate.
• 12:35
  It
• 12:35
  is
• 12:35
  unusual
• 12:36
  to
• 12:36
  find
• 12:36
  somebody
• 12:37
  who's
• 12:37
  35
• 12:38
  and
• 12:38
  they
• 12:38
  had
• 12:38
  it.
• 12:39
  They
• 12:39
  have
• 12:39
  MDD
• 12:39
  single
• 12:40
  episode
• 12:40
  the
• 12:41
  first
• 12:41
  time.
• 12:42
  But
• 12:42
  again,
• 12:42
  that's
• 12:42
  why
• 12:43
  you
• 12:43
  ask
• 12:43
  for
• 12:43
  a
• 12:43
  family
• 12:44
  history
• 12:44
  and
• 12:44
  try
• 12:44
  to
• 12:45
  make
• 12:45
  sense
• 12:45
  of
• 12:45
  this.
• 12:46
  I
• 12:46
  hope
• 12:46
  this
• 12:47
  helps
• 12:47
  you
• 12:48
  have
• 12:48
  a
• 12:48
  better
• 12:48
  appreciation
• 12:49
  and
• 12:49
  be
• 12:50
  very
• 12:50
  picky
• 12:50
  about
• 12:50
  the
• 12:51
  adjustment
• 12:51
  disorder
• 12:52
  versus
• 12:52
  mdd.
• 12:53
  And
• 12:53
  I
• 12:53
  think
• 12:53
  it's
• 12:54
  gonna
• 12:54
  make
• 12:54
  you
• 12:54
  a
• 12:54
  more
• 12:55
  precise
• 12:56
  diagnostician
• 12:57
  because
• 12:59
  adjustment
• 12:59
  disorders
• 13:00
  are
• 13:00
  extremely
• 13:01
  common
• 13:01
  and
• 13:02
  so
• 13:02
  is
• 13:02
  major
• 13:02
  depressive
• 13:03
  disorder.
• 13:04
  And
• 13:04
  knowing
• 13:04
  the
• 13:04
  difference
• 13:05
  or
• 13:05
  having
• 13:05
  a
• 13:05
  little
• 13:05
  more
• 13:06
  clarity
• 13:06
  I
• 13:07
  think
• 13:07
  is
• 13:07
  super,
• 13:08
  super
• 13:08
  important.
• 13:09
  If
• 13:10
  you
• 13:10
  become
• 13:10
  a
• 13:10
  Patreon
• 13:11
  member,
• 13:11
  I
• 13:11
  am
• 13:12
  going
• 13:12
  to
• 13:12
  include
• 13:13
  nine
• 13:14
  things
• 13:14
  you
• 13:15
  should
• 13:15
  know
• 13:15
  about
• 13:15
  adjustment
• 13:16
  disorders.
• 13:17
  A
• 13:17
  clinical
• 13:17
  guide
• 13:18
  that
• 13:18
  really
• 13:18
  distills
• 13:19
  some
• 13:19
  of
• 13:19
  the
• 13:19
  greatest
• 13:19
  wisdom
• 13:20
  about
• 13:20
  adjustment
• 13:20
  disorders
• 13:21
  and
• 13:21
  that
• 13:21
  will
• 13:21
  be
• 13:22
  available
• 13:22
  to
• 13:22
  our
• 13:23
  patreon
• 13:23
  members.
• 13:24
  It's
• 13:24
  $3
• 13:25
  a
• 13:25
  month
• 13:26
  to
• 13:26
  keep
• 13:26
  giving
• 13:27
  you
• 13:27
  real
• 13:28
  rich
• 13:28
  evidence
• 13:29
  based
• 13:29
  handy
• 13:29
  go
• 13:30
  buys
• 13:30
  to
• 13:30
  help
• 13:30
  you
• 13:31
  pass
• 13:31
  your
• 13:31
  boards
• 13:31
  and
• 13:31
  be
• 13:31
  at
• 13:32
  the
• 13:32
  top
• 13:32
  of
• 13:32
  your
• 13:32
  game.
• 13:32
  We
• 13:33
  like
• 13:33
  to
• 13:33
  keep
• 13:33
  it
• 13:33
  creative
• 13:34
  and
• 13:34
  new.
• 13:34
  We
• 13:35
  have
• 13:35
  a
• 13:35
  lot
• 13:35
  of
• 13:35
  good
• 13:35
  resources
• 13:36
  for
• 13:36
  Patreon
• 13:37
  members.
• 13:37
  So
• 13:37
  keep
• 13:37
  spreading
• 13:38
  the
• 13:38
  good
• 13:38
  word.
• 13:38
  All
• 13:39
  of
• 13:39
  you
• 13:39
  stay
• 13:39
  warm.
• 13:40
  It's
• 13:40
  pretty
• 13:41
  brutal
• 13:41
  out
• 13:41
  there
• 13:42
  and
• 13:42
  God
• 13:42
  forbid
• 13:43
  don't
• 13:43
  drive
• 13:44
  because
• 13:44
  we
• 13:44
  don't
• 13:44
  want
• 13:45
  you
• 13:45
  sliding
• 13:45
  all
• 13:45
  over
• 13:46
  the
• 13:46
  place.
• 13:47
  That
• 13:47
  would
• 13:47
  not
• 13:47
  be
• 13:47
  fun.
• 13:48
  So
• 13:48
  anyway,
• 13:49
  my
• 13:49
  friends
• 13:49
  take
• 13:49
  good
• 13:50
  care
• 13:50
  and
• 13:50
  go
• 13:51
  to
• 13:51
  the
• 13:51
  show
• 13:51
  notes
• 13:51
  to
• 13:52
  become
• 13:52
  Patreon
• 13:52
  members
• 13:53
  or
• 13:53
  to
• 13:53
  email
• 13:53
  me
• 13:54
  because
• 13:54
  you
• 13:55
  can
• 13:55
  email
• 13:55
  me
• 13:55
  episode
• 13:56
  ideas
• 13:56
  or
• 13:57
  questions
• 13:57
  and
• 13:58
  we're
• 13:58
  going
• 13:58
  to
• 13:58
  collaborate
• 13:59
  and
• 13:59
  make
• 13:59
  this
• 14:00
  the
• 14:00
  coolest
• 14:00
  study
• 14:01
  hall
• 14:01
  ever.
• 14:02
  Anyway,
• 14:03
  love
• 14:03
  you
• 14:03
  all.
• 14:03
  Thank
• 14:03
  you
• 14:04
  for
• 14:04
  tuning
• 14:04
  in.
• 14:04
  I'm
• 14:05
  out.
• 14:05
  Bye
• 14:05
  bye.