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Board Bombs: The KEY Schizophrenia Symptoms Most Students Underestimate · Pearls and Prep

• 0:00
  Foreign.
• 0:04
  Welcome
• 0:05
  back,
• 0:05
  my
• 0:05
  friends,
• 0:06
  to
• 0:06
  another
• 0:06
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:07
  and
• 0:07
  Prep.
• 0:08
  Npz.
• 0:08
  Here,
• 0:08
  your
• 0:09
  preceptor
• 0:09
  in
• 0:09
  your
• 0:10
  pocket,
• 0:10
  your
• 0:10
  go
• 0:11
  to
• 0:11
  place
• 0:11
  for
• 0:11
  pearls
• 0:12
  that
• 0:12
  prep
• 0:12
  you
• 0:12
  to
• 0:13
  practice.
• 0:13
  We
• 0:14
  have
• 0:14
  a
• 0:14
  board
• 0:15
  bomb
• 0:15
  today,
• 0:16
  my
• 0:16
  friends,
• 0:16
  back
• 0:17
  by
• 0:17
  popular
• 0:18
  demand.
• 0:18
  You
• 0:19
  all
• 0:19
  love
• 0:19
  these.
• 0:19
  I
• 0:20
  love
• 0:20
  these.
• 0:20
  They're
• 0:20
  fun,
• 0:21
  they're
• 0:21
  quick,
• 0:22
  they're
• 0:22
  high
• 0:22
  yield,
• 0:23
  and
• 0:23
  they're
• 0:23
  exciting.
• 0:24
  And
• 0:24
  here
• 0:24
  we
• 0:25
  go.
• 0:25
  Without
• 0:25
  further
• 0:25
  ado,
• 0:26
  you
• 0:27
  have
• 0:27
  a
• 0:27
  32
• 0:28
  year
• 0:28
  old
• 0:28
  male,
• 0:29
  we'll
• 0:29
  call
• 0:29
  him
• 0:29
  Garrett,
• 0:31
  with
• 0:31
  a
• 0:31
  six
• 0:31
  year
• 0:32
  history
• 0:32
  of
• 0:32
  schizophrenia.
• 0:33
  He's
• 0:33
  brought
• 0:33
  to
• 0:33
  your
• 0:33
  clinic
• 0:34
  with
• 0:34
  his
• 0:34
  mother.
• 0:35
  Now,
• 0:35
  she
• 0:35
  tells
• 0:36
  you
• 0:36
  that
• 0:36
  he
• 0:37
  occasionally
• 0:37
  talks
• 0:38
  to
• 0:38
  himself.
• 0:39
  He
• 0:39
  believes
• 0:39
  his
• 0:40
  neighbors
• 0:40
  are
• 0:40
  monitoring
• 0:41
  him,
• 0:41
  but
• 0:42
  these
• 0:42
  symptoms
• 0:42
  have
• 0:42
  improved
• 0:43
  significantly
• 0:44
  since
• 0:44
  starting
• 0:44
  Risperdal.
• 0:45
  Now,
• 0:46
  despite
• 0:46
  all
• 0:46
  his
• 0:46
  improvements,
• 0:47
  she's
• 0:48
  most
• 0:48
  concerned
• 0:49
  that
• 0:49
  he's
• 0:49
  dropped
• 0:50
  out
• 0:50
  of
• 0:50
  his
• 0:50
  vocational
• 0:50
  training
• 0:51
  program.
• 0:51
  He's
• 0:52
  not
• 0:52
  really
• 0:52
  hanging
• 0:52
  out
• 0:52
  with
• 0:52
  his
• 0:53
  friends
• 0:53
  anymore.
• 0:53
  He's
• 0:53
  not
• 0:54
  really
• 0:54
  showering.
• 0:55
  He's
• 0:55
  showing
• 0:55
  very
• 0:55
  little
• 0:56
  interest
• 0:56
  in
• 0:56
  activities
• 0:57
  he
• 0:57
  previously
• 0:58
  enjoyed.
• 0:59
  His
• 0:59
  speech
• 1:00
  is
• 1:00
  kind
• 1:00
  of
• 1:00
  sparse
• 1:01
  with
• 1:01
  you.
• 1:01
  He's
• 1:01
  not
• 1:01
  talking
• 1:02
  a
• 1:02
  whole
• 1:02
  lot
• 1:03
  on
• 1:03
  the
• 1:03
  mental
• 1:03
  status
• 1:03
  exam.
• 1:04
  He's
• 1:04
  calm,
• 1:04
  cooperative,
• 1:05
  with
• 1:05
  a
• 1:05
  flat
• 1:06
  affect,
• 1:06
  minimally
• 1:07
  spontaneous
• 1:08
  speech,
• 1:09
  and
• 1:10
  intermittent
• 1:10
  auditory
• 1:11
  hallucinations.
• 1:12
  It
• 1:12
  looks
• 1:12
  like
• 1:12
  he's
• 1:12
  kind
• 1:13
  of
• 1:13
  responding
• 1:13
  to
• 1:14
  some
• 1:14
  internal
• 1:14
  stimuli
• 1:15
  potentially.
• 1:16
  Now,
• 1:16
  he's
• 1:16
  oriented
• 1:17
  and
• 1:17
  his
• 1:17
  thought
• 1:17
  process
• 1:18
  is
• 1:18
  linear
• 1:18
  though.
• 1:19
  So
• 1:19
  which
• 1:20
  of
• 1:20
  the
• 1:20
  following
• 1:20
  symptom
• 1:21
  domains
• 1:21
  is
• 1:22
  most
• 1:22
  strongly
• 1:22
  associated
• 1:23
  with
• 1:23
  this
• 1:23
  patient's
• 1:24
  decline
• 1:24
  in
• 1:25
  social
• 1:25
  and
• 1:26
  occupational
• 1:26
  functioning?
• 1:28
  Okay,
• 1:29
  is
• 1:29
  it
• 1:29
  A,
• 1:30
  persecutory
• 1:31
  delusions,
• 1:32
  B,
• 1:32
  auditory
• 1:33
  hallucinations,
• 1:34
  C,
• 1:35
  negative
• 1:35
  symptoms,
• 1:36
  D,
• 1:36
  disorganized
• 1:37
  thinking
• 1:38
  or
• 1:39
  E,
• 1:39
  medication
• 1:40
  side
• 1:40
  effects
• 1:41
  or.
• 1:41
  Okay,
• 1:42
  there's
• 1:42
  no
• 1:42
  F.
• 1:43
  Now,
• 1:45
  so
• 1:46
  basically
• 1:46
  the
• 1:46
  question
• 1:47
  is
• 1:47
  asking,
• 1:48
  which
• 1:49
  symptom
• 1:49
  domain
• 1:50
  is
• 1:51
  most
• 1:51
  responsible
• 1:52
  for.
• 1:53
  For
• 1:53
  this
• 1:53
  patient's
• 1:54
  decline
• 1:54
  in
• 1:55
  his
• 1:55
  ability
• 1:55
  to
• 1:56
  meet
• 1:56
  friends
• 1:56
  and
• 1:57
  work?
• 1:57
  And
• 1:58
  I'll
• 1:58
  add
• 1:58
  to
• 1:58
  this
• 1:59
  question
• 1:59
  just
• 1:59
  briefly
• 2:00
  and
• 2:00
  I
• 2:01
  will
• 2:01
  say,
• 2:01
  which
• 2:02
  of
• 2:02
  these
• 2:02
  symptoms
• 2:03
  that
• 2:03
  I
• 2:03
  just
• 2:03
  mentioned,
• 2:04
  which
• 2:04
  of
• 2:05
  those
• 2:05
  symptom
• 2:05
  domains
• 2:06
  that
• 2:06
  I
• 2:06
  just
• 2:06
  mentioned
• 2:06
  is
• 2:07
  actually
• 2:07
  the
• 2:07
  most
• 2:08
  functionally
• 2:09
  disabling
• 2:09
  in
• 2:09
  schizophrenia?
• 2:11
  Okay,
• 2:11
  that's
• 2:12
  an
• 2:12
  even
• 2:12
  better
• 2:12
  way
• 2:13
  to
• 2:13
  look
• 2:13
  at
• 2:13
  this
• 2:13
  question.
• 2:14
  So,
• 2:14
  in
• 2:14
  addition
• 2:14
  to
• 2:14
  Garrett,
• 2:15
  his
• 2:15
  social
• 2:16
  and
• 2:16
  occupational
• 2:17
  dysfunction,
• 2:18
  what
• 2:18
  symptoms
• 2:19
  more
• 2:19
  broadly
• 2:20
  are
• 2:20
  responsible
• 2:21
  for
• 2:21
  the
• 2:21
  greatest
• 2:22
  deal
• 2:22
  of
• 2:22
  functional
• 2:22
  impairment
• 2:24
  and
• 2:24
  long
• 2:24
  term
• 2:24
  disability
• 2:25
  and
• 2:25
  schizophrenia?
• 2:26
  Again,
• 2:26
  is
• 2:26
  it
• 2:26
  persecutory
• 2:27
  delusions,
• 2:28
  auditory
• 2:29
  hallucinations,
• 2:30
  negative
• 2:30
  symptoms,
• 2:32
  disorganized
• 2:32
  thinking,
• 2:33
  or
• 2:33
  medication
• 2:34
  side
• 2:34
  effects?
• 2:35
  Now,
• 2:35
  you
• 2:35
  can
• 2:35
  pause
• 2:36
  this,
• 2:36
  you
• 2:36
  can
• 2:37
  talk
• 2:37
  to
• 2:37
  your
• 2:38
  professors,
• 2:38
  go
• 2:39
  into
• 2:39
  your
• 2:39
  Zoom
• 2:39
  breakouts,
• 2:40
  discuss
• 2:41
  this
• 2:41
  with
• 2:41
  peers.
• 2:43
  All
• 2:43
  right,
• 2:44
  so
• 2:44
  spoiler
• 2:45
  alert,
• 2:45
  we're
• 2:45
  going
• 2:45
  to
• 2:45
  get
• 2:46
  into
• 2:46
  the
• 2:46
  answers
• 2:46
  here.
• 2:47
  So,
• 2:47
  my
• 2:48
  friends,
• 2:48
  I'm,
• 2:48
  I'm
• 2:48
  going
• 2:48
  to
• 2:49
  go
• 2:49
  straight
• 2:49
  to
• 2:49
  the
• 2:49
  answer
• 2:50
  rather
• 2:50
  than
• 2:50
  Go
• 2:50
  to
• 2:50
  the
• 2:50
  wrong
• 2:51
  ones
• 2:51
  like
• 2:51
  I
• 2:51
  usually
• 2:51
  do.
• 2:52
  But
• 2:52
  the
• 2:53
  answer
• 2:53
  here
• 2:53
  is
• 2:53
  negative
• 2:54
  symptoms.
• 2:55
  Okay?
• 2:56
  Negative
• 2:56
  symptoms
• 2:57
  are
• 2:58
  the
• 2:58
  greatest
• 2:58
  driver
• 2:59
  of
• 2:59
  long
• 2:59
  term
• 3:00
  disability
• 3:00
  in
• 3:01
  schizophrenia
• 3:02
  and
• 3:03
  I
• 3:03
  would
• 3:03
  argue
• 3:03
  one
• 3:04
  of
• 3:04
  the
• 3:04
  most
• 3:04
  overlooked
• 3:06
  elements
• 3:07
  in
• 3:07
  psychiatry.
• 3:08
  It's
• 3:08
  exactly
• 3:09
  why
• 3:09
  we
• 3:09
  do
• 3:10
  this
• 3:10
  podcast,
• 3:11
  Pearls
• 3:11
  and
• 3:11
  Prep,
• 3:11
  right?
• 3:12
  I
• 3:12
  call
• 3:13
  my
• 3:13
  work
• 3:13
  that
• 3:13
  I
• 3:13
  do
• 3:14
  here
• 3:14
  Pearl
• 3:14
  dives,
• 3:15
  right?
• 3:15
  I
• 3:15
  go
• 3:15
  into
• 3:15
  the
• 3:16
  depths
• 3:16
  of
• 3:16
  the
• 3:16
  ocean
• 3:17
  and
• 3:17
  I
• 3:17
  try
• 3:17
  to
• 3:18
  find
• 3:18
  big
• 3:18
  shiny
• 3:19
  pearls
• 3:20
  or
• 3:21
  data
• 3:21
  or
• 3:21
  evidence
• 3:22
  or
• 3:22
  topics
• 3:23
  that
• 3:24
  we
• 3:24
  all
• 3:24
  need
• 3:24
  to
• 3:25
  look
• 3:25
  at.
• 3:25
  And
• 3:26
  when
• 3:26
  we
• 3:26
  look
• 3:26
  at
• 3:26
  them,
• 3:26
  they
• 3:27
  kind
• 3:27
  of
• 3:27
  blind
• 3:27
  us
• 3:28
  and
• 3:28
  make
• 3:28
  us
• 3:29
  see
• 3:29
  the
• 3:29
  world
• 3:30
  totally
• 3:31
  in
• 3:31
  a
• 3:31
  different
• 3:31
  fashion.
• 3:32
  But
• 3:32
  my
• 3:32
  point
• 3:33
  is
• 3:33
  I
• 3:34
  look
• 3:34
  for
• 3:34
  the
• 3:34
  big
• 3:34
  flashy
• 3:35
  pearls.
• 3:35
  I
• 3:35
  bring
• 3:36
  them
• 3:36
  up
• 3:36
  to
• 3:36
  you
• 3:37
  because
• 3:37
  it's
• 3:38
  incredibly
• 3:38
  important
• 3:39
  and
• 3:39
  they're
• 3:39
  just
• 3:39
  laying
• 3:39
  there
• 3:40
  sometimes.
• 3:40
  And
• 3:41
  this
• 3:41
  is
• 3:41
  one
• 3:42
  that
• 3:42
  struck
• 3:42
  me
• 3:42
  when
• 3:42
  I
• 3:43
  dove
• 3:44
  into
• 3:44
  the
• 3:45
  research
• 3:45
  and
• 3:45
  it's
• 3:45
  like,
• 3:46
  yeah,
• 3:46
  we
• 3:46
  are
• 3:46
  so
• 3:47
  good
• 3:48
  at
• 3:48
  conquering
• 3:49
  or
• 3:49
  trying
• 3:49
  to
• 3:50
  conquer
• 3:50
  the
• 3:51
  big
• 3:51
  flashy
• 3:53
  features
• 3:54
  of
• 3:54
  schizophrenia,
• 3:55
  right?
• 3:55
  The
• 3:55
  hallucinations,
• 3:56
  the
• 3:56
  delusions,
• 3:57
  the
• 3:57
  people
• 3:57
  who
• 3:58
  feel
• 3:58
  like
• 3:58
  they're
• 3:58
  being
• 3:58
  recorded,
• 3:59
  the
• 4:00
  devils
• 4:01
  that
• 4:01
  they
• 4:01
  see
• 4:01
  on
• 4:01
  their
• 4:02
  shoulder,
• 4:02
  the
• 4:02
  shadows,
• 4:03
  the
• 4:04
  persecutory
• 4:05
  command
• 4:06
  style
• 4:07
  hallucinations
• 4:08
  where
• 4:08
  people
• 4:08
  are
• 4:08
  being
• 4:09
  told
• 4:09
  to
• 4:09
  jump
• 4:09
  off
• 4:10
  a
• 4:10
  cliff
• 4:10
  or
• 4:10
  drive
• 4:10
  into
• 4:11
  traffic.
• 4:11
  It's
• 4:12
  big,
• 4:12
  it's
• 4:12
  flashy,
• 4:12
  it's
• 4:13
  Hollywood,
• 4:13
  it's
• 4:13
  violent.
• 4:14
  And
• 4:14
  don't
• 4:14
  get
• 4:14
  me
• 4:14
  wrong,
• 4:14
  it
• 4:15
  is
• 4:15
  significantly
• 4:15
  impairing.
• 4:17
  But
• 4:17
  we
• 4:18
  need
• 4:18
  to
• 4:18
  stop
• 4:18
  and
• 4:18
  ask
• 4:19
  ourselves,
• 4:20
  are
• 4:20
  we
• 4:20
  treating
• 4:21
  both
• 4:21
  sides
• 4:22
  to
• 4:22
  this?
• 4:22
  Right?
• 4:23
  And
• 4:24
  there
• 4:24
  is
• 4:24
  no
• 4:25
  FDA
• 4:25
  approved
• 4:26
  treatment
• 4:27
  in
• 4:27
  America
• 4:28
  for
• 4:29
  negative
• 4:29
  symptoms
• 4:30
  and
• 4:30
  schizophrenia,
• 4:30
  and
• 4:31
  yet
• 4:31
  they
• 4:31
  are
• 4:31
  the
• 4:32
  single
• 4:32
  greatest
• 4:32
  driver
• 4:33
  of
• 4:34
  long
• 4:34
  term
• 4:34
  functional
• 4:35
  disability.
• 4:36
  Not
• 4:36
  the
• 4:36
  big
• 4:36
  flashy
• 4:37
  hallucinations
• 4:38
  and
• 4:38
  delusions
• 4:38
  and
• 4:38
  disorganization.
• 4:40
  That's
• 4:40
  a
• 4:40
  really
• 4:41
  big
• 4:41
  deal
• 4:41
  because
• 4:42
  it
• 4:43
  takes
• 4:43
  up
• 4:43
  a
• 4:43
  big
• 4:43
  chunk
• 4:44
  of
• 4:44
  the
• 4:44
  DSM
• 4:44
  5
• 4:44
  TR
• 4:45
  diagnosis.
• 4:45
  It's
• 4:46
  probably
• 4:46
  the
• 4:46
  most
• 4:46
  prominent
• 4:47
  one.
• 4:47
  It's
• 4:47
  the
• 4:47
  one
• 4:48
  we
• 4:48
  think
• 4:48
  about
• 4:48
  most
• 4:49
  when
• 4:49
  we
• 4:49
  think
• 4:49
  of
• 4:49
  schizophrenia.
• 4:50
  It's
• 4:51
  very
• 4:51
  similar
• 4:51
  to
• 4:51
  bipolar.
• 4:52
  When
• 4:52
  you
• 4:52
  ask
• 4:53
  people
• 4:53
  or
• 4:53
  students
• 4:54
  or
• 4:55
  anybody,
• 4:55
  clinicians
• 4:56
  who've
• 4:56
  been
• 4:56
  in
• 4:57
  the
• 4:57
  game
• 4:57
  for
• 4:57
  30
• 4:57
  years,
• 4:57
  what
• 4:58
  are
• 4:58
  the
• 4:58
  biggest
• 4:58
  signs
• 4:59
  of
• 4:59
  bipolarity?
• 5:00
  And
• 5:00
  they're
• 5:00
  going
• 5:00
  to
• 5:00
  all
• 5:00
  say
• 5:01
  grandiosity,
• 5:02
  pressured
• 5:02
  speech,
• 5:03
  goal
• 5:03
  directed
• 5:04
  activity,
• 5:04
  decreased
• 5:05
  need
• 5:05
  for
• 5:05
  sleep,
• 5:05
  increased
• 5:06
  energy,
• 5:06
  okay?
• 5:07
  And
• 5:07
  like
• 5:08
  1
• 5:08
  out
• 5:08
  of
• 5:08
  30
• 5:09
  people
• 5:09
  raise
• 5:09
  their
• 5:09
  hand
• 5:10
  and
• 5:10
  talk
• 5:10
  about
• 5:10
  the
• 5:11
  depression
• 5:11
  symptoms,
• 5:12
  even
• 5:12
  though
• 5:12
  we
• 5:12
  know
• 5:12
  that,
• 5:13
  that
• 5:13
  the
• 5:13
  depression
• 5:13
  is
• 5:14
  like
• 5:14
  80%
• 5:15
  of
• 5:15
  the
• 5:15
  experience
• 5:16
  from,
• 5:16
  of
• 5:16
  that
• 5:16
  patient
• 5:17
  is
• 5:17
  going
• 5:18
  to
• 5:18
  be
• 5:18
  in
• 5:18
  a
• 5:18
  depressed
• 5:19
  mood
• 5:19
  state.
• 5:19
  And
• 5:20
  not
• 5:20
  the
• 5:20
  big
• 5:20
  flashy
• 5:21
  Hollywood
• 5:21
  manic
• 5:22
  symptoms
• 5:23
  where
• 5:23
  you
• 5:23
  sell
• 5:24
  your
• 5:24
  girlfriend's
• 5:24
  car
• 5:25
  to
• 5:25
  a
• 5:26
  Bolivian
• 5:26
  dictator.
• 5:27
  So
• 5:29
  this
• 5:29
  is
• 5:29
  why
• 5:29
  I
• 5:30
  think
• 5:30
  this
• 5:30
  is
• 5:30
  so
• 5:30
  fascinating,
• 5:31
  because
• 5:32
  this
• 5:32
  is
• 5:32
  a
• 5:32
  huge
• 5:33
  functional
• 5:33
  Limitation,
• 5:34
  Right.
• 5:34
  Folks
• 5:35
  who
• 5:35
  have
• 5:36
  negative
• 5:36
  symptoms
• 5:37
  untreated,
• 5:38
  there's
• 5:39
  massive
• 5:39
  implications
• 5:40
  to
• 5:40
  that,
• 5:40
  right?
• 5:40
  Garrett,
• 5:41
  in
• 5:41
  this
• 5:41
  case,
• 5:42
  he's
• 5:42
  not,
• 5:42
  he's
• 5:42
  not
• 5:43
  showering,
• 5:43
  he's
• 5:43
  not
• 5:44
  interested
• 5:44
  in
• 5:44
  hobbies.
• 5:45
  So
• 5:45
  he's
• 5:45
  not
• 5:45
  connecting
• 5:46
  with
• 5:46
  people,
• 5:46
  he's
• 5:46
  not
• 5:47
  even
• 5:47
  seeing
• 5:47
  his
• 5:47
  friends.
• 5:48
  He
• 5:48
  doesn't
• 5:49
  have
• 5:50
  the
• 5:50
  initiative
• 5:51
  to
• 5:51
  even
• 5:52
  go
• 5:52
  out,
• 5:52
  find
• 5:53
  a
• 5:53
  partner,
• 5:54
  learn
• 5:54
  how
• 5:54
  to
• 5:54
  weld
• 5:55
  or
• 5:55
  be
• 5:56
  a
• 5:56
  plumber
• 5:56
  or
• 5:56
  an
• 5:57
  electrician.
• 5:57
  Right.
• 5:57
  These
• 5:58
  vocational
• 5:58
  jobs
• 5:58
  he
• 5:59
  doesn't
• 5:59
  have
• 6:00
  maybe
• 6:00
  the
• 6:00
  cognitive
• 6:01
  reserve,
• 6:02
  the,
• 6:02
  the
• 6:03
  cognitive
• 6:03
  capacity
• 6:04
  is
• 6:04
  significantly
• 6:05
  compromised
• 6:06
  in,
• 6:06
  with,
• 6:07
  with
• 6:07
  respect
• 6:07
  to
• 6:08
  these
• 6:08
  negative
• 6:08
  symptoms.
• 6:09
  The
• 6:09
  range
• 6:10
  of
• 6:10
  emotions
• 6:10
  make
• 6:11
  it
• 6:11
  hard
• 6:11
  to
• 6:11
  connect
• 6:11
  and
• 6:11
  read
• 6:12
  people
• 6:12
  and
• 6:12
  navigate
• 6:13
  your
• 6:13
  world.
• 6:13
  Right.
• 6:13
  The
• 6:14
  emotional
• 6:14
  landscape
• 6:15
  is
• 6:15
  so
• 6:15
  key
• 6:16
  in
• 6:16
  human
• 6:16
  nature
• 6:17
  in
• 6:17
  general.
• 6:17
  Right.
• 6:18
  Emotions
• 6:18
  help
• 6:19
  us
• 6:19
  navigate
• 6:19
  the
• 6:19
  world.
• 6:20
  And
• 6:20
  these
• 6:20
  are
• 6:21
  restricted,
• 6:22
  they're
• 6:22
  just
• 6:23
  sometimes
• 6:23
  absent
• 6:24
  entirely.
• 6:25
  And
• 6:25
  it's
• 6:25
  really
• 6:26
  debilitating.
• 6:27
  In
• 6:27
  our
• 6:27
  future
• 6:27
  episode
• 6:28
  that's
• 6:28
  about
• 6:28
  to
• 6:29
  be
• 6:29
  released,
• 6:29
  we're
• 6:29
  going
• 6:29
  to
• 6:30
  talk
• 6:30
  about
• 6:30
  specific
• 6:31
  receptor
• 6:31
  targets.
• 6:32
  What
• 6:32
  is
• 6:33
  the
• 6:33
  receptor
• 6:34
  that
• 6:34
  we
• 6:34
  need
• 6:34
  to
• 6:34
  target
• 6:35
  to
• 6:36
  improve
• 6:37
  negative
• 6:37
  symptoms
• 6:38
  and
• 6:38
  schizophrenia?
• 6:39
  What
• 6:39
  are
• 6:39
  three
• 6:40
  or
• 6:40
  four
• 6:40
  medications
• 6:40
  we
• 6:41
  can
• 6:41
  look
• 6:41
  to
• 6:42
  that
• 6:42
  may
• 6:42
  improve
• 6:43
  the
• 6:43
  negative
• 6:43
  symptom
• 6:44
  experience?
• 6:44
  How
• 6:45
  do
• 6:45
  we
• 6:45
  even
• 6:45
  tell
• 6:45
  the
• 6:45
  difference
• 6:46
  between
• 6:46
  a
• 6:46
  negative
• 6:47
  symptom
• 6:47
  in
• 6:47
  schizophrenia
• 6:48
  and
• 6:48
  like
• 6:49
  depression
• 6:49
  or
• 6:50
  a
• 6:50
  medication
• 6:50
  side
• 6:51
  effect?
• 6:51
  Right.
• 6:51
  Because
• 6:52
  they
• 6:52
  can
• 6:52
  mimic
• 6:52
  each
• 6:53
  other
• 6:53
  so
• 6:53
  extensively.
• 6:54
  And
• 6:54
  if
• 6:55
  you
• 6:55
  don't
• 6:55
  get
• 6:55
  that,
• 6:55
  right,
• 6:56
  that
• 6:56
  mimic,
• 6:57
  then
• 6:57
  you
• 6:57
  might
• 6:57
  prescribe
• 6:58
  the
• 6:58
  wrong
• 6:58
  medication
• 6:59
  because
• 7:00
  you
• 7:00
  anticipate
• 7:01
  this
• 7:01
  as
• 7:02
  a
• 7:02
  depression
• 7:03
  when
• 7:03
  it's
• 7:03
  a
• 7:03
  negative
• 7:04
  symptom
• 7:04
  of
• 7:04
  schizophrenia.
• 7:05
  When
• 7:05
  we
• 7:06
  could
• 7:06
  optimize
• 7:06
  therapy
• 7:07
  actually,
• 7:07
  instead
• 7:08
  of
• 7:08
  just
• 7:08
  making
• 7:09
  this
• 7:09
  less
• 7:09
  bad,
• 7:10
  we
• 7:10
  can,
• 7:11
  we
• 7:11
  can
• 7:11
  target
• 7:12
  a
• 7:12
  medication
• 7:13
  that
• 7:13
  specifically
• 7:14
  improves
• 7:15
  those
• 7:15
  medication
• 7:16
  side
• 7:17
  effects.
• 7:17
  And
• 7:17
  I
• 7:17
  will
• 7:17
  give
• 7:17
  you
• 7:18
  a
• 7:18
  hint.
• 7:18
  It
• 7:19
  is
• 7:19
  targeting
• 7:19
  the
• 7:19
  D3
• 7:20
  receptor.
• 7:21
  And
• 7:21
  there's
• 7:21
  a
• 7:21
  relatively
• 7:22
  new
• 7:22
  kid
• 7:22
  on
• 7:22
  the
• 7:22
  block
• 7:23
  that
• 7:23
  exclusively
• 7:24
  targets
• 7:25
  the
• 7:25
  D3
• 7:26
  receptor,
• 7:26
  which
• 7:27
  has
• 7:27
  a
• 7:27
  lot
• 7:27
  of
• 7:28
  promise
• 7:28
  and
• 7:28
  good
• 7:28
  evidence
• 7:29
  behind
• 7:29
  it.
• 7:30
  And
• 7:30
  I
• 7:30
  will
• 7:30
  add,
• 7:31
  that
• 7:31
  medication
• 7:32
  is
• 7:33
  also
• 7:33
  approved
• 7:33
  in
• 7:34
  Europe
• 7:34
  for
• 7:34
  negative
• 7:35
  symptoms.
• 7:35
  We
• 7:35
  do
• 7:35
  not
• 7:35
  have
• 7:36
  one
• 7:36
  that's
• 7:36
  approved
• 7:36
  for
• 7:36
  negative
• 7:37
  symptoms
• 7:37
  here.
• 7:38
  So
• 7:38
  tune
• 7:38
  into
• 7:38
  what
• 7:39
  that
• 7:39
  medication
• 7:39
  is.
• 7:40
  We're
• 7:40
  going
• 7:40
  to
• 7:40
  do
• 7:40
  deep
• 7:41
  dives
• 7:41
  on
• 7:41
  our
• 7:41
  Patreon
• 7:42
  page
• 7:42
  with
• 7:43
  respect
• 7:43
  to
• 7:43
  that
• 7:43
  medication
• 7:44
  too,
• 7:45
  and
• 7:45
  why
• 7:45
  it's
• 7:45
  different
• 7:46
  and
• 7:46
  what
• 7:46
  could
• 7:47
  be
• 7:47
  a
• 7:47
  real
• 7:48
  game
• 7:48
  changer.
• 7:49
  If
• 7:49
  we
• 7:50
  have
• 7:50
  a
• 7:50
  radar
• 7:50
  for
• 7:51
  negative
• 7:51
  symptoms,
• 7:51
  we
• 7:52
  know
• 7:52
  what
• 7:52
  they
• 7:52
  are,
• 7:52
  we
• 7:52
  know
• 7:53
  how
• 7:53
  to
• 7:53
  target
• 7:53
  them
• 7:54
  and
• 7:54
  we
• 7:54
  act
• 7:54
  accordingly.
• 7:55
  Right?
• 7:55
  It's
• 7:56
  not
• 7:56
  enough,
• 7:56
  my
• 7:56
  friends,
• 7:57
  that
• 7:57
  we
• 7:57
  look
• 7:58
  at
• 7:58
  schizophrenia
• 7:58
  and
• 7:59
  we
• 7:59
  declare
• 7:59
  victory
• 8:00
  because
• 8:00
  the
• 8:01
  patient
• 8:01
  is
• 8:01
  no
• 8:01
  longer
• 8:02
  seeing
• 8:02
  shadows
• 8:02
  or
• 8:02
  hearing
• 8:03
  self
• 8:03
  critical
• 8:03
  voices.
• 8:04
  That's
• 8:04
  not
• 8:04
  enough,
• 8:05
  Right?
• 8:05
  Mission
• 8:06
  is
• 8:06
  not
• 8:06
  accomplished.
• 8:07
  Mission
• 8:08
  is
• 8:08
  accomplished.
• 8:08
  When
• 8:08
  the
• 8:08
  positive
• 8:09
  symptoms
• 8:10
  have
• 8:10
  been
• 8:10
  eliminated
• 8:11
  and
• 8:11
  the
• 8:11
  negative
• 8:12
  Symptoms
• 8:12
  are
• 8:13
  accounted
• 8:13
  for.
• 8:13
  And
• 8:14
  those
• 8:14
  negative
• 8:14
  symptoms,
• 8:15
  as
• 8:15
  we
• 8:15
  have
• 8:15
  shown,
• 8:16
  are
• 8:17
  functionally
• 8:18
  debilitating.
• 8:19
  They're
• 8:20
  functionally
• 8:20
  debilitating
• 8:21
  if
• 8:21
  you
• 8:21
  don't
• 8:21
  have
• 8:22
  an
• 8:22
  interest
• 8:22
  in
• 8:22
  doing
• 8:22
  things,
• 8:23
  if
• 8:23
  you're
• 8:23
  not
• 8:24
  talking
• 8:24
  a
• 8:24
  lot
• 8:24
  in
• 8:25
  general,
• 8:26
  if
• 8:26
  you
• 8:26
  don't
• 8:26
  feel
• 8:26
  sociable,
• 8:27
  if
• 8:28
  you
• 8:28
  don't
• 8:28
  feel
• 8:28
  like
• 8:29
  moving
• 8:29
  to
• 8:30
  do
• 8:30
  a
• 8:30
  task
• 8:30
  and
• 8:30
  to
• 8:31
  complete
• 8:31
  a
• 8:31
  task
• 8:31
  at
• 8:32
  all.
• 8:32
  Just
• 8:33
  imagine
• 8:33
  all
• 8:33
  of
• 8:34
  the
• 8:34
  things
• 8:34
  in
• 8:34
  your
• 8:34
  life
• 8:34
  right
• 8:35
  now
• 8:35
  that
• 8:36
  you
• 8:36
  could
• 8:36
  not
• 8:36
  do
• 8:36
  or
• 8:37
  would
• 8:37
  not
• 8:37
  do
• 8:37
  if
• 8:38
  those
• 8:38
  negative
• 8:39
  symptoms
• 8:39
  were
• 8:40
  still
• 8:40
  untreated,
• 8:41
  right?
• 8:42
  And
• 8:42
  it's
• 8:42
  like
• 8:42
  you
• 8:43
  have
• 8:43
  a
• 8:43
  psychiatrist
• 8:44
  or
• 8:44
  a
• 8:44
  psych
• 8:45
  NP
• 8:45
  who's
• 8:45
  clapping
• 8:46
  in
• 8:46
  front
• 8:46
  of
• 8:46
  you
• 8:46
  with
• 8:46
  a
• 8:47
  party
• 8:47
  hat
• 8:47
  on
• 8:47
  because
• 8:48
  they
• 8:48
  were
• 8:48
  able
• 8:48
  to
• 8:49
  get
• 8:49
  rid
• 8:49
  of
• 8:50
  your
• 8:50
  positive
• 8:50
  symptoms
• 8:51
  and
• 8:51
  they're
• 8:52
  giving
• 8:52
  each
• 8:52
  other
• 8:52
  high
• 8:53
  fives
• 8:53
  in
• 8:53
  the
• 8:53
  break
• 8:53
  room.
• 8:54
  And
• 8:54
  here
• 8:54
  you
• 8:55
  are
• 8:55
  and
• 8:55
  you
• 8:55
  have
• 8:55
  no
• 8:56
  interest
• 8:56
  to
• 8:56
  even
• 8:56
  work
• 8:56
  at
• 8:57
  Taco
• 8:57
  Bell.
• 8:58
  But
• 8:58
  you
• 8:59
  know,
• 8:59
  it's
• 8:59
  a
• 8:59
  big
• 8:59
  victory
• 9:00
  for
• 9:00
  the
• 9:00
  clinicians
• 9:01
  and
• 9:01
  you're
• 9:01
  not
• 9:02
  really
• 9:02
  feeling
• 9:02
  a
• 9:02
  victory.
• 9:03
  Your
• 9:03
  family's
• 9:03
  estranged
• 9:04
  from
• 9:04
  you,
• 9:04
  they
• 9:04
  start
• 9:04
  taking
• 9:05
  it
• 9:05
  personally.
• 9:05
  They
• 9:06
  don't
• 9:06
  understand,
• 9:06
  maybe
• 9:07
  they
• 9:07
  don't.
• 9:07
  They
• 9:07
  haven't
• 9:08
  been
• 9:08
  provided
• 9:08
  the
• 9:08
  psychoeducation
• 9:09
  that
• 9:09
  these
• 9:10
  negative
• 9:10
  symptoms
• 9:11
  are
• 9:11
  a
• 9:11
  feature
• 9:11
  of
• 9:12
  schizophrenia
• 9:13
  and
• 9:13
  they
• 9:13
  slowly,
• 9:14
  you
• 9:14
  know,
• 9:15
  corrode
• 9:16
  their
• 9:16
  relationships
• 9:17
  with
• 9:17
  others.
• 9:18
  So
• 9:18
  this
• 9:19
  is
• 9:19
  a
• 9:19
  big
• 9:19
  deal.
• 9:19
  And
• 9:20
  I'm
• 9:20
  passionate
• 9:21
  about
• 9:21
  this
• 9:21
  topic
• 9:22
  again
• 9:22
  because
• 9:22
  it's,
• 9:23
  I
• 9:23
  think
• 9:23
  it's
• 9:24
  overlooked
• 9:24
  so
• 9:24
  much,
• 9:25
  but
• 9:25
  also
• 9:26
  it
• 9:26
  speaks
• 9:27
  to
• 9:27
  so
• 9:27
  many
• 9:27
  biases
• 9:28
  we
• 9:28
  have
• 9:28
  in
• 9:28
  psychiatry
• 9:29
  and
• 9:29
  how,
• 9:29
  if
• 9:29
  we're
• 9:30
  aware
• 9:30
  of
• 9:30
  them,
• 9:30
  we
• 9:30
  can
• 9:30
  be
• 9:31
  better
• 9:31
  practitioners,
• 9:32
  right?
• 9:33
  Because
• 9:33
  people
• 9:34
  do
• 9:34
  declare
• 9:35
  victory,
• 9:35
  right?
• 9:35
  When
• 9:36
  they
• 9:36
  can
• 9:36
  slay
• 9:37
  the
• 9:37
  dragons
• 9:37
  in
• 9:38
  bipolarity.
• 9:38
  Oh,
• 9:39
  they're
• 9:39
  not
• 9:39
  grandiose
• 9:39
  anymore.
• 9:40
  Oh,
• 9:40
  I
• 9:40
  got
• 9:40
  them
• 9:40
  to
• 9:41
  sleep.
• 9:41
  I
• 9:41
  got
• 9:42
  them
• 9:42
  to
• 9:42
  not
• 9:42
  have
• 9:43
  that
• 9:43
  manic
• 9:44
  behavior
• 9:44
  anymore.
• 9:45
  Or
• 9:45
  they're
• 9:45
  not,
• 9:45
  they're
• 9:46
  not
• 9:46
  delusional
• 9:46
  anymore.
• 9:47
  Yay.
• 9:47
  You
• 9:47
  know,
• 9:47
  I
• 9:48
  did
• 9:48
  my
• 9:48
  job.
• 9:48
  It's
• 9:49
  such
• 9:49
  a
• 9:49
  dragon
• 9:50
  I
• 9:50
  slave.
• 9:50
  But
• 9:51
  we
• 9:51
  have
• 9:51
  to
• 9:51
  look
• 9:51
  at
• 9:51
  the
• 9:51
  nitty
• 9:52
  gritty
• 9:52
  and
• 9:53
  you're
• 9:53
  not
• 9:53
  done
• 9:54
  until
• 9:54
  you're
• 9:54
  done.
• 9:54
  You're
• 9:55
  not
• 9:55
  done
• 9:55
  until
• 9:55
  those
• 9:56
  negative
• 9:56
  symptoms
• 9:56
  are
• 9:56
  treated.
• 9:57
  And
• 9:57
  in
• 9:57
  bipolarity,
• 9:58
  you're
• 9:58
  certainly
• 9:59
  not
• 9:59
  done
• 9:59
  if
• 9:59
  the
• 10:00
  underlying
• 10:00
  depression
• 10:01
  is
• 10:01
  still
• 10:01
  eating
• 10:01
  away
• 10:02
  at
• 10:02
  your
• 10:02
  patient
• 10:02
  and
• 10:03
  they're
• 10:03
  chronically
• 10:03
  suicidal
• 10:04
  or
• 10:05
  they
• 10:05
  still
• 10:06
  have
• 10:06
  a
• 10:07
  very
• 10:07
  negative
• 10:07
  self
• 10:08
  view
• 10:08
  of
• 10:08
  themselves,
• 10:09
  or
• 10:09
  they're
• 10:09
  not
• 10:09
  enjoying
• 10:10
  their
• 10:11
  stamp
• 10:12
  collection
• 10:13
  or
• 10:13
  gardening
• 10:14
  or
• 10:14
  going
• 10:15
  out
• 10:15
  with
• 10:15
  friends,
• 10:15
  right?
• 10:16
  These
• 10:16
  are
• 10:16
  functional
• 10:17
  real
• 10:17
  world
• 10:17
  problems.
• 10:18
  And
• 10:18
  the
• 10:19
  more
• 10:19
  we
• 10:19
  flesh
• 10:19
  them
• 10:20
  out
• 10:20
  from
• 10:20
  our
• 10:20
  patients,
• 10:21
  the
• 10:21
  better.
• 10:22
  But
• 10:22
  for
• 10:22
  patients,
• 10:23
  they
• 10:23
  don't
• 10:23
  really
• 10:23
  care
• 10:23
  about
• 10:24
  criterion
• 10:24
  A,
• 10:25
  B
• 10:25
  and
• 10:25
  C.
• 10:25
  They
• 10:26
  don't
• 10:26
  really
• 10:26
  care
• 10:26
  about
• 10:26
  your
• 10:27
  PHQ9
• 10:28
  or
• 10:28
  your
• 10:28
  GAD7
• 10:29
  they
• 10:29
  care
• 10:30
  that
• 10:31
  they
• 10:31
  can
• 10:32
  have
• 10:32
  a
• 10:32
  normal
• 10:33
  conversation
• 10:33
  with
• 10:33
  their
• 10:33
  partner
• 10:34
  again,
• 10:35
  that
• 10:35
  they
• 10:35
  can
• 10:35
  plan
• 10:36
  their
• 10:37
  nine
• 10:37
  year
• 10:37
  old's
• 10:38
  birthday
• 10:38
  party,
• 10:39
  that
• 10:39
  they're
• 10:39
  able
• 10:40
  to
• 10:41
  work
• 10:42
  as
• 10:42
  an
• 10:42
  IT
• 10:43
  consultant
• 10:43
  and
• 10:44
  get
• 10:44
  through
• 10:44
  the
• 10:44
  day
• 10:45
  without
• 10:45
  crying
• 10:46
  in
• 10:46
  their
• 10:46
  back
• 10:47
  of
• 10:47
  their
• 10:47
  car.
• 10:48
  Normally
• 10:48
  you'd
• 10:49
  probably
• 10:49
  go
• 10:49
  to
• 10:49
  the
• 10:49
  front
• 10:50
  of
• 10:50
  your
• 10:50
  car
• 10:50
  if
• 10:50
  you
• 10:50
  were
• 10:50
  crying.
• 10:51
  I
• 10:51
  don't
• 10:52
  know
• 10:52
  why
• 10:52
  your
• 10:52
  instinct
• 10:53
  would
• 10:53
  be
• 10:53
  to
• 10:53
  go
• 10:53
  to
• 10:53
  the
• 10:53
  back.
• 10:54
  Maybe
• 10:54
  the
• 10:54
  back's
• 10:54
  more
• 10:54
  of
• 10:55
  a
• 10:55
  private
• 10:55
  place.
• 10:55
  Actually
• 10:56
  I
• 10:56
  don't
• 10:57
  know.
• 10:57
  I
• 10:57
  would
• 10:57
  probably
• 10:58
  choose
• 10:58
  the
• 10:58
  front.
• 10:59
  Put
• 11:00
  the
• 11:00
  shades
• 11:00
  down
• 11:01
  or
• 11:01
  shades
• 11:01
  up.
• 11:02
  I,
• 11:02
  I
• 11:02
  whatever,
• 11:03
  you
• 11:03
  get
• 11:03
  my
• 11:03
  point.
• 11:04
  But
• 11:05
  anyway,
• 11:05
  I
• 11:06
  hope
• 11:06
  you
• 11:06
  enjoyed
• 11:06
  this.
• 11:07
  This
• 11:07
  was
• 11:07
  a
• 11:07
  fun
• 11:08
  one.
• 11:08
  It's
• 11:08
  one
• 11:09
  to
• 11:09
  never
• 11:09
  forget.
• 11:10
  Your
• 11:11
  next
• 11:11
  tattoo
• 11:11
  should
• 11:12
  not
• 11:12
  be
• 11:12
  a
• 11:12
  dragon
• 11:13
  or
• 11:13
  a
• 11:13
  skull
• 11:14
  or
• 11:14
  some
• 11:15
  quote
• 11:15
  from
• 11:15
  your
• 11:16
  deceased
• 11:17
  grandmother.
• 11:18
  Your
• 11:18
  next
• 11:18
  tattoo,
• 11:19
  if
• 11:19
  you
• 11:19
  get
• 11:20
  one,
• 11:20
  should
• 11:21
  be
• 11:21
  a
• 11:21
  reminder
• 11:22
  that
• 11:22
  negative
• 11:22
  symptoms
• 11:23
  are
• 11:23
  the
• 11:23
  most
• 11:23
  functionally
• 11:24
  disabling
• 11:25
  piece
• 11:25
  of
• 11:26
  schizophrenia.
• 11:27
  And
• 11:27
  with
• 11:27
  that,
• 11:27
  my
• 11:27
  friends,
• 11:29
  take
• 11:29
  care
• 11:29
  of
• 11:29
  yourselves.
• 11:30
  Bye
• 11:31
  bye.