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Six Shocking Mental Health Pearls That Will Transform Your Clinical Practice · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:06
  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.
• 0:08
  It's
• 0:09
  NPZ
• 0:09
  here,
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:11
  pocket.
• 0:12
  Can't
• 0:13
  wait
• 0:13
  for
• 0:13
  today.
• 0:14
  We
• 0:14
  have
• 0:15
  six
• 0:16
  shocking
• 0:16
  pearls.
• 0:17
  Shocking
• 0:18
  pearls
• 0:18
  that
• 0:18
  I
• 0:19
  think
• 0:19
  will
• 0:20
  completely
• 0:20
  alter
• 0:21
  the
• 0:22
  way
• 0:22
  you
• 0:22
  see
• 0:23
  your
• 0:23
  patients
• 0:23
  and
• 0:23
  the
• 0:24
  way
• 0:24
  you
• 0:24
  practice.
• 0:24
  And
• 0:24
  I
• 0:25
  say
• 0:25
  that
• 0:25
  because
• 0:26
  it
• 0:27
  really
• 0:27
  has
• 0:28
  shocked
• 0:28
  me.
• 0:28
  These
• 0:29
  pearls
• 0:29
  are,
• 0:29
  I
• 0:29
  think,
• 0:30
  the
• 0:30
  most
• 0:30
  shocking.
• 0:30
  I
• 0:31
  come
• 0:31
  across
• 0:31
  pearls
• 0:32
  every
• 0:32
  day.
• 0:32
  Part
• 0:33
  of
• 0:33
  my
• 0:33
  job
• 0:33
  here
• 0:33
  at
• 0:33
  Pearls
• 0:34
  and
• 0:34
  Prep
• 0:34
  is
• 0:35
  to
• 0:35
  really
• 0:35
  scour
• 0:36
  the,
• 0:37
  the
• 0:37
  mud
• 0:37
  or
• 0:37
  the
• 0:38
  sand
• 0:38
  at
• 0:39
  the
• 0:39
  bottom
• 0:39
  of
• 0:39
  the
• 0:39
  ocean
• 0:40
  and
• 0:40
  find
• 0:40
  those
• 0:40
  little
• 0:40
  pearls
• 0:41
  for
• 0:41
  you
• 0:41
  that
• 0:42
  could
• 0:42
  really
• 0:43
  make
• 0:43
  a
• 0:43
  difference
• 0:43
  in
• 0:44
  your
• 0:44
  practice,
• 0:44
  in
• 0:44
  your
• 0:44
  patients
• 0:45
  lives,
• 0:45
  or
• 0:46
  if
• 0:46
  you're
• 0:46
  trying
• 0:46
  to
• 0:46
  pass
• 0:47
  your
• 0:47
  boards
• 0:47
  or
• 0:47
  do
• 0:48
  well
• 0:48
  in
• 0:48
  school.
• 0:49
  My
• 0:49
  job
• 0:49
  is
• 0:49
  to
• 0:49
  find
• 0:50
  those
• 0:50
  pearls
• 0:51
  to
• 0:51
  really
• 0:51
  maximize
• 0:52
  your
• 0:52
  time
• 0:53
  and
• 0:54
  really
• 0:54
  get
• 0:54
  you
• 0:54
  thinking
• 0:55
  about
• 0:55
  psychiatry
• 0:56
  in
• 0:56
  radically
• 0:57
  new
• 0:57
  ways.
• 0:57
  Well,
• 0:58
  this
• 0:58
  is
• 0:58
  a
• 0:58
  doozy.
• 0:58
  I've
• 0:59
  been
• 0:59
  looking
• 0:59
  forward
• 0:59
  to
• 0:59
  this
• 0:59
  episode
• 1:00
  for
• 1:00
  a
• 1:00
  very
• 1:01
  long
• 1:01
  time.
• 1:01
  And
• 1:01
  I
• 1:01
  collected
• 1:02
  about
• 1:03
  three
• 1:03
  or
• 1:03
  four
• 1:04
  of
• 1:04
  these
• 1:04
  pearls.
• 1:04
  And
• 1:04
  I
• 1:05
  said,
• 1:05
  wait,
• 1:05
  let
• 1:05
  me
• 1:05
  just
• 1:06
  keep
• 1:06
  doing
• 1:07
  my
• 1:07
  daily
• 1:08
  research
• 1:08
  and
• 1:09
  readings
• 1:09
  and
• 1:10
  let
• 1:10
  me
• 1:10
  keep
• 1:10
  practicing
• 1:11
  and
• 1:11
  let
• 1:11
  me
• 1:11
  see
• 1:12
  if,
• 1:12
  if
• 1:12
  I
• 1:13
  can
• 1:13
  get
• 1:13
  to
• 1:13
  six
• 1:13
  pearls.
• 1:14
  And
• 1:14
  when
• 1:14
  I
• 1:14
  get
• 1:14
  to
• 1:14
  six,
• 1:15
  that's
• 1:15
  just
• 1:15
  the
• 1:15
  OCD
• 1:16
  number
• 1:16
  in
• 1:16
  my
• 1:16
  head.
• 1:17
  I,
• 1:17
  I
• 1:17
  thought,
• 1:17
  when
• 1:17
  I
• 1:17
  get
• 1:17
  to
• 1:18
  six,
• 1:19
  I'm
• 1:19
  going
• 1:19
  to
• 1:19
  make
• 1:19
  a
• 1:19
  podcast
• 1:20
  episode
• 1:20
  because
• 1:21
  the
• 1:22
  first
• 1:22
  few
• 1:22
  pearls
• 1:23
  I
• 1:23
  had,
• 1:23
  I
• 1:23
  said,
• 1:24
  wow,
• 1:25
  these
• 1:25
  are
• 1:25
  pretty
• 1:25
  remarkable.
• 1:26
  And
• 1:26
  I
• 1:26
  think
• 1:26
  if
• 1:27
  everybody
• 1:27
  thought
• 1:27
  about
• 1:27
  this
• 1:27
  and
• 1:28
  talked
• 1:28
  about
• 1:28
  this
• 1:28
  and
• 1:29
  knew
• 1:29
  this,
• 1:29
  it
• 1:30
  would
• 1:30
  really
• 1:31
  change
• 1:31
  the
• 1:31
  way
• 1:31
  we
• 1:32
  see
• 1:32
  things.
• 1:32
  And
• 1:32
  so,
• 1:33
  yes,
• 1:33
  I
• 1:33
  am
• 1:33
  very
• 1:33
  excited
• 1:34
  for
• 1:34
  this.
• 1:34
  Now,
• 1:35
  before
• 1:35
  we
• 1:35
  begin,
• 1:35
  just
• 1:36
  a
• 1:36
  little,
• 1:36
  small
• 1:36
  little
• 1:37
  plug
• 1:37
  would
• 1:38
  love
• 1:38
  if
• 1:38
  you
• 1:38
  all
• 1:39
  for
• 1:39
  just
• 1:39
  $3
• 1:40
  a
• 1:40
  month.
• 1:40
  That
• 1:41
  is,
• 1:42
  that
• 1:42
  is
• 1:43
  like
• 1:43
  a
• 1:43
  bag
• 1:43
  of
• 1:43
  Doritos
• 1:44
  these
• 1:44
  days.
• 1:45
  Three
• 1:45
  bucks
• 1:46
  a
• 1:46
  month.
• 1:46
  You
• 1:47
  will
• 1:47
  have
• 1:47
  so
• 1:47
  much
• 1:47
  value
• 1:48
  added
• 1:48
  to
• 1:49
  your
• 1:49
  practice,
• 1:50
  to
• 1:50
  your
• 1:50
  journey
• 1:51
  as
• 1:51
  a
• 1:51
  student.
• 1:51
  If
• 1:51
  you
• 1:51
  become
• 1:52
  a
• 1:52
  Patreon
• 1:52
  member,
• 1:52
  just
• 1:53
  go
• 1:53
  to
• 1:53
  the
• 1:53
  show
• 1:53
  Notes,
• 1:54
  find
• 1:54
  my
• 1:54
  Patreon
• 1:55
  page,
• 1:55
  and
• 1:55
  become
• 1:56
  Patreon
• 1:56
  members.
• 1:56
  It's
• 1:57
  three
• 1:57
  bucks
• 1:57
  a
• 1:57
  month.
• 1:57
  You
• 1:58
  get
• 1:58
  tons
• 1:58
  of
• 1:58
  visuals,
• 1:59
  rating
• 1:59
  scales,
• 2:00
  evidence
• 2:01
  based
• 2:01
  pearls,
• 2:02
  beautiful
• 2:03
  literature,
• 2:03
  beautiful
• 2:04
  materials
• 2:05
  for
• 2:05
  you
• 2:05
  to
• 2:05
  just
• 2:05
  soak
• 2:06
  up,
• 2:06
  nerd
• 2:06
  out,
• 2:07
  and
• 2:07
  be
• 2:07
  at
• 2:08
  the
• 2:08
  top
• 2:08
  of
• 2:08
  your
• 2:08
  game
• 2:08
  in
• 2:09
  mental
• 2:09
  health.
• 2:10
  And
• 2:10
  so
• 2:10
  that
• 2:11
  would
• 2:11
  be
• 2:11
  a
• 2:11
  great
• 2:11
  idea.
• 2:12
  Show
• 2:12
  notes,
• 2:13
  Patreon.
• 2:13
  Go
• 2:14
  for
• 2:14
  it.
• 2:14
  All
• 2:14
  right,
• 2:14
  without
• 2:15
  further
• 2:15
  ado,
• 2:15
  let's
• 2:15
  get
• 2:16
  into
• 2:16
  these
• 2:16
  juicy
• 2:16
  pearls.
• 2:17
  Now,
• 2:17
  this
• 2:18
  one
• 2:18
  is
• 2:19
  a
• 2:19
  somber
• 2:19
  one.
• 2:20
  It's
• 2:20
  a
• 2:20
  serious
• 2:20
  one.
• 2:21
  And
• 2:21
  when
• 2:21
  I
• 2:22
  first
• 2:22
  heard
• 2:22
  this,
• 2:22
  my
• 2:23
  eyes
• 2:23
  bulged
• 2:23
  out
• 2:24
  of
• 2:24
  my
• 2:24
  head.
• 2:24
  I
• 2:24
  couldn't
• 2:25
  believe
• 2:25
  it.
• 2:25
  Okay,
• 2:26
  and
• 2:26
  the
• 2:26
  pearl
• 2:27
  goes
• 2:27
  like
• 2:27
  this.
• 2:28
  4%
• 2:29
  of
• 2:29
  postpartum
• 2:30
  psychosis
• 2:31
  results
• 2:32
  in
• 2:32
  infanticide
• 2:33
  when
• 2:33
  untreated,
• 2:34
  making
• 2:35
  it
• 2:35
  one
• 2:35
  of
• 2:35
  the
• 2:36
  most
• 2:36
  dangerous
• 2:36
  psychiatric
• 2:37
  emergencies,
• 2:38
  my
• 2:39
  friends,
• 2:39
  again,
• 2:40
  my
• 2:40
  eyes
• 2:41
  bulged
• 2:42
  out
• 2:42
  of
• 2:42
  my
• 2:42
  brain
• 2:43
  when
• 2:43
  I
• 2:44
  heard
• 2:44
  this
• 2:45
  statistic.
• 2:45
  I
• 2:45
  couldn't
• 2:46
  believe
• 2:46
  it.
• 2:46
  And
• 2:47
  I'll
• 2:47
  be.
• 2:47
  You
• 2:47
  know,
• 2:47
  I'm
• 2:47
  ashamed
• 2:48
  to
• 2:48
  say
• 2:49
  that
• 2:49
  if
• 2:49
  I
• 2:49
  had
• 2:49
  to
• 2:49
  guess
• 2:50
  this
• 2:50
  statistic
• 2:51
  prior
• 2:52
  to
• 2:52
  knowing
• 2:52
  it,
• 2:53
  I
• 2:53
  would
• 2:53
  have
• 2:53
  thought
• 2:53
  it
• 2:54
  was
• 2:54
  like
• 2:54
  1
• 2:54
  in
• 2:55
  20,000
• 2:55
  or
• 2:56
  30,000.
• 2:57
  I
• 2:57
  would
• 2:57
  have
• 2:57
  thought
• 2:57
  it
• 2:57
  was
• 2:58
  just
• 2:58
  this
• 2:58
  thing
• 2:58
  you
• 2:58
  hear
• 2:59
  on
• 2:59
  the
• 2:59
  news
• 2:59
  every
• 2:59
  once
• 3:00
  in
• 3:00
  a
• 3:00
  while.
• 3:01
  Four
• 3:02
  percent,
• 3:02
  my
• 3:02
  friends,
• 3:03
  that
• 3:03
  is
• 3:04
  absolutely
• 3:05
  jarring.
• 3:06
  And
• 3:06
  again,
• 3:06
  the
• 3:07
  key.
• 3:07
  The
• 3:07
  key,
• 3:07
  the
• 3:08
  key
• 3:08
  word
• 3:08
  here
• 3:08
  is
• 3:08
  untreated.
• 3:09
  Okay?
• 3:10
  And
• 3:11
  that
• 3:11
  should
• 3:11
  give
• 3:12
  you
• 3:13
  some
• 3:13
  sense
• 3:14
  of
• 3:14
  confidence
• 3:14
  that
• 3:14
  if
• 3:14
  you
• 3:15
  can
• 3:15
  identify
• 3:15
  this
• 3:15
  and
• 3:15
  ask
• 3:16
  the
• 3:16
  right
• 3:16
  questions
• 3:17
  and
• 3:17
  do
• 3:18
  your
• 3:18
  due
• 3:18
  diligence,
• 3:19
  absolutely,
• 3:19
  we
• 3:19
  can
• 3:20
  make
• 3:20
  this
• 3:21
  never
• 3:21
  happen
• 3:21
  to
• 3:22
  you
• 3:22
  in
• 3:22
  your
• 3:22
  career.
• 3:23
  And
• 3:23
  God
• 3:24
  forbid
• 3:24
  it
• 3:24
  ever
• 3:25
  happens
• 3:25
  to
• 3:26
  a
• 3:26
  mom
• 3:26
  and
• 3:27
  their
• 3:28
  child.
• 3:28
  This
• 3:29
  is
• 3:29
  an
• 3:29
  absolute
• 3:30
  emergency.
• 3:31
  It's
• 3:31
  potentially
• 3:32
  devastating.
• 3:33
  And
• 3:33
  so
• 3:33
  postpartum
• 3:34
  psychosis,
• 3:35
  my
• 3:35
  friends,
• 3:35
  when
• 3:36
  I
• 3:36
  see
• 3:36
  it,
• 3:36
  I
• 3:37
  treat
• 3:37
  it
• 3:37
  as
• 3:37
  a
• 3:37
  dire
• 3:38
  emergency.
• 3:39
  It
• 3:39
  must
• 3:40
  be
• 3:40
  contained,
• 3:40
  it
• 3:40
  must
• 3:41
  be
• 3:41
  addressed.
• 3:41
  It
• 3:41
  must
• 3:42
  be
• 3:42
  assessed.
• 3:44
  Ask
• 3:44
  all
• 3:45
  the
• 3:45
  questions
• 3:45
  you
• 3:45
  need
• 3:46
  to
• 3:46
  ensure
• 3:47
  that
• 3:49
  mom
• 3:49
  is
• 3:49
  safe.
• 3:50
  And
• 3:50
  if
• 3:50
  she's
• 3:51
  not
• 3:51
  safe,
• 3:51
  get
• 3:51
  her
• 3:51
  the
• 3:51
  care
• 3:52
  that
• 3:52
  she
• 3:52
  needs,
• 3:52
  because
• 3:52
  it
• 3:53
  is
• 3:53
  a
• 3:54
  postpartum
• 3:54
  psychosis
• 3:55
  is
• 3:55
  an
• 3:55
  absolute
• 3:56
  emergency.
• 3:57
  And
• 3:57
  remember
• 3:57
  that
• 3:58
  up
• 3:58
  to
• 3:58
  50%
• 3:59
  of
• 3:59
  women
• 3:59
  who
• 3:59
  develop
• 3:59
  postpartum
• 4:00
  psychosis,
• 4:01
  they
• 4:01
  don't
• 4:01
  even
• 4:01
  have
• 4:01
  a
• 4:01
  psychiatric
• 4:02
  history,
• 4:03
  right?
• 4:03
  So
• 4:03
  a
• 4:03
  lot
• 4:03
  of
• 4:03
  these
• 4:04
  cases
• 4:04
  are
• 4:04
  occurring
• 4:05
  without
• 4:05
  warning
• 4:06
  signs.
• 4:07
  They
• 4:07
  can
• 4:07
  involve
• 4:07
  suicidal
• 4:08
  ideation
• 4:08
  in
• 4:09
  19%
• 4:09
  of
• 4:09
  cases
• 4:10
  when.
• 4:11
  When
• 4:11
  this
• 4:11
  postpartum
• 4:12
  psychosis
• 4:12
  is
• 4:13
  happening.
• 4:13
  And
• 4:14
  this
• 4:15
  is
• 4:15
  just
• 4:15
  a
• 4:15
  really
• 4:16
  big
• 4:17
  problem.
• 4:17
  But
• 4:17
  it's
• 4:17
  also
• 4:18
  an
• 4:18
  opportunity
• 4:18
  for
• 4:18
  OB
• 4:19
  GYNs
• 4:19
  and
• 4:20
  pediatricians
• 4:20
  and
• 4:21
  primary
• 4:21
  care
• 4:21
  physicians
• 4:22
  being
• 4:22
  the
• 4:23
  first
• 4:23
  points
• 4:23
  of
• 4:24
  contact
• 4:25
  to
• 4:25
  kind
• 4:25
  of
• 4:26
  identify
• 4:26
  this.
• 4:27
  Especially,
• 4:27
  you
• 4:27
  know,
• 4:27
  I'll
• 4:28
  always
• 4:28
  ask
• 4:29
  a
• 4:29
  lot
• 4:29
  of
• 4:29
  these
• 4:30
  women,
• 4:30
  did
• 4:31
  you
• 4:31
  have
• 4:31
  a.
• 4:31
  What
• 4:32
  was
• 4:32
  your
• 4:32
  previous
• 4:32
  pregnancy
• 4:33
  like?
• 4:33
  What
• 4:33
  was
• 4:34
  your
• 4:34
  previous
• 4:34
  postpartum
• 4:35
  experience
• 4:36
  like?
• 4:37
  Did
• 4:37
  you
• 4:37
  feel
• 4:38
  depressed
• 4:38
  before,
• 4:39
  during,
• 4:39
  or
• 4:40
  after
• 4:40
  you
• 4:40
  delivered
• 4:41
  your
• 4:41
  baby?
• 4:41
  What
• 4:41
  was
• 4:41
  that
• 4:42
  like?
• 4:42
  Were
• 4:42
  you
• 4:42
  having
• 4:43
  surreal
• 4:43
  experiences
• 4:45
  that
• 4:46
  kind
• 4:47
  of
• 4:47
  scared
• 4:47
  you
• 4:47
  or
• 4:48
  were
• 4:48
  different
• 4:48
  or
• 4:48
  people
• 4:49
  maybe
• 4:49
  wouldn't
• 4:49
  understand?
• 4:50
  Were
• 4:50
  you
• 4:50
  seeing
• 4:50
  or
• 4:51
  hearing
• 4:51
  things
• 4:51
  that
• 4:51
  were
• 4:51
  unusual
• 4:52
  to
• 4:52
  you?
• 4:53
  Did
• 4:53
  you
• 4:53
  feel
• 4:54
  like
• 4:54
  your
• 4:54
  ability
• 4:54
  to
• 4:54
  just
• 4:56
  feel.
• 4:58
  Navigate
• 4:58
  yourself
• 4:59
  in
• 4:59
  the
• 4:59
  world
• 4:59
  was
• 5:00
  off?
• 5:00
  Did
• 5:00
  you
• 5:00
  distrust
• 5:01
  other
• 5:01
  people?
• 5:01
  Did
• 5:01
  you
• 5:01
  want
• 5:02
  to
• 5:02
  harm
• 5:02
  your
• 5:02
  baby?
• 5:02
  Now
• 5:03
  you
• 5:03
  don't
• 5:03
  want
• 5:03
  to
• 5:04
  pepper
• 5:05
  your.
• 5:05
  The
• 5:06
  mom
• 5:06
  with
• 5:06
  questions.
• 5:06
  This
• 5:07
  is
• 5:07
  a
• 5:07
  therapeutic,
• 5:08
  fluid,
• 5:08
  open,
• 5:09
  collaborative
• 5:09
  conversation
• 5:10
  where
• 5:11
  you
• 5:11
  guys
• 5:12
  are
• 5:12
  working
• 5:13
  together
• 5:14
  to
• 5:15
  establish
• 5:15
  safeguards
• 5:16
  and
• 5:16
  ensure
• 5:17
  a
• 5:17
  safe
• 5:17
  and
• 5:17
  therapeutic
• 5:18
  pregnancy
• 5:19
  and
• 5:19
  robust
• 5:20
  mental
• 5:20
  health,
• 5:20
  right?
• 5:21
  So
• 5:21
  this
• 5:21
  is
• 5:21
  a
• 5:21
  very
• 5:21
  collaborative
• 5:22
  approach.
• 5:23
  And
• 5:25
  in
• 5:25
  my
• 5:25
  experience,
• 5:26
  the
• 5:27
  females
• 5:28
  that
• 5:28
  I
• 5:28
  speak
• 5:28
  with
• 5:28
  about
• 5:29
  this
• 5:29
  are
• 5:29
  very
• 5:30
  compassionate
• 5:30
  and
• 5:31
  they're
• 5:31
  very
• 5:31
  understanding.
• 5:32
  It's
• 5:33
  a
• 5:33
  very
• 5:33
  touchy
• 5:33
  issue.
• 5:34
  Right.
• 5:34
  I
• 5:34
  mean,
• 5:34
  this
• 5:34
  is
• 5:34
  a
• 5:35
  big
• 5:35
  deal.
• 5:35
  And
• 5:35
  remember,
• 5:36
  there's
• 5:36
  a
• 5:36
  lot
• 5:36
  of
• 5:36
  stigma
• 5:37
  involving
• 5:37
  this.
• 5:38
  Mothers
• 5:39
  experiencing
• 5:39
  these
• 5:39
  kinds
• 5:40
  of
• 5:40
  intrusive
• 5:40
  thoughts
• 5:41
  about
• 5:41
  harming
• 5:41
  their
• 5:41
  infant.
• 5:42
  They
• 5:42
  often
• 5:42
  won't
• 5:43
  disclose
• 5:43
  it
• 5:44
  due
• 5:44
  to
• 5:44
  fear
• 5:44
  of
• 5:45
  losing
• 5:45
  custody
• 5:45
  or
• 5:46
  being
• 5:46
  judged.
• 5:46
  So
• 5:47
  it's
• 5:47
  really
• 5:47
  important
• 5:47
  we
• 5:48
  normalize
• 5:48
  these
• 5:49
  questions.
• 5:49
  You
• 5:49
  know,
• 5:50
  something
• 5:50
  along
• 5:50
  the
• 5:50
  lines
• 5:50
  of,
• 5:51
  hey,
• 5:51
  some
• 5:51
  new
• 5:52
  mothers
• 5:52
  have
• 5:52
  scary
• 5:52
  thoughts
• 5:53
  about
• 5:53
  their
• 5:53
  babies.
• 5:54
  Have
• 5:54
  you
• 5:54
  experienced
• 5:55
  anything
• 5:55
  like
• 5:55
  that?
• 5:56
  You
• 5:56
  know,
• 5:56
  framing
• 5:57
  it
• 5:57
  as
• 5:57
  common
• 5:57
  can
• 5:58
  kind
• 5:58
  of
• 5:58
  open
• 5:58
  the
• 5:58
  door
• 5:59
  to
• 5:59
  these
• 5:59
  conversations.
• 6:01
  Right.
• 6:01
  And
• 6:01
  being
• 6:02
  on
• 6:02
  the
• 6:02
  alert
• 6:03
  for
• 6:04
  not
• 6:04
  just
• 6:04
  the
• 6:04
  depressive
• 6:05
  symptoms
• 6:06
  that
• 6:06
  we
• 6:06
  often
• 6:07
  can,
• 6:07
  can
• 6:08
  try
• 6:08
  to
• 6:08
  catch,
• 6:09
  but
• 6:09
  the
• 6:09
  hyperactivity,
• 6:11
  impulsivity.
• 6:12
  Right.
• 6:13
  Some
• 6:13
  of
• 6:13
  the
• 6:13
  more
• 6:15
  opposite
• 6:16
  spectrum
• 6:17
  symptoms
• 6:17
  here.
• 6:17
  Right.
• 6:18
  Sudden
• 6:18
  elation,
• 6:19
  decreased
• 6:19
  need
• 6:19
  for
• 6:20
  sleep,
• 6:20
  what
• 6:21
  might
• 6:21
  be
• 6:21
  mistaken
• 6:21
  as
• 6:22
  new
• 6:22
  mom
• 6:22
  energy
• 6:23
  or
• 6:23
  just
• 6:24
  kind
• 6:24
  of
• 6:24
  giddy
• 6:24
  sleep
• 6:25
  deprivation?
• 6:25
  No,
• 6:25
  this
• 6:25
  could
• 6:26
  potentially
• 6:26
  be
• 6:27
  a
• 6:27
  broader
• 6:27
  mood
• 6:28
  disorder
• 6:30
  teetering
• 6:31
  into
• 6:31
  some
• 6:31
  psychotic
• 6:32
  features.
• 6:33
  And
• 6:33
  that
• 6:33
  might
• 6:34
  not
• 6:34
  be
• 6:34
  volunteered
• 6:35
  to
• 6:35
  you.
• 6:35
  Right.
• 6:36
  So
• 6:37
  the
• 6:38
  early
• 6:38
  screening
• 6:39
  is
• 6:39
  key.
• 6:39
  A
• 6:39
  good
• 6:39
  knowledge
• 6:40
  of
• 6:40
  the
• 6:40
  past
• 6:40
  pregnancy,
• 6:41
  if
• 6:41
  there
• 6:41
  is
• 6:41
  no
• 6:41
  past
• 6:42
  pregnancy,
• 6:43
  a
• 6:43
  very
• 6:43
  good
• 6:44
  understanding
• 6:44
  of
• 6:45
  what
• 6:45
  this
• 6:46
  mother's
• 6:46
  baseline
• 6:47
  mental
• 6:47
  health
• 6:47
  looks
• 6:48
  like,
• 6:48
  historical
• 6:48
  mental
• 6:49
  health
• 6:49
  looks
• 6:49
  like.
• 6:49
  Has
• 6:50
  she
• 6:50
  been
• 6:50
  depressed
• 6:51
  before?
• 6:51
  Has
• 6:51
  she
• 6:51
  had
• 6:51
  psychotic
• 6:52
  episodes
• 6:53
  before?
• 6:53
  Has
• 6:53
  she
• 6:54
  had
• 6:54
  mood
• 6:54
  episodes
• 6:55
  where
• 6:55
  we're
• 6:56
  not
• 6:56
  just
• 6:56
  talking
• 6:56
  depression,
• 6:57
  but
• 6:57
  some
• 6:58
  of
• 6:58
  the
• 6:58
  bipolarity
• 6:59
  symptoms?
• 7:00
  And
• 7:01
  again,
• 7:01
  if
• 7:01
  not,
• 7:01
  we
• 7:02
  still
• 7:02
  need
• 7:02
  to
• 7:02
  brace
• 7:02
  for
• 7:03
  impact,
• 7:03
  just
• 7:03
  in
• 7:03
  case,
• 7:04
  and
• 7:04
  recognize
• 7:05
  that
• 7:05
  the,
• 7:05
  the
• 7:05
  postpartum
• 7:06
  window,
• 7:06
  that
• 7:07
  two
• 7:07
  week
• 7:07
  window
• 7:08
  is
• 7:08
  especially
• 7:08
  critical
• 7:09
  for
• 7:10
  us
• 7:10
  to
• 7:10
  be
• 7:10
  on
• 7:10
  guard
• 7:11
  and
• 7:12
  not
• 7:12
  just
• 7:12
  start
• 7:12
  the
• 7:12
  conversation
• 7:13
  right
• 7:14
  after
• 7:14
  delivery,
• 7:14
  but
• 7:15
  start
• 7:15
  it
• 7:15
  well
• 7:15
  before
• 7:16
  and
• 7:16
  normalize
• 7:17
  this
• 7:17
  stuff
• 7:18
  so
• 7:18
  the
• 7:18
  stigma
• 7:19
  can
• 7:19
  be
• 7:19
  challenged
• 7:20
  a
• 7:20
  little
• 7:20
  bit.
• 7:20
  The
• 7:20
  conversation
• 7:21
  becomes
• 7:21
  more
• 7:22
  fluid,
• 7:22
  and
• 7:23
  it
• 7:23
  becomes
• 7:23
  this
• 7:23
  more
• 7:24
  predictable
• 7:24
  intervention
• 7:25
  that
• 7:25
  we
• 7:26
  can
• 7:26
  absolutely
• 7:26
  treat
• 7:27
  for.
• 7:27
  We
• 7:27
  will
• 7:27
  do
• 7:28
  future
• 7:28
  episodes
• 7:29
  on
• 7:29
  what
• 7:29
  this
• 7:29
  treatment
• 7:29
  looks
• 7:30
  like,
• 7:30
  how
• 7:30
  to
• 7:31
  handle
• 7:31
  things.
• 7:31
  But
• 7:31
  just
• 7:32
  so
• 7:32
  you
• 7:32
  know,
• 7:32
  right.
• 7:33
  Untreated
• 7:34
  postpartum
• 7:34
  psychosis,
• 7:35
  4%
• 7:36
  results
• 7:36
  in
• 7:37
  infanticide.
• 7:37
  That
• 7:38
  is,
• 7:39
  it
• 7:39
  just
• 7:39
  gives
• 7:39
  you
• 7:39
  a
• 7:40
  sense
• 7:40
  of
• 7:40
  urgency.
• 7:41
  I
• 7:41
  think
• 7:41
  if
• 7:42
  we
• 7:42
  didn't
• 7:42
  have
• 7:42
  it
• 7:42
  before,
• 7:43
  I'm
• 7:43
  sure
• 7:43
  we
• 7:43
  all
• 7:43
  do.
• 7:44
  Right.
• 7:44
  We
• 7:44
  recognize
• 7:45
  intuitively
• 7:46
  postpartum
• 7:46
  psychosis
• 7:47
  is
• 7:47
  a
• 7:47
  major
• 7:47
  problem,
• 7:48
  but
• 7:49
  now
• 7:49
  we
• 7:49
  have
• 7:50
  a
• 7:50
  jarring
• 7:50
  statistic
• 7:51
  attached
• 7:51
  to
• 7:52
  it.
• 7:52
  And
• 7:52
  it's
• 7:52
  an
• 7:52
  all
• 7:53
  hands
• 7:53
  on
• 7:53
  deck
• 7:53
  approach.
• 7:54
  Right.
• 7:54
  Ob,
• 7:55
  primary
• 7:55
  care,
• 7:55
  pediatrics,
• 7:57
  you
• 7:57
  in
• 7:58
  the
• 7:58
  mental
• 7:58
  health
• 7:58
  space
• 7:59
  and
• 7:59
  working
• 8:00
  collaboratively
• 8:01
  together,
• 8:02
  getting
• 8:02
  collateral
• 8:03
  if
• 8:03
  needed.
• 8:04
  Um,
• 8:04
  let's
• 8:05
  move
• 8:05
  on
• 8:05
  to
• 8:05
  pearl
• 8:05
  number
• 8:05
  two.
• 8:06
  But
• 8:06
  I
• 8:06
  hope
• 8:06
  that,
• 8:06
  that
• 8:07
  you
• 8:07
  kind
• 8:07
  of
• 8:07
  let
• 8:07
  that
• 8:07
  marinate
• 8:08
  my
• 8:08
  friends,
• 8:08
  and
• 8:09
  we'll
• 8:09
  chat
• 8:09
  about
• 8:09
  it
• 8:09
  later.
• 8:10
  Now,
• 8:10
  Pearl
• 8:10
  number
• 8:11
  two,
• 8:11
  we
• 8:11
  just
• 8:11
  did
• 8:12
  a
• 8:12
  really
• 8:13
  riveting
• 8:13
  podcast
• 8:14
  episode.
• 8:15
  How
• 8:15
  old
• 8:16
  am
• 8:16
  I?
• 8:16
  I'm
• 8:16
  like
• 8:16
  80.
• 8:16
  I
• 8:17
  don't
• 8:17
  think
• 8:17
  I've
• 8:17
  ever
• 8:17
  used
• 8:17
  that
• 8:18
  word
• 8:18
  before.
• 8:19
  Riveting
• 8:20
  podcast
• 8:20
  episode
• 8:20
  on
• 8:21
  vitamin
• 8:21
  D
• 8:21
  deficiency.
• 8:22
  What
• 8:22
  the
• 8:23
  cutoffs
• 8:23
  are,
• 8:23
  what
• 8:23
  that
• 8:24
  looks
• 8:24
  like.
• 8:25
  The,
• 8:25
  the
• 8:25
  greater
• 8:26
  implications
• 8:26
  of
• 8:27
  having
• 8:27
  vitamin
• 8:27
  D
• 8:27
  efficiency
• 8:28
  on
• 8:28
  brain
• 8:29
  derived
• 8:29
  neurotropic
• 8:30
  factor,
• 8:30
  neuroprotection
• 8:31
  immunity.
• 8:32
  We
• 8:32
  did
• 8:32
  a
• 8:32
  great
• 8:32
  episode
• 8:33
  on
• 8:33
  that.
• 8:33
  I
• 8:33
  highly
• 8:33
  recommend
• 8:34
  you
• 8:34
  go
• 8:34
  to
• 8:34
  that
• 8:35
  episode.
• 8:35
  But
• 8:35
  this
• 8:36
  next
• 8:36
  Pearl,
• 8:36
  Vitamin
• 8:37
  D
• 8:37
  deficiency
• 8:38
  can
• 8:38
  occur
• 8:39
  in
• 8:39
  up
• 8:39
  to
• 8:39
  76%
• 8:40
  of
• 8:41
  of
• 8:41
  psychiatric
• 8:42
  inpatients.
• 8:43
  Well,
• 8:43
  that
• 8:44
  is
• 8:44
  huge,
• 8:45
  right?
• 8:45
  That
• 8:45
  is
• 8:45
  absolutely
• 8:46
  huge.
• 8:46
  Up
• 8:46
  to
• 8:47
  76%
• 8:47
  of
• 8:48
  psychiatric
• 8:48
  inpatients
• 8:49
  could
• 8:49
  have
• 8:49
  a
• 8:49
  vitamin
• 8:50
  D
• 8:50
  deficiency.
• 8:50
  I
• 8:51
  know
• 8:51
  in
• 8:51
  my
• 8:51
  past
• 8:51
  podcast
• 8:52
  some
• 8:52
  evidence
• 8:53
  showed
• 8:53
  up
• 8:53
  to
• 8:53
  83%
• 8:55
  of
• 8:55
  outpatients
• 8:56
  may
• 8:56
  have
• 8:56
  vitamin
• 8:57
  D
• 8:57
  deficiencies.
• 8:58
  And
• 8:58
  that's
• 8:58
  usually
• 8:59
  defined
• 8:59
  as
• 9:00
  a
• 9:00
  vitamin
• 9:01
  D
• 9:01
  level
• 9:01
  of
• 9:01
  less
• 9:01
  than
• 9:02
  30.
• 9:03
  So
• 9:04
  again,
• 9:05
  I
• 9:05
  talked
• 9:05
  about
• 9:06
  this
• 9:06
  in
• 9:06
  a
• 9:06
  previous
• 9:06
  episode,
• 9:07
  but
• 9:07
  to
• 9:07
  me
• 9:07
  this
• 9:07
  was
• 9:08
  jarring.
• 9:08
  Again,
• 9:10
  to
• 9:10
  be
• 9:10
  humble,
• 9:11
  I
• 9:12
  would
• 9:12
  have
• 9:12
  never
• 9:12
  guessed
• 9:13
  it
• 9:13
  was
• 9:13
  in
• 9:13
  the
• 9:13
  neighborhood
• 9:14
  of
• 9:14
  76
• 9:14
  or
• 9:15
  83.
• 9:15
  I
• 9:16
  would
• 9:16
  have
• 9:16
  thought
• 9:16
  it
• 9:16
  was
• 9:17
  13
• 9:17
  or
• 9:17
  20
• 9:17
  or
• 9:18
  25.
• 9:19
  This
• 9:19
  was
• 9:19
  a
• 9:19
  jarring
• 9:20
  statistic
• 9:20
  that
• 9:20
  made
• 9:21
  me
• 9:22
  pause
• 9:23
  and
• 9:23
  really
• 9:24
  consider
• 9:24
  how
• 9:25
  I'm
• 9:25
  going
• 9:25
  to
• 9:25
  approach
• 9:26
  my
• 9:26
  average
• 9:27
  patient
• 9:27
  later
• 9:27
  on.
• 9:28
  This
• 9:28
  is
• 9:29
  potentially
• 9:29
  low
• 9:29
  hanging
• 9:30
  fruit,
• 9:30
  my
• 9:30
  friends.
• 9:30
  It's
• 9:31
  like
• 9:31
  a
• 9:31
  tsh,
• 9:31
  right,
• 9:32
  where
• 9:32
  you
• 9:32
  want
• 9:32
  to
• 9:33
  be
• 9:33
  able
• 9:33
  to
• 9:33
  identify
• 9:34
  if
• 9:34
  this
• 9:34
  is
• 9:35
  one
• 9:35
  of
• 9:35
  the
• 9:35
  problems.
• 9:36
  If
• 9:36
  somebody
• 9:36
  has,
• 9:37
  you
• 9:37
  know,
• 9:37
  reoccurring
• 9:38
  depression
• 9:38
  or,
• 9:39
  and,
• 9:40
  and
• 9:40
  it's
• 9:40
  just
• 9:40
  stubborn
• 9:41
  and
• 9:41
  they
• 9:41
  can't
• 9:41
  seem
• 9:41
  to
• 9:42
  get
• 9:42
  past
• 9:42
  it.
• 9:42
  And
• 9:42
  I'm
• 9:43
  not
• 9:43
  saying
• 9:43
  this
• 9:43
  is
• 9:43
  going
• 9:43
  to
• 9:43
  be
• 9:43
  a
• 9:44
  be
• 9:44
  all
• 9:44
  end
• 9:44
  all.
• 9:44
  You,
• 9:44
  you
• 9:45
  supplement
• 9:45
  with
• 9:45
  vitamin
• 9:46
  D
• 9:46
  and
• 9:46
  everybody's
• 9:46
  hunky
• 9:47
  dory
• 9:47
  at
• 9:48
  the
• 9:48
  same
• 9:48
  time.
• 9:48
  It's
• 9:49
  this
• 9:49
  low
• 9:49
  hanging
• 9:50
  fruit
• 9:50
  that
• 9:50
  can
• 9:50
  often
• 9:51
  be
• 9:51
  sitting
• 9:51
  there.
• 9:51
  And
• 9:52
  I've
• 9:52
  seen
• 9:52
  this.
• 9:52
  I've
• 9:52
  had
• 9:52
  patients
• 9:53
  with
• 9:53
  critically
• 9:54
  low
• 9:54
  vitamin
• 9:54
  D
• 9:55
  levels
• 9:55
  and
• 9:55
  they've
• 9:55
  been
• 9:56
  struggling
• 9:56
  with
• 9:56
  depression
• 9:57
  unnecessarily
• 9:58
  for
• 9:58
  years
• 9:58
  and
• 9:59
  it's
• 9:59
  like
• 9:59
  one
• 9:59
  hand
• 10:00
  tied
• 10:00
  behind
• 10:00
  their
• 10:00
  back.
• 10:01
  Right?
• 10:01
  Remember
• 10:02
  bdnf,
• 10:03
  the
• 10:03
  kind
• 10:03
  of
• 10:03
  miracle
• 10:04
  grow
• 10:04
  for
• 10:04
  your
• 10:04
  brain,
• 10:05
  the
• 10:05
  molecule
• 10:05
  responsible
• 10:06
  for
• 10:07
  synaptic
• 10:07
  plasticity
• 10:08
  and
• 10:08
  growing
• 10:08
  new
• 10:09
  brain
• 10:09
  connections?
• 10:09
  Well,
• 10:10
  that's
• 10:10
  really
• 10:10
  undermined
• 10:11
  when
• 10:11
  you
• 10:12
  don't
• 10:12
  have
• 10:12
  your
• 10:13
  vitamin
• 10:13
  D
• 10:13
  in
• 10:13
  optimal
• 10:14
  levels.
• 10:14
  Vitamin
• 10:15
  D,
• 10:15
  as
• 10:16
  we've
• 10:16
  learned,
• 10:16
  is
• 10:16
  a
• 10:17
  rate
• 10:17
  limiting
• 10:18
  precursor
• 10:18
  to
• 10:18
  serotonin
• 10:19
  synthesis.
• 10:20
  So
• 10:20
  again,
• 10:20
  my
• 10:21
  friends,
• 10:22
  very
• 10:22
  important
• 10:23
  and
• 10:23
  this
• 10:24
  changes
• 10:24
  the
• 10:24
  game.
• 10:25
  You
• 10:25
  definitely
• 10:25
  want
• 10:25
  to
• 10:26
  peek
• 10:26
  behind
• 10:26
  the
• 10:26
  curtain
• 10:26
  and
• 10:27
  make
• 10:27
  sure
• 10:27
  there's
• 10:27
  no
• 10:27
  vitamin
• 10:28
  D
• 10:28
  deficiency.
• 10:29
  So
• 10:30
  that's
• 10:31
  a
• 10:31
  fun
• 10:31
  Pearl.
• 10:31
  Again,
• 10:32
  I
• 10:32
  had
• 10:32
  to,
• 10:32
  I
• 10:32
  had
• 10:33
  to
• 10:33
  put
• 10:33
  that
• 10:33
  in
• 10:33
  here,
• 10:33
  because
• 10:34
  I
• 10:34
  think
• 10:34
  it's
• 10:34
  just
• 10:35
  all
• 10:35
  encompassing
• 10:36
  and
• 10:36
  very
• 10:37
  important.
• 10:37
  Third,
• 10:38
  Pearl,
• 10:38
  my
• 10:38
  friends,
• 10:40
  this
• 10:40
  one
• 10:40
  we've
• 10:41
  mentioned
• 10:41
  in
• 10:41
  a
• 10:41
  previous
• 10:42
  episode,
• 10:43
  maybe
• 10:44
  it
• 10:44
  might
• 10:44
  also
• 10:44
  be
• 10:44
  one
• 10:45
  of
• 10:45
  our
• 10:45
  future
• 10:45
  episode
• 10:46
  drops.
• 10:46
  Regardless.
• 10:48
  Shocking.
• 10:48
  Pearl,
• 10:49
  coming
• 10:49
  at
• 10:49
  you
• 10:50
  here.
• 10:51
  The
• 10:51
  pooled
• 10:52
  mean
• 10:52
  duration
• 10:53
  of
• 10:53
  undiagnosed
• 10:54
  bipolar
• 10:55
  disorder
• 10:55
  is
• 10:55
  9.1
• 10:56
  years,
• 10:57
  with
• 10:58
  median
• 10:58
  delays
• 10:59
  in
• 10:59
  diagnosing
• 11:00
  5
• 11:00
  years
• 11:01
  for
• 11:01
  bipolar
• 11:01
  1
• 11:02
  and
• 11:02
  11
• 11:02
  whopping
• 11:03
  years
• 11:04
  for
• 11:04
  bipolar
• 11:04
  2.
• 11:05
  Now
• 11:05
  that,
• 11:06
  again,
• 11:06
  is
• 11:06
  shocking.
• 11:07
  I
• 11:07
  know
• 11:07
  when
• 11:07
  I
• 11:07
  share
• 11:07
  this
• 11:08
  statistic
• 11:08
  with
• 11:08
  a
• 11:09
  lot
• 11:09
  of
• 11:09
  NP
• 11:10
  students
• 11:10
  or
• 11:11
  colleagues,
• 11:11
  this
• 11:12
  also,
• 11:12
  a
• 11:12
  lot
• 11:13
  of,
• 11:13
  a
• 11:13
  lot
• 11:13
  of
• 11:13
  jaws
• 11:14
  start
• 11:14
  to
• 11:14
  drop
• 11:14
  here
• 11:15
  because
• 11:15
  this
• 11:15
  is
• 11:15
  a
• 11:16
  very
• 11:16
  humbling
• 11:17
  statistic.
• 11:18
  And
• 11:19
  so
• 11:20
  what
• 11:20
  it's
• 11:20
  saying
• 11:20
  here
• 11:21
  basically
• 11:21
  is
• 11:21
  the
• 11:21
  average
• 11:23
  time
• 11:23
  that
• 11:24
  it
• 11:24
  takes
• 11:24
  to
• 11:24
  diagnose
• 11:25
  a
• 11:25
  bipolar
• 11:25
  disorder
• 11:26
  is
• 11:26
  nine
• 11:26
  years.
• 12:22
  And
• 12:22
  if
• 12:22
  you
• 12:22
  want
• 12:22
  to
• 12:22
  stratify
• 12:23
  that,
• 12:23
  the
• 11:29
  median
• 12:24
  delay,
• 12:24
  some
• 12:24
  of
• 12:25
  the
• 12:25
  evidence
• 12:25
  shows,
• 12:25
  is
• 12:26
  five
• 12:26
  years
• 12:26
  for
• 12:26
  bipolar
• 12:27
  I.
• 12:27
  That's
• 12:27
  still
• 12:27
  a
• 12:27
  long
• 12:28
  time
• 12:28
  to
• 12:29
  not
• 12:29
  be
• 12:29
  diagnosed
• 12:29
  properly
• 12:30
  with
• 12:30
  Bipolar
• 12:30
  I
• 12:31
  or
• 12:31
  11
• 12:31
  years
• 12:32
  for
• 12:32
  bipolar
• 12:33
  2.
• 12:33
  Well,
• 12:33
  this
• 12:34
  is
• 12:34
  absolutely
• 12:36
  unbelievable,
• 12:36
  right?
• 12:37
  Because
• 12:37
  this,
• 12:37
  we
• 12:37
  know
• 12:37
  this
• 12:38
  disorder
• 12:38
  has
• 12:38
  so
• 12:39
  much
• 12:40
  morbidity
• 12:40
  and
• 12:40
  mortality
• 12:41
  and,
• 12:42
  and
• 12:42
  there's
• 12:42
  so
• 12:42
  much
• 12:42
  damage
• 12:43
  in
• 12:43
  relationships
• 12:44
  and
• 12:44
  in
• 12:44
  finances
• 12:44
  and
• 12:45
  in
• 12:45
  just
• 12:45
  overall
• 12:45
  mental
• 12:46
  health
• 12:46
  with
• 12:46
  this.
• 12:47
  And
• 12:47
  so
• 12:47
  I,
• 12:48
  I
• 12:48
  thought
• 12:48
  this
• 12:48
  was
• 12:48
  a
• 12:49
  really
• 12:50
  interesting
• 12:51
  challenge,
• 12:52
  kind
• 12:52
  of
• 12:52
  a.
• 12:53
  It.
• 12:53
  This
• 12:54
  is
• 12:54
  just
• 12:54
  sort
• 12:54
  of
• 12:54
  the,
• 12:57
  a
• 12:57
  fascinating
• 12:58
  challenge
• 12:58
  that
• 12:58
  we're
• 12:58
  all
• 12:59
  called
• 12:59
  to,
• 13:01
  to
• 13:01
  know,
• 13:01
  put
• 13:02
  our
• 13:02
  hands
• 13:02
  in
• 13:02
  the
• 13:02
  middle
• 13:02
  and
• 13:02
  help
• 13:03
  with
• 13:03
  this
• 13:03
  because
• 13:04
  it's
• 13:04
  such
• 13:04
  a
• 13:04
  big
• 13:05
  deal.
• 13:05
  Okay?
• 13:06
  And
• 13:07
  we
• 13:07
  know
• 13:07
  one
• 13:08
  of
• 13:08
  the
• 13:08
  reasons
• 13:09
  that
• 13:09
  this
• 13:09
  is
• 13:09
  so
• 13:10
  hard
• 13:10
  to
• 13:10
  diagnose.
• 13:11
  First
• 13:12
  of
• 13:12
  all,
• 13:12
  a
• 13:12
  lot
• 13:12
  of
• 13:12
  the
• 13:13
  symptoms
• 13:13
  can
• 13:14
  overlap,
• 13:14
  right?
• 13:14
  Hyperactivity
• 13:15
  can
• 13:15
  look
• 13:16
  like
• 13:16
  adhd.
• 13:16
  Racing
• 13:17
  thoughts
• 13:17
  is
• 13:17
  a
• 13:18
  diagnostic
• 13:18
  criteria
• 13:19
  in
• 13:19
  gad.
• 13:20
  But
• 13:20
  it's
• 13:20
  also.
• 13:21
  Racing
• 13:21
  thoughts
• 13:21
  or
• 13:22
  flight
• 13:22
  of
• 13:22
  ideas
• 13:22
  can
• 13:22
  happen
• 13:23
  in
• 13:23
  bipolarity.
• 13:24
  Not
• 13:24
  need,
• 13:24
  not
• 13:25
  sleeping
• 13:25
  well,
• 13:25
  that's
• 13:25
  the
• 13:25
  entire
• 13:26
  dsm.
• 13:26
  You're
• 13:27
  not
• 13:27
  sleeping,
• 13:27
  right?
• 13:28
  Are
• 13:28
  you
• 13:28
  not
• 13:28
  sleeping
• 13:28
  because
• 13:29
  of
• 13:29
  nightmares?
• 13:29
  Are
• 13:29
  you
• 13:29
  not
• 13:30
  sleeping
• 13:30
  because
• 13:30
  you're
• 13:31
  depressed?
• 13:31
  Are
• 13:31
  you
• 13:31
  not
• 13:31
  sleeping
• 13:32
  because
• 13:32
  you're
• 13:32
  so
• 13:32
  energized
• 13:33
  and
• 13:33
  manic,
• 13:33
  you
• 13:33
  don't
• 13:34
  feel
• 13:34
  like
• 13:34
  you
• 13:34
  need
• 13:34
  to
• 13:34
  sleep?
• 13:35
  Right?
• 13:35
  There's
• 13:36
  so
• 13:36
  many
• 13:36
  reasons
• 13:37
  that
• 13:38
  this
• 13:39
  is
• 13:39
  hard
• 13:39
  to
• 13:39
  diagnose
• 13:40
  because
• 13:40
  the
• 13:41
  symptoms
• 13:41
  can
• 13:42
  mimic
• 13:42
  so
• 13:42
  many
• 13:42
  other
• 13:43
  things.
• 13:43
  I
• 13:43
  didn't
• 13:43
  even
• 13:44
  mention
• 13:44
  borderline,
• 13:45
  right?
• 13:45
  The
• 13:45
  overlap
• 13:46
  between
• 13:46
  borderline
• 13:47
  and
• 13:47
  bipolar
• 13:48
  can
• 13:48
  be
• 13:48
  frustratingly
• 13:49
  difficult
• 13:50
  to
• 13:50
  parse
• 13:50
  out
• 13:51
  when
• 13:51
  you
• 13:51
  only
• 13:51
  have
• 13:52
  60
• 13:52
  minutes
• 13:52
  to
• 13:52
  do
• 13:52
  it,
• 13:53
  or
• 13:53
  God
• 13:53
  forbid,
• 13:53
  you
• 13:53
  have
• 13:54
  30
• 13:54
  minutes
• 13:54
  to
• 13:54
  do
• 13:54
  it.
• 13:55
  And
• 13:56
  so
• 13:56
  it's
• 13:56
  very
• 13:56
  complicated.
• 13:57
  Another
• 13:58
  huge
• 13:58
  reason
• 13:58
  this
• 13:59
  is
• 13:59
  hard,
• 13:59
  very
• 13:59
  hard
• 14:00
  to
• 14:00
  diagnose
• 14:01
  is
• 14:01
  that
• 14:01
  75%
• 14:02
  of
• 14:02
  the
• 14:03
  time
• 14:03
  that
• 14:03
  these
• 14:04
  folks
• 14:04
  are
• 14:04
  symptomatic
• 14:04
  they're
• 14:05
  depressed.
• 14:05
  So
• 14:06
  they're
• 14:06
  not
• 14:06
  walking
• 14:07
  around,
• 14:08
  you
• 14:09
  know,
• 14:09
  they're
• 14:09
  not,
• 14:10
  they're
• 14:10
  not
• 14:11
  going
• 14:11
  150
• 14:12
  miles
• 14:12
  per
• 14:13
  hour
• 14:13
  on
• 14:13
  the
• 14:13
  highway.
• 14:13
  They're
• 14:13
  not
• 14:15
  spending
• 14:15
  $55,000
• 14:17
  on,
• 14:18
  you
• 14:18
  know,
• 14:18
  trying
• 14:19
  to
• 14:19
  be
• 14:19
  a
• 14:19
  professional
• 14:20
  archery
• 14:21
  player.
• 14:21
  They're,
• 14:22
  you
• 14:22
  know,
• 14:22
  you
• 14:23
  don't
• 14:23
  see
• 14:23
  that
• 14:23
  75%
• 14:24
  is
• 14:24
  the
• 14:25
  depression.
• 14:25
  So
• 14:25
  75%
• 14:26
  of
• 14:26
  the,
• 14:27
  they're
• 14:27
  walking
• 14:27
  around
• 14:28
  with
• 14:28
  a
• 14:28
  legitimate
• 14:29
  DSM
• 14:30
  diagnosis
• 14:31
  that
• 14:31
  people
• 14:32
  take
• 14:32
  at
• 14:32
  face
• 14:32
  value
• 14:33
  and
• 14:33
  say,
• 14:33
  well,
• 14:33
  this
• 14:33
  must
• 14:33
  be
• 14:34
  depression.
• 14:34
  You
• 14:35
  take
• 14:35
  em
• 14:35
  to
• 14:35
  primary
• 14:35
  care,
• 14:36
  those
• 14:36
  visits
• 14:36
  are
• 14:37
  often
• 14:37
  15
• 14:37
  minutes
• 14:38
  and
• 14:39
  they
• 14:39
  give
• 14:39
  you
• 14:39
  a
• 14:39
  PHQ9.
• 14:40
  Well,
• 14:40
  a
• 14:41
  PHQ9
• 14:41
  doesn't
• 14:42
  have
• 14:42
  the
• 14:43
  hypomanic
• 14:45
  criteria,
• 14:45
  the
• 14:45
  man,
• 14:45
  the
• 14:46
  manic
• 14:46
  criteria
• 14:47
  on
• 14:47
  the
• 14:47
  PHQ9.
• 14:48
  So
• 14:48
  in
• 14:48
  a
• 14:48
  very
• 14:48
  short
• 14:49
  duration
• 14:49
  of
• 14:50
  a
• 14:50
  visit
• 14:51
  in
• 14:51
  a
• 14:51
  primary
• 14:51
  care
• 14:52
  Office
• 14:52
  with
• 14:52
  the
• 14:53
  PhQ9,
• 14:54
  when
• 14:54
  75%
• 14:55
  of
• 14:55
  the
• 14:55
  time
• 14:55
  those
• 14:55
  people
• 14:55
  are
• 14:56
  going
• 14:56
  to
• 14:56
  show
• 14:56
  up
• 14:56
  depressed,
• 14:57
  it
• 14:57
  doesn't
• 14:57
  bode
• 14:58
  well
• 14:58
  to
• 14:58
  make
• 14:59
  this
• 14:59
  diagnosis
• 14:59
  when
• 15:00
  that
• 15:00
  is
• 15:00
  the
• 15:01
  usual
• 15:01
  first
• 15:02
  point
• 15:02
  of
• 15:02
  contact.
• 15:03
  So
• 15:03
  you
• 15:04
  can
• 15:04
  see
• 15:04
  how
• 15:05
  devilishly
• 15:05
  difficult
• 15:06
  this
• 15:06
  is
• 15:07
  in
• 15:07
  a
• 15:07
  lot
• 15:07
  of
• 15:07
  places
• 15:08
  that
• 15:08
  require
• 15:08
  you
• 15:08
  to
• 15:09
  go
• 15:09
  to
• 15:09
  primary
• 15:09
  care
• 15:09
  first
• 15:10
  before
• 15:10
  you
• 15:10
  go
• 15:10
  to
• 15:10
  mental
• 15:11
  health.
• 15:11
  So
• 15:11
  the
• 15:11
  initial
• 15:12
  screen
• 15:12
  is
• 15:12
  so
• 15:13
  compressed,
• 15:13
  it
• 15:13
  doesn't
• 15:13
  really
• 15:14
  even
• 15:14
  capture
• 15:14
  this.
• 15:15
  And
• 15:15
  when
• 15:15
  you
• 15:16
  try
• 15:16
  to
• 15:16
  capture
• 15:16
  it,
• 15:16
  it's
• 15:17
  hard.
• 15:17
  Right,
• 15:17
  because
• 15:17
  people
• 15:18
  are,
• 15:18
  when
• 15:18
  they
• 15:18
  are
• 15:19
  manic
• 15:19
  or
• 15:19
  hypomanic,
• 15:20
  they
• 15:20
  might
• 15:20
  think
• 15:20
  they
• 15:21
  felt
• 15:21
  really
• 15:21
  good.
• 15:21
  They
• 15:22
  don't
• 15:22
  want
• 15:22
  to
• 15:22
  change
• 15:23
  that
• 15:23
  or
• 15:23
  flip
• 15:24
  that.
• 15:24
  And
• 15:24
  in
• 15:24
  hindsight,
• 15:25
  it
• 15:25
  might
• 15:25
  be
• 15:25
  equated
• 15:26
  by
• 15:26
  them
• 15:26
  as
• 15:27
  a
• 15:27
  good
• 15:27
  mood
• 15:28
  as
• 15:28
  opposed
• 15:28
  to
• 15:28
  this
• 15:29
  destructive,
• 15:30
  dysfunctional
• 15:31
  mood
• 15:31
  that
• 15:31
  needs
• 15:31
  to
• 15:32
  be
• 15:32
  treated.
• 15:32
  I
• 15:32
  know
• 15:33
  in
• 15:33
  my
• 15:33
  experience,
• 15:33
  a
• 15:34
  lot
• 15:34
  of
• 15:34
  my
• 15:34
  patients
• 15:34
  with
• 15:35
  bipolar
• 15:35
  2
• 15:36
  look
• 15:36
  back
• 15:36
  and
• 15:36
  think
• 15:37
  that
• 15:37
  it
• 15:37
  was
• 15:37
  actually
• 15:38
  pretty
• 15:38
  productive,
• 15:38
  but
• 15:39
  in
• 15:39
  reality,
• 15:39
  when
• 15:39
  you
• 15:40
  look
• 15:40
  really
• 15:40
  close,
• 15:41
  it
• 15:41
  wasn't
• 15:41
  that
• 15:41
  productive.
• 15:42
  Right.
• 15:42
  They're
• 15:42
  signing
• 15:44
  leases
• 15:44
  that
• 15:45
  they
• 15:45
  later
• 15:45
  regret.
• 15:46
  They're
• 15:46
  investing
• 15:46
  in
• 15:47
  companies
• 15:47
  that
• 15:47
  don't
• 15:47
  turn
• 15:48
  out
• 15:48
  the
• 15:48
  way
• 15:48
  they
• 15:48
  want
• 15:48
  them
• 15:49
  to.
• 15:49
  Right.
• 15:49
  They're
• 15:49
  breaking
• 15:50
  up
• 15:50
  prematurely
• 15:51
  with
• 15:51
  partners
• 15:52
  or
• 15:52
  making
• 15:52
  kind
• 15:53
  of
• 15:53
  rash
• 15:53
  decisions
• 15:54
  that
• 15:54
  have
• 15:54
  permanent
• 15:54
  consequences
• 15:55
  that
• 15:55
  aren't
• 15:56
  as
• 15:56
  big
• 15:56
  and
• 15:56
  flashy,
• 15:57
  that
• 15:57
  they
• 15:57
  end
• 15:57
  up
• 15:57
  in
• 15:57
  the
• 15:58
  hospital,
• 15:58
  but
• 15:59
  at
• 15:59
  the
• 15:59
  same
• 15:59
  time
• 15:59
  it's
• 16:00
  very
• 16:00
  problematic
• 16:01
  and
• 16:01
  very
• 16:02
  corrosive.
• 16:03
  Right.
• 16:03
  We
• 16:03
  talked
• 16:03
  in
• 16:04
  previous
• 16:04
  episodes
• 16:04
  how
• 16:05
  a
• 16:05
  bipolar
• 16:06
  one
• 16:06
  is
• 16:06
  like
• 16:06
  a
• 16:06
  raging
• 16:07
  forest
• 16:07
  fire.
• 16:08
  It's
• 16:08
  really
• 16:09
  flashy.
• 16:10
  It's
• 16:10
  obvious,
• 16:10
  it's
• 16:11
  extremely
• 16:11
  destructive.
• 16:12
  And
• 16:13
  then
• 16:13
  we
• 16:13
  talked
• 16:14
  about
• 16:14
  how
• 16:15
  bipolar
• 16:16
  2
• 16:16
  is
• 16:16
  kind
• 16:17
  of
• 16:17
  like
• 16:18
  mold
• 16:18
  that's
• 16:18
  accruing
• 16:19
  in
• 16:19
  the
• 16:19
  how
• 16:19
  home.
• 16:20
  Right.
• 16:20
  It'll
• 16:20
  slowly
• 16:21
  corrode.
• 16:22
  It'll
• 16:22
  slowly
• 16:22
  corrode
• 16:23
  the
• 16:23
  home.
• 16:24
  It's
• 16:24
  not
• 16:24
  as
• 16:24
  visible,
• 16:25
  but
• 16:25
  it's
• 16:26
  really
• 16:26
  destructive
• 16:27
  also.
• 16:27
  Right.
• 16:27
  And
• 16:27
  so
• 16:28
  both
• 16:28
  of
• 16:28
  them
• 16:28
  deserve
• 16:29
  a
• 16:29
  heck
• 16:29
  of
• 16:29
  a
• 16:29
  lot
• 16:30
  of
• 16:30
  our,
• 16:31
  of
• 16:31
  our
• 16:32
  attention.
• 16:32
  All
• 16:33
  right,
• 16:33
  let's
• 16:33
  move
• 16:33
  on
• 16:33
  to
• 16:33
  Pearl
• 16:34
  4.
• 16:34
  Okay.
• 16:35
  This
• 16:35
  one
• 16:35
  is
• 16:35
  also
• 16:36
  a
• 16:36
  pretty
• 16:36
  big
• 16:37
  one
• 16:37
  that
• 16:37
  I
• 16:37
  remember
• 16:38
  being
• 16:38
  shocked
• 16:39
  with
• 16:40
  in
• 16:40
  nursing
• 16:40
  school.
• 16:41
  But
• 16:41
  nonetheless,
• 16:42
  I
• 16:42
  still
• 16:42
  put
• 16:43
  it
• 16:43
  on
• 16:43
  here
• 16:44
  because
• 16:45
  I
• 16:45
  think
• 16:45
  that
• 16:46
  the
• 16:46
  borderline
• 16:47
  personality
• 16:49
  community,
• 16:50
  individuals
• 16:51
  who
• 16:51
  have
• 16:51
  borderline
• 16:52
  personality,
• 16:53
  as
• 16:53
  we
• 16:53
  all
• 16:53
  know,
• 16:54
  they
• 16:54
  can
• 16:54
  be
• 16:54
  unfairly
• 16:55
  stigmatized.
• 16:56
  They
• 16:56
  can
• 16:56
  be
• 16:56
  challenging
• 16:57
  sometimes
• 16:57
  to
• 16:58
  work
• 16:58
  with
• 16:58
  because
• 16:58
  their
• 16:59
  early
• 16:59
  childhood
• 17:00
  dynamics
• 17:01
  have
• 17:01
  created
• 17:02
  certain
• 17:02
  personality
• 17:03
  traits
• 17:04
  that
• 17:04
  are
• 17:04
  challenging
• 17:05
  at
• 17:05
  times.
• 17:06
  Right.
• 17:06
  And
• 17:06
  so
• 17:06
  I
• 17:06
  think
• 17:06
  this
• 17:07
  population
• 17:07
  deserves
• 17:08
  an
• 17:09
  olive
• 17:09
  branch
• 17:09
  and
• 17:10
  they
• 17:10
  deserve
• 17:10
  a
• 17:11
  lot
• 17:11
  of
• 17:11
  compassion.
• 17:11
  Cause
• 17:12
  this
• 17:12
  is
• 17:12
  a
• 17:12
  very
• 17:12
  serious
• 17:13
  personality
• 17:14
  disorder.
• 17:15
  And
• 17:15
  it.
• 17:15
  And
• 17:16
  so
• 17:16
  here's
• 17:16
  the
• 17:16
  pearl.
• 17:17
  The
• 17:17
  pearl
• 17:17
  is
• 17:17
  at
• 17:17
  approximately
• 17:18
  6%.
• 17:18
  I've
• 17:19
  seen
• 17:19
  up
• 17:19
  to
• 17:19
  10%
• 17:20
  in
• 17:20
  some
• 17:20
  of
• 17:20
  the
• 17:20
  evidence,
• 17:21
  but
• 17:21
  approximately
• 17:22
  6%
• 17:22
  of
• 17:22
  individuals
• 17:23
  with
• 17:23
  borderline
• 17:24
  personality
• 17:24
  disorder
• 17:25
  eventually
• 17:25
  die
• 17:26
  by
• 17:26
  suicide.
• 17:27
  Again,
• 17:27
  the
• 17:27
  rates
• 17:28
  of
• 17:28
  range
• 17:28
  in
• 17:29
  the
• 17:29
  evidence
• 17:29
  anywhere
• 17:29
  from
• 17:30
  5
• 17:30
  to
• 17:30
  10%.
• 17:31
  And
• 17:33
  that's
• 17:33
  not
• 17:33
  to
• 17:33
  say
• 17:34
  that
• 17:34
  52
• 17:35
  to
• 17:35
  84%
• 17:38
  will
• 17:38
  actually
• 17:39
  attempt
• 17:39
  to
• 17:39
  commit
• 17:40
  suicide.
• 17:40
  They
• 17:40
  won't
• 17:41
  do
• 17:41
  it,
• 17:42
  they
• 17:42
  won't
• 17:42
  complete
• 17:42
  it.
• 17:43
  That's
• 17:43
  5
• 17:43
  to
• 17:44
  10%.
• 17:44
  But
• 17:44
  52
• 17:45
  to
• 17:45
  84%
• 17:46
  will
• 17:46
  try.
• 17:47
  Now,
• 17:48
  of
• 17:48
  all,
• 17:49
  the
• 17:49
  one
• 17:50
  study
• 17:50
  showed
• 17:50
  that
• 17:51
  of
• 17:51
  all
• 17:52
  the
• 17:53
  mental
• 17:53
  health
• 17:53
  issue
• 17:54
  psychiatric
• 17:55
  disorders,
• 17:56
  BPD
• 17:57
  emerged
• 17:57
  as
• 17:57
  the
• 17:58
  most
• 17:58
  robust
• 17:58
  predictor
• 17:59
  of
• 17:59
  a
• 17:59
  suicide
• 17:59
  attempt
• 18:00
  among
• 18:01
  all
• 18:01
  of
• 18:01
  them.
• 18:02
  Okay.
• 18:02
  And
• 18:02
  that's
• 18:02
  independent
• 18:03
  of
• 18:03
  comorbid
• 18:04
  depression,
• 18:04
  substance
• 18:05
  use,
• 18:05
  PTSD
• 18:05
  or
• 18:06
  childhood
• 18:06
  trauma.
• 18:07
  So
• 18:07
  that
• 18:08
  is
• 18:08
  a
• 18:08
  really,
• 18:09
  really
• 18:10
  big
• 18:10
  deal,
• 18:11
  my
• 18:11
  friends.
• 18:12
  Imagine
• 18:13
  that
• 18:14
  your
• 18:14
  next
• 18:14
  100
• 18:15
  patients
• 18:15
  with
• 18:15
  borderline
• 18:16
  personality
• 18:16
  disorder,
• 18:17
  and
• 18:17
  it
• 18:18
  won't
• 18:18
  take
• 18:18
  you
• 18:18
  that
• 18:18
  long
• 18:19
  if
• 18:19
  you're
• 18:19
  in
• 18:19
  a
• 18:19
  busy
• 18:20
  practice
• 18:20
  to
• 18:20
  see
• 18:20
  your
• 18:20
  next
• 18:21
  100
• 18:21
  patients
• 18:21
  with
• 18:22
  borderline
• 18:22
  personality
• 18:22
  disorder,
• 18:23
  to
• 18:23
  think
• 18:23
  that
• 18:24
  statistically
• 18:24
  up
• 18:24
  to
• 18:25
  one
• 18:25
  in
• 18:25
  ten
• 18:25
  of
• 18:25
  them,
• 18:25
  up
• 18:26
  to
• 18:26
  ten
• 18:27
  of
• 18:27
  those
• 18:27
  hundred,
• 18:28
  may
• 18:28
  eventually
• 18:29
  die
• 18:29
  by
• 18:29
  suicide,
• 18:30
  per
• 18:30
  the
• 18:30
  statistics,
• 18:31
  my
• 18:31
  friends,
• 18:32
  that
• 18:32
  is
• 18:33
  absolutely
• 18:33
  jarring.
• 18:34
  And
• 18:35
  I
• 18:35
  know
• 18:35
  everyone
• 18:35
  in
• 18:35
  the
• 18:35
  mental
• 18:36
  health
• 18:36
  community
• 18:36
  does
• 18:37
  their
• 18:37
  absolute
• 18:37
  damn
• 18:38
  best.
• 18:38
  We
• 18:38
  have
• 18:38
  loads
• 18:39
  of
• 18:39
  compassion.
• 18:40
  We're
• 18:40
  in
• 18:40
  this
• 18:40
  field
• 18:40
  for
• 18:41
  a
• 18:41
  reason.
• 18:41
  But
• 18:41
  again,
• 18:42
  sometimes
• 18:43
  these
• 18:43
  patients
• 18:43
  can
• 18:43
  present
• 18:44
  unique
• 18:44
  challenges.
• 18:45
  And
• 18:45
  we've
• 18:45
  heard
• 18:46
  through
• 18:46
  the
• 18:46
  grapevine,
• 18:47
  right,
• 18:48
  that
• 18:48
  people
• 18:48
  can
• 18:48
  often
• 18:49
  say,
• 18:49
  okay,
• 18:49
  this
• 18:49
  is
• 18:49
  a
• 18:49
  very
• 18:50
  difficult
• 18:50
  situation.
• 18:51
  We
• 18:51
  feel
• 18:51
  like
• 18:52
  there's
• 18:52
  manipulation
• 18:52
  going
• 18:53
  on,
• 18:53
  there's
• 18:53
  attention
• 18:54
  seeking
• 18:54
  going
• 18:54
  on.
• 18:55
  But
• 18:55
  my
• 18:55
  friend,
• 18:55
  stigma
• 18:56
  be
• 18:56
  damned,
• 18:56
  these
• 18:57
  people
• 18:57
  suffer
• 18:58
  and
• 18:58
  they
• 18:58
  suffer
• 18:58
  hard.
• 18:58
  And
• 18:59
  there's
• 18:59
  a
• 18:59
  really
• 18:59
  good
• 19:00
  treatment,
• 19:01
  dialectical
• 19:01
  behavioral
• 19:02
  therapy,
• 19:02
  that
• 19:03
  can
• 19:03
  absolutely
• 19:04
  treat
• 19:05
  borderline
• 19:05
  and
• 19:05
  even
• 19:06
  relinquish
• 19:06
  it
• 19:06
  entirely.
• 19:07
  Now,
• 19:07
  that's
• 19:08
  going
• 19:08
  to
• 19:08
  be
• 19:08
  for
• 19:08
  a
• 19:08
  separate
• 19:09
  episode.
• 19:09
  But
• 19:09
  my
• 19:10
  friends,
• 19:10
  6%,
• 19:11
  up
• 19:11
  to
• 19:11
  10%
• 19:12
  of
• 19:12
  these
• 19:12
  folks
• 19:13
  will
• 19:13
  eventually
• 19:13
  die
• 19:14
  by
• 19:14
  suicide.
• 19:15
  That
• 19:15
  should
• 19:15
  inspire
• 19:16
  an
• 19:17
  unbelievable
• 19:17
  amount
• 19:18
  of
• 19:18
  compassion
• 19:18
  in
• 19:18
  all
• 19:18
  of
• 19:19
  our
• 19:19
  hearts
• 19:19
  and
• 19:20
  it
• 19:20
  might
• 19:20
  give
• 19:21
  us
• 19:21
  the
• 19:21
  kind
• 19:21
  of
• 19:21
  patience
• 19:22
  that
• 19:22
  we
• 19:22
  need
• 19:22
  during
• 19:23
  some
• 19:23
  of
• 19:23
  these
• 19:23
  challenging
• 19:24
  personality
• 19:25
  dynamics
• 19:26
  that
• 19:26
  present
• 19:26
  in
• 19:27
  our
• 19:27
  office.
• 19:27
  And
• 19:28
  so
• 19:28
  let's
• 19:29
  definitely
• 19:31
  throw
• 19:32
  our
• 19:32
  hearts
• 19:32
  out
• 19:32
  to
• 19:33
  these
• 19:33
  folks.
• 19:33
  Cause
• 19:33
  it's
• 19:33
  certainly
• 19:34
  not
• 19:34
  easy.
• 19:35
  Pearl
• 19:35
  number
• 19:36
  five.
• 19:36
  And
• 19:37
  we
• 19:37
  kind
• 19:37
  of
• 19:37
  touched
• 19:38
  on
• 19:38
  the
• 19:38
  primary
• 19:38
  care
• 19:39
  bipolar
• 19:39
  thing
• 19:39
  here,
• 19:40
  but
• 19:40
  this
• 19:40
  really
• 19:41
  sums
• 19:41
  it
• 19:41
  up
• 19:42
  more
• 19:43
  crisply.
• 19:43
  Nearly
• 19:44
  25%
• 19:45
  of
• 19:46
  people
• 19:46
  initially
• 19:46
  diagnosed
• 19:47
  with
• 19:47
  MDD
• 19:48
  will
• 19:48
  have
• 19:49
  their
• 19:49
  diagnosis
• 19:49
  switched
• 19:50
  to
• 19:50
  bipolar
• 19:50
  disorder
• 19:51
  within
• 19:51
  five
• 19:51
  years.
• 19:52
  Now,
• 19:52
  for
• 19:52
  the
• 19:52
  primary
• 19:52
  care
• 19:53
  folks
• 19:53
  that
• 19:53
  listen
• 19:53
  to
• 19:53
  this,
• 19:55
  this
• 19:55
  is
• 19:55
  probably
• 19:56
  a
• 19:57
  very
• 19:57
  shocking
• 19:58
  one
• 19:58
  and
• 19:58
  a
• 19:58
  very
• 19:58
  unsettling
• 19:59
  one.
• 19:59
  And
• 20:00
  I
• 20:00
  know
• 20:00
  they
• 20:00
  do
• 20:00
  their
• 20:00
  absolute
• 20:01
  best
• 20:01
  and
• 20:01
  they
• 20:02
  work
• 20:02
  with
• 20:02
  us
• 20:02
  very
• 20:03
  closely.
• 20:03
  And
• 20:04
  I
• 20:04
  know
• 20:04
  my
• 20:04
  primary
• 20:05
  care
• 20:05
  docs
• 20:05
  teach
• 20:06
  me
• 20:06
  so
• 20:06
  much
• 20:06
  and
• 20:07
  I
• 20:07
  like
• 20:07
  to
• 20:07
  think
• 20:08
  I
• 20:08
  impart
• 20:08
  some
• 20:09
  wisdom
• 20:09
  to
• 20:09
  them.
• 20:10
  And
• 20:10
  so
• 20:10
  to
• 20:10
  think
• 20:11
  that
• 20:12
  one
• 20:12
  in
• 20:12
  four
• 20:13
  of
• 20:13
  the
• 20:13
  patients
• 20:13
  that
• 20:13
  they're
• 20:14
  convinced
• 20:14
  may
• 20:14
  have
• 20:14
  depression
• 20:15
  based
• 20:15
  on
• 20:15
  their
• 20:15
  short
• 20:16
  interactions
• 20:16
  with
• 20:16
  them,
• 20:17
  based
• 20:17
  on
• 20:17
  that,
• 20:19
  the
• 20:19
  fact
• 20:19
  that
• 20:19
  a
• 20:19
  fourth
• 20:20
  of
• 20:20
  them
• 20:20
  might
• 20:20
  be
• 20:20
  bipolar,
• 20:21
  you
• 20:21
  add.
• 20:22
  Or
• 20:22
  in
• 20:22
  five
• 20:23
  years.
• 20:23
  And
• 20:23
  you
• 20:23
  add
• 20:24
  the
• 20:24
  fact
• 20:24
  that
• 20:25
  the
• 20:25
  most
• 20:25
  common
• 20:25
  first
• 20:26
  line
• 20:26
  treatment
• 20:26
  would
• 20:26
  be
• 20:26
  antidepressant
• 20:27
  monotherapy.
• 20:28
  When
• 20:28
  all
• 20:28
  you're
• 20:28
  seeing
• 20:29
  is
• 20:29
  depression
• 20:29
  and
• 20:29
  you're
• 20:29
  diagnosing
• 20:30
  depression.
• 20:31
  And
• 20:31
  yet
• 20:31
  that
• 20:31
  monotherapy
• 20:32
  can
• 20:32
  cause
• 20:33
  cycling
• 20:34
  and
• 20:35
  mixed
• 20:35
  features
• 20:36
  and
• 20:36
  can
• 20:36
  potentially
• 20:37
  precipitate
• 20:38
  a
• 20:38
  manic
• 20:39
  episode,
• 20:39
  my
• 20:39
  friends,
• 20:40
  that
• 20:40
  is
• 20:40
  hair
• 20:40
  on
• 20:41
  fire.
• 20:41
  Scary.
• 20:42
  And
• 20:42
  that's
• 20:43
  why
• 20:43
  I
• 20:43
  love
• 20:43
  this
• 20:43
  Pearl,
• 20:44
  because
• 20:44
  it
• 20:44
  keeps
• 20:44
  us
• 20:44
  on
• 20:44
  our
• 20:45
  toes,
• 20:45
  right?
• 20:46
  For
• 20:46
  those
• 20:46
  poor
• 20:46
  primary
• 20:46
  care
• 20:47
  managers,
• 20:47
  it's
• 20:48
  like
• 20:48
  playing
• 20:48
  that
• 20:48
  game
• 20:48
  Minesweeper.
• 20:49
  I
• 20:49
  don't
• 20:50
  know
• 20:50
  if
• 20:50
  you've
• 20:50
  ever,
• 20:50
  guys,
• 20:50
  if
• 20:51
  you
• 20:51
  guys
• 20:51
  have
• 20:51
  ever
• 20:51
  played
• 20:51
  that
• 20:52
  on
• 20:52
  those
• 20:52
  old
• 20:52
  1990s
• 20:53
  computers
• 20:53
  where
• 20:54
  you
• 20:54
  got
• 20:54
  to
• 20:54
  press
• 20:54
  a
• 20:55
  square
• 20:55
  and
• 20:55
  you're
• 20:55
  hoping
• 20:56
  it's
• 20:56
  not
• 20:56
  like
• 20:56
  a
• 20:56
  grenade
• 20:57
  that
• 20:57
  blows
• 20:57
  up,
• 20:58
  right?
• 20:58
  And
• 20:59
  so
• 20:59
  these
• 20:59
  poor
• 20:59
  primary
• 21:00
  care
• 21:00
  docs,
• 21:00
  they
• 21:01
  have
• 21:01
  like
• 21:01
  a
• 21:01
  ,thousand
• 21:02
  squares
• 21:02
  and
• 21:02
  250
• 21:03
  of
• 21:03
  them
• 21:04
  are
• 21:04
  those
• 21:05
  little
• 21:05
  landmine
• 21:06
  grenades.
• 21:07
  And,
• 21:07
  and
• 21:07
  if
• 21:07
  they
• 21:08
  press
• 21:08
  1,
• 21:08
  the
• 21:08
  game
• 21:08
  is
• 21:09
  over,
• 21:09
  right?
• 21:09
  And
• 21:09
  in
• 21:10
  this
• 21:10
  case,
• 21:11
  you
• 21:11
  know,
• 21:11
  I
• 21:11
  don't
• 21:11
  wanna
• 21:11
  say
• 21:12
  the
• 21:12
  game
• 21:12
  is
• 21:12
  over.
• 21:12
  People
• 21:12
  don't
• 21:13
  die
• 21:13
  necessarily,
• 21:14
  but
• 21:14
  it's,
• 21:14
  it's
• 21:15
  potentially
• 21:15
  problematic.
• 21:16
  And
• 21:16
  you're,
• 21:16
  you're
• 21:17
  giving
• 21:17
  a
• 21:17
  treatment
• 21:17
  first
• 21:18
  line
• 21:18
  that's
• 21:19
  gonna
• 21:19
  make
• 21:19
  this
• 21:19
  much
• 21:19
  muddier
• 21:20
  and
• 21:20
  more
• 21:21
  resistant
• 21:21
  and
• 21:21
  more
• 21:21
  difficult
• 21:22
  and
• 21:22
  could
• 21:22
  throw
• 21:23
  somebody
• 21:23
  even
• 21:23
  into
• 21:23
  a
• 21:23
  hospitalization.
• 21:24
  So
• 21:25
  very
• 21:26
  important
• 21:26
  statistic,
• 21:27
  the
• 21:27
  last
• 21:27
  Pearl,
• 21:28
  Pearl
• 21:28
  six.
• 21:29
  Which
• 21:29
  I
• 21:29
  think
• 21:30
  kind
• 21:30
  of
• 21:30
  brings
• 21:30
  this
• 21:30
  all
• 21:31
  home,
• 21:31
  my
• 21:31
  friends.
• 21:32
  Also
• 21:32
  kind
• 21:32
  of
• 21:32
  a
• 21:33
  shocker.
• 21:33
  And
• 21:33
  this
• 21:33
  one
• 21:34
  humanizes
• 21:34
  things.
• 21:35
  80%
• 21:36
  of
• 21:36
  all
• 21:37
  of
• 21:37
  us,
• 21:37
  the
• 21:38
  whole
• 21:38
  World,
• 21:38
  the
• 21:38
  globe,
• 21:39
  worldwide.
• 21:39
  Pitbull.
• 21:40
  80%
• 21:41
  will
• 21:41
  meet
• 21:41
  criteria
• 21:42
  for
• 21:42
  a
• 21:43
  psychiatric
• 21:43
  disorder
• 21:44
  at
• 21:44
  some
• 21:44
  point
• 21:44
  in
• 21:44
  their
• 21:44
  lifetime.
• 21:45
  80%,
• 21:46
  my
• 21:46
  friends.
• 21:48
  So
• 21:49
  I
• 21:49
  think
• 21:49
  that
• 21:50
  this
• 21:50
  pearl
• 21:51
  fundamentally
• 21:51
  challenges
• 21:52
  the
• 21:52
  concept
• 21:52
  of
• 21:53
  mental
• 21:53
  illness
• 21:53
  as
• 21:53
  affecting
• 21:54
  a
• 21:54
  minority.
• 21:56
  This
• 21:56
  is
• 21:56
  a
• 21:56
  statistical
• 21:57
  norm,
• 21:57
  not
• 21:57
  an
• 21:58
  exception.
• 21:59
  And
• 21:59
  so
• 21:59
  mental
• 21:59
  health
• 21:59
  screening
• 22:00
  should
• 22:00
  be
• 22:01
  as
• 22:01
  routine
• 22:02
  as
• 22:02
  screening
• 22:02
  for
• 22:02
  hypertension
• 22:03
  or
• 22:03
  diabetes.
• 22:04
  That
• 22:04
  is,
• 22:04
  80%
• 22:06
  of
• 22:06
  people
• 22:06
  around
• 22:07
  the
• 22:07
  globe
• 22:08
  will
• 22:08
  have,
• 22:09
  will
• 22:09
  meet
• 22:09
  some
• 22:09
  will
• 22:10
  meet
• 22:10
  criteria
• 22:10
  for
• 22:11
  a
• 22:11
  psychiatric
• 22:12
  disorder
• 22:12
  at
• 22:13
  some
• 22:13
  point
• 22:13
  in
• 22:14
  their
• 22:14
  lives.
• 22:14
  I
• 22:15
  have
• 22:15
  so
• 22:16
  much
• 22:16
  love
• 22:17
  and
• 22:17
  compassion
• 22:17
  for
• 22:17
  this
• 22:18
  pearl
• 22:18
  because
• 22:18
  it
• 22:19
  just
• 22:19
  goes
• 22:19
  to
• 22:19
  show,
• 22:19
  we're
• 22:20
  all
• 22:20
  human.
• 22:20
  We
• 22:20
  live
• 22:21
  in
• 22:21
  a
• 22:21
  crazy
• 22:21
  world.
• 22:22
  There's
• 22:22
  no
• 22:22
  shame
• 22:23
  in
• 22:23
  getting
• 22:23
  treatment.
• 22:24
  And
• 22:27
  this
• 22:27
  is,
• 22:27
  this
• 22:28
  is
• 22:28
  not
• 22:28
  some
• 22:29
  small
• 22:29
  group
• 22:30
  of
• 22:30
  people
• 22:30
  that
• 22:30
  aren't
• 22:31
  resilient
• 22:31
  and
• 22:32
  oh,
• 22:33
  why
• 22:33
  don't
• 22:33
  they
• 22:33
  pull
• 22:34
  them
• 22:34
  up
• 22:34
  by
• 22:34
  their
• 22:34
  bootstraps?
• 22:35
  No,
• 22:35
  this
• 22:35
  is
• 22:35
  now
• 22:36
  a
• 22:36
  human
• 22:36
  condition,
• 22:37
  80%
• 22:38
  of
• 22:38
  the
• 22:38
  world.
• 22:38
  And
• 22:39
  we
• 22:39
  should
• 22:39
  treat
• 22:39
  it
• 22:40
  as
• 22:40
  such.
• 22:40
  It's
• 22:40
  no
• 22:40
  different
• 22:41
  than
• 22:41
  somebody
• 22:41
  who
• 22:41
  catches
• 22:42
  pneumonia
• 22:43
  or
• 22:43
  has
• 22:43
  hypertension.
• 22:44
  Right?
• 22:44
  These
• 22:44
  are
• 22:44
  things
• 22:45
  that
• 22:45
  happen
• 22:45
  to
• 22:45
  human
• 22:46
  beings
• 22:46
  and
• 22:46
  we
• 22:46
  have
• 22:46
  to
• 22:46
  have
• 22:47
  compassion
• 22:47
  for
• 22:47
  it
• 22:48
  because
• 22:48
  they
• 22:49
  are
• 22:49
  real
• 22:49
  and
• 22:50
  certainly
• 22:50
  can't
• 22:51
  be
• 22:51
  that
• 22:51
  80%
• 22:51
  of
• 22:52
  the
• 22:52
  world
• 22:52
  is
• 22:52
  not
• 22:52
  resilient.
• 22:53
  And
• 22:54
  so
• 22:55
  I
• 22:55
  think
• 22:55
  that's
• 22:55
  a
• 22:55
  very
• 22:56
  important
• 22:57
  pearl
• 22:57
  to
• 22:58
  keep
• 22:58
  in
• 22:58
  our
• 22:58
  back
• 22:59
  pockets.
• 22:59
  My
• 22:59
  friends,
• 23:00
  there
• 23:00
  are
• 23:00
  two
• 23:00
  more
• 23:00
  pearls
• 23:01
  that
• 23:01
  if
• 23:01
  you
• 23:01
  become
• 23:02
  Patreon
• 23:02
  members,
• 23:03
  they
• 23:03
  are
• 23:03
  equally
• 23:04
  as
• 23:04
  shocking
• 23:05
  and
• 23:05
  interesting
• 23:05
  and
• 23:06
  will
• 23:06
  change
• 23:06
  the
• 23:07
  way
• 23:07
  you
• 23:07
  look
• 23:07
  at
• 23:07
  your
• 23:07
  practice.
• 23:08
  Those
• 23:08
  are
• 23:08
  exclusively
• 23:09
  for
• 23:09
  our
• 23:09
  good
• 23:09
  friends
• 23:10
  on
• 23:10
  Patreon.
• 23:10
  But
• 23:11
  if
• 23:11
  you're
• 23:11
  listening
• 23:11
  to
• 23:11
  this
• 23:11
  and
• 23:12
  you
• 23:12
  don't
• 23:12
  want
• 23:12
  to
• 23:12
  become
• 23:12
  a
• 23:12
  Patreon
• 23:13
  member,
• 23:14
  that
• 23:14
  is
• 23:14
  totally
• 23:14
  fine
• 23:15
  too.
• 23:15
  You
• 23:15
  are
• 23:15
  still
• 23:15
  a
• 23:15
  good
• 23:16
  friend.
• 23:16
  We
• 23:16
  still
• 23:17
  love
• 23:17
  you
• 23:17
  and
• 23:17
  appreciate
• 23:18
  you.
• 23:18
  And
• 23:18
  if
• 23:19
  you'd
• 23:19
  like,
• 23:20
  we'd
• 23:20
  love
• 23:21
  for
• 23:21
  you
• 23:21
  to
• 23:21
  give
• 23:21
  us
• 23:21
  a
• 23:21
  little
• 23:21
  rating
• 23:22
  on
• 23:22
  Apple.
• 23:22
  Give
• 23:22
  us
• 23:23
  five
• 23:23
  stars,
• 23:23
  write
• 23:23
  a
• 23:23
  comment.
• 23:24
  But
• 23:24
  if
• 23:24
  not
• 23:25
  all
• 23:25
  good,
• 23:26
  just
• 23:26
  soak
• 23:26
  up
• 23:27
  these
• 23:27
  pearls.
• 23:28
  Help
• 23:28
  the
• 23:28
  people
• 23:28
  you
• 23:29
  work
• 23:29
  with.
• 23:30
  Help
• 23:30
  your
• 23:30
  dear
• 23:30
  patients
• 23:31
  live
• 23:31
  better
• 23:31
  lives.
• 23:32
  That's
• 23:32
  what
• 23:32
  this
• 23:32
  is
• 23:32
  all
• 23:32
  about,
• 23:33
  right?
• 23:33
  Pearls
• 23:33
  and
• 23:34
  prep
• 23:34
  is
• 23:34
  all
• 23:34
  about
• 23:35
  collecting
• 23:36
  knowledge.
• 23:37
  Because
• 23:37
  knowledge
• 23:37
  is
• 23:38
  power
• 23:38
  and
• 23:38
  the
• 23:38
  power
• 23:39
  is
• 23:39
  yours
• 23:40
  to
• 23:40
  make
• 23:41
  your
• 23:41
  patients
• 23:41
  lives
• 23:42
  better
• 23:42
  and
• 23:43
  smoother
• 23:43
  and
• 23:43
  more
• 23:44
  gratifying.
• 23:44
  I'm
• 23:44
  signing
• 23:45
  off
• 23:45
  now.
• 23:45
  I
• 23:45
  hope
• 23:45
  you
• 23:46
  all
• 23:46
  enjoy
• 23:46
  this.
• 23:46
  Until
• 23:46
  next
• 23:47
  time,
• 23:47
  take
• 23:47
  care,
• 23:47
  my
• 23:47
  friends.
• 23:48
  Bye.