Episode 5 - Mood Disorders Part 1

Shall we? So we're gonna start uh talking about mood disorders today. I'm hoping we can get quite a way through it. Uh we probably won't finish up with mood We'll get as far as we can. Um So first of all, um mood disorders are gonna come in two broad flavors. Uh unipolar, uh what we call major depression. and bipolar disorders. So the key thing here is that both of these disorders have depression as one of the symptoms Uh in bipolar disorder, as you know, we're just essentially adding in

Depression. Um what'll happen, what we'll see is that there are two types of bipolar disorder. One where depression is the primary symptom and the other where ma uh mania is the primary symptom. And in the in those cases the Um about uh fifteen percent uh Men uh fifteen percent of men will experience a depressive disorder at some point uh in their life. Um and about twenty four percent

Quite high prevalence. One of the reasons why I I sort of start out with this disorder, because it's the one you're most likely to see on a day-to-day basis. Um when we uh when uh I was talking about college response, which is the Screening program that's run by Screening for Mental Health. That's one of those programs. Service learning projects. Um they screened six hundred colleges at six hundred colleges last year. Um thirty seven thousand uh students were screened in person.

Forty eight thousand were screened online and um that showed a quite high uh prevalence. Now obviously this Skewed by the fact that it's those people that are either doing the screening uh in person or going online to do it. Plus the people some of the people that go online are probably But still uh it's it's a serious problem on college campuses uh especially. So

So what do we tend to see in terms of um uh symptomology of depression? You know, what are the things you associate with depression? Suicide, good. Uh disinterest in previously enjoyable activities or lack of enjoyment of those activities. Isolation and withdrawal, yeah. Yeah. Yeah, from from uh people. Um Um uh there can be disturbances in sleep either way, either uh hypersomnia or hyposomnia, either sleeping too much or sleeping too little. Yeah. God.

Okay. So there is an association between substance use and uh depression. Um it's unclear what that association is, but um there's definitely. Although I'll say that there's an association with substance use and lie. Um one of the primary ones that you'll see is feelings of worthlessness. But now all these things that you've identified so far, for the most part, have been what we call the retarded symptoms. the um withdrawal, the um sadness, sleeping too much.

like that. And uh but as I said, it's important to recognize that depression can also be seen in terms of what are known as agitated symptoms. And that's, you know, really this kind of experience where someone is ruminat you know, they'll be ruminating in their mind, um, they'll be anxious, their mind will be going at a mile a minute, they'll be pacing. You know, it'll almost look like mania, but it But it's depression. Um Pulling on things.

You know, pulling on your hair or picking at your skin is one of the agitated symptoms. And oftentimes people will just sort of suddenly shout. It's not the same as like Tourette's syndrome or a verbal tick, but um they'll suddenly you know, they'll their anxiety will cause them to suddenly say something like, I didn't do that. Right. You know, this rumination that's going on in their head causes them to have to verbally express that frustration.

Yeah, sense of being overwhelmed with with hard daily activities. React to um Sure, sure, sure. Absolutely. Yeah. Yeah. Uh this well yeah, we use that terminology when we talk about um schizophrenia and I kinda These would be considered the negative symptoms and these would be considered the positive symptoms. You know, positive being there's something there, a negative being there's something taken away. Yeah. Yeah. Um

So we typically see um depressed mood, what we call dysphoria. Um we you really identified most of those things already. Um And um we talked about anidonia, um loss of interest in previously uh enjoyable things. Um there's something that was identified by Aaron Beck who's one of the main figures in uh studying depression. Uh Beck developed what's called the Beck Depression. questionnaire formats that's used in diagnosis. And um he called this the uh depressive triad.

Um the idea that um it is um a problem of self And a problem of environment and a problem of future. um that um we have this sense that there's something wrong with us As an individual, we have this sense that there's something wrong with our interaction with the environment and a sense that um there's something wrong with our f sense of the future, our hopefulness for the future.

And he says when those three things you know, you can have a a couple of these things and not go into a depression. But he says when you have all those three things it really um really drags people down. So that's sort of the um kind of cognitive idea about um your thoughts about the self, your thoughts about the environment, your thoughts about the future are all very distorted.

uh you don't really see yourself as yourself really is. You see yourself as a depressed self or as a worthless self. You don't see the environment as a re environment. You see the environment as threatening or the environment as uh uh undesirable. And you don't see the future as the future really is. You see the future as bleak or um hopeless. Typically we also see um just a real slowing down of cognitive processes during depression. People just think

And you'll see this uh reflected in the um Unquiet Mind memoir that we're reading. Um you'll see how her depression really slows down her thinking. Um And it tends uh to be not so much of a problem on short term tasks that people can complete right away. But when things drag out for a long time uh again that sense of um worthlessness is going to start to pervade that and it's gonna be difficult to sort of plan for things in the future because uh the future just seems so bleak.

You know, we don't often ang we don't often uh associate anxiety with depression, but again, even with the uh retarded form of depression as well as the agitated form, people will experience this anxiety. Partly because they remember how they used to be and not like they used to be. And um that's gonna raise a lot of anxiety for people. And as you said, uh suicide uh is an unfortunate Consequence of depression sometimes, and suicidal ideation, thoughts of

If I'm so worthless, you know, why am I even bothering taking up space on this planet? I'm using up resources that other more useful people could use, so I should just die, right? Now suicidal ideation is a long way from uh planning or uh or actually attempting to You know, that's one of the things that um we don't talk about that much in

in this class that I think it's important to stress. These diseases, these disorders are chronic disorders that go on and on and on for people and oftentimes fatal. So, um, you know, it's hard to really grasp the seriousness of uh of these disorders sometimes unless you think of them like cancer. Um and think of it as like cancer before we had very good treatment. You know, we're treatments for cancer are getting better and better.

But there was a time when if you had cancer it was really bleak. Um and in the same way, uh our treatments are getting better for uh mental illness, but there are some mental illnesses where the treatment difficult and so um the uh the chronic nature of these diseases and the um sometimes fatal nature is uh something I like to talk about.

So those are the symptoms in terms of cognition and affect. Behaviorally, um, we tend to see uh behavior changes in uh movement and speech. And it's either going to be retarded, slowed down, or added. go either way. So it's gonna be a difficult diagnosis just observing those behavioral traits. Um you're gonna have to go into cognition and affect to try to figure out uh if it's uh Uh depression. Um somatic symptoms. We talked about this.

Uh disturbed sleep, uh either uh hypersomnia or hyposomnia. So people will either sleep too much or they'll have insomnia, wake up too early, can't get back to sleep. Um piece of data from uh sleep disorders is that more serious kind of clinical depression tends to be associated more with um waking up uh too early.

rather than not being able to go to sleep, for example. Um and um there's not you know, again it's an association, it's not sh it's not causal Those those disturbances tend to be associated with more uh serious depression. We talked about eating, and we didn't talk about loss of libido. sex. Um and general sort of uh somatic kinds of Oftentimes just um being tired all the time, lethargy, um pains, uh joint.

aches in the body. And again, uh these are oftentimes the more prevalent symptoms in some cultures. For example, in East Asian cultures, you'll typically see these somatic and not the affective uh uh symptoms that we typically associate with depression. Uh that's a good question. Uh do they not experience them or is it um something in the culture that makes it undesirable to report them? I don't know. Yeah, that's a good question.

Um also I think that a lot of times most of us have the same depression have a Um I am not aware of that. But I could imagine I mean I'm not fruitful on a problem, but I Yeah, It's not one of the side effects of the antidepressants. Uh that's anecdotal evidence. I haven't seen any research. Um any time you're adding stress

you're compromising the immune system. So these are stressful disorders to have. So I can I can see how stress, but I don't think it's depression specifically, but more the stress Some immune uh dysfunction. Yeah.

There are some subtypes of depression. The one you've probably heard of is SAD, seasonal affective disorder. Living in Oregon. Um what it typically tends to be related to is uh just basically when the sun goes down earlier in the winter and it doesn't come up till later. Um those long nights in the winter tend to be associated with higher rates of depression. And that is confirmed by the idea that the seasonality is reversed in the southern hemisphere.

So we see it more in November, December, January, February in the northern hemisphere and more in June, July, August in the Southern Hemisphere. About one percent of people population will uh have seasonal affective disorder. And it tends to be more intense as you get further away from the equator. So um uh you know the sort of uh What do they call it? Scandinavian, Slavic, um, Norwegian areas tend to have high rates of uh seasonal affective disorder. Uh

Uh postpartum depression is considered one of the subtypes of depression. Uh and again the prevalence is about one percent a month. women who have had children. Um do you have any more data on that than I don't? Um our figures are more like Your figures in terms of what's who who's Oh, okay. Okay. Okay. And a lot of times it's all being wrapped under postpartum depression. But because of all these variations which don't all look like someone who's depressed, then they're always I'm sorry.

Thank you. Yeah. Okay. And then um then there is also a differentiation six months a month. And the two week temp um transient breeding period of baby blues, which is not depression, but is very depression and not something that stays with him unless Yeah. I'd like to see that uh clinical data if you can get it together. Yeah. Uh the um and I don't know how uh probably in that uh chapter of the DSM it has uh diagnostic features of um the subtype. Probably, yeah. Most likely, yeah.

Um let's take a look at um

a video clip of a fellow who uh I think he has uh major depressive disorder. And um uh we'll we can chat about it after. What does it feel like internally in those times when you are very depressed? You're absolutely alone. Or you feel you are alone. You feel absolute worthlessness. You feel that there's no There's as uh you you believe every

Initially diagnosed as having major depression. Not until age forty eight. Can you tell me about that? You want that diagnosed? You want me to lead up to it a little bit? Whatever is comfortable for you. I think that um In college I was I could be on the dean's list or would I would they bounce graduated, I I was teaching And I well if you can't teach you become an administrator. So I have a a master's degree in in uh um education. married, we had two children.

So really uh you know one of the things that that illustrates real well is that very extreme you know, the world's worst teacher, the world's worst administrator, right? That very dichotomy The uh depressive disorders.

Uh when we think about disorders, one of the things that uh we have to think about and talk about is um where do they come from? Uh what's causing them? And so uh when we think about those theories we're gonna explore um mostly all three of these, um biological theories.

from uh the psychological aspect That is um people's effective coping mechanisms and their ability to deal with them uh effectively and then the social uh the interpersonal, intergroup, uh relational kinds of aspects uh of these disorders that may lead up Um I'm gonna pause and I'm gonna and then you know of course we always have to talk about the biopsychosocial model and how these things all function together. Um I'm gonna pause this for just a second.

So let's talk about biology. Um first of all, genetics. Um when we do genetic studies for psychological disorders, what we look at is what's called the concordance rates uh for twins. So how likely is it that a pair of twins will have these uh this disorder? Um and so we look at monozygotic twins, right? Monozygotic meaning Same DNA. One egg, one sperm, same DNA. Uh dizygotic meaning what? Two eggs, two sperm, different genes, same intrauterine environment. Right.

Commonly called identical twins, right? So uh among monozygotic twins we see a concordance rate of, depending on the study you look at, uh somewhere between uh forty and fifty five percent, fifty four percent. Um but in dizygotic twins that concordance rate goes way down and it approaches the general population. So um there's pretty strong evidence that uh there is some genetic predisposition involved in um

depression and mood disorders. We do see an even stronger link though with genetic So we're seeing that kind of play out in the um unquiet mind book that we're reading. There are some differences in brain function. Um particularly in the prefrontal cortex. Prefrontal cortex tends to show reduced activity, the amygdala These can actually show either reduced activity or too much activity. Uh but um the more common is to show lower activities.

We also have some indications that there may be some neurotransmitter dysfunctions involved in depression. And so um particularly they're looking at uh researchers are looking at the monoamine class of neurotransmitters. So um serotonin Um norepinephrine and dopamine. Dopamine is the neurotransmitter that you should associate with.

Um you stimulate the dopamine producing areas in the brain, uh you get a feeling of euphoria. Um we think that that's related to uh sub Um Serotonin uh is a neurotransmitter that is a very calming, has a very calming effect, and um the notion is that there's too little serotonin available. um for individuals who have depression. So when we treat them with and the reason that we think that's the case, we treat them with drugs that helps increase the level of serotonin.

and they get better. So um there's probably uh there's probably a link there. Um you've probably heard of one of the treatments for depression. SSRI drugs. Have you heard of that? Um selective Uh reuptake inhibitor. Um and essentially what that does is it leaves more serotonin in the synapse. of between two neurons.

um so that there's more available to be used. It inhibits the reuptake process. This is getting back into intro psych and what you learned about neurobiology. Um I'll go into this in a little more detail. And another class is called the M A O I Monoamine um uh oxidase inhibitors. And what these do is instead of uh inhibiting the reuptake of serotonin back

the neurons. This is inhibiting the action of this monoaminoxidase, which is an enzyme that breaks down the neurotransmitters It keeps those neurotransmitters from getting broken down and so that they can be used on the receptor. So these are biological explanations for why uh how serotonin might be involved and how we can intervene and help people maintain higher levels. And people generally tend to show good uh responses to the SSRI class. The MAOIs aren't used much anymore.

Um because Uh they have a lot of interactive effects with over the counter drugs, other prescription drugs, and foods. So you may see if you pick up like um uh medicine over the counter and you look on the back under the warnings, uh fairly frequently you'll see uh do not use if you're taking an MAOS. Um so these aren't used so much anymore. Those were an earlier class of antidepressants. The SSRIs are the uh more f uh recent class of antidepressants.

Okay. So psychological explanations. Here we go with Aaron Basket. Uh Beck says uh how you think is a very important component in how you feel. Thinking, that is cognition, is directly related to And um what he says is we learn these patterns of thinking in childhood that result in negative affect. Uh for one thing, um negative self schemas, the idea that we generally tend to think of ourselves as not adequate or inadequate or not good people, not good children.

um this sort of constant uh rumination about negative thoughts rather than positive thinking. Um and then just basically when you think about the environment, when you think about the world Uh you you are distorting the the perception. You know, the reality is different the objective reality to other objective observers is different than your distorted perception.

And so what as I said, what he'll say is there's this cognitive triad where these negative views of the self and of the environment and of the future all combine to really um create this really intense uh sad Very um deep sadness, um worthlessness, hopelessness. So um, you know, there is something about um looking on the bright side.

But that's not necessarily a way out of depression. Um but those people who may have that more optimistic view, especially early in life, may be more uh maybe less likely to develop depression later in life. So You know how to improve your mood? Put a pencil between your tape. Yeah, yeah. V fascinating research. Um basically activating the muscles that are involved with smiling uh causes measurable changes in uh in mood. Yeah.

There you go. You know, active pressure and acupuncture about the meridian and tweet sure that this part of your hand is different as any So um what do other besides Beck what do other people say? Well first of all there's uh Sell Seligman's uh explanation about learned help. Marty Seligman is a um psychologist. I think he's at Yale.

And um what he discovered was um when you put uh an organism, in this case he his classic experiment used dogs, when you put them in a situation where they can't escape from some unpleasant stimulus they will eventually just lie down and like not bother trying to escape. And then what becomes even more bizarre is if you give them the ability to escape, they won't even use it. So it's this idea that you just learn that you're helpless to avoid being uh in this situation.

The um another uh is that handle? N not necessarily. It depends on how uh valuable the outcome of the research is. And uh you know, how uh damaging it is, yeah. How uh how well regarded is that very easy? Uh pretty well regarded, yeah. Quite highly regarded, yeah. Yeah. It's uh demonstrated and replicated on numerous uh in numerous different environments, numerous different organisms. Oh yeah. Uh Yale, I think. Yeah, Martin Sully.

Um not really. She's um generally considered to be uh I have what's something called the stock Yeah, um, where you begin to identify with your captors. Um but that syndrome has not very good empirical support, so Um Another uh explanation from the psychological perspective is that um

We have um in we all have different styles of attribution. Um what's attribution mean? Yeah, that's why I asked. Um our framework for describing sort of the one that's why. So a framework perhaps for understanding and describing causal relationships? Um And it is highly subjective. And so what uh one of the psychological theories is that um we have different kind of kinds of attribution styles on different

uh dimensions. So some of us attribute our successes and our failures to more internal qualities. our uh ability, our strength uh or our inability or our weakness. Others attribute uh their successes and failures more to extract attributes. Well I just got lucky or um you know that test was just too hard.

Right. Um Stability and instability is another domain where they're looking at attributional styles. Some people tend to um attribute their behavior to more stable factors, others attribute their behavior factors and global and uh specific attributions are another factor. So um some people will make global attributions about themselves. Right a and others will make more specific domain dependent attributions, right?

So some people might globally perceive their themselves as more uh externally influenced. Their locus of control is more external. and um they don't have control over their events and the environment. You know, their life is kind of subject to the whim of the environment. And that, you know, is going to lead to certain kinds of thinking and certain kinds of attitudes. Um and then also uh interpersonal factors. Um time and time again, uh this is gonna come up.

Uh social support. Um clinic research on uh clinical disorders time and time again shows the value of social support in positive outcomes from And you'll see that theme actually come up in An Unquiet Mind. So uh what we see in people with depression is they tend to have smaller social support networks and those social support networks tend to be less supportive of recovery.

and perhaps even encouraging of uh disability or or or illness. Um we tend to see less supportive families in people with depression and um Uh you know, it's a bummer to be around someone who's depressed. So um again, these aren't causal factors. They there's prob there's an association, there's a probably a complex interaction of these uh of the But we do tend to see these things uh more associated with depression. I'm trying to help somebody out.

Seems like it's just draining you and then you then you have to pull back in order to to That's what I mean, it's interactive. Yeah. Yep. But I think that's absolutely true. It makes huge It's balanced. Um that's why I think the extended support system social Mm-hmm. Really isolated. Yeah, either from their by their own design or by just the progress of the illness, yeah. And no place else to go with it. Maybe get some support.

It depends where you are. Yeah. There are there are support groups in uh mostly in major cities, but certainly not. Um so biopsychosocial. Um so social factors that have uh that are related with depression, certainly socioeconomic status, and we'll see this over and over again in uh medical uh people with in lower socio economic status groups have higher rate

Uh what's up with the idea that women tend to have higher rates of these disorders? I gave you the statistics earlier, and uh so women are you know basically about twice as likely. likely to have these disorders. Um One idea is the high rates of sexual assault. Um with women the statistics are about one in four by the time they reach eighteen will uh have been sexually Then have about um half that

That's about double. And so uh one in seven for men. So there may be uh something related to sexual assault that may have a factor. And then physical assaults, um So uh women obviously uh women tend to be more likely to be the victims of uh domestic violence. uh whereas men oftentimes tend to be uh more involved in uh public fight. Um so, you know, that domestic violence is more sort of shaming. Um the public violence is more sort of um from an aspect Masculinity and protection. Yeah.

Uh and the idea that here that women in uh domestic violence situations, the person who's uh beating them is typically a trusted individual. So you've put your trust one. They've betrayed that trust and that's extraordinarily disrupting um psychologically.

Um there's also some interesting uh hypotheses about the effects of industrialization. Um the idea that uh depression rates have increased historically uh partly because uh we've moved more away from our own individual subsistence production and more into this um uh uh you're becoming more of a cog in the machine, right? And you become less individualized, more de individualized. And that can be

disturbing. Industrialization also tends to show um tends to lead to uh increases in the divide between the rich and the poor and that can exacerbate um depression. And in uh Western culture there are also some hypotheses about the idea that it is not acceptable in Um this culture expects you to be happy, to be um productive, to be up, to be doing things.

Uh and guess what? In bipolar disorder in those manic phases, you're looking good in those terms, right? Um but in the depression phases you look like crap. So um so our sort of Western cultural expectations may feed into these things too. Um we expect to be happy, we don't expect to be unhappy. Um Any ideas on this? Questions? They're associational, yeah. There's no causal relationship. And some of these are hypotheses rather than actual research. Um

You know, this is this doesn't get supported, this hasn't been uh studied that much. Uh there's a lot more study here um that uh shows some associations. Yeah. There were extended family, you know, grandparents and then so That's a good hypothesis and it would be worth uh trying to look at, yeah.

Um extended families can be beneficial if they're supportive extended families. That's you know, there's all kinds of variables in there, that's part of the problem. Well I would imagine that I I'm totally very quickly. that's part of the stuff that I'm writing about. But I would imagine that the lack of support or the dysfunctions that we see or talk about so much in families may be a result of these twists and So I worship.

variation in, you know, the whole way we approach things that could be impacting family net that used to traditionally Yeah. It's just uh so difficult to randomly assign children to being either in a um attachment, a secure attachment or an insecure attachment group. Yeah. Yeah, yeah, yeah, yeah.

if you're a part of a cog of a great machine and you're doing your part to make the country run, you might feel uh if you were in a more collective basic culture if that's what you want, you'd feel that you're doing your Mm. Okay. Good. Good. Yeah. Alternative hypotheses, yeah. And you can make your own opportunity with your number eleven in the birth order. It's not like you don't gonna not inherit anything. Right, right, right. You're right. You're right. You know. Um so yeah.

That's what I say. So it's very difficult to generalize that view to every individual and every family, right, and every culture. So it just you know, deserves more research. Yay. That makes more jobs for researchers. Hold on just a second.

Are you uh can you guys stick around for about Um I've just got one more uh clip. Um this is a clip uh from um a news I think it was from like a news show or documentary in Australia. And it's about a woman uh with uh bipolar disorder and um She uh it's about her descent into the disorder and then about uh her recovery. I think it's a worthwhile way to end the class today. And then when we pick up um on next class we'll talk more about treatments uh for the disorders. Okay?

So hopefully this will play okay. Kate was the second in family of four and the only girl Brass, she's about four, very Субтитры создавал DimaTorzok Kate O'Connor had it all. After excelling her high school certificate, her future looked like the rest of her life had been, full of promise and reward. Then six months into the house. things started to go terribly wrong.

came came home from a a a skiing holiday in her first year of university, she was eighteen and a half, and she She said to a a screening children with language couldn't. sort of friendship where we fight. I was really scared because I you know, I was petrified about losing my best friend and thought you know, I w wasn't quite sure about what the future held.

What Sue O'Connor found that night in the gutter outside their family home petrified her too. It was a freezing all snight and it was three in the morning and she was Um obviously uh you'd have to say almost insane, um raving Mm. it was screaming and yelling and telling me to whatever, you know Uh I have to do something. What do you do? Kate's father swaggered into a car. He was taking her to the Royal North Shore Hospital in Sydney, but at a set of lights, she jumped out and escaped.

Later, her mother drove to the hospital only to find that her daughter and husband had never arrived. We came across the scene outside Cramour Junction, which is the area which we were coming from, and there was an ambulance and a police car. Kate by now was completely psychotic and refusing to cooperate. After being threatened with a straitjacket, she gave in and was taken by ambulance to the Royal North Shore Hospital.

The next day she was scheduled involuntarily into a psychiatric hospital where she remained for nine weeks. Kate O'Connor was eventually diagnosed with bipolar disorder or manic depression as it used to be known. Hers was one of the most extreme forms of the condition, dominated by manic and delusual highs, then followed by crushing lows. Depression is one of the most debilitating aspects of this disorder. The news was shattering for Sue O'Connor, whose only mother was bipolar.

It could be up to seventy percent today. Episodes can often start with psychotic behaviour. Sue felt guilty for passing on the gene to her own. I think I'm done with that. It was my fault. I had passed this on. And yes, I have. But it tells my mother that I hadn't passed on to her. what was that all about? And I I still I think, um, you know, definitely in retrospect, was not convinced deep down that I had a real condition.

For five years, after that first devastating episode, Kate was well and life continued as it had been. Never have to return to hospital. Then one morning she started to feel invincible. Her creativity knew no bounds. you know, the mission of God maybe, you know, maybe I was John, I was when I found, you know, John Francis. Kate was scheduled once again into a psychiatric hospital. She hated being there and thought it was all a conspiracy.

Around the I've been in Baumea and I've walked down to the shore into that um I guess it's Rosale Bay or just and had gone asking someone who could just take another boat out of the country. I mean most of them just a position vote, so Without her, she wouldn't say who she was or where she belonged, but eventually he must have been able to get my phone number from her. By the time to O'Connor Ranch, Kate was gone. I thought that that was like the wife, which is good.

One thing that's common with with the episodes is you think you're invincible and you can spend as much as you want and if you started spending and more partying and less sleeping which led to um the bomb ready to explode. After the last episode, Kate went through another crushing period of depression. By now she had five major psychotic episodes. It had interfered with her life, her career and her relationships.

She's like my sister. She's not my friend anymore. She's my family. She's I need her as much as she needs me, I think. So it's I can't put into words how much she means to me. She's been such an amazing friend for so many years now I can't even imagine my life without that person. has the friendship ever been too much of a living? No. No. No way. Kate O'Connor decided a year ago to come off all her medications, including the antipsychotics and mood stabilizers.

slow mentation, that they can cause weight gain, lots of things a young active person doesn't want to have. And for Kate in particular if these were incredibly burdensome. to have a trial off medication, those circumstances would include being very well informed about about the illness, being This approach is not one of a psychiatrist would agree to for many people. Kate is a

There is a real risk that she could have another psychotic episode. Most doctors do not agree with stopping medication and advise people to consult themselves. But Kate does have a strategy in place. Her family and some friends have her permission, if they see any early warning signs, to contact her doctor and she will be medicated. be managed out of the hospital in the future. More than likely there will be another episode. Hopefully it won't be.

I don't I get a lot of inspiration from her because what she has to go through just in her day to day life, you know, opposed to everyone else. We can all go out and What Kate has shown you over the years is that one day she finds a lovely partner who will support her and she can live her life as she would like. Um and I see great signs of that happening now. She has she's blossomed and

So, you know, uh a real uh illustrates some really uh salient points that we made here. You know, the idea that there's probably uh um the idea that it tends to be a chronic disorder that um uh that exists over time. Uh and the importance of social And having that supportive context uh you know, even allows her to uh discontinue medication for a while.

Sorry that took uh more of the time than I thought it would. Um so I'll see you I guess on uh Next Friday again. One of those days. Um the eighth, the Friday the eighth, you're scheduled to have a midterm exam. I won't be here, but I'll schedule someone else to have. Yeah, there will be. Uh about a week ahead of time. Yeah, I'll probably bring a copy into class too. Yeah. Yeah.