 Hi everyone, thanks for having me back. My name's Dr. Emily Deans, I'm a psychiatrist originally from Texas and then I did my training up in Massachusetts where I live in practice now and outpatient psychiatry. I'm not a researcher, but I've always been a clinician but I've always been interested in all sorts of weird and wild things and alternative treatments and things like that and so it was always my intention to figure out of all this sort of maybe ancestral wisdom and ancestral health, how could that help me with my psychiatric patients? And so I developed a blog in that eventually went on to psychology today called evolutionary psychiatry and I've just been investigating genes, psychiatric risk in all sorts of, I have lots of writing and have done lots of talks on food and mood, on parasites and mood and all sorts of kind of strange things that maybe I'm one of the only people interested in some of it. Recently with the COVID-19 pandemic, I've always been really interested in infectious disease and how it affected humans, physiology, immunology and evolution in humans. And so COVID-19 was really from a healthcare provider on a personal level very difficult time but from an intellectual level it's a very interesting time for me. So I thought I would put together this talk to talk about historically how pandemics and infectious disease cause psychiatric symptoms, historically what we had witnessed with other pandemics and then the second part of the talk talks about some of the genes that predispose us to psychiatric illness and how perhaps infectious disease in our past might have been a reason that we have preserved these genes over time because they can be deleterious for your mental health. So I think the main thing to really understand with the first part of this talk is that I come from the perspective, a lot of people think about the hygiene hypothesis that our immune system functions the best if we have lots of natural inputs, right? And that maybe your OCD or other problems or your autoimmune disease is caused by your mom being a clean freak, right? That's kind of this sort of general idea about the hygiene hypothesis. When you look at immunology it's actually a much more complicated and a lot of our infectious disease is not paleolithic at all. We did not co-evolve with respiratory viruses, right? Those are all diseases of civilization. They're diseases that come from domesticating animals. They're diseases that come from high population density, immunosuage problems, things like that. So when we talk about the hygiene hypothesis and bugs that our immune system co-evolved with for hundreds and hundreds of thousands of years, we're really talking about parasites. We're talking about like the dirt microbes that the microbiome professor was talking about yesterday and we're talking about our commensals, the commensal bacteria that live inside our body. We're not really talking about influenza, RSV, a lot of sexually transmitted diseases because they all required high population density to kind of spread. Now they have made their impact on our evolution and on our brains because we've evolved for the last 10,000 years with agriculture. And so I'm just gonna talk about this but that's what I want you to keep in mind about infectious disease. There are good aspects of it for our health and exposure to parasites in a certain window probably and we may have some of our autoimmune diseases of civilization maybe due to that. But in my view and from a lot of what I've read about, there's very little evidence that exposure to respiratory illnesses is beneficial for our health at all. So psychiatric disease like major depression, psychotic disorders, anxiety disorders, OCD, they're all caused by a combination of genetic loading and it's ticked on by the switch of environmental stress. Environmental stress is a very general term, right? Outside of a few families, there's some triplet repeats on certain chromosomes that make very high incidence of schizophrenia in certain families, seems to be true of autism. Most psychiatric disease has a polygenic risk, okay? There's probably thousands of at risk genes and most of the genes that we found actually put people at higher risk for many different psychiatric diseases. Not that a bunch of people show up with ADHD, OCD, schizophrenia, and that's, it's quite rare to have all those at the same times. It's just that there's so many genes and so much risk and it also depends on when the environmental stress triggers, there's like time window. So autism, the time window is when you're very little. Schizophrenia tends to be teenage years to early 30s depending on your age. Dementia tends to be, the switch for that tends to be tricked on in your late years, all right? So just keep that in mind. So these are the environmental stress risk factors which I talk about a lot of them, right? Because your genes are your genes, you can't change them, well not without CRISPR. But we can do a lot about a lot of these things and classical treatment focuses most on medicines and psychological stress with therapy and managing social stress with therapy. But a lot of people don't talk about nutrition which is why I've written a bunch about it, inflammation and autoimmune triggers of psychiatric illness. And this last one, which is particular interest to me as a psychiatrist who spent a lot of time in hospitals treating people who had sudden onset of psychiatric disease that came with their hospital treatment or the infection. So infectious disease is actually a big trigger for psychiatric illness. And why would that be? And why something like a major depressive disorder, so seclusion, body aches, brain fog, all of these symptoms are someone with just a real pure major depressive disorder are very similar minus the fever and minus the virus to being sick with a cold or influenza, right? And when you talk to people with chronic fatigue it's like they have a flu that never goes away. And why is that? They think that actually major depressive disorder is sort of a sickness syndrome where you can find excitatory and inflammatory cytokines in the blood of people who have bipolar disorder when they're manic or depressed or people with major depressive disorder. So the whole body is inflamed in these conditions. And that's how our body knows how to act when we're inflamed is to kind of hunker down and maybe kind of be depressed for a while. So they think it's all related. And what I see as a psychiatrist not infrequently are things like delusional disorder. They're very scary. They actually tend to occur in mid-age, maybe 30s to 40s. And that's an unusual age for a new onset psychosis to occur. And what I'm really talking about is someone who doesn't have any other signs of schizophrenia or anything like that. So they're not having a degradation and functioning so much, but they suddenly believe, for example, that the FBI is out to get them. And they think, there's often lots of numbers and every white car that comes by is them being monitored. A lot of delusions have to do with stuff that's going on in the world. So back in the early, the late 90s, when I went to medical school, there was a lot of HIV fears. You're delusionally feared that somebody came up and poked you with a needle and gave you HIV. After that, after 9-11, there was a lot of fears about both the FBI national security but also the terrorists were after you. So whatever kind of the worries that are in the general context can become people's focused delusional beliefs. And it can completely overtake their lives. They talk about it all their time to their loved ones. They can lose their husbands, their families, their wives. They can lose their money, their job. And it can be really devastating. It's very hard to treat. And what they found after COVID was we were having a lot more cases of this than usual. Okay, so people, and this is from the New York Times, and it's rare, right? So it's not very well studied, but people have COVID and then a few months later they get delusional. And it's my thought that all of these delusional cases that I've seen, and I know some that actually did have medical causes. So someone got one after Lyme disease. I have another patient who has it when they have active celiac disease. I have another patient who got it with interferon treatment for hepatitis C. So all these infectious and medicine triggers for these. I do think that my patients with delusional disorder probably had maybe a respiratory illness that they didn't even think it was just a cold. And then months later, they just got really unlucky and they developed delusional disorder. Again, super rare, don't freak out, but it's just one of the things that happens. And this was a study from the Lancet. There are issues with this study, don't get me wrong, but they looked at people who had 236,379 survivors of COVID six months later. I'm looking at their electronic medical records and they found that huge numbers of them had psychiatric comorbidity with or outside COVID. Now this is a lot of different things. So some people had depression and brain fog for several months after. Some people had ongoing long COVID chronic fatigue, which often involves a lot of psychiatric symptoms for multiple reasons. And this also includes the people who got very ill, you know, who have strokes, dementia, people who are on the ICU who didn't have enough oxygen and their brains kind of didn't really survive that. And then a lot of people very sick in the ICU with COVID get very delirious, partly because they're so sick and it goes on for so long. So when you're sick in the ICU, you're under sedation, you don't know where you are, there's frequently psychotic symptoms with that, hearing voices, seeing things that aren't there. And it's just, it's frequent with COVID and it's also a sign of increased mortality if you become delirious when you're ill. And some of us, you know, when my kid gave me hand, foot and mouth disease, I had a high fever and I was like seeing things in my vision. So we all can have little benign hallucinations from time to time. And I wouldn't necessarily consider that like a frank psychosis by any means, but delirium, you can definitely get psychotic. I've had patients run out and try to kill the security guard when they were very, very ill because they thought that the security guard was trying to like kill them, right? So some of you might be thinking, Jesus, COVID, COVID, COVID, everybody's freaking out about this stupid pandemic. I'm tired of hearing about it. She's the Lancet study and all of that, they're just looking at it now, whatever. It's no big deal. And I'm, so this is why I'm gonna bring up all sorts of different older pandemics too because they had psychiatric symptoms as well. And because they were pandemics, it happened to a lot of people at once. You have much higher incidents, all right? So these are all sorts of other, all sorts of other little viruses and bugs that we get from our population living, improper sewage, things like that. So look at the, this is a JAMA and look at the date, January 25th, 1919. And so this was a paper describing psychosis associated with the influenza pandemic. Along with the influenza pandemic, there was a copandemic. Some people think they were related, but it did start in 1916 or 1917, whereas influenza was definitely 1918, 1919. And encephalitis lethargica extended from like 1917 to about slowly dropping off over the next decade or two. And what happened, just reading this, besides producing physical symptoms of an acute central nervous system infection, encephalitis lethargica, at times can progress to a coma and death. Survivors were sometimes afflicted with Parkinsonism, so being stiff and maybe a tremor and having sometimes dementia and so it's a movement disorder associated with damage to the brain. Or with bizarre behavioral disturbances. Some survivors, mostly adolescents, suffered pseudo-psychopathic states. So children who had been normal became disinhibited. They would run out damaged property and attack strangers in the street. Few neurological abnormalities were seen in these cases, so you didn't see signs of stroke or other things. Sporadic cases of encephalitis are still seen throughout the world of encephalitis lethargica. My great uncle was a healthy teenage boy in 1918, 1919, and he got encephalitis lethargica and was institutionalized for the rest of his life, which was only a few more decades. So here's the Russian flu. This is a wood print from a Parisian newspaper. The Russian flu pandemic was in 1890. And a lot of people think we can't prove it yet. We dug up frozen samples of the 1918 flu, so we have samples of that virus, but we don't have samples of the 1890 flu. A lot of people think it was the first emergence of the coronavirus OC43 and not a flu virus at all. And people would talk about long-term effects for years after having the flu, including neuralgia, neurasthenia, which is sort of an old-fashioned way of someone being kind of neurotic and thinking about their feelings and stuff all the time. Nerve exhaustion, which is sort of like we would call chronic fatigue. Grip catalepsy, so they would suddenly have postural issues or suddenly become disinhibited. Psychosis, prostration, so they would just lie down and knock it up again, inertia, anxiety, and paranoia. So here is a atypical polio myelitis that caused an epidemic of chronic fatigue in mostly women in 1934, here in Los Angeles County. There were 59 cases kind of all at once, so they thought that they all kind of got chronic fatigue all at the same time, and they had mental dullness and painful severe headache, painful moving of their eyes and gastrointestinal distress. It turned out when they actually sampled them that they had diphtheria, this wasn't polio at all, so this was just a weird strain of diphtheria that had unusual symptoms, because diphtheria is usually, it was called the morbid sore throat for a reason, right? So benign myalgic encephalomyelitis is another term that we use for chronic fatigue, and there's several epidemics in 1956, 1959. There were headaches, myalgia, parisus, mental symptoms, but there was no fever and nobody died. So there was outbreak in London in 1955, and they all tend to have some of them long term, and so at the time they thought it was probably an infectious cause, because there are, again, multiple people all at once. Typhoid fever, this is a bacterial. I've mostly been talking about viruses, but this is a bacterial disease. We don't really see it now, because we have modern sewage systems, but it's a salmonella typhus that's passed by bad water or very close contact or contaminated food, and you would generally have, because it's salmonella, right? You would have gastrointestinal diarrhea or constipation, a fever, but occasionally you would get a confusional states, delirium, generalized myoclonus, which is really, really fast twitching, and then again that Parkinsonism or psychosis, and so this was an outbreak in the mid-20th century, and they were wondering if it was a combination of typhoid fever plus other conditions like malnutrition. All right, so I've kind of talked about how different pandemics and illnesses over time has caused psychiatric symptoms, and now I'm gonna talk about how pandemics have kind of left their mark on the human genome. For COVID, there are a few genetic risk factors that we've found. They've mostly been involved, so 13%, in a sample of 987 people in the ICU, 13% had antibodies against interferon. Some of that is genetic, some of that may be an autoimmune issue. 13% is a huge number to find sort of a genetic finding. Only 0.3% of healthy individuals who had had COVID had these autoantibodies, right? So this was something that we found that really predisposed you to, if you got COVID and who knows how many people around here have their certain genes on chromosome three, none of these people had had serious respiratory illness before, so it doesn't seem to predispose you to generalize weakness to respiratory illnesses. It was specific for COVID. You might have heard that type A blood might make you more at risk. That's actually not true. Type A and type O, they're all the same. We're all in the same boat with that. So historically, populations were more homogeneous and they lived more with each other and there was less spreading back and forth. There was lots of spreading over all of time if human history, but people scored a state in one place much longer than we do now, obviously. And so infectious stressors left an imprint on the population. So famous examples are cystic fibrosis, which protects you against tuberculosis. And so this is the heterozygic advantage. So if you have two cystic fibrosis genes, you get cystic fibrosis and back then you would die when you were very young. If you have one, you're protected against tuberculosis which is probably really important in Europe in the last several centuries. And the other one's sickle cell, right? If you're heterozygous for the sickle cell trait, you don't get sickle cell disease, but you're protected against malaria, right? So there are other genes like this that we have carried forward and some of them may or may not predispose us to psychiatric disease. So here's one, this is kind of a CAC NA1C gene. This is a really exciting gene because people who have the double mutant for this gene are at risk for all sorts of different, they're at higher risk for schizophrenia, autism, depression and bipolar disorder. The mutant actually gives you more of these channels. This is putting it way too simply to the point of being misleading, but it kind of enables you to think harder. It's quite common in the population, it's more than 10% or double mutant and when something's preserved like that, it could have a pretty deleterious effect. With autism, schizophrenia, depression, if they hit early, you have a hard time raising your kids, right? So you could have be at an evolutionary disadvantage with this, but I tend to think that it might be associated with other maybe advantages of being able to think a little bit harder if you have just one of the genes, right? Or even two. So the APOE4 gene, everyone knows about that. APOE4 is the original ancestral allele, but those who carry it have actually higher risk of Alzheimer's disease and depression. It's associated with increased inflammation in general, at least it's associated with the Western diet. E2 is protective, so if you have E2, 1 E2 or 2 E2 alleles, your risk for Alzheimer's goes down, but the E4 allele might be protective, they postulate maybe against childhood diarrhea illness and those with E2 seem to be more vulnerable to tuberculosis and malaria. So you can see how in populations there are different stressors that might change how a population, how genes spread through a population. Sometimes it's just a founding effect and everybody has a gene because the first couple who got there had the gene, right? So some of the most studied and debated alleles associated with depression are the short and long form of the 5-H-T-T-L-P-R gene, which is the promoter region for the serotonin reuptake receptor and that's where SSRIs actually work and there are a couple of large long term studies that show that people with the double short gene have a higher risk of developing major depression when exposed to early childhood intense trauma whereas the long form of this gene is protective. However, the short gene isn't all bad. Those who have it have a lower risk of dying from sudden infant death syndrome and it's associated with higher circulating cytokines in response to stress, which is sometimes in a population being able to mount a higher stress response might be adaptive and might save you. In Asian populations, very, very high rates of short-short. It's not associated, if you have short-short, you're not destined to get depression. It's kind of a complicated interaction. So you can see just how different selection pressures have changed populations and changed maybe our risk to psychiatric disease. All right, so this one's complicated on purpose. This is, I'm talking about MTHR here, which gets a lot of press. Low MTHR is associated with increases in homocysteine and may put you at a higher overall inflammatory tone in general. The thing about MTHR and psychiatry is that if someone comes in depressed and they have a double MTHR, there are studies that show I can just give them methylfolate and I can make them feel better, right? That's really cool because methylfolate is better than giving people like an SSRI that causes sexual dysfunction and other issues. So in places where there's sufficient folate in the food, MTHR deletions and mutations are very prevalent. And why would that be if it's probably deleterious for maybe maternal, maybe having kids because of low folate, stuff like that? So what they do think is that these MTHR issues are having these inefficiencies and making methylfolate might protect you against infections, maybe against, they definitely in mice it's been shown to protect you against a cytomegalovirus infection or cytomegalovirus as kind of like EBV or Epstein-Barr causing mono. It can protect you against sexually transmitted diseases and hepatitis B. So it's not all good to have a super-duper MTHR system. You might be protected against other things because you have it. And it's almost absent in Sub-Saharan Africa because there are much lower folate in the soil there. So almost everybody in Sub-Saharan Africa has the fully functioning MTHR genes. And that's pretty much it. It's just, I just find this combination going from genes to psychiatric illness and then away from maybe our history of epidemics and the pressures that they put on different populations and how that's now reflected and how we walk around and do that now. I just find that stuff really interesting. So I hope you did too. Thank you. Thank you, Emily. We have plenty of time for questions. You wanna start? Yeah, hi, very nice talk. Very interesting, especially the historical aspect. Thank you for that. Have you looked into the relationship between the oxidative stress caused by inflammatory diseases and I mean, I know it's a known factor in neurological diseases and in some neurological conditions as a common denominator between these two. Yeah, so a lot of the genes that seem to predispose to psychiatric illness have to do in some that are found with schizophrenia. It's pretty nitty gritty stuff, but they found genes in glycolysis. They found genes in redox reactions and basically if you have enough genes that kind of muck up your recovery and repair system in your brain. So the energetics process of it, maybe you're a little bit weaker at that. So you need a little bit more energy in the throughput and so if you get a diminished energy for any reason, you might start to be in trouble whereas someone who didn't have that gene are fully efficient there, but also in the recovery and repair. So part of this CAC and A1C gene has to do with synaptic plasticity and making what's called BDNF which is brain-derived neurotrophic factor which also helps your neurons recover and repair. And by recover and repair, that means getting rid of inflammation, getting the redox and the oxidation products out, getting rid of your garbage and then having time to kind of get the neurons back together and their little tendrils out to the right places and not kind of being pulled back and cut off and dying if it's spattered off. So there are lots, there are thousands of risk genes and some of the most interesting work has been by this researcher in the Midwest and he's taken samples of people who died with schizophrenia and he takes frozen samples of their brains and he goes and he finds the neurons and finds the products of glycolysis and stuff like that and finds differences in their brains versus and he had to find brains that hadn't been exposed to antipsychotics just to make sure that it wasn't due to that. And so he was able to demonstrate that. It's really interesting work. Thank you. You made a comment about blood type not relating to COVID risk and I was just wondering if you happen to know why people tend to think that because I have a lot of patients that say that. Yeah, so with SARS-1, which is very, very similar to SARS-2 and early SARS-2 papers, there did tend to be a higher level of type A people who ended up in the ICU. When they did much bigger studies over much larger populations that did not pan out. So if you're a type O, like I am, I'm sorry, you were not more protected against COVID. SARS-1, there were only like 8,000 cases worldwide, I think. So they didn't have enough people to sort of see that, I don't think. So this is a bit of a weird anecdote. It takes a moment to set up, but I've done like a lot of end of one experiments and one that was very weird and not intended was during a carb swap experiment. I experienced this acute effect where within like 60 seconds, this usually didn't happen. My mood suddenly changed to where quite literally I became not only really exhausted, but I also felt oddly pessimistic about things across the spectrum in my life. And I wrote a big long blog post about it and talked about it a lot online at the time. But because of that happening, much later in time, going back to last year, I had a family member who was very familiar with that episode that happened with me who got COVID. Said they experienced almost exactly what it was that I described, almost verbatim. It didn't take place that acutely like within seconds, but it did seem to take place over the day. And so that's why I was very interested in what your talk was gonna be because I myself am very curious just how much this can have an impact on our brain chemistry and how much that literally can change things like even outlook. Right, so my own personal experience, I had Lasik surgery and I had to use steroid eye drops for the time period of four days when I used this eye drops, I was depressed. I would look outside, the sky would be blue and I'd be like, nothing matters. I'm usually a pretty optimistic sunny person. So it was a great experience for me as a psychiatrist obviously, but you can have, you know, steroids are just remaking our cortisol, right? And inflammatory things. So I didn't really talk about why COVID would cause psychiatric illness. A lot of it's that systemic inflammation cortisol. Some of it though, there could be direct invasion. So when people get really ill, the virus goes in and attacks your brain directly. And people were worried that the nasal, the lack of smell that comes with COVID was actually an invasion by the oropharynx into the brain, in the nasopharynx. That probably isn't the case. It is the case in some people. The pandemic flew in 1919. One of the first symptoms was often a tremendous bloody nose. So it could be different ways, but it happens in different ways. And you'll see people sometimes, so chronic fatigue, you can often get it after a viral illness, but some young, healthy athletes get it after an injury. So our body kind of responds to a lot of different things in sort of the same way, because it doesn't have, it has lots of different kits, tools in its kit, but it tends to, you know, sometimes it responds with the wrong tools. Great, thanks. So I like you and am fascinated by this. And then you might know, so just due to serendipity, I'm part of a science book club. And the book that we're reading right now is one that you might know, Survival of the Sickest. Have you come across that one? Yeah, I haven't seen it. It's totally brilliant. And so I recommend it to anyone who loves this topic. I'll just read two sentences from the description. The author proposes the most common elements, diabetes, hemicromatosis, cystic fibrosis, sickle cell anemia came into existence for very good reasons. At some point they helped our ancestors survive some grand challenge to their existence. So what the author does is goes back in time, identifies the grand challenge, like what you've done here, but with he has obviously more time. So if anyone's fascinated by this, it's Survival of the Sickest New York Times bestseller about 10 years ago. Yeah, I mean, obesity protects us against diabetes. You're eating extra energy and you store it out of the circulation. You don't get diabetes. People who can't get obese, they proceed to really bad type two diabetes. It's very difficult to control and requires insulin pretty fast. Sometimes it's called type two and a half diabetes or type 1A, yeah, 1.5, sorry. Great talk, thanks. Great talk. In terms of evolutionary explanations, you're saying you found it hard to find reasons for some of the infectious agents to have benefits to us, right? But what about cross species infections? And one of the ones that comes to mind is this Toxoplasma gondii that cats pass to rats to make them lose inhibition and become fearless and then the cats can capture them. So are there other examples there that might explain some of the, for example, the pandemic organisms that come from exotic animals and is there sort of a cross species explanation for why they might be here? Yeah, I mean, the bad guy is the virus, right? And the virus doesn't care about what we think about politics. It doesn't care about what we think about a lot of different things. All it wants is to infect the next susceptible human meat bag, right? And so that's what Toxo does. And it happened, when the cicada thing happened, everyone was talking about that fungus that killed them and made them brainless and then they found that birds were dying because they were eating the cicadas that had the fungus. So there are lots of cross species stuff and some of it is from agriculture and some of it's like mosquitoes, right? They fly around and they just have, if you have a lot of maybe cows who have a certain illness that might spread to humans, then the mosquitoes happily take one from one to the other. So bugs find a way. I can't really think, Toxo Gandhi is associated with higher rates of schizophrenia. If you have Toxo Gandhi, and I believe even if your parents have it, there's sort of a higher risk of mental illness of the kids later in life. So there's all sorts of downstream effects of these infections. I think what I'm trying to portray with what I said at the beginning is that some people think that there's a value in kind of getting sick and getting well that that made our immune system stronger. It did train our immune system, but you might have other bad effects on your body, on your brain from being infected. It's probably better not to be infected at all. And the exception are those old friends that I talked about, which are commensal bacteria, pseudocommensals, which are the dirt-borne illnesses. And then maybe eukaryotic parasites, which are almost absent now in our bodies. And 50 million, no, 50,000, 50 million, sorry. Lots of kids in Africa die of hookworm every year. So there's a benefit to not having hookworm rampant in the population and having clean sewage, right? We don't wanna throw the baby out with the bathwater, is what I'm saying. Thank you. I appreciate your talk, especially the level of detail and the mechanistic explanations. I was observing that the genes you were identifying in psychiatry are similar to, or the same as genes we study in mercury toxicity. The APOE gene, the difference between the protective and the risky is the amount of cysteine sulfur and mercury target sulfur. And then the calcium channels and what was the other one? I can't remember, you had another one that we study in mercury. But in looking at the literature overall, it's been my impression trying to study an iatrogenic toxicant that there's just no funding for that, but it looks like there's ample funding to study infectious disease, so. Depends on the infectious disease. Well, maybe there's never ample funding. I mean, tuberculosis will kill more people in the world this year than COVID probably, and we don't have a ton of funding for it, because it hardly affects the new world. Yeah, but when you study a toxicant like dental amalgam or vaccine mercury, not only is there no funding, there's censorship, so. Yeah, I don't really know about those things. Yeah, and you're not gonna know unless you dig. And if you dig and get hooked like I did, then you can't write about it for your mainstream magazine because you'll get dropped. So it's a dilemma. Yeah, no, it can be hard to figure out and write about some of these things. Hi, I'm Kevin Boyd, I'm a pediatric dentist, and I'm asking you for some advice, and I want you to please listen to this, and I need to know if I am maybe in trouble. So you got that voicemail from a patient, like a mother of a patient? Yes, she used to work for Oprah, and she started this kind of stuff four or five years ago, and I just, you know, she wanted to take me into confidence that people were out to get her. Well, now it's her adult daughter I treated all her life, and now she's threatening me. Do I need to call the police or, you know? It probably wouldn't hurt to just have it on file. You know, most people who are delusional aren't violent. They tend to get violent when they're scared. And the best predictor of future violence is past violence. So you might be able to get a detective to look up a criminal record on this person or something like that. And often it's sort of a crime of convenience, right? So they can be very obsessed, can be very scary to be on sort of the wrong side of this kind of thing. It often shifts around, you know, so they might be deeply obsessed with you for a little while, but probably time and distance is probably good. And now people can seek revenge. It doesn't seem to be working. It's been five years. Yeah, yeah, yeah. And it's very sad, you know, that this woman, you know, I'm sorry that this has happened to you. Well, just to caveat, the patients I'm gonna talk about next lecture, they don't talk to me this way. So, I have evidence. But I mean, imagine if that was like your sister, right? Totally normal, living a normal life, and then all of a sudden she becomes obsessed with being implanted with the chip. You know, it's rare, again, it's rare, but it's scary for everybody when it happens, and people often overreact, and people often underreact, because they don't even know what to do. And so that's why, you know, fortunately as a psychiatrist, I've seen this before and we're trained in sort of dealing with violence and how to assess a violence risk. Her past record is the important part here. Okay, so she hasn't been going to her local, you know, sometimes people are delusional to show up outside, you know, in Hollywood outside a star's house or outside of this, and they might be arrested several times. That would be a higher risk of danger, right? But if she never does that, if she just calls or she's just online or something, and it's been five years, I wouldn't, you have to worry about it, but I would kinda tuck it back in your head. You have better things to think about. Well, let's thank Dr. Emily Deans once again. And we have a nice 30 minute break now before Kevin Boyd's talk, which will be at 11 o'clock, so please go out, get some sunshine, some movement, kick your shoes off, barefoot walking, and go to the silent auction to try and win a t-shirt. And we'll see you back here at 11 a.m.