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>> Good evening I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its tenth year matters the Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here on the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial 866- (969) to seven to zero.

>> Now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

If you'd like to contact me with an email question that I can answer on the on the air you may write me via the Internet at matters of the mind all one word at a dog that's matters of the mind at WFYI Dog and I'll start tonight's program with a caller.

>> Hello Bobby.

Welcome to Matters of Mind.

Hello.

Hello Bobby.

>> I'm wondering if you could describe ADHD.

>> Sure.

ADHD is a phenomenon that occurs starting in childhood, Bobby and by definition it's going to start by the time you're about ten or twelve years of age.

So it's not something that you're going to typically hear about starting in the adult years.

>> It's usuall something else if you notice ADHD symptoms in the adult years it starts in the childhood years.

And Bobby, think of ADHD as being a phenomenon where a person will have trouble with focus and distractibility in a similar way that somebody can have difficulty with her vision .

>> OK, so if you have trouble with your vision it usually starts in childhood and you have difficulty with seeing things at a distance and that's called nearsightedness.

So if you have nearsightedness that typically does start in childhood and it's a day to day phenomenon, it doesn't you don't have good days with your vision in bad days with your vision you have nearsightedness.

It's there every day.

It's various severity.

Some people have mild nearsightedness where it's only problematic in certain situations.

>> Other people have nearsightedness to the degree where they need to put their eyeglasses on or their correct lenses on as soon as they get out of bed.

So there's different severities with with visual disturbances.

It's a day to day phenomenon and it typically occurs in childhood.

>> That's the same phenomena with ADHD Bobbit with ADHD starts in childhood.

>> It's typically a day to day phenomenon and it's something that has different severity.

So you'll hear about some people who have worse ADHD symptoms than others.

For some people it's impairing such that they have a hard time getting through school.

>> Other people have ADHD where it's an annoyance and it's something is problematic to the and concentrate three times harder than everybody else but they get through school.

>> But when they get to a certain level of academic challenge like college or even graduates, that's where it's more problematic for them with ADHD if you are challenged if you find something to be novel and exciting, you're going to be fine.

You're going to be able to focus on as a matter of fact, people can often hyper focus on things that are very interesting and exciting to them if it's not very interesting and exciting which describes a lot of our academic training, it can be very, very difficult to get through school.

And this is where Bobbie, I often compare ADHD to nearsightedness.

If you have a child with nearsightedness you want them to get eyeglasses or corrective lenses as soon as possible.

If you have a child with ADHD and if it's a if it's impairing if it's to the point where it's giving them difficulty academically or socially, people with ADHD will have trouble with tact.

They'll have trouble speaking before their turn.

They'll have a trouble being annoying to their peers so they often don't get invited to social events because of those kind of personality traits.

>> So because of that if ADHD is impairing either in school socially that can be a problem.

>> Now as you go through life we now know that about 90 percent of ADHD symptoms do linger to some degree.

Hyperactive symptoms are more prominent with boys and more prominent in younger years.

Hyperactive symptoms are characterized by impulsivity, having trouble with anger outbursts, having trouble with difficulty getting along with other people, getting along in there's the inattentiveo hyper- inattentive type of ADHD or it's called ADHD where it's more prominent with girls where you have more trouble with studying and focusing on different things especially conversations.

>> So with ADHD there's different severities, there's different types and it will often go on to the adult years.

>> Now what happens, Bobbie, with ADHD the front part of the brain is underactive especially right here the left front part of the brain called the dorsolateral prefrontal cortex.

It's underactive and it's not allowing you to focus and concentrate and keep your mind on things.

>> A second part of the brain is not functioning so well is this middle part of the brain.

>> This middle part of the brain tends to help you with distractibility and allow you to focus on things at hand and not get so distracted.

This part of the brain in the middle here is not functioning so well either.

>> So when you've got the anterior argument here not functioning so well, that's going to be an issue where you're going to have a hard time with distractibility.

>> So with ADHD it's a phenomenon where you have trouble with attention span and you have trouble distractibility things that are not very interesting to you.

>> Now again I want to emphasize many people will notice that their child or grandchild with ADHD symptoms will be very focused on things that are exciting and interesting for them matter fact they can be so focused they can have a tremendous memory and they can have almost photographic recall with different things.

>> So it's not that they have lower IQ.

As a matter of fact the misconception about people with ADHD will be that they have lower IQ.

>> No, they actually have higher IQ as compared to people without ADHD.

>> So people with ADHD are often very capable but it's it's like sending them to school and singing, sending them to social environments, needing eyeglasses but not having them wear eyeglasses.

So they're squinting.

They're having difficulty because they have nearsightedness.

Well the same thing can happen with ADHD.

>> They're poorly focused.

So basically when we treat ADHD symptoms, Bobbie, we're often treating ADHD symptoms like putting eyeglasses on the brain to allow the brain to be able to focus adequately so they'll be able to keep their mind on things and be more attentive and have less distractibility Bobbie.

That's a very, very long answer to a very brief question.

>> But any other thoughts or questions on your behalf ?

Well, the person that I know that they say has ADHD, a lot of things are happening.

She's lying.

She's stealing.

>> Does that go along with that?

I'll give you a tablet to her mother.

She talks tablet to her father.

>> Yeah, there's some of that that might be there but there's a different phenomenon called a conduct disturbance where children with conduct disturbances will have trouble with those so-called immoral behaviors not necessarily associated with ADHD but with ADHD impulsivity and having difficulty with social interactions can be a factor and that's why in the prison system it's thought that over half the people in the prison systems have ADHD because they have so much trouble with impulse control and thereby they can have these conduct disturbances the later on become antisocial behavior in adults.

>> So it's not something that automatically goes along with ADHD the lying stealing things like that that's a different phenomenon.

>> But with ADHD there's a there's a component of that that involves impulsivity where people think don't think before they say something and they don't think before they do something and they tend to do things that they should or later regret.

People with conduct disturbances and anti-social behaviors will often not regret doing these immoral type of behaviors.

>> So that's kind of a different phenomenon with stealing and lying itself can be associate with ADHD but ADHD by itself is not certainly something that directly leads to stealing and lying.

>> Bobby OK, that's what I was wondering this this is a child I'm talking about.

>> Yeah yeah.

We can diagnose ADHD in children.

I mean child psychiatrists are good at identifying it better than those of us who are more adult psychology.

>> But the child psychiatrist can sometimes pick up ADHD as young as five six years of age .

>> The brain is still growing until you're twenty three twenty four years of age, Bobby so the front part of the brain continues to grow and growing role and for some people that helps them grow out of the impulsivity, the hyperactivity this associate with ADHD when they have full development of the front part of the brain.

But when you're a child my goodness, the front part of the brain has not grown adequately and we often compare impulsivity compared to children perhaps at the same age who don't have ADHD.

>> Keep it in mind that children will have a majority because they are children.

>> So if you're a child you're going to have trouble with impulsivity and you're going to have trouble with behavior that's not really responsible but it's because you're immature and you're a child and your brain is not fully developed.

>> Alfandary mind that to parents of of of children who are in the adolescent years or early adult years that their children are growing up.

They're young adults are still growing up until they get to be twenty four years of age and that's when the brain is fully developed and that's when a lot of young adults start to get it and they understand some of the behaviors and the things they did when they were younger weren't really in their best interests and those things that the parents told them all those years start to make sense once they get to be about twenty three twenty four years of age children, boys and girls, boys or boys are more likely boys are more likely to have ADHD ADHD with a hyperactive symptoms compared to girls.

Girls typically are more inattentive and that's why with girls attention deficit disorder is often overlooked because they're the quiet inattentive students in the class.

>> They don't cause any trouble.

The boys are loud, they're hyperactive, they're getting in trouble.

>> The disruptive those are the ones who get into trouble and they get the attention of a lot of people.

ADHD is highly genetic, Bobbie.

So only psoriasis which is a medical condition where people have a skin condition that's the only only medical condition that's more genetic than ADHD.

>> ADHD is almost as genetic as height itself.

>> So it tends to run in families.

It's often not picked up and the parents perhaps until the parents go back and realize that oh yeah, I had some of those symptoms too especially as I was growing up.

But it's a highly genetic condition.

But I always emphasize to people, Bobbie, it is associated typically with a higher IQ compared to people who don't have ADHD right now.py smart.

>> You often hear that.

You often hear but they get themselves into trouble.

She doesn't like this.

She doesn't like the study but when she gets ready she gets three days.

>> Oh wow.

You know, yeah, it comes down to finding having the studies that are found to be interesting so if they can find them interesting and be challenged and get excited about their studies, they can be all over it and they can be very, very good students.

There's a misconception, Bobbie, that if you're a good student you can't have ADHD.

That's not true at all.

If you're a good student you can have ADHD.

>> It's often that you have to work about three times harder than everybody else, right?

I think so.

Well, thank you so much for answering my question, Bobbie.

Thanks for your call about bye now.

>> Take care.

Bye.

Well, let's go to our first -mail question for the night.

Heather, our first email right there you're not father of My Grandchild is five and has expressed thoughts of harming themselves.

Is this something that I should take seriously since they're so young?

By all means, if your five year old is expressing thoughts of suicide, I want to know right off the bat as a caregiver, as a parent, as a grandparent why what are you thinking?

What are you talking about?

You know, you don't want to make the assumption that the five year old is simply trying gain attention.

The five year old might be expressing a sense of overwhelming disabling ability to cope with her current circumstances.

>> So when people of any age are considering suicide, it's a means of saying I'm feeling hopeless, I'm devastate by my current life circumstances, I can't go on anymore and it's a decision you are making as a means of trying to get out of their current& life circumstances.

It's not cowardly.

It's something that goes along with people who often have depression.

I want to make sure that child is assessed by starting out perhaps with pediatrician, primary care clinician, mental health clinician.

>> But five years of age you shouldn't be thinking about suicide at that point.

You shouldn't be thinking about suicide at any age but especially the five years of age.

I'd want to know what's the why behind that that the five year old you're about that with somebody as a five year old hearing about it on television or some kind of social media.

>> So I'd want to know what that's all about right up front but try to get that five year old assessed.

Thanks for your thanks for email.

>> Let's go to our first our next caller.

Hello Carla.

Welcome to Mastermind.

Probably you'd mentioned you're having difficulty focusing and concentrating during conversations and while doing work.

>> Is this cause for concern?

Is there anything that you can take over the counter if you're having trouble focusing and concentrating and following conversations?

>> Carla, I'd go back to the big question how long has it been going on if it started in childhood, if it's been going on day by day since childhood, if it's always been a problem?

>> Yeah, that could be ADHD as I was discussing with Bobby which is a lifelong condition if you've noticed that occurring more recently.

>> OK, we often talk about difficulty with depression.

Depression will give you difficulty with processing speed, difficulty following conversations depression itself clinically significant depression will give you difficulty with a lot of the symptoms of ADHD.

So when I hear about somebody who's thirty five years of age and they say I think I have adult onset ADHD and because they've only had trouble concentrating for the past two or three years that's probably not ADHD per say it's probably something giving you the symptoms of ADHD depression being one of those concerns.

>> Carla, as a female you can have symptoms of difficulty concentrating and following conversations simply from having low thyroid and we hear about that not uncommonly women especially will have difficulty with low thyroid and it can occur especially after childbirth for many women.

>> But low thyroid will give you difficulty with fatigue, hair loss, constipation, hot flashes sometimes chills can go either way you can have difficulty with cardiac rhythm disturbances where your heart might raise periodically.

You might notice that you're more cold than usual but along with that you can have difficulty with following conversation and having trouble with concentrating and having trouble with your memory.

So low thyroid is the first thing I'd want to really consider for your low iron being another factor some women will heavily and when they have a heavy menstruations month by month or Lyonel go down, down, down and when your iron's low that will give you a lot of symptoms of inattentiveness and memory problems if you have sleep apnea, sleep apnea is where you snore at night or you pause your breathing at nighttime thereby you're not exchanging airflow adequately at nighttime, not getting enough oxygen to the brain that will the next day give you difficulty not only with tiredness and sometimes sleepiness but also with focus and concentration.

>> So as we assess people for these kind of symptoms of poor concentration and difficulty with following with memory and focusing on things, we will often assess them for sleep apnea.

So I mentioned low thyroid low and sleep apnea.

>> Diabetes can be another issue if you have blood glucose disturbances that can sometimes give you some poor memory concentration difficulties, difficulty following conversations that will come and go.

>> So there's lots of different things that could happen there.

I think it goes back to how long has it been there?

Have you taken any new medications since this is all happening?-Sumiko Some medicatil give you difficulty.

The focus and concentration.

So if you started a medication two months ago and two months ago you started having trouble following conversations and focusing that could be from that medication.

So we're always trying to put these type of things together.

How long has it been going on?

What kind of things might have been associated with it?

Then we try to break down the different symptoms you're having sometimes with getting some blood tests as a means of determining what's causing the difficulty with focusing and following conversations.

Kalila, talk it over you primary care clinician and see where you can start from there.

Thanks for your call.

Let's go next caller.

Hello, Jacob.

>> Welcome to Matters of Mind.

Jacob, you ought to know about subliminal messaging.

How does that work and how does it affect your subconscious?

Basically Jacob, subliminal messaging has been something that's been studied for at least seven decades and it's where you'll get a little brief messages often under forty milliseconds which seems to be the time period where your brain can consciously process information.

>> But it's a very brief blip a of message that your outside part of your brain, your gray matter doesn't really pick up a notice that you're inside subconscious part of the brain is noticing and you can sometimes it elicit a feeling or an emotion that you don't understand why it's there.

>> So subliminal messaging is very brief blips of messaging that you're conscious outside part of your brain.

>> You're thinking part of your brain isn't able to realize is getting message but the subconscious part of the brain is and it's something that has been around for a long time and it's something that has been used sometimes in marketing and in various different venues.

>> Jacob, thanks for your call.

Let's go next email question our next e-mail question raised your daughter Fauver I had a stutter growing up and went through extensive speech therapy to get rid of it.

>> Is it possible for my stutter to return with cognitive decline as I get older?

STUTTERING doesn't usually return with cognitive decline later on.

>> Usually when you study early on you have the speech therapy that will take care of things you can have stuttering later on due to various neurological conditions that can bring it all basically stuttering as a condition where your basal ganglia in the middle part of the brain right in here is affected.

>> It's actually a neurological condition.

It's not a condition that's thought to be related to anxiety or engrosses even though anxiety can make stuttering worse.

Sure.

But stuttering itself is thought to be a neurological condition and we actually treat it with medications that block dopamine.

So we're stuttering it's thought that you have an excessive amount of dopamine being released from the basal ganglia area and if you block the dopamine that can drastically decrease stuttering right now the main medications we're using for stuttering will be Abilify Saffron's Zyprexa or Olanzapine has been used in the past.

Risperidone had been used part of that time but we use a so-called antipsychotic medications as dopamine blockers to try to help with that.

>> Thanks for your email.

>> Let's go next caller.

Hello Sheila.

Welcome to Matters of Mind.

>> Sheila, you had mentioned that you were just promoted at work into a supervisory role but youre having issues speaking with confidence to your team is imposter syndrome a real thing?

>> I don't know what you're really mean by imposter syndrome, Sheila.

You're having difficulty speak with confidence to your team.

Are you thinking that you're an imposter and you are not in a role where you're qualified for the position that wouldn't be imposter syndrome but basically it might come down to a confidence issue for you.

So think back Sheila.

Why were you promoted about Give yourself some credit there.

You're promoted to the supervisory role because of your your qualifications, your abilities and what you're able to demonstrate to the team around you.

So you're in that role for a purpose.

No one you weren't presumably given that role just arbitrarily so the the purpose f your being in that role is to step up and be able to be a leader.

>> So imposter syndrome I don't think that's something you're really to Scott.

You're not describing a psychiatric a mental health issue.

There is a condition called Kapre syndrome where you perceive that you're truly somebody else or people around you other people.

So that's a psychiatric disturbance but you're describing some difficulty with confidence to get into your role and to be able to establish the of the confidence you need.

>> You need to be able to do the type of things to get the job done and step up and be a leader for the people around you.

>> Sheila, thanks for your call.

Disconnect caller.

Hello Douglas.

Welcome to Matters of Mind.

Douglas, you want to know what part of the brain does Parkinson's disease affect Parkinson's disease is neurological condition where people will have difficulty with shuffling their in their gait.

They don't have much arms wing.

They might have a little bit of drooling occasionally.

I don't have much expression to their face.

They'll often have difficulty with gastrointestinal problems not uncommonly where they might have trouble holding their bowels.

I mean a lot of different things can go along with Parkinson's sometimes you'll see a little bit of a tremor in their hands with medication treatment.

Often that much of that is mitigated but with Parkinson's disease is a condition where there's a deterioration of the middle part of the brain called the substantia nigra the substantia nigra nigra is referring to a darkened area and there's about forty percent to 60 percent of a decrease of the substantia when people have Parkinson's disease it's a decreased transmission of dopamine.

>> What do you do about it?

Well, you increase dopamine transmission by either inhibiting the breakdown of dopamine in the brain or you directly stimulate different parts of the brain with dopamine receptors, the dopamine receptors with opioid medications that fire up those receptors.

>> So you're trying to increase dopamine one way or another the Parkinson's disease as a neurological condition that's affecting this little bitty part of the brain inside there where it's gradually deteriorating sometimes is associated with dementia not always but many times it can have a debilitating neurological effect where people notice the movement disturbances themselves.

Muhammad Ali, for instance, had Parkinson's disease.

Many people remember him at the Los Angeles Olympics as he was holding the torch.

>> He was heavily medicated at that time.

Obviously Muhammad Ali is a good example.

The shuffling gait, the tremulousness, the difficulty with facial expression and it is a deterioration of that middle part of the brain.

>> Douglas, thanks for your call.

Let's go to an email question.

Our next e-mail question reads Deirdre to Farber When I go for a walk I seem to get happier.

>> Is there a correlation between walking and my mood?

Yes.

Keep walking, stay happy going for a walk.

>> Number one, you're getting some fresh air.

You're getting some sunshine hopefully.

But that'll help in itself.

But when you go for a walk and have any kind of physical activity, two things are happening and the more strenuous the activity the better for a lot of people.

You don't want to overexert yourself 30 minutes is off an adequate five days a week based on some recent studies looking at the effect of exercise on the mood.

But thirty minutes a day five days a week of some kind of intense exercise including walking can be helpful and what's happening there on the brain is you're getting an increase in an excitatory chemical called glutamate at the same time of increased sing and inhibitory chemical called GABA.

>> So glutamate fires you up GABA gives you a calming effect .

>> You get both of those increased after you exercise enigmatical include walking especially if it's brisk walking.

>> So you're getting your fresh air, you're getting some sunshine but you're also in the brain getting this nice effect in increasing this excitatory and inhibitory chemical so you feel energized but yet you feel calm so exercise is a marvelous means of helping the mental health .

So why don't we just simply prescribe exercise to every single person we see in psychiatry?

>> Well, we try to encourage those kind of habits.

Here's the problem when you have mental health issues and you're depressed, you're not sleeping, you're tired, you don't have any motivation.

>> You have a hard time getting started with exercising.

So often what we're trying to do we might give people medication or ideas from a counseling perspective but we've got to get them rolling again from a neurobiological standpoint that get them out there to exercise but exercise sure it's good for all of us but even people in pretty good health , mental health neglect to exercise.

>> So it's something that takes motivation, takes energy and it takes initiative to do it.

Let's take our last caller.

>> Hello Kenny.

Welcome to the Mind.

Can you you want to know by about the antipsychotic medication in general are they reliable?

>> How are they relabeled to treat different conditions?

Basically I don't like the term antipsychotic medications, Kenny, because they're used for so many of them and so many of the reasons these are medications that are No.

One typically blocking dopamine but they do so many other things like serotonin and norepinephrine.

So these medications also have effects on post-traumatic stress.

They have effects on bipolar mood stabilization, keeping the mood more level.

They have effects on appetite for some people.

They have a lot of other effects in just relieving the psychotic symptoms of schizophrenia or mood disturbances.

So antipsychotic medications have a lot of other effects often at lower doses.

>> Lower doses can help for instance with depression by increasing dopamine transmission at low doses.

So antipsychotic medications traditionally we're calling them dopamine receptor untag this nowadays but dopamine receptor dopamine receptor blocking agents is what we're calling them dopamine receptor blocking agents.

These are medications that often have effects on serotonin and norepinephrine and help in so many other ways.

Thanks for your call, Kenny.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues, you may contact me via the Internet at Matters of Mind at WFYI Dog and I'll see if I can get to the question on the air.

I'm psychiatrist Jeff Harvard.

You've been watching Matters of mind on PBS Fort Wayne now available on YouTube.

>> Thanks for watching.

Have a good evening.

Good night