good evening, I'm psychiatrist Jay Fawver live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind Now and its twenty eight year Matters of 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 in the Fort Wayne area by dialing (969) 27 two zero or if you're calling anywhere coast to coast you may dial toll free at 866- (969) 27 two 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.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WSW Edgard that's matters of the mind at WFYI Dog and I'm going to start tonight's program with a call from Gail.

>> Hello Gail.

>> Welcome to Matters of the Mind.

Oh thank you.

I've talked to you before about my daughter who's mentally challenged and is age 59.

She's been in a very nice labor and angry for most of two years.

She's fixated day and night about coming home.

She thinks out loud and talks in her sleep about coming home .

Her behaviors are increasing a lot.

She's on Seroquel fifty at night and Daily Lithium 300 B.i.g.

and no I'm so 300 in the morning and 150 at night gabapentin one hundred b.i.g.

Estero for tremors.

She's just started getting tremors and her legs are 36 milligrams and the truck so I think it's 50 milligrams bid.

What can be done for continuous fixation and anger.

It seems like so many medications do cause anger and obviously fatigue but she's in a bad way and so are we.

>> We're just feeling pretty helpless now.

>> Gail, very importantly, how is she doing in the group home with her anger with that very nice broad combination of medications?

Not well.

I mean she's taking on people using words that she never used to use hand gestures she never used to use.

It's very emotionally upsetting to see the change in her personality.

You had not doing well and the staff has trouble with her.

>> OK, there's one staff that's able to handle her very well but the others are struggling.

>> Yeah.

And I presume that you figure you wouldn't be able to manage her that well at home either.

>> Well, my husband 88 I'm 81.

He's I know we're both pretty handicapped and even if we did when we die she's going to have to go back to a waiver.

All right.

It's going to be worse but I'm willing to listen to everything you have to say.

>> Well, a group home experience like that, Gail, is something that's necessary for her for the time being.

Gebek, as you probably are aware twenty thirty years ago she would have been in a state hospital for perhaps years and now at least there's a group home setting where it's more there's more independence.

The medications to which you referred have a very broad range of mechanisms and what you mentioned wouldn't cause her necessarily to have a disinhibited effect.

The biggest concern we have with a lot of medications will be that they can make you feel worse and make a more angry and more emotional and more aggressive the medications to which you refer to including gabapentin Seroquel also known as Quartier Pain Lithium Naltrexone and Austro those are medications that would not be expected to cause increased aggression.

>> As a matter of fact, it's a really nice combination of medications that address aggression and irritability and moodiness in entirely different ways.

Now Intrexon works on opiate receptors and you might one might think well gee, she's not an opiate addict.

>> Well, if you block opiate receptors it can decrease aggression as well, not naltrexone.

Fifty milligrams is doing gabapentin relatively low dosage that you mentioned there basically can give you a calming effect.

There's a lot of room to move up on the dosage with these medications.

So it sounds like our clinicians are intentionally giving her low dose of medications.

>> But Gabapentin gives a calming effect indirectly working on the firing of individual nerves themselves quit typing or Seroquel at a very low dosage to which you referred just fifty milligrams at bedtime is dosage that will help with sleep but it won't carry over the next day and typically make a person drowsy won't cause that and of course lithium has been around gee as a salt in the ground for ever since the founding of mankind founding of our earth and it's been around forever.

It's just that lithium was discovered back in the nineteen forties to be a medication it can stabilize the mood.

>> It is a salt but lithium is a very good anti aggressive medication.

It's something that can be monitored with blood tests.

The main concerns we always have with lithium is to make sure somebody doesn't get too much.

If somebody gives too much lithium they can get a tremor from that.

Now your daughter might be getting a tremor from older medication she might have taken previously the dopamine receptor blockers, the so-called antipsychotic medications Seroquel Taiping being one of them.

But at low doses it wouldn't be expected to cause the difficulty with tremors.

So the tremor that your daughters might might be having could possibly be from lithium if the dosage is a bit too high there is a yet another medication that is available for a person with aggression that decreases the tremor related to lithium that's called a beta blocker or something like propranolol metoprolol.

>> These are medications that will block adrenaline and indirectly they will block dopamine and they can help with aggression as well.

A lot of different options out there, Gail.

It's perfectly normal for your daughter to say she wants to come home.

Of course somebody in the group home wants to come home but you have to be realistic on her needs and if she's developmentally challenged, if he has that type of degree of aggression, I can see perfectly well why she wouldn't be on an antidepressant medication.

I know that sounds kind of weird but antidepressant medications they're affecting serotonin, dopamine, norepinephrine.

If they increase in transmission they can sometimes make people more irritated, more aggressive, more emotional.

>> And she's not on any though.

So the type of medications that can typically make a person more emotional.

>> Gail, your daughter is not on based on what you've described so good combination.

>> She's on low doses of every single thing that you mentioned .

So there is room to move up on the dosages if she needs to do so.

Gail, I wish you the best.

Thanks for calling.

Let's go our next caller.

Hello, Susan.

Welcome.

The mastermind Susan, you want to know is autism hereditary autism has a very complicated genetic profile.

>> It involves hundreds of genes.

If you have a fraternal twin who doesn't have your same genetics but you shared a with your fraternal twin, you about and in your fraternal twin has autism you have about a 20 percent genetically of have a 20 percent chance of having autism.

>> If you have an identical twin where you have the exact same genes, you might have up to a 90 percent chance of having autism.

So it is genetic to some degree .

It's just that there are some environmental factors and the genetics are exceptionally complicated.

So autism has a genetic component to it.

It often goes along with ADHD which is considered to be one of the more genetic conditions we know in medicine entirely psoriasis which is a skin condition is more genetic and ADHD but ADHD is highly genetic.

It tends to run in families often goes along with autism for some people.

>> Thanks for your call.

Let's go next e-mail question.

Our next e-mail question reads Dear Father, does there come a point where I'm taking too many medications?

Are there ways to look at the medication from my depression and anxiety and simplify it so that I only need to take one or two pills a day?

That's something in which you would have a very important discussion with your clinician but you can do some of the work ahead of time.

Here's what you do.

You go back into your medication history and try to figure out what medications it took and how long you took them, what kind of dosages you took.

Do the best you can to figure all that out once you get engaged in assigned to a particular clinician that your clinician should do that for you.

But you need to have a thorough assessment of all the medications you've taken, how long you took, how they did for you, what side effects you did, why you went off of them and try to figure all that out .

And as the medications were added which of which you're currently taking you sort out OK, did I feel better when this one was added that I felt better when this one was increasing the dosage?

>> So you try to go through that step by step by step your clinician needs to assess do you have any overlap mechanisms of action with any of your medications in which one of the medications might be able to be eliminated?

So you want to try to identify what medications are working the best for you, what dosages are working the best for you and was it really worth it to add on any other medications now in the brain?

>> The brain is a very complex organ.

The central nervous system is highly complex.

>> The brain itself has over 80 billion neurons in it and each individual neuron has or has over twenty thirty thousand branches and then we have at least eighty neurotransmitters in the brain that are working and we're trying to sort that all out and try to give somebody entirely different mechanisms of action to try to help them ease their symptoms and to do that sometimes you need two and three and four different mechanism of action to try to help somebody relieve the symptoms they're experiencing.

>> Gail earlier mentioned that her daughter was taking several medications but the medications to which she referred all had different mechanisms of action.

So with that in mind it's a good combination.

What you don't want are mechanisms of actions with medications that are overlapping.

>> Thanks for your email.

Let's go back to Gail.

Gail, you had another follow up question concerning your daughter.

>> I'm sorry.

That's what she is a constant feature, both of which goes to the women's center frequently for stores from her face elbows, legs.

She's just a mess.

We can't get her to stop so she it seems to me she was undocks accepted at one time and hit list but they took her orthodox opinion.

>> I have no idea and that's a very good point for you to to remind her clinicians Gail Dock's pin had an old trade name called Synacthen.

It also is known as Add a pin doc spin's been around since the nineteen fifties 1960s maybe but it is something that you can use at 10 and 25 milligrams a day for the purpose of what's called neurotic dermatitis.

>> That's an old term that we use neurotic excoriation or a self injurious behavior but people will pick at their skin gaile because sometimes they do it because they're a little anxious, a little nervous and when you pick at your skin you'll actually release opiates, natural opiates that are in your skin when you release natural opiates in your skin it goes to your brain and briefly gives you a calming a soothing effect.

>> It sounds really strange for that to happen but that's why people will pick up their skin and actually cut themselves occasionally when they get extremely distressed because it gives their brain a soothing effect by the release of the natural opiates that are in your skin.

So what you try to do is give somebody a medication that might mitigate that need and I nossa tall six milligrams twice a day can be used I nosotros a natural compound that some people will use.

Dock's Pendo has been around for a long time.

When I was in my medical school training I did an elective with a dermatologist and I saw several people with what was called neurotic dermatitis and he indeed did prescribe Dock's for those people.

I've seen that use for many, many years so that's a possibility.

Now I did mention earlier that if you give somebody an antidepressant medication it sometimes can make aggression and irritability worse.

>> But the doses of pain that she would be using would be no more than twenty five milligrams a day if you get over fifty milligrams a day of pain then you can have increased moodiness and increased irritability but at ten or twenty five milligrams a day for neurotic excoriation cutting, neurotic dermatitis picking whatever you want to call ten or 20 milligrams of ten or twenty five milligrams a day of duckpin wouldn't typically be problematic for for making the moodiness or the aggression any worse.

>> Gail Gail, thanks for your call.

Let's our next e-mail question our next e-mail question reads Dear dear father I've read that sleep deprivation therapy is a technique for treating depression.

Is this true?

How does it work?

If you had asked me about sleep deprivation 40 years ago I would have said yeah, we sometimes will use that what was happening forty years ago this is back in the nineteen eighties somebody would go into a psychiatric hospital and the first thing that would happen would be they'd be encouraged to try to stay up later and later in the evening because it was believed and it still is observed that when people have depression they have more dream asleep you have more dreams sleep when you're depressed you might not sleep as much but when you do sleep you have more dreams sleep.

>> It was thought 40 years ago that if you could mitigate or decrease that dream sleep you'd have an improvement with depression and people would get a little bit of a high when they would get by with less sleep.

>> You might have noticed that in your own personal life if you have a night where you don't sleep so well, sometimes you actually feel pretty revved up the next day for a while then you feel worse.

Now with everything we know about sleep, with everything we know about depression now we know that sleep is a psychiatric vital sign.

We are always in psychiatry asking people about their quality of sleep because we sleep.

>> What you're trying to do is go into dream sleep where you can recharge this left front part of your brain called the dorsolateral prefrontal cortex .

That part of the brain will recharge when you're going into deep, when you're going into dream sleep and when you go into deep sleep the rest of your brain will recharge and you'll actually feel physically and mentally better the next day.

So we know getting by on less sleep is going to be more problematic for you night by night by night and even two or three nights of impaired sleep can affect your concentration if your concentration is affected it's going to affect your coping skills if your coping skills are going to be affected, you're not going to be able to put up with things as well and you're going to be more snappy irritable.

You're going to have less stress resilience so lack of sleep can be problematic.

>> So now when somebody goes on a psychiatric hospital, for instance, one of the first things they're trying to do is help them sleep and not trying to keep them up with sleep deprivation so it's not a treatment I would recommend and it can be particularly dangerous for somebody who has an underlying condition called called bipolar disorder, bipolar disorder where people have manic highs where they don't need to sleep and they're impulsive and they're aggressive and they're hyped up and they're talking really fast going from topic to topic.

>> They have these manic depressive lows.

If you have a person with bipolar disorder intentionally not sleep, it can aggravate the manic highs and it's like throwing fuel on the fire for their mood disturbance so it could be dangerous for somebody who has a bipolar condition.

>> Thanks for your call.

Let's go to our next caller.

>> Hello Gerald.

Welcome to Mastermind Gerald.

Do you want to know if a person is suffering from stress related dissociative amnesia?

Would they regain that memory if they got rid of the stressor a stress related dissociative amnesia that could be post-traumatic stress.

>> Gerrold And when somebody has post-traumatic stress what will happen is the mid part of the brain down here gets fired up with adrenaline.

>> The adrenaline goes to the memory center of the brain over here in the hippocampus and that can temporarily shut that down.

So if you've had a particularly traumatic event happen in your life sometimes you can have periods of time where your brain as a coping mechanism will make you forget stuff and it's a way of helping you get through the day if you have traumatic memories coming back up, you forget those memories as a means of being able to decrease your anxiety so your brain kind of has a circuit breaker effect on memories that can be problematic for you.

So if you get rid of the trauma, will the memories improve?

Will they come back?

Maybe maybe not.

It depends on what kind of memories were there and are they still problematic for you.

So the first thing you always want to do obviously is to try to decrease some of the trauma but sometimes just as a means of self-preservation, people will not be able to remember things that were traumatic for them in the past.

That's not all bad.

>> It used to be thought that you had to remember all your traumatic memories to be able to be healed and that's has been shown not to be true at all.

Sometimes it's best to hide the very bad traumatic memories and be able to get on with your life as long as you're able to cope and you're able to manage the rest of your life well.

But if you have recollection of traumatic memory, sometimes it can create unnecessary anxiety and you have to be able to get past that.

Now sometimes it's important to understand the context of the traumatic memories and kind of have an understanding why they're occurring and be able to cope with them in that manner.

But if you're having dissociation and you're having spells where you're forgetting about different memories based on a present trauma, sometimes that's a means of the brain trying to hit a circuit breaker to decrease the likelihood that it will be overwhelmed at that time.

Thanks for your call.

Let's go next caller.

Hello Joanie.

Welcome to Matters of Mind Joanny.

>> Want to know about the prevalence of dissociative identity disorder for people with complex PTSD or complex PTSD where you've had repetitive not just one time but repetitive trauma and yeah, the prevalence of of dissociative identity disorder previously known as multiple personality disorder.

The prevalence of dissociative identity disorder is about anywhere between three to five percent from what I recall.

>> So it's not really common much, much, much more common with women.

It's more common if a trauma occurred when you were a young child especially under eight years of age.

So there's a lot of factors associated with it.

>> But if you had repeated trauma time after time after time and you're less than eight years of age, it's more likely that you're going to have dissociative identity disorder later on.

And what dissociative identity disorder means is you're going to have spells that go on for a matter of seconds, minutes, sometimes an hour or two where you will go into a different personality and not remember that you went to that personality and some people can have two or three different personalities.

One might be strong, one might be weak, one might be more assertive and they have different type of personality characteristics and they're a means of coping with life circumstances.

So if you've gone through a lot of trauma during that trauma, especially as a small child, you don't have any way to cope with that.

>> So what do you do?

You kind of zone out and you kind of step back from the whole situation and in doing so it's your brain's coping with different situations that way and sometimes going into a different dreamlike state of a personality.

The problem occurs when you're 25, 30, 45 years of age and it's still going on when you're under situations where you're not necessarily directly traumatized but you're in situations where you have maybe a boss who may raise his or her voice towards you and reminds you of past trauma all of a sudden you go into a different type of personality.

So that's where it becomes impairing as an adult when you have reminders to throw you into that pass coping style of personality switch like that.

>> So it can occur especially with young children who have been repeatedly traumatized and much more common with women more so than men more so than men.

>> Thanks for your call.

Let's go next caller.

Hello Jeff.

Welcome to Matters of Mind.

>> Jeff, you want to know about any serious mental health side effects to Singulair mantic you cast is as a side effects related to singular like there are with Benadryl entirely for medication.

Singulair and Benadryl are entirely different.

Singulair is a leukotriene receptor blocker basically goes to the brain so does go to the brain and in blocking Leukotrienes it affects inflammation.

So Singulair is a medication that can decrease the inflammatory response to asthma and that's where it's mainly used sometimes allergic rhinitis where you have a runny nose but Singulair as a lookout trying receptor blockers sometimes can affect dopamine and serotonin and in doing so can cause some people to be more irritable, anxious, aggressive, depressed and fatigued.

About one out of six people on singular will get a headache so we hear about that as a psychiatrist when I hear that somebody is on Singulair I don't automatically say up all your problems are from singular .

I try to get them to go back to how they were feeling before they took the Singulair for instance of these sort singular two months ago.

OK, how are you feeling before you took the singular two months ago and try to go back in time and try to associate if the Singulair after they took that if that was associated with their current symptoms entirely.

But Singulair is a very popular medication for asthma and allergic rhinitis so it's something that for many people they tolerate it just fine.

But there are some people that just can't tolerate the CNS or the central nervous system effect of a leukotriene receptor blocker in doing so they can't take Singulair but we always look back to the cause and they affect the chicken and the egg that occur that your current symptoms occur concurrently with taking the singular.

>> Thank you for your call.

Let's go to next caller.

Hello Carter.

Welcome to Matters of Mind.

Carter, you want to know about the traits of avoidant attachment disorder?

How can it be a hindrance and what's a typical treatment plan?

Avoidant attachment disorder is basically where somebody is having difficulty from childhood with attaching often it's a parental issue where they have difficulty attaching with a parent mother, father typically and it goes on into later life as a as an adult they have difficulty with interpersonal relationships and they have trouble with really bonding and being able to attach with other people and they have trouble with love relationships and they'll have difficulty many times with friendships because they have trouble with trust goes back to childhood experiences.

>> Main treatment will be from a psychotherapy standpoint people can be involved in group therapies for that type of condition individual therapy to try to help them with trust and help with attachment in itself.

But it often goes back to early childhood development with parental bonding.

>> Carter, thanks for your call.

Let's go to our last email.

Our last email reads Detective Oliver is a brain structure that's responsible for being aware of a social interaction.

Yes, there is.

If I open up the brain here, if you look at the front part of the brain, the inside part of the brain, the top part of the brain is right up here.

>> It's called the dorsal medial prefrontal cortex.

The dorsal medial prefrontal cortex gets your thoughts in perspective to the people with whom you're associating.

In other words, you might associate differently with people in one environment versus another based on your level of comfort and your emotions will be regulated in different ways based on who with whom you're interacting.

So if you're in a very solemn serious environment like a funeral or maybe you're in a church environment, you might interact with people in a bit more solemn way than you would if you were at a football game or basketball game or if you're out there with your buddies.

>> So basically your dorsal medial prefrontal cortex which is right in here its dorsal because it's up above a little bit here ventral medial prefrontal cortex is below it but that's the part of the brain that helps you regulate your emotions based on your social interactions.

So it takes an information and a process is allowing you to look at the people around you and thinking OK, are my emotions in line with the people I'm around and how am I going to regulate my emotions in those kind of situations?

So now you might not yell out a cheer at a funeral home or in a church environment that the way you might at a basketball game or a football game because you're in a different social environment.

So we regulate our moods not uncommonly based on our social contacts and the people with whom we're interacting.

Thanks for your email unforced.

I'm out of time for this evening if you have any questions concerning mental health issues you may email me at matters the mind you have a dog.

I'll see if I can get to that next week.

I'm psychiatrist Jeff Oliver and you've been watching matters of the mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight