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

Welcome to Matters of the Mind now that twenty fifth 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 issue, give me a call here at PBS or Wayne and the Fort Wayne area by dialing (969) 27 two zero or if you're calling place 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 Pardoo Fort Wayne Campus.

>> And if you'd like to contact me with an e-mail question that you can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFA ECG that's matters of the mind at the Blue Dog and after tonight's program with a question I recently received, it reads Dear Doctor, Father, I've been treated for depression and anxiety and things are going pretty well with my medications and therapy.

My concern is that I now live alone.

I worry that I won't have accountability to someone and I worry that someone won't look after me for my safety.

Do you have any advice?

Yeah, no one.

I mean it's important we all have somebody kind of watching over somebody for whom we can be accountable so you need to try to have some kind of social network that you can develop now that might start with your therapist.

Your therapist can give you some ideas sometimes people will have case management where they have a long term medical or a mental health issue where they have case managers assigned to them to try to help them with that.

But I would suggest that you try to become involved in some kind of social network for some people that can involve becoming involved in an exercise group at a gym.

Some people can be involved in a church group and have that kind of such social network available to them.

But it's important that you maintain that accountability to somebody else have somebody keep an eye on how you're doing because it's often other people, whether it be a family member or friend or just a social acquaintance who will recognize that you're having any difficulties from a mental health standpoint than you may realize you're with yourself all the time.

>> Other people will notice changes in your behavior, your attitude, your way or speak before you even notice it.

So it's important that other people get to know you and you maintain that accountability.

We had a lot of mental health crises due to the covered restrictions because during the restrictions we had the lockdown that went on for months and months and it was devastating for many people because they weren't able to socialize the way they did before.

>> They couldn't go to the gym.

They couldn't go to church.

I heard about those big those shoes that were most traumatic for people because people would go to the gym not only to exercise but to socialize.

People would go to church because it was not only maintaining their spiritual means of connection but they had this social network at church and that was their family.

That was our community and went with the restrictions.

>> They lost all that and many people are having difficulty getting back to that because they became depressed during the the restrictions and they remain depressed and part of depression will be where you have trouble with motivation initiative.

>> You don't want to do things anymore.

You lose and payment with things that used to enjoy and it becomes a vicious cycle because if you quit doing pleasurable activities you end up becoming more depressed and then as you become more depressed you no longer want to be involved in those pleasurable activities.

So it's very much a vicious cycle.

So I'm always encouraging people to try to get involved with socialization and pleasurable activities you used to enjoy even though you might not feel like it at the time.

>> We get into habits, we get into patterns.

Sometimes it takes up to forty five to 60 days to create a new habit new pattern of of behavior.

>> But it's important that you try to socialize and get out around people again even though you become accustomed to living more alone over the recent times.

>> Thanks for email question.

Let's go to our next e-mail question.

>> Our next e-mail question reads Deardourff over what is TBD?

That would be tardive dyskinesia.

>> I hear people keep talking about it when they mention antipsychotic medications.

Tardive dyskinesia is a phenomenon that we've known about for several decades and it's a phenomenon that basically involves blockage of dopamine receptors for a long period of time.

Antipsychotic medications are used not only for the purpose of helping people come back to reality but as they are also used for mood stabilization for people with bipolar disorder.

They're used for individuals who are having trouble with depression sometimes will be added on it's tiny doses for depression but what they have in common the impact of blocking dopamine receptors and when you block dopamine receptors especially very tightly over the course of time you can out more dopamine receptors so the body has this natural rebound Meccano somewhere if you block receptors it'll grow more receptors like that.

So if you grow more dopamine receptors you'll have a greater sensitivity to dopamine.

If you have a greater sensitivity to dopamine you could have twitches and tics.

They can start in the tongue.

We your tongue's kind of writhing around a little bit.

People will look like they are wearing dentures when they are not because their tongues moving around they can have hard blinking where a blink really hard.

They can have shoulder twitches, they can have thrusting movements of their trunk but it usually involves the face.

Early on about half the people who developed tardive dyskinesia antipsychotic medications will do so early in the course of treatment within the first five years.

So about half the people who take antipsychotic medications who eventually get PTD will get them early in the course of treatment within the first five years.

Now if you get tardive dyskinesia there's about a 50 50 chance it'll go away on its own if you go off the antipsychotic medication within a year.

So if you go off the antipsychotic medication within a year about a 50 50 chance of it going away.

>> So who's at risk?

The people at highest risk for tardive dyskinesia and these twitches and tics that occur and primarily in the face will be individuals who are on high potency high doses of antipsychotic medications for long periods of time.

So the longer you're on an anti psychotic at the higher dosage you're going to be more likely to have tardive dyskinesia.

It appears to be more likely for people who on the antipsychotic medications that are the tighter dopamine receptor blockers.

So the older ones are notorious for it from it.

>> But we've seen it even with the newer antipsychotic medications older people as we get older were more prone to having tardive dyskinesia.

>> So that's a common phenomenon for for people as we get older there are other risk factors such as having Type two diabetes.

Smoking can be a risk factor for tardive dyskinesia.

There are some genetic risk factors that we can kind of examine.

There's a CMT genotype CMT is a particular enzyme that breaks down dopamine.

If you have a cold empty genotype of vowel that's a predictor that you might be more prone to having started Conesa if you break down if you break down dopamine a little bit differently that can be a factor people have that have this dopamine two gene it's called deletion gene.

They're more likely to get tardive dyskinesia and for some strange reason if you're a stabilizer for this particular ISOO enzyme called to desex about eight percent of the population has that that's another risk factor.

So we put all these risk factors together and we try to determine who's going to be at higher risk for tardive dyskinesia and we look at who's more likely to develop TRD and those people we try to avoid we try to avoid antipsychotic medications if they have situations where oh maybe they have a mood disorder disorder and they might not need a true antipsychotic medication, maybe we can go another direction for those people.

So if they have a lot of risk factors for tardive dyskinesia we try to avoid the psychotic medications the best we can.

>> Thanks for your email.

Let's go to our next caller.

>> Our next caller is Mike.

Hello Mike.

Welcome to Matters of Mind.

Well, Mike, you had a question about your currently taking risperidone one milligram every day and you're taking about 250 milligrams of deisel also known as Depakote and you're taking 250 milligrams three times a day and you're taking a milligram of beans dropping three times a day, you know, so you've been shaking a lot.

Could you be taking too much risperidone at one milligram a day?

Wouldn't cause a lot of shaking.

I think you're shaking could be from Divx Alperovitz and I'd really want you to talk to your clinician about this because if you're shaking from the IV approx in the shaking is not directly to risperidone and you're taking Benn's Trovan three times a day the beans and can actually put you at higher risk on down the line with tardive dyskinesia which I just mentioned.

>> Those are the tics and twitches you can get in your face and then Surapong is an anticholinergic medication.

In other words as a side effect it can give you a dry mouth, dry eyes and constipation but it can also make you more likely to develop these tics and twitches related to the risperidone.

So it's often kind of tricky risperidone and I valproic or Depakote can give you tremors but the tremors are due to Binz Trovan.

You want to get off the if the tremors are due to risperidone you want to get off the beans Tropeano because the beans open will specifically address the tremors from the risperidone.

And keep in mind a milligram of risperidone is a very, very small dosage with risperidone it's not uncommon to go up to three or even six milligrams a day.

So you're on a pretty low dosage of risperidone and that would sometimes be associated with restlessness, shakiness in some cases difficulty with a shuffling gait if you got to the higher doses but one MG is very small amount with DI Valproic that is a medication.

It's an antiepileptic medication.

It's a mood stabilizer 250 milligrams three times a day, a seven and fifty milligrams a day sometimes will have people take all of that at bedtime.

>> If you take all of Divx out at bedtime sometimes it'll give you a better sleep and fewer side effects during the day which would include tremors but out prick's if you are getting too much of it Mike yeah it can give you a tremor.

>> Our usual doses on develop cruxes between 50 and maybe 100 on the blood level.

>> So it's something in which you can get a blood level get at about twelve hours after your prior dosage and get a good look at what the right dosage might be for you.

>> But if you're getting too much of a dosage on develop drugs and that's in the form of valproic acid, it'll come across as a tremor and that's where you need to drop the dosage a little bit.

Mike, it sounds like based on your medications you might be treated for schizoaffective disorder or bipolar disorder where you would need a combination of medications for the purpose of mood stabilization and those are two good medications divx approx or Depakote tends to have very nice antiinflammatory effects on the brain.

It's thought when people have manic episodes they have inflammation of the brain and part of the inflammation is related to this particular protein called one hundred s one hundred go sky high in the brain when somebody has mania.

So when somebody is mania they don't need to sleep.

Their thoughts are going a mile a minute.

They're impulsive, they're doing things the same thing the the ordinarily wouldn't do or say and die of our projects and lithium are two medications to do a remarkable job in settling down the inflammation related to mania.

So the key with that Alperovitz however is to keep the dosage low enough where it will still be effective for you make sure it's safe, keep an eye on the blood levels.

Sometimes we'll look at the white blood cell counts as well as the liver function tests specific to make sure it's being safe on the bone marrow in the liver and want to make sure people aren't having weight gain with a dove.

Alperovitz is a medication it can contribute to weight gain for some people so it's a medication that's still extensively used.

It's phenomenal for the relief of bipolar mania and we can use it with other medications with success like risperidone.

>> But the tremors that's something where you want to sort out is a due to risperidone.

Is it due to Dove Alperovitz if it's due to dove out the beans drop and probably is not going to help with the tremors.

If anything it's going to make you more likely to have difficulty with tardive dyskinesia later on.

>> So it's something that's very important for you to within which to speak with your clinician.

>> Thanks for your call, Mike.

Let's go to our next email our next email read your daughter Fauver.

What's the likelihood of high blood sugars from an antipsychotic?

Well, I mentioned in antipsychotic a couple of times already so antipsychotic medications can be associated with higher blood sugars not necessarily directly due to the antipsychotic medication, although that is a part of the risk.

But keep in mind people treated with antipsychotic medications often have schizophrenia, bipolar disorder and schizophrenia and bipolar disorder were associated with high blood sugars over 100 years ago there was an article a hundred years ago in nineteen twenty two and the author was Dr Lawrence and he was from Madison, Wisconsin and he identified people with schizophrenia and what was known back then as manic depressive disorder.

They are prone to have higher blood sugars and higher sensitivity to glucose so they had what we now call an abnormal glucose tolerance test.

So if they had a bunch of sugar as a drink and then had their blood sugars checked a couple hours later, they were higher than you would expect.

That's called an abnormal glucose tolerance test or an impaired glucose tolerance.

>> That was a hundred years ago and that was one hundred years ago before antipsychotic medication were even available.

>> So we know the disease state of schizophrenia and bipolar disorder are highly prone to be associated with high blood sugars.

Now there's a lot of risk factors with high blood sugars.

Weight gain is a risk factor but it's not the risk factor.

The psychotic medications in some cases are associated with higher blood sugars.

So that could be a factor for some people because they gain weight and that can contribute to higher blood sugars.

But increasing weight is not the only risk factor for diabetes.

It's thought that when people are prone to developing diabetes based on a long term study was published thirteen years ago the risk factors for higher blood sugars were coming on for 13 years before they actually developed diabetes.

>> So by the time you develop diabetes you've been having higher insulin levels.

You've been having gradually higher blood glucose as you've been having higher triglyceride rise which is a fatty acid you've been having those kind of phenomena occur for at least thirteen years before it even occurred.

>> So if you started antipsychotic medication and started developing higher blood sugars that was probably already prone to occur for you.

So it's something that is not directly related to just the antipsychotic medication.

>> There's a lot of other risk factors with it and there's an argument that if adequately control the condition of schizophrenia and bipolar disorder by relieving the stress associated with those conditions that might in itself decrease the stress hormone cortisol and thereby decrease your likelihood of developing diabetes.

But diabetes is not a condition that develops overnight.

It doesn't develop when you start taking a psychotic medication.

It's been there sometimes the antipsychotic medication can contribute to some weight gain, higher triglycerides and once in a while that can tip the scale figuratively and literally to throwing you into some diabetes.

But the diabetes will probably still be there and it's not like you'll become a diabetic if you stop the antipsychotic medication.

It's just a matter of your getting adequate control of the blood sugars and getting the diabetes treated itself.

And sometimes we use medications not uncommonly like metformin.

Metformin has been around for gee forty years now.

>> It's been around for a long time and it's a medication that basically will decrease the insulin secretion and decrease the likelihood that glucose is going to be produced in the liver and thereby can be a very early treatment for diabetes.

It's been shown to be effective in decreasing weight gain associated with antipsychotics.

So metformin five hundred thousand milligrams twice a day is not commonly used for individuals who are taking antipsychotic medications as a means of mitigating some of the likelihood they might have in developing diabetes not necessarily directly due to the antipsychotic medication but due to the underlying condition for which they are being treated.

>> Thanks for your email.

Let's go to our next caller.

Hello Jeremiah.

Welcome to Matters of Mind.

>> Jeremiah, you had mentioned that you have brain fog and what could be the cause and can be treated when people have difficulty with thinking and processing information.

A lot of things come to my mind as a psychiatrist, Jeremiah, for instance, it could go back to your to a to a person having chemotherapy for cancer treatment.

I saw an individual earlier today who has experienced brain fog due to chemotherapy from five years ago and it's been persistent since that time.

>> So we look at a lot of different factors out there .

Obviously if somebody smoked marijuana marijuana can give you brain fog.

Marijuana for many people will help them feel calmer.

They like the apathetic feeling they get from marijuana.

They like the feeling they get from marijuana.

But unfortunately especially with younger people, it can suppress the growth of white matter all over the brain.

And white matter is the insulation of the individual nerve cells and people who have suppressed growth of the White matter of the individual nerve cells can have difficulty processing information and they can overall decrease their overall IQ so brain fog can be related to using marijuana.

Alcohol is notorious for causing brain fog especially with women because women metabolize alcohol one third the rate as do men because they just don't have as much alcohol Deidre's Janis's an enzyme in their stomachs and livers so one drink for a woman's like three drinks for a man.

So if a woman has three drinks a day it might not sound like much like a man having nine drinks a day.

Alcohol will supposedly go to this area of the brain called the hippocampus and shrink it down some.

That's why women are so much more prone to having memory disturbances and brain falling from the use of alcohol.

Many, many times we'll hear about people having brain fog and they have hypothyroidism so low thyroid is a common reason for brain fog.

So that's something we will want to assess.

I mentioned diabetes earlier as being a condition that gradually develops over the course of 13 years for many people and if you have diabetes, low blood sugars, high blood sugars will give you difficulty processing information.

>> A classic reason for brain fog will be somebody who's had depression, people with depression will often say that it's like their brain just doesn't have enough Internet speed.

You know, we have the the dial up modems from the old days and now we have extremely fast Internet if you have fiber optics especially and that's the way your brain should be working.

But when you have depression sometimes it decreases the speed of processing.

It's like you're on the old Internet speed and you just can't process from one thought to another adequately and it really slows people down so slow processing speed is very common when somebody has depression.

So if you go to your clinician and you talk about having brain fog, your clinician is going to think about all these different things the use of various substances like alcohol or marijuana.

The clinician will think about low thyroid, diabetes, depression.

These are all different things we can go through but another mechanical type of factor that can be related to brain fog will be sleep apnea, sleep apnea, something we're identifying in the field of psychiatry more and more over the past five years such that in my practice one of the six patients who are in our practice are diagnosed with sleep either by us or by an outside clinician and we're treating them for various conditions for depression or difficulty concentration.

But we've identified sleep apnea and a lot of people and basically that's where somebody might be snoring might have pauses and they're breathing at night.

They're not getting enough air flow to their lungs thereby not getting enough oxygen to the brain at nighttime and that will cause them to have difficulty with concentration and thinking the next day people with sleep apnea will often say they are awakening frequently during the night and the last thing you want to do is just give them sleep medication.

You want to make sure they don't have sleep apnea have no one but people with sleep apnea will often awaken with a dull headache.

They might have a little nausea in the morning and they're just kind of feel tired and they'll feel like they need a nap and they just don't feel right the whole day.

They'll often come to our office and they perceive they have adult onset ADHD or add well ADD or ADHD starts in childhood and it's their day by day by day.

>> It's kind of like near-sightedness people with nearsightedness typically have nearsightedness starting in childhood.

It's their day by day by day.

It doesn't go away and you don't have good days with your vision and bad days with your vision.

>> The same is true for your ADHD.

The difficulty, the concentration, the brain fog, the poor, the poor information processing will be there every day on a fairly consistent basis.

So when that's the case we go back to how long those symptoms been there with sleep apnea.

Now they might have been there for a few years or a few months with aid.

Typically those symptoms have been there every day since somebody was a small child.

So aid is much more persistent .

Sleep apnea is something that for many people have more has more recent onset sleep apnea is due to having too much fat in your neck or just having a collapsing of the throat airway so that you don't breathe quite as well.

>> We used to be that we think that only older overweight men had sleep apnea these men who were picnicking and according to Charles Darwin and they would have these big thick throats, these necks that were over 17 inches and they often were overweight, they had hypertension and that's what we try to identify with sleep apnea.

Those are the people we screened.

But now days we screen skinny women if they snore, if they pause in their breathing in nighttime, we'll take a look at them and we can do so with home sleep studies used to be people people had to go in the labs to get sleep studies.

>> Now the home poly sonograms are identified as being accurate for identifying sleep apnea and if you have sleep apnea you can mechanically get support at nighttime it sounds like it'd be burdensome to do.

But once people get successfully treated for sleep apnea they feel quite a bit different.

They can think more clearly.

They have better focus.

They are less depressed, they have less fatigue and those are the kind of symptoms for which people are often referred to us as psychiatrists fatigue, depression people can't concentrate and often we'll find that they have sleep apnea as being a big factor underlying.

Thanks for thanks for your call.

Let's go next caller.

Hello Theresa.

Welcome to Of Mind.

Theresa, you mentioned that you had a son who had a bad heat stroke and had depression prior to heat stroke and now he's having a lot of anxiety.

He's constantly dizzy and he's you're wondering if it's due to medical or psychiatric conditions when you've had heat stroke, Tresa, it can indeed affect heat stroke is due to the hypothalamus right smack in the middle of the brain here not regulating the temperature adequately during that time and you can have some long term conditions from that.

I wouldn't necessarily say it's entirely due to depression but if you had depression before the heat stroke yeah.

it's more like he's going to have depression after the heat stroke.

But if you think about heat stroke depending on its severity as being potentially giving him a little bit of a traumatic brain injuries kind of like a concussion for instance, it's something that can give you difficulty with anxiety, moodiness, irritability thereafter.

And we see that sometimes when people have a head injury in general.

So whether somebody had a concussion, maybe a stroke based on where the stroke was located in the brain, people can have the aftermath of having difficulty with irritability, personality changes, moodiness.

They get short tempered.

They don't put up with things very well.

They have very poor stress, resilience where a little things get to them and that's because with any kind of brain trauma you can have an excessive amount of glutamate released with an excessive amount of glutamate released.

You can have depression, you can have your ability moodiness.

So what will often do for people in those kinds of situations is give them a medication of blocks, excessive glutamate transmission and that would be an anti epileptic like a medication like Lamotrigine Lamictal been around for a long time or use that slowly increasing doses so people don't get a rash but it's something that stabilizes glutamate especially for people who have had traumatic brain injuries.

>> Sometimes people will respond to a vitamin called NASSI and Acetylcysteine in a 600 milligrams twice a day sometimes as a vitamin will help people.

That's not a vitamin that's more of a natural supplement that people could take if you shouldn't take an AC if you do have a sulfa allergy because it does have a sulfur component to it kind of like smells like sulfur when you first open up the powder with an but in AC sometimes something we'll use.

But talk to your son's clinician about the possibility that the heat stroke stroke might have caused any brain injury that hopefully is going to be transient.

>> It's going to be temporarily problematic for him.

But in the meantime the question would be do you change his treatment for anxiety or depression in the meantime to specifically address symptoms that might have been associated with the heat stroke itself because heat stroke and if it was prolonged, if it was serious, sometimes that will deprive the brain of oxygen for a little bit at a time and can give him some prolonged difficulties with what we call nowadays is a traumatic brain injury.

Theresa, thanks for your call.

Unfortunately I'm out of time for this evening if you have questions about mental health issues and I can answer on the air you may write me via the Internet at matters of the mind all one word at WFA a dot org.

I'm psychiatrist Chef Olver and you've been watching matters of Mind on PBS Fort Wayne God willing and PBS will go back again next week.

>> Have a good evening.

>> Good night