.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

eight , seven, six, five, four .

>> Good evening.

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

Welcome to Matters of the Mind now that's twenty seventh 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 the Fort Wayne area by dialing (969) 27 two zero or if you're calling anywhere coast to coast you may dial 866- (969) 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 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 a via the Internet at matters of the mind.

That's all one word at egg that's matters of the mind at WFA a dog and I'll start tonight's program with an email question I recently received.

>> It reads Dear Dear Father, do people diagnosed with bipolar disorder also suffer from depression?

>> How are the two different?

>> Well, that's a very good question in the sense that bipolar disorder is a phenomenon where people will have highs and their mood and they can have difficulty with having decreased need for sleep, irritability, impulsivity.

They can have trouble with doing things and saying things they ordinarily would not do or say and it can be very abrupt and it can go on for two to five days, sometimes over a week.

That's bipolar disorder on the manic side and then with bipolar disorder you can go into depressive lows where you crash into lows and you don't want to do anything you want to sleep all the time you're socially withdrawn.

>> It's quite the opposite specked REM or polar opposite of the highs.

That's why it's called bipolar disorder by means to poller means one extreme or another depression is where you more often than not will have difficulty with sadness, lack of difficulty or difficulty with enjoying things, lack of motivation, lack of initiative and it could go on day by day by day up to weeks if not months for some people.

So the key from a diagnostic standpoint is to identify who has the manic highs and who has just the lows because if somebody has highs and lows we want to give them a mood stabilizer which would act somewhat as a cruise control for the mood as so if you have bipolar disorder you want to have a cruise control in a mood to kind of level out the highs and lows if you have just lows and predominately depressive spells, you want to have more of an accelerator on the mood, not something that's going to put you in a manic highs but something that can bring you out of the lows themselves.

So with that being said, it's important that we make that diagnostic distinction to try to help people stabilize their mood in the case of a bipolar disorder patient or try to help them bring your mood up out of the unnatural low if they have depression.

>> Thanks for your email.

Let's go to our first caller.

>> Hello Joyce.

Welcome to Matters of Mind.

Joyce, you had a question concerning menopause and brain changes.

>> Yes, I was wondering sometimes give difficulty brain changes particularly here in the hippocampus, the hippocampus is the library part of the brain.->> It's right hers yellow part of the brain.

The brain kind of shaped like a boxing glove with a thumb out here be in the temporal lobe on the top of the thumb is the hippocampus.

>> That's where the memory and the the in the attention center of the brain can be so that mainly it's more like a library of the brain when you have menopausal symptoms often you'll have a shrinkage of that part of brain because this part of the brain is very sensitive to estrogen with menopause and the average age of menopause is 51 years of age.

>> We're hearing about it occurring earlier and earlier with a lot of women.

But where's your estrogen level goes down?

You'll have difficulty with absentmindedness and sometimes memory because less estrogen is fertilizing this little hippocampus area here the hippocampus is fertilized by estrogen.

>> It's very sensitive to estrogen in that area as the estrogen starts to go down you'll have trouble with memory and some absentmindedness.

>> Hormonal replacement therapy sometimes is helpful for a while for women and then you do adjust over the course of time .

>> But what you don't want to do is you're going through menopause.

Joyce would be for instance drink alcohol if you drink alcohol.

>> Alcohol is very toxic on the hippocampus.

So the combination of drinking alcohol while going to early menopausal symptoms can be very detrimental to your memory.

>> So we are very adamant about telling people, you know, if you're a woman you want to hold the alcohol consumption to no more than one maybe at the very, very most two drinks because two drinks for a woman is like six drinks for a man anyway because women do not metabolize alcohol as quickly and as well as men will.

So two drinks for a woman is like the blood level of six drinks for a man.

So that's why alcohol would be particularly toxic on this particular part of the brain in the hippocampus.

But that's the main part of the brain where menopause will affect the brain itself.

It has to do with a memory center right there.

Joyce Joyce, thanks for your call.

Let's go to next caller.

Hello, Cedric.

>> Welcome to Matters of Mind.

>> Cedric, you want to know how does how you eat affect your mental health ?

Cedric I'd like to be able to say here's the diet you want to use and I do hear some professionals say here's a diet everybody needs.

>> I don't believe that I think everybody will respond differently based on their diets.

And I was just asked over the weekend by somebody at church will we have genetic testing someday for determining what diet is best for us and I think we will.

>> The complicated aspect about genetic testing, however, is that there might be dozens if not hundreds of genetics that will affect certain symptomatology including our lifestyle.

So there might be many, many, many different types of ways that genetics will affect what best diet would be for us.

>> So with some people it's they'll they'll say they do best with gluten free diet.

>> Other people will say a low carb diet.

Other people will say ketogenic diet.

Other people will say intermittent fasting and everybody will respond differently.

Many people will say a plant based diet will change their lives in terms of how they feel physically and emotionally.

So I think it's all depending on how you respond to those diets and keep track of how different diets make you feel.

>> Some people will feel lousy if they have refined carbohydrates and they're eating a bunch of chips out of a bag or out of a box, they will feel terrible with that.

Other people not so bad with it maybe until they get older and it starts catching up with them.

>> If you have insulin resistance where your insulin levels are unnaturally high now they might be keeping your glucose intact for now.

But if you're unnaturally elevating your insulin levels you can have effects of emotional and cognitive state on your brain.

So bottom line is, Cedric, from a dietary standpoint you have to find what works best for you generally I'm a big fan of intermittent fasting with a low carbohydrate diet for most people that seems to do best for them if they and maintain that type of diet as as a lifestyle.

Intermittent fasting basicallypd then you go ideally without any snacks after about six p.m.

So you're basically fasting for about 18 hours and eating over a six hour period day by day.

Not not everybody responds well to that.

Some people will find they overeat during those six hours and the people will say that they are actually less hungry during those six hours of feeding but eighteen hours off, six hours on works for a lot of people and if you are especially watchful of how many carbohydrates you're taking and try to limit the carbohydrates especially the refined processed foods that for many people just don't do so well from an emotional and a concentraion standpoint.

>> Cedric, thanks for your call.

Let's go to our next caller.

Hello Robert.

Welcome to Matters of Mind.

Robert, you want to know how depression and disruptive mood dysregulation disorder are similar how they're different?

Disruptive mood dysregulation disorder is a disturbance that has been developed for children and adolescents to try to diminish their lifelong diagnosis of having bipolar disorder.

In other words, children and adolescents will have mood disruptions that are out of proportion and they are overreact even they have difficulty with putting up with things of stress resilience that doesn't necessarily mean they have bipolar disorder which well technically is going to be a lifelong condition once you have bipolar disorder to some degree those highs and lows can be problematic for you over the course of time.

>> So disruptive mood dysregulation disorder is a childhood and adolescent condition where you're overreactive an overly aggressive based on circumstances more so than expected for somebody your age in other words is out of proportion to what it would be.

>> That kind of reaction is out of proportion to what would be expected for somebody your age now depression sadness seen in an adolescent or child can be also manifested by irritability.

But more often than not can be characterized by social withdrawal.

Declining declining academic enjoying things and not communicating as much as what you would expect for somebody that age.

So depression and disruptive mood dysregulation disorder are quite different.

But the main key with DMD disruptive mood dysregulation disorder is that it'll look more like a bipolar type of phenomenon for people but it's only diagnosed with children and adolescents.

>> Robert, thanks for your call.

Let's go our next caller.

Hello Jody.

Welcome to Matters of Mind.

>> Joanny, want me to elaborate on the lunar phases of bipolar disorder and schizophrenia?

>> You know, it's been speculated over the course of the years, Joni, what what kind of correlation is with the phases of the moon to mood swings?

>> And I've seen research all over the place some research saying yeah, does it make any difference on the research insisting that it does and if you talked to a lot of hospital worker, they will say that with a full moon or mostly full moon there are more admissions and there's more erratic behavior.

I don't think we have enough evidence out there to say that the lunar phases will affect the mood as they do the the waves of the sea at this point.

But it's something that's kind of interesting.

>> I've actually seen some people speculate that when there's a full moon more people are out and about and they're doing things because there's more light outside the nighttime.

>> So if they're out and about in the evening they're more awake, they're up and around and if they're up and around at night they're getting less sleep with less sleep that could aggravate symptoms of bipolar disorder or schizophrenia.

So there's a lot of speculation about that.

I don't think it's necessarily the face of the moon itself.

It's the light that's causing them to stay awake and be up at night.

So it'll be interesting to see how that goes.

>> Joanny Jurnee, thanks for your call us Goyeneche caller.

Hello Stella.

Welcome to Of Mind Stella.

>> You want to know if Trazodone is an effective medication for grief grief if to the point where it's considered to be major depressive disorder which is basically pathological or complicated grief Stella is a condition where you often have difficulty with sleeping many people as are going into prolonged very complicated grieving and they're having day by day with difficulty with enjoying things, getting motivated, going to work, socializing.

They even think about death themselves when people get to that point in their grieving they'll often have trouble with sleep and if you start lacking sleep Stella, you'll start having difficulty with being able to concentrate lack of sleep itself will give you difficulty with judgment because the front part of your brain at nighttime when you're sleeping is resting if you're not resting the front part of your brain at nighttime is like getting having a cell phone battery that's not getting an adequate charge.

So you're plug in on your charge on your cell phone is not adequate.

That's what happens when you're not sleeping with dream sleep and deep sleep throughout the night.

>> So if you're not sleeping adequately at night, the front part of your brain doesn't get recharged.

If the front part of the brain doesn't get recharge, you don't have good attention span the next day.

You don't have good judgment.

>> You can't think clearly and that will in the long run give you more difficulty with mood and mood disturbances.

So where is Trazodone come with all that Trazodone comes in with all that because Trazodone will specifically affect a couple of the serotonin receptors that allow you to have a nice deep sleep and that's why we like Trazodone for sleep.

>> It was never approved for sleep.

>> It was approved back in nineteen ninety one I believe it was nineteen ninety one it was approved for depression and it was approved for depression.

>> A dose is between three hundred and 600 milligrams a day.

We don't use those kind of doses for for sleep anymore.

>> We use doses of between 50 and 200 milligrams a bed time for sleep because of low doses Trazodone will help give you a deep good quality of sleep and help recharge the brain.

>> So if I was to hear about somebody using Trazodone for grief, I'd say that's a good treatment if are having trouble with sleep because Trazodone will help normalize your sleep efficiency.

It'll allow you to have the deep sleep the REM sleep, the kind of sleep that you need to be able to recharge your brain to allow you to function at your highest.

The next day.

Grieving is often time limited process for people if you fall into a major depression where day by day by day you're having trouble with getting out of bed doing your daily expected activities, it goes on for over two weeks.

Sometimes another antidepressant medication can be added but Trazodone and the 21st century is being used more at lower doses 50 to 200 milligrams a bedtime mainly for difficulty sleep as opposed to how it was originally designed that be for depression back in 1991.

>> Thanks for your call.

Let's go next caller.

Hello Gerald.

Welcome to the mind George.

Do you want to know why do your dreams feel like they last all night?

>> They probably just last are a matter of minutes Gerald but they're very, very into in terms of how dreams work.

>> I mentioned Trazodone allowing you to have better quality sleep overall basically when you're dreaming the thinking part of your brain, the part of your brain you're having to use right now to pay attention.

>> What I'm saying it's fired up right here.

It's called the dorsolateral prefrontal cortex and it's on the left side more than the right side.

But this part of the brain right up front here when you're thinking, focusing, concentrating that's part of the brain is really work and work and when it's working all day gets tired so you need to rest at night when you rested at night that part shuts down.

You go in and dream sleep when you go into dream sleep if you think about it Gerald you're your logical part of brain's not working when your logical part of the brain's not working you go into all this abstract dreaming oil ask for a few minutes but your time perception is way off so it might feel like it's going on for hours but when you look at REM sleep under electroencephalogram for people are egs REM sleep something lasting for a period of minutes for people you tend to have your first spell of REM sleep most commonly about an hour an hour and a half after you fall asleep and as you go through the night you have more spurts of REM sleep having the most REM sleep shortly before you awake in the next morning.

So as you go through the night you have more dream sleep and it goes to the night more frequenty and more intensity intensely as it goes on.

>> When you are having your dreams though, just think about if you awaken and remember your dreams you're not going to remember them for very long.

>> Your dreams are like a whiteboard there get erased really really fast after you awaken.

>> But when you're awake and if you do think about your dreams often they have to do is something that happened over the past 48 hours.

p>> So something abstractly happened within the past 48 hours.

Somehow they came back into your head.

You're trying to process to some degree when you're dreaming at nighttime and that's kind of how they come out.

>> But your dreams are like putting messages up on a whiteboard.

>> They get erased very, very quickly unless you write them down or really put some thought into it or talk about them for that matter.

>> Most of us can't remember our dreams by noon because they've got been erased very, very quickly.

Thanks for your call.

Let's go our next e-mail question our next e-mail question reads Dear to the father.

>> I have an old friend who recently became homeless.

I'm worried about the situation complicating his depression.

How can I talk him into keeping his appointments?

I'm happy to drive if necessary if he's having difficulty with pdepression as you can imagine, that's probably going to aggravate his difficulty with homelessness, homelessness and in other words, if you have trouble with depression you're going to have difficulty finding a job, socialize with people, interacting with people so depression will aggravate the likelihood of having homeless because depression will cause you to have worsening judgment in general.

>> So the whole idea of having appointments for treating depression or treating the whole concept of case management when you're homeless, the whole idea there is to try to find you a meaningful place to live and be able to find either through a mission to an apartment complex through some kind of government subsidized housing, some place to be able to live and when people are depressed they give up on all that.

They tend to look at their whole life as being hopeless and with hopelessness and helplessness that actually aggravates the likelihood of not only being homeless but also want to take your life so that whole sense of despair can be problematic and as a cascade.

>> So the best thing to do with dealing with homelessness is to maintain the hope, be interactive with other people, find work, find meaningful activity, find good social contacts and maintain that kind of network.

>> Thanks for email.

Let's go next caller.

Hello Carter.

Welcome to Matters of Mind.

>> Carter, you want to know when you have a panic attack what's happening to your body and mind?

Why does it feel like a heart attack, a panic attack originates usually in this little amygdala part of the brain up here in the front tip of the thumb, the temporal lobe amygdala is the fear, anger and anxiety center of the brain.

So you can feel kind of anxious in some cases but what really happens when you have a panic attack this middle part of the brain on the stem here really gets fired up and all this norepinephrine gets fired out when norepinephrine gets fired out, it's like an adrenaline effect.

Norepinephrine and epinephrine are chemically related.

>> Epinephrine is often referred to as adrenaline.

So what happens is yeah, you have an adrenaline blast within ten minutes of having the panic attack your heart starts racing.

You get sweaty, lightheaded, you feel like you're going to die.

>> You feel like you need to escape.

You can have trouble with tremulousness, cold chills or hot sweats.

>> You can get sweaty all over.

You can have nausea, diarrhea feels like you're feeling horrifically miserable and it goes on for several minutes in some case for several hours.

>> So for some people, OK, when we hear about a panic attack we try to sort back do you remember anything that actually initiated the whole process of the panic attacks because from a psychological standpoint there's the fight or flight phenomenon where you're in life circumstances where you're back up into a corner and because you're backed up into a corner you feel like there's no way out of the situation.

So it's a fight or flight phenomenon phenomenon you can either run from the situation or you try to hang in there and it feels like you're having a heart attack with all these panic attack symptoms.

So a panic attack is where you have an abrupt surge of anxiety and it's an adrenaline rush during that time.

>> Now when I hear about panic attacks now Carter, I'm also sorting out OK, how many energy drinks do you drink every day if you drink any at all, how much caffeine are you consuming?

Could be other factors.

I've seen some people with panic attacks who had a heart arrhythmia.

In other words, they their heart starts fluttering and it goes really, really fast periodically there's a phenomenon that occurs more with women than men called postural orthostatic tachycardia syndrome also known as Pott's with Pott's particular with women seems to be an autoimmune condition.

>> The pots the heart's just starts racing really, really fast and then they get lightheaded.

>> Many women have been referred to me with the symptoms of a panic attack but as I talk to them I realize they might be having pot so I have them go to a cardiologist.

They get this test called a tilt test and the test test will diagnose Pott's then they get the appropriate treatment for Pott's.

So we have to sort out, OK, what's causing these panic attacks?

>> I think gee, twenty years ago when people had panic attacks the thinking was oh you're having a lot of anxiety.

Let's give you a Xanax and Klonopin and some medication that would just calm down the anxiety.

>> But I think we need to be more thoughtful in what's causing the underlying panic attacks and conditions like Pott's.

>> They weren't discussed twenty years ago.

Now we know all about Pott's.

We know more about these other MELINE underlying medical conditions that might be related to panic.

High thyroid can cause of panic.

>> I've seen people low glucose when they get hypoglycemic they can have symptoms of panic so I think it we need to as clinicians look at the temporal relationship between when the panic attacks started, what might have been going on then and what kind of medical work has workup has been done to date?

Carter but you're right, it feels just like a heart attack for some people and hey, we've got to assess that too.

If you're at risk for having a heart attack, you need to be assessed for that.

>> Carter, thanks for your call.

Let's go our next caller.

Hello, Darla.

Welcome to Matters of Mind.

>> Darla, you want to know what are the signs of paranoid schizophrenia in when it should cause concern?

A paranoid schizophrenia is a chronic lifelong condition, Dahla it doesn't come and go and if you have it you want to treat it as not unlike epilepsy when people have epilepsy they need treatment.

You don't just see what happens if they truly have epilepsy, if they have epilepsy, if they've had recurrent episodes of seizures they need to be on some kind of antiepileptic uptick medication paranoid schizophrenia as the name implies paranoid means they're fearful of other people and their intentions.

But with schizophrenia it's a long process probably develops to some degree in the it has a genetic predisposition, doesn't affect everybody.

>> There are triggers for schizophrenia that will bring out the psychotic symptoms for some people, not others.

But usually when people have paranoid schizophrenia as adolescents you can kind of see some of the we call them pre morbid signs where they can have difficulty with social anxiety.

They're more withdrawn, they have trouble with hygiene.

They might take care of themselves as well.

They're a little bit more apprehensive about the intentions of other people.

>> They take things the wrong way.

They might hear voices or hear sounds in the background that nobody else can hear and they might have some difficulty just with interpersonal relationships and communicating in general many people with adolescent pre morbid symptoms will be diagnosed with autistic spectrum conditions and they do indeed have autistic features.

But when you have your first psychotic episode where you distinctively hear auditory hallucinations that nobody can hear, you hear voices talking to you, you have fixed false beliefs.

We call them delusions where people have beliefs that are very frightening to them and they're not possibly true.

They'll have difficulty processing their thoughts.

>> So when they talk to people they'll kind of go from one topic to another but they don't flow in their speech.

We call that loose association.

>> So these are the kind of symptoms of paranoid with a psychotic episode where somebody is hearing voices, they're delusional, they're not taking care of themselves.

>> They might even be withdrawing from school or their job situation or in that time with a psychotic episode.

It's like a seizure episode if you have a seizure you don't want to have another seizure.

>> If you have a psychoticpepise another psychotic episode because if you have a seizure, the more seizures you have, the more treatment resistant and treatment refractory you become.

It's more difficult to treat somebody who's had many, many, many seizures.

>> The same is true with psychosis.

If somebody has six bouts of psychosis they're much more difficult to treat with medication compared if if they've had one battle psychosis.

>> So if you have one battle psychosis you want to keep those psychotic episodes under wraps and keep them in very, very control so they don't occur again because there is with like seizures and with epilepsy with psychosis, with schizophrenia there will be recurrent damage to the brain, particularly the front part of the brain.

The judgment part of the brain with each subsequent psychotic episode.

And that's why in the 21st century now we have several medications that are long acting injectable medications because a hallmark of schizophrenia will be lack of awareness.

You have the illness.

The problem with treating somebody is schizophrenia is they don't realize that they have schizophrenia.

So the need for these long acting injectable medications that are occurring over the course of their lasting over the course of one month, three months and not even six months, they stay in a person's system long term so they don't have to think necessarily about taking their medication and their denial about having the illness won't be so problematic because they have a long acting injectable in their system.

>> Thanks for your question.

Let's go to next caller.

Hello Sean.

Welcome to America.

Mind Sean, you had mentioned your loved one suffers from severe anxiety and should you be concerned that that might lead to suicide?

>> What side should you watch for ?

Sean, if your loved one has a family history of suicide, that's always a risk factor itself.

If your loved one has a history of suicidal behavior, him or herself, that's a risk factor.

Anxiety indeed and insomnia will be risk factors for suicidality.

>> However, there are other factors as well when somebody gives up hope that's a key feature with suicidal behavior is if somebody is giving away their possessions, if they have nothing for which to live, if they have a significant loss recently where they've lost their job or they lost a relationship, those can all be factors themselves.

But Sean, if you have any concerns about your loved one who has severe anxiety having suicidal thinking, make sure you have that loved one.

See a primary care clinician or some mental health clinician as soon as possible.

>> Sean, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air, you may write me via the Internet at matters of the mind all one word at a dog.

>> I'm psychiatrist Jeff offered you've been watching matters of mind on TBS Fort Wayne now available on YouTube Godwill and PBS willing I'll be back again next week.

Thanks for watching.

Goodnight Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.