.

good evening.

I'm psychiatrist Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 25th 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 here.

>> PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular 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 a via the Internet at matters of the mind all one word at WFB ECG that's matters of the mind at Oregon.

I'll start tonight's program with an email question I received this week.

>> It reads Dear Dr. Farber, can a person be diagnosed with bipolar disorder solely on the testimony of a witness to their behavior?

>> How do you determine that a person no longer has the borderline personality disorder, the bipolar disorder diagnosis?

>> I believe that's what they're referring to.

Can that be determined on the testimony of a diagnosed person themselves?

Basically what you're talking about is collateral information, collateral information is where an outside person, a family member, a friend observed somebody in the describes their behaviors it would be kind of difficult based on simply collateral information to definitively make that kind of diagnosis.

It's always nice to talk to the patient, him or herself and try to determine what kind of symptoms they've been having.

For instance, when you talk to a patient you can sometimes pick up when you're in a manic episode that they're having racing thoughts.

They're going from topic to topic.

They're not making a lot of sense and you can ask them how well they're sleeping.

Collateral information might not know about their sleep whereas the patient, him or herself would know about their sleep so the lack of sleep and especially the lack of need for sleep such that that person feels especially energized the next day despite not getting sleep is very important to that diagnosis of bipolar disorder.

>> Now bipolar disorder is where somebody has manic highs oh lasting anywhere typically between four days up to seven or ten days and there's different types of bipolar disorder but all those manic highs people don't need to sleep as much.

>> They're especially energized.

They're often oh elevated in their mood but they can be kind of irritable and nasty at times they have racing thoughts.

>> They'll go from one topic to another to another to another.

They often will do things impulsively and they say things and do things they ordinarily would not say or do.

People with bipolar disorder will often notice that they'll have these revved up spells that lasts for several days.

Then they crash and there's different types of bipolar disorder.

There's the major depression with mixed features is where basically somebody has these manic highs for one, two or three days and then they crash into these big lows.

They might have bipolar two disorder where they have four to six days of the highs.

>> The highs don't get them in too much trouble but they're significantly noticeable by other people and that's what you're the information to which you're referring by collateral information and people with bipolar disorder will often then crash into two weeks of lows and then you have bipolar one disorder where somebody will be manic for at least seven days.

They might get themselves in the hospital due to the mania and they may or may not crash into depression and you're referring to collateral information perhaps an outside person reporting what kind behavior they're exhibiting and having mental health clinicians diagnosis diagnose.

We can be suspicious of particular types of behaviors that are reported as being kind of different diagnoses but we can't be definitive even so in a definitive diagnosis, especially if somebody floridly manic they're in the emergency room, they need to get a urine drug screen to be able to determine if they're under the influence of drugs at that time that might throw them into manic highs and those drugs can be cocaine .

They can be any type of stimulants such as amphetamines, Ritalin and so forth.

>> Different stimulant can make somebody look just like they're having a manic high.

So we still have to examine the patient and try to determine what's going on now as a collateral and form it as a family member or a friend or just an outside observer.

You can report within the bounds of confidentiality what your noticing to the clinician who may be treating the individual.

>> However, the clinician would not necessarily be obligated to report back to you about their findings because that's a so-called confidentiality boundary limitation so you can report anything you want to a clinician but that clinician is not obligated and probably won't necessarily report back to you concerning their findings unless the patient, him or herself provides that permission.

You might have heard about something along the lines of hip hip is basically where from a documentation standpoint the documentation is supposed to be shared in the seamless manner between one provider and to another.

>> But with Hippo's there's also confidentiality laws but we've always had and from an ethical standpoint we should have been abiding by them anyway but with Hipp of violations that's often referred to as confidentiality confidentiality, boundary violations and that's where a clinician reports to somebody about a patient's here well where that patient is not provided that particular permission to do so.

So an outside provider can provide very important collateral information about a person's behavior because often they'll observe that person's behavior.

I see people all the time whose spouse might join them during the interview and mention what they are noticing and a hopefully loving and nonjudgmental manner.

>> But it's always the patient we need to really examine and interview to be able to determine what's going on and be a little bit more definitive from their perspective.

>> Thanks for your email.

Let's go to our next email.

I believe I have a second one.

>> The next email reads Disruptive over how much of a factor is diet and exercise in mental health ?

Well, diet and exercise can be obviously a very significant factor with mental health just like it can be with any kind of cardiac health , with lung health , with liver health .

>> Our whole body tends to be fueled by our diets and we can be impacted by exercise from a dietary standpoint, some people from a mental health standpoint are affected significantly by certain foods.

I have indeed seen people who are significantly affected by GMO based wheat gluten will be a problem for them and gluten will cause them to be irritable or depressed or anxious.

I've seen some people who are very sensitized by the effects of soy.

Soy is in a lot of different things nowadays but soy can have a mood and cause mood disturbance for some people so I'll often advise people to try to chart a record or just kind of be aware of the different foods they're eating and how they can make them feel.

And we see this classically with people who are on the verge of becoming diabetic and are in this so-called prediabetic state where when they have too much sugar, if they have birthday cake cookies, if they have some desserts they feel terrible and it's because their blood sugar is going up and possibly rebounding and then in an exaggerated manner going down and they're getting hypoglycemia.

>> So that's often somebody who's on the verge of getting diabetes and developing diabetes.

So we'll advise people to be observant of what kind of foods they're eating from a mental health standpoint we do not recommend that people eat big meals, especially spicy meals late at night because you won't sleep as well.

So if you eat a lot at night you won't sleep as well.

Many people will notice that if they have a high carbohydrate diet they'll feel lousy.

And we've known for years now that a ketogenic diet which is basically a high protein and higher fat diet, a ketogenic diet is actually preferred for some types of epilepsy and we've seen that perhaps for bipolar disorder for some mood disturbances, a high protein and lower carbohydrate diet might be advantageous for those people but they have to be able to stick with it and that's sometimes difficult to do when you're already having trouble with depression and motivation and energy and initiative as it is so from a dietary standpoint it's different for different people.

>> You know, we can always talk about the importance of a low carbohydrate, higher vegetable, higher fruit type of content in the diet, decreasing refined sugars and different starches that might cause people to have problematic moods.

>> But it it's varies from individual to individual.

Some people can get by with a more liberal diet.

Other people can't.

Now from an exercise standpoint I was just talking to a person today who had tension headaches and I advised him to try to increase weight training or resistance training because when you have tension headaches basically it's where the the really thin muscles around your hard skull are getting tense and they're trying to squeeze in and with tension headaches people often get achiness around the front part of their scalp though notice their eyes sockets getting kind of achy.

They'll notice the back of their necks getting sore and it often gets worse as the day goes on day by day by day for people as that people get more stressed out.

Well, No one you want to try to identify what stresses you out but exercising especially doing weight training when you're having tension headache can be helpful because if you're tensing and you're exercising your muscles and the rest of your body often much of that tension in the scalp will start to diminish.

So exercising can be helpful for people who have anxiety, especially if they have a lot of difficulty with various physical phenomenon like the tension headaches.

Perhaps they have backache, perhaps even have chest pain on occasion when they're having a lot of trouble with anxiety.

You always want to rule out that they don't have a cardiac or a heart issue.

What you want to rule out that their back can tolerate exercise and they don't have a disc herniation that could be problematic for them.

So they want to do the exercise under close supervision with a a certified trainer or somebody who is experienced in observing and making sure that somebody is able to complete the exercises in a responsible manner.

>> Now aerobic exercising which can be running, biking, being on an elliptical that's particularly good for depression because aerobic exercise where you're getting your heart rate up to about 80 percent of your maximum heart rate for a few minutes, maybe 20 minutes, 30 minutes might be all you certainly need but aerobic exercising can be very good for depression and it's thought that when people will complete the aerobic exercise they will increase this chemical in the front part of the brain called brain derived neurotrophic factor which basically is like fertilizer for the brain and it helps the brain neuromas become more fluffy and there's also a protein that's released and the heart it's called atrial naturally peptide and it's a type of protein that's released to the heart and actually slows down the heart rate in the long run.

>> But when you get your heart rate going really fast in the long run your exercising will decrease your heart rate that makes you less anxious and that particular peptide is increased for women interestingly enough when they're pregnant because they're pregnant naturally they will have this calming effect on their heart and their heart .

Their heartbeat can actually decrease during pregnancy because of that particular peptide.

It's the same peptide that's released when you exercise intensely with aerobic exercising so exercising can be good weight training especially for anxiety, aerobic exercising especially for depression.

But it's generally good not only for the physical health but also the mental health .

>> How much exercise do you need?

Typically no more than about 30 minutes a day five days a week is fine.

It does count if you do an hour three times a week perhaps as an alternative.

But what you don't want to do is oh an hour and a half two hours on a regular basis unless you're in pretty good shape because what you don't want to have is the experience of overuse injuries where if you exercise intensely one day a week or once every other week and you just go at it, you're going to be so sorry you can't walk the next day.

>> That means you well might have had a more detrimental effect and people who exercise that intensely often aren't encouraged to doing it.

So if you exercise for about 20 ,30 minutes more days than not, you'll often feel the motivation to get back out there and exercise and feel good and you'll feel physically good but hopefully not too sore and you'll feel mentally sharper because we now know that exercise actually sharpens the ability of the brain to function and often advise people if they have a big meeting or a big interview the that's going to be later in the day make sure to exercise for 30 minutes that morning because their brain will be sharper.

>> We were told years ago never to skip breakfast.

>> I would recommend that for many people as long as you don't have blood sugar difficulties or diabetes and under the under the approval of your physician or nurse practitioner, certainly you can skip breakfast the day of your exercising as long as you're not exercising too intently because the combination of intermittent fasting where you skip breakfast and exercising to a mild degree or thirty minutes no more than that can often really sharpened up the brain functioning and a lot of people out in Silicon Valley will do that as a strategy to help them become more creative and be able to work with their software better that way.

Thanks for your question.

>> Let's go to our first caller.

Hello Mabel.

Welcome to Matters of Mind Will.

>> You mentioned that your anxiety makes it difficult to fall asleep and you wondered can it also affect the quality of your sleep throughout the night if you have a lot of anxiety, maybe you'll have difficulty falling asleep.

Why?

Because your brain's still going you're worrying about things and you try to store still sort things out in the darkness of the night.

So as who was it Simon and Garfunkel sang The Sounds of silence that is the whole premise of that particular song.

>> I think it Quiet The Darkness becomes their friend and they're there all of a sudden in the darkness and they're there alone with their thoughts and for many people with anxiety that's exactly what they experienced.

So I often advise people to try to write down their anxieties earlier in the evening, their top three anxieties and also try to sort out very briefly what you can do about them and understand what you can't do about them.

Some anxieties we just don't have a lot of control over what happens with certain things that might worry us and that's what worries all about worries about having uncertainty about future events and at some point you have to be able to give that up unless you are making some creative type of and you're considering some type of possibilities on what you're going to do about those particular things that cause you to be anxious in the future.

>> So if you have some meaningful productive ideas for addressing things, great.

Think about earlier in the evening but don't take it to bed with you.

For many people they are out with friends, family.

They're busy all day they're working and all of a sudden they go to bed and for the first time all day it's quiet and they're alone with their thoughts and they start thinking about things and they start worrying about things and that will keep you awake later.

>> Our sleep onset is regulated by melatonin.

Melatonin comes from the pineal gland that's right the middle of the brain and the pineal gland is little pea shaped piece of tissue right here in the middle of the brain and it is the front front of the brain looking at you so the pineal gland is right in the middle.

>> It secretes melatonin when it gets dark.

So when it gets dark the pineal gland secretes melatonin and that's why melatonin is called the vampire hormone because it goes up it gets up when it gets dark.

So melatonin goes up when it gets dark and melatonin will make you tired.

>> It lasts for about 30 minutes.

So it's giving your brain a chemical signal that it's time to go to sleep.

>> So if people take a melatonin pill it may or may not work for them.

If you're worrying if you're really anxious, you can fight past that effect of melatonin and next thing you know it's an hour, hour and a half later you're still awake.

But our brain kind of goes in cycles.

It takes about another hour and a half of your brain to get sleepy again.

>> So you might have to wait if you're typically prone to going to bed at about ten thirty at night and you don't get to sleep because you're anxious, you're worrying about stuff.

Next thing you know you're it's eleven o'clock eleven thirty you're wide awake and might not be until midnight that you get to sleep again because it might take about an hour and a half cycle for you to be able to get sleepy again so people will have difficulty getting to sleep because of anxiety.

>> Now will that cause you to thereafter have disturbances and the rest of your sleep you hit it spot on often with difficulty the anxiety you have trouble going to sleep but once you get asleep you might be able to get to sleep.

>> Depression will often keep people awake, people depression and that's often the cascade you'll have trouble with worry and anxiety that gives you difficulty sleep difficulty with sleep on the long run will often give you difficulty with depression and you'll have depression and that will cause you to have trouble with what we call middle insomnia where you awaken periodically throughout the night or you might awaken early in the morning way before you intend to get up but yet you're wide awake so depression will often cause people more difficulty with middle insomnia and insomnia as the night goes on some people with a lot of anxiety especially if it's traumatic in nature can have nightmares and that will keep them up.

People with depression will often have a suppression of their dreams and they won't get as good a quality of sleep so people depression by dreaming less will often have more difficulty with their memories because we need to dream night by night to be able to retain our memories.

So if you lack dreaming that's not necessarily a good thing because it can suppress your memories and that in the long run can affect your concentration and your ability to process information.

That's why people with depression have difficulty with processing information.

They have trouble with concentration and and recall.

>> Thanks for your call.

Let's go our next caller.

Hello Lucy.

Welcome to Matters of Mind.

Well, Lucy had mentioned that your mother had three strokes and now she's got a lot of mental fuzziness and is less coherent.

>> Is there anything that help with that for communication for her?

There are ways Lucy, that neurologist will address difficulty with what we call cognition following a stroke.

>> Now here's what happens following a stroke, Lucy there's a release of an excessive amount of a chemical called glutamate and when glutamate is excessive it's insanitary chemical.

But when there's brain damage of various types, whether it be a stroke, whether it be a head injury, excessive glutamate is released and sometimes glutamate needs to be stabilized to make people less fuzzy .

So there's various ways to address that.

For instance, there's Memantine which is a medication that is used in the treatment of Alzheimer's disease that can diminish the difficulty with excessive glutamate transmission.

>> There's Lamotrigine Lamictal that can be useful sometimes for memory disturbances and even personality changes that can occur during a stroke.

So that's a start.

Sometimes neurologist will give people who have had a stroke the dementia medications that increase coaling indirectly medications like Aricept rhapsodized.

>> These are medications that increase acetylcholine and in doing so can sometimes help bring back and restore some of the memory disturbances.

>> Once in a while they'll use a stimulant occasionally a stimulant can be helpful for memory, concentration and distractibility for somebody who's had a stroke depending on what the nature of their memory disturbances might be.

But a stimulant can sometimes low doses like Ritalin or on a small amount of amphetamine they can be used.

>> But as you can imagine, Lucy, there's risks in doing that because a stimulant can make the heartbeat go faster, can increase the blood pressure and for older folks sometimes that can be problematic when they already are having high blood pressure or even heart disturbances overall.

So more likely than not they might be more prone to using a medication is going to affect glutamate and stabilize that out.

So she's having memory problems.

Make sure she follow up with the neurological clinic who has been following her and have them keep tabs on how she's doing now as a general rule of thumb, when somebody had strokes the first six months, there needs to be a lot of rehabilitation during that time to try to get their memory and their functioning back within the first year, sometimes two years.

>> That's when they get their maximum capabilities and the return of the functioning that they're going to see.

So you want to really try to work with them over that first six months to a year or so to be able to get back to the best memory functioning as possible .

>> Lucy, thanks for your call.

Let's go to our next e-mail question next e-mail question read not a favor.

Have you ever worked as a consultant for a church to rule out mental illness in cases of possession?

I presume you mean demon possession?

I have not worked as a consultant for a church for that particular purpose.

However, when we talk about demon possession I believe as a Christian myself that I believe that all illnesses can be related to the original sin and the potential for demon possession because if you read the New Testament the demons were not involved with illness that were exclusive to mental health or psychiatric disturbances.

Very clearly there were other sources of illness in the New Testament in which Jesus was able to cure these individuals a woman who was heavily bleeding undoubtably had some severe menstrual irregularities and she couldn't stop bleeding from that.

He healed her.

>> Several people died presumably from the demon possession it was described in the New Testament and they were brought back to life .

Yeah, there are cases of mental illness and the New Testament where people were described as having demon possession but so were people with epilepsy and epilepsy and our logical condition.

So in blindness I mean the list goes on and on.

So from my perspective I don't think that we should talk about demon possession being exclusive to the field of psychiatry or mental health .

We can say that all illness is based on the original sin as well as our propensity toward getting sick and we do get sick our bodies age nobody is immortal.

So getting sick itself does not necessarily mean that we've done something sinful and just means that our bodies aging and we're all individuals.

We're not robots.

We're all made differently and we're made differently from a genetic standpoint.

We have past life experiences.

Yeah, we have differences in diet and exercise and we control we can control that to some degree but our life experiences will affect our overall physical health and for some reasons that we can't explain.

Some people will die earlier despite their having a very healthy lifestyle and other people will die later even though they've not had a healthy lifestyle.

So there's a lot of things we don't know but from a biblical perspective there's a time and a place for all of us to to have our lives come to an end and the most important thing for us is to be able to live life as fulfilling as possible day by day, hour by hour, minute by minute.

>> Every breath we take it's important for us to be able to live our life to the fullest and be and always be reminded that there's only so many so much time any of us have in this world.

Thanks your email.

Let's our next caller.

>> Hello Wilson.

Welcome to Matters of the Mind .

Wilson, you have mentioned that you had a thyroid breakdown on the highway and now you have a lot of anxiety on the highway.

Not really sure what a thyroid break down the highway means.

So I'm going to presume that you might have had a panic attack that could have been related to maybe a thyroid disturbance and I can understand that.

So you want to know about anxiety on the highway when you go on the highway the best thing you can do Wilson, is to try to recover from the panic that your brain is consciously and unconsciously associating with being on the highway and the best thing to do is as old as the old saying was get back on the horse.

>> If you fall off the horse you get back on it.

You need to get back on the highway and just go from one exit to the next and you can drive the country roads for a while.

>> But when we're talk about the highway a lot of times people in the 21st century are talking about the interstate.

So you need to get back on the interstate but take short trips .

>> What you're doing and taking short trips is basically desensitizing to your brain to perceiving that the highway the interstate is what caused your brain to have the panic attack because your brain is telling you that right now that it was that instance incidence.

>> It was being on the highway ,being on the interstate.

>> That's what caused you to have a panic attack and that's not necessarily the case.

I mean it might have been an environmental precipitant one way or another but you might have a panic attack just out of nowhere and by definition that's what a panic attack will typically be.

>> It's an unprovoked spontaneous emergence of a fast heart rate sweatiness, dizziness.

You can have nausea, chest pain .

Some people even have diarrhea when they have panic attacks and it's a horrible feeling and it surges within ten minutes but it comes out of nowhere and many people will associate the panic attack with what they were doing at the time.

You're associating with being with it being on the highway but that's where you need to get back on the highway to try to reconvince your brain that that might not necessarily be the case.

Wohlsen, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions about 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 WFYI a dog.

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

I'll be back again next week.

Have a good evening.

Thanks for watching.

Goodnight