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>> Good evening.

I'm psychiatrist Jeff Ofer live from Fort Wayne , Indiana.

Welcome to Matters of the Mind Now and its seventh 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 four calling any place else coast to coast you may dial 866- (969) 27 do zero and on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which are 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 WFYI Dog that's matters of the mind at WFYI org and I have a couple of emails that I received this past week.

The first one reads Your adoptive father our son 34 years old with schizophrenia has a slightly lowered platelet count and very high serum ferritin serum ferritin means that there's a lot of iron storage and takes 12 milligrams of olanzapine that's also known as Zyprexa and 256 milligrams of haloperidol and palmitate every 31 days.

That's a long acting injectable.

>> Does serotonin to a receptor antagonism thin the blood he'll be due to take another biomarker blood test in the future.

>> It's thought that clozapine also known as Clozaril of all the different antipsychotic medications has the most to do with bone marrow suppression.

>> Now your little white blood cell counts are are due to increases or decreases of bone marrow activity in the bone marrow which is inside the bone is for you make your little platelets and your white blood cells and red blood cells and it's thought that if you have high ferritin there's a possibility that you're not making enough red blood cells and that could give you some anemia.

But you also mentioned the low platelet counts.

So with that in mind, yeah, clozapine or Clozaril is the most likely to cause problems followed by olanzapine also known as Zyprexa.

Olanzapine has chemical structure very similar to clozapine and then the third in line in terms of the likelihood of causing any difficulty with bone marrow suppression would be quite Taiping also known as Seroquel.

All three of those have a chemical structure called a die benzo days DPN pain structure and a benzodiazepine structure is thought that maybe have something to do with the bone marrow suppression risperidone which is the parent compound of AdOne is also one of those medications that will give you a likelihood of bone marrow suppression.

>> Why does it occur?

Is a serotonin to a antagonism?

I don't know but I don't think so and the reason I say that is because there's a medication called Carolita which is used as an antipsychotic medication but also as a mood stabilizing medication.

Carolita predominantly will block serotonin 2A receptors if it was response for bone marrow suppression as a mechanism that the likelihood of caplets causing bone marrow suppression and platelet decreases in white blood cells decreases would be sky high.

But it's not SOCAP light.

It doesn't tend to do that.

>> So what I wonder if it's problematic obviously olanzapine pela Paradorn for your son might be working so you want to try to do what you can not to have to change medications but if you do have change to change medication go to something else and something else.

Now we have available a medication called Copp Envy.

You might have heard about it.

It came out a few months ago but Koban Fee has no effect on dopamine to speak of and for the past six decades our focus in the treatment of schizophrenia has been that of blocking dopamine.

>> Well if you not just block dopamine but decrease the excessive amount of dopamine being produced to begin with and that's what's causing schizophrenia that might be a better mechanism of action.

So what benefit does is it actually stimulates these acetylcholine receptors and in doing so downstream it decreases the firing of the dopamine.

>> So if you think about the treatment schizophrenia, what we've been doing over the course of the past six decades has been primarily blocking the targets of dopamine.

So if you think about a shotgun range, you have this shotgun firing out dopamine shotgun's going all these different dopamine receptors.

>> There's five well-known dopamine receptors that are available in the brain and the body.

>> So you're blocking these various receptors on their targets.

Well, how about just decrease in the bullets coming out of the shotgun?

That's what Karpinsky Bentley will actually do.

So instead of the traditional antipsychotic medications that are blocking the targets CO benefits decreasing the likelihood of excessive dopamine to occur, why is that important for your son while maybe and there's a possibility it's a theory that the dopamine blockade by the various antipsychotic medications is somewhat responsible for the bone marrow abnormalities.

>> So if you block dopamine for some reason it can mess up your bone marrow production of platelets, white blood cell counts and red blood cells.

So if you do that, that can cause you the difficult that you've described Kobani would not affect dopamine in that way.

So the good news is there are other options for people who are having those difficulty with the red blood cell count, the white blood cell count and the platelets production that are sometimes associated with these newer atypical antipsychotic medications.

>> Thanks for your email.

Let's go to our first caller.

Hello, Sandy .

What can mastermind Sandy you want to know is does giving up alcohol for dry January have a positive impact on your brain?

I would think Sandy giving up alcohol for any period of time has a good effect on the brain now does it totally reverse any possible damage has been done if somebody's been a heavy drinker?

>> I don't know.

But the brain is very resilient.

So if you give up alcohol entirely number one, if you've been heavily drinking, you know you can have alcohol withdrawal that can be a problem but not uncommon when people abstain from alcohol when they've been drinking moderately we're talking three or four drinks a day.

They've been drinking moderately not to the point they're dependent on the alcohol but it just enough to give them a buzz decreasing and even eliminating the alcohol entirely.

Yeah, it can help with your concentration, your focus, your ability to stay alert.

We know that alcohol is a depressant.

It can make you more depressed.

Going over alcohol sometimes will make people have less depression.

It can certainly improve your sleep because if you drink out alcohol anywhere close to bedtime it can cause you to have disruptions in the cycles of your sleep so you can have a lot of benefits.

You might not notice it until a week or two into January if that's when you a person you know is choosing to be abstinent from alcohol.

But it's certainly worth a try and just see how you feel over that time.

>> If somebody is having one or two drinks a day it might not be as noticeable.

But if you're having more than two drinks a day you might notice that it does tend to help with concentration, focus, sleep and a lot of other things .

>> Thanks for your call.

Let's go next caller.

Hello Trish.

Welcome to Matters of Mind.

Trish, you want to know is it common to create fake scenarios in order to sleep by pretending you're somewhere else?

You know, it's a technique that many people will use, Trish, where you have to be able to relax the brain the last thing you need to be doing at bedtime is thinking about other stuff.

So if you have a lot of worries, if you have a lot of stuff in your mind, get them off your mind earlier in the night, write down your worries, write down what might be troubling you and very importantly try to write down if you can do something about them or not.

So for that reason many people are recommended to use a worry diary where they document earlier in the day you don't want to document on your worry diary after about 7:00 p.m. or so if you intend to go to bed at 10:00 or 11:00 p.m. you want to get those worries off your mind, do something that's going to get your mind off the worries and I think that's what you're describing in terms of just imagining being somewhere else.

You're just trying to dissociate yourself from your current stresses and your current problems.

That's OK.

But many people do the same thing by reading reading a novel reading even history something that has chapters where there will be a definitive end to that chapter so you can put the book down at that time.

But keep in mind that when you're going to bed it's like catching a bus that comes around every hour and a half.

If you miss that bus and you're for whatever reason staying awake, you miss the bus, you're brains going to stay awake for another hour and a half or so.

So you need to get in the routine where you go to bed about the same time every night you have the same routine every night your brain is getting the signal that it's a certain time, it's time to go to sleep.

>> But if you're watching a ballgame or you're reading something really exciting, you're looking a social media and it's keeping you you might not wake you might not go to sleep for another hour and a half or so.

>> So you don't want to do something that's going to impede your ability, go to sleep and if it just means getting down to relaxing and thinking about something else, imagining going to someplace else, that's OK.

It used to be that people would talk about counting sheep.

It's a whole concept of just trying to dissociate your mind from your current difficulties.

So whatever works for you but try to get to a same routine night after night after night.

>> Thanks for your call.

Let's go next caller.

Hello Ben.

Welcome to Mars the mind then you want to know is it important to establish boundaries and expectations and relationships early or just let things flow depends on how urgent that relationship might be, Ben.

I mean generally you want to get to know somebody in a relationship and that's where you're referring to letting things flow.

But sometimes you have to have more of an urgency in getting to understand another person's needs and their understanding your needs.

>> But it depends on the nature of the relationship overall, Ben.

But generally people will get to know each other.

>> It's an evolving process.

People who have been married for 30, 40, 50 years are still in many ways getting to know each other and that's OK. >> But there are some issues you want to get resolved very, very quickly if they're going to be highly problematic.

>> Ben, thanks for your call.

Let's go to our next caller.

Hello, Shannon.

Welcome to Mary's Mind.

>> Shannon, you want to know what are the common sides to recognize autism autism as a condition where people have difficulty with change.

We call it resilience and psychiatry but basically we have difficulty with change.

Things need to be the same relationship.

Social interactions are often awkward because people with autism will have a trouble.

The trouble with this right front part of the brain that contains what's called mirror neurons mirror neurons are neurons as you might expect that help you mirror the behaviors of other people so natural whether you're conscious of doing so or not, you will mirror their behaviors.

>> Other people sometimes their mannerism or sometimes their voice inflection.

>> That's a way that you're relating and basically connecting with them so that's why sometimes you'll hear about people even taking on different accents when they're in the presence of other people now you might not want to do that because that can appear somewhat condescending to them but it's a matter of mirroring your ability to connect with them.

>> People with autism lack that ability so people with autism will often talk and talk and talk and talk.

That's called pedantic speech.

They will not have an awareness that other people are not really interested in what they are saying anymore and they will not allow other people to join the conversation without that pedantic monotone speech will often be a key factor.

The difficulty with change as I mentioned, many people will get extremely stressed out.

>> They'll get extremely anxious if they're in an unfamiliar environment, if they're not in a routine.

So people with autism need a very specific routine otherwise they can get very stressed out people autism will often notice things that other people do not and as a matter of fact the Israeli Defense Forces will have people with autism specifically embedded in certain areas to help them understand intelligence.

>> It's really fascinating.

It was thought that twenty , thirty years ago that people with autism should be excluded from the military and in the Israeli Defense Forces people want to be part of that if they're part of the Israeli community.

So they want to be part of the military and the people with autism used to be excluded.

>> Now they're actually included and they can see things on photographic imaging that other people just don't pick up so well.

>> So people with autism will have some tremendous abilities that other people might not experience but they will have difficulty sometimes interacting with others and people might perceive them as being unfriendly or kind of being in a world of their own.

But they often will have really interesting intellectual abilities.

Thanks for your call.

Let's go next email our next email reads Dear Dr. Fauver, are there any good mental hacks for starting a new habit?

The first thing you ought to try to do and you're starting a new habit is make yourself accountable accountable to other people.

Tell the people you're going to do it.

So if you have a habit that you want to start that can be exercising, can be going for a walk every day and be doing Bible study on a regular basis .

OK, talk about other people talk talk about it with other people and let them know that you're doing it and that way they can check in on you every now and then.

That's the best thing you can really do with starting any new habit.

Also document your progress and make yourself accountable by writing down what you're doing and the reasons why you might have skipped the particular good habit here and there.

But I think the best mental how you can really do is just making yourself accountable to other people when you're trying to start something new and talk to them, let them know how you're doing with it.

>> Thanks for your email.

Let's go to our next caller.

Hello Paul.

Welcome to Matters of Mind.

>> Paul, you had mentioned you're having trouble with sleeping.

We just talked about that a little bit and now you find it difficult to concentrate and make quick decisions.

Are these two different issues difficulties, concentration and making quick decision?

>> Yeah, those are sometimes the same issues, Paul.

And if you're having trouble sleeping, keep in mind that during your sleep you're recharging this left front part of your brain, especially the front part of your brain is the part of the brain that you use to help you focus concentrate have improved processing speed with going from one thought and one idea to another and that part of the brain at nighttime needs to rest.

It's like recharging yourself for cell phone battery where if you don't adequately recharge your cell phone battery your cell phone doesn't work so well the next day if you don't get deep good quality sleep that includes dream sleep this floor left front part of your brain just won't work so well.

>> So you'd mentioned having difficulty with follow through with things and constant creation and what we call speed of processing executive functioning is decision making that all goes hand-in-hand with getting an a good night's sleep.

Now what I'm often going to explore when I hear about somebody having those complaints, Paul, will be sleep apnea and it's something that as a psychiatrist we try to identify because many people will have psychiatric disturbances if they indeed have sleep apnea.

Sleep apnea is where you might snore or you pause in your breathing at nighttime and that means you have less airflow going to your lungs and thereby less oxygen going to the brain at night during those eight hours a night that you're trying to sleep and it's going well.

It's like being suffocated off and on throughout the entire night.

It will have an effect on your concentration the next day many people will sleep apnea will awaken with a headache, a little bit of nausea but they'll be sleepy and tired throughout the next day.

But in psychiatry we often hear about people having difficulty with concentration focus and they might find that things aren't as enjoyable.

They might have trouble with motivation.

They might have trouble with even sadness that can all be directly due to sleep apnea.

>> So we strongly advise people to get a sleep study.

We do order sleep studies but often the primary care doctors will do so as well and they sleep studies call a poly sonogram probably sonogram can now be done at home so you do it in the comfort of your own bed, take it into a sleep specialist the next day and they will read it typically within a week and let you know if you have clinically significant sleep apnea that is a treatable condition by many different means not only by a mask but sometimes by a surgical procedure and there's even a device that you can put under the skin that can keep you from having sleep apnea.

>> So there's a lot of different ways to treat sleep apnea.

But I talk to your family clinician about any possibilities that you might have sleep apnea, OK, if you have depression that can give you difficulty sleep and difficulty with concentration.

So clinical depression will be a factor as well sometimes we'll look for other medical conditions like low thyroid as being a reason for people having difficulty with concentration and focus.

>> But when people have difficulty keeping their mind on things, memory making decisions those are all in the context of what we call cognition and that's something that can be addressed and it should be.

>> Thanks for your call.

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

That's another follow up for sleep.

It looks like it says during the five favor what are some good habits to establish when attempting to get to bed earlier?

>> I stay up too late most nights I need to be in bed by eleven.

When do I turn off the television?

Other devices any general advice for stopping caffeine?

Is it OK to read in bed?

OK, let's talk about lot of those different things caffeine.

>> If you're having trouble getting to sleep by 11pm you want to give up the caffeine earlier and earlier and earlier.

>> So it might for some people they can't drink caffeine after about four p.m. in the afternoon and that's what it takes.

OK, that's when you give up the caffeine.

So that's the easy part.

When do you turn off the television and it's not just television that I'm concerned about when I hear people having a hard time going to bed many people go to their go to beds with their cell phones and the cell phone acts as a modern day television.

>> It's often too bright.

There are devices that can maybe affect the brightness of the cell phone and that might help you sleep a little bit.

But it's not just the brightness that keeps you awake.

It's your brain doing things and still processing information.

Many times when people would watch television they watch a sitcom for the fifth time and it was just something to get their mind off their daily activities and that was OK.

So watching a boring sitcom at nighttime before you go to bed for many people that was actually not a bad idea to get them in a routine of getting the sleep.

But when you're on your cell phone, especially going to social media, going to different areas where it's interacting with you and keeping you through the algorithm in gauged in looking at something else and looking at something else, looking at something else you can miss that bus to which I was referring you just still wide awake at eleven o'clock.

Next thing you know you don't want to go to bed till twelve thirty or so so reading is going to be better in that regard because reading is something that your brain is having to focus on something but don't read something highly exciting and don't read something it doesn't have chapters you want to read something that has chapters so you get to an end of a certain section and be able to stop reading is a very good way to help you go to sleep.

And the nice thing about reading a get you into a routine of OK I'm going to be reading now I'm reading and it's about ten o'clock it's ten thirty so when you're reading your chances are it's going to make you a little bit tired just from the cognitive processing of reading itself.

So after thirty minutes or so you're naturally going to get more tired.

So reading is excellent for helping you go to sleep.

Cell phone television not so much.

You want to probably give those up by 10 p.m. if you intend to get to sleep by eleven o'clock at night.

Now some people are using small amounts of melatonin very, very safe to use for most people.

>> Keep it under five milligrams at night time with melatonin.

You want to take it about thirty minutes to an hour before you go to bed melatonin actually suppresses insulin release which is very interesting because you don't want to eat before you go to bed anyway because that can keep you awake and melatonin will actually suppress insulin which naturally should be suppressed by your own melatonin at nighttime.

But it can actually potentially help with some people by my understanding with Type two diabetes because it gives your body a little bit of a rest from the excessive amount of insulin that gets released for a lot of people during their sleep.

>> So for those people you could try a little bit of melatonin just to give your brain chemical signal to go to sleep and if you took that around ten or ten o'clock or ten thirty with the intention of getting the sleep around eleven that could be helpful to melatonin is very, very inexpensive.

You don't need the sustained release version.

Just get a regular version.

If it's a ten milligram tablet immediate release tablet cut it in half it's a five milligram tablet even better could even cut that in half for that matter.

But a little bit of melatonin could also help your brain get to sleep a little bit earlier in general try not to exercise in the evening for many people that's when they have to exercise.

If you have to you have to but try to exercise earlier in the day if you exercise after about six or seven p.m. many times that can keep you awake.

And I did mention you don't want to eat after seven o'clock or so.

>> It's not good for your body in general but if you eat later in the evening it will cause you to have quirky insulin releases anyway and that can sometimes interfere with your with your sleep and sometimes give you a higher likelihood of gastric gastric reflux where you have heartburn.

>> Thanks for your email.

Let's go to our next caller.

Hello Dale.

>> Welcome to Matters of Mind.

Dale, you want to know what does it mean for an antidepressant to be extended release and does it mean that you can skip a dose if that's extended release and oppressive medications, Dale, are primarily for the purpose of keeping you from having withdrawal do they're very short they're short duration of action.

>> The one that comes to my mind off the bat is Effexor Venlafaxine extended release.

You want to take a Venlafaxine in the form of extended release because the immediate release venlafaxine gets out of your system so quickly for some people they had to take it even three times a day because they'd feel these the sensation of shocks and buzzes and headache and loopy feelings and they didn't like how they felt when I was getting other system.

So there are some adolescents that need to be extended release and Venlafaxine is one of them.

If it's extended release it doesn't mean that you you can skip a dosage periodically.

You could skip a dosage on the medications that have very long half life .

Now your clinician can tell you more about those but as an example Fluoxetine also known as Prozac it's been around since 1987.

If you skip a dosage of flu vaccine, chances are you're not going to notice how much and with Fluoxetine since the last in your system for days you could potentially take a double dosage two days later if you skipped a dosage with Treinta also known as Vaud.

Oxendine also stays in your system for days so there are certain medications based on we call it or halflife it just means or duration of action if you skip the dosage it wouldn't be a big deal.

Sometimes we tell people to double up if they skip the dosage sometimes not.

But if it's a medication extended release typically it's just so it can slowly release in the gut and that just gives you less likelihood of withdrawal in general the effects are being the main one that is problematic in that regard.

But I'd suggest that you take the medication on a regular day to day basis if you can get that routine and that means taking the same time every day if you can.

Dale, thanks for your call.

Let's go next caller.

Hello Cody.

Welcome to the Mind.

Cody, you want to know can major depression make changes in your prefrontal cortex and are those changes permanent?

The good news is, Cody, that yeah, major depressive disorder can do a couple of things in the prefrontal cortex is the prefrontal cortex the front part of the brain, the dorsolateral prefrontal cortex, major depression will make that part of the brain less active.

Now the good news is, Cody, it's temporary.

You bet it's temporary so it can make that part of the brain less active.

It can make this front part of the brain called the orbital lateral prefrontal cortex right above the eyeball.

That's why it's called orbital lateral but it's right above the eyeball.

This part of the brain that you used to think if you did the right thing it's executive part of the brain that makes the decisions for you.

And if you have depression it's actually overactive and you might think oh that's great if it's overactive it means I'm making really good decisions.

Right?

No, I mean if you're having like an overactive boss who can't make a decision and you get stuck in room you don't things and it's like a boss that micromanages the rest of the organization, that's not a good thing.

>> So characteristics of major depression will be that you can't concentrate so well and then you tend to ruminate on things and you're always questioning if you did the right thing those parts of the brain.

>> Yeah, that will change during that time.

Certainly not permanent.

There's a lot of studies over the past twenty years demonstrating that we have this natural Miracle-Gro in our brains called brain derived neurotrophic factor and as we get that fired up with exercise with proper sleep medications can do that.

But with increases in brain derived neurotrophic factor it can actually fertilize these neurons and make them more fluffy because it's thought that long term depression can make your neurons less fluffy.

And it's not that the neurons die off, they just get less fluffy.

So it's like a Bush that has less branching.

That's what happens in your brain with major depressive disorder.

So we have means to help them with more fluffiness.

>> Thanks for your call.

Ask our last caller a hello and welcome to Marionberry Matters of mind and you were talking about the brain there.

>> What are some of the techniques you can practice to manage anxiety environment you can't control?

What's a first Ketanji?

Try to understand what you can and can't control if you can't control it, let it go.

You can't control those kind of environments.

Try to understand what you can control around you and deal with those situations accordingly.

>> But the first key will be if you can't control what's happening around you, be aware of that.

That's where you back off of that and realize you can't control them.

Angie, thanks for your call.

>> Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues, give me an email that I can answer on the air by writing me at Matters of the mind ATWA Dog I'm psychiatrist Farber and you've been watching matters of mine on PBS for Wayne God willing and PBS willing.

I'll be back again next week.

>> Thanks for watching.

Goodnight