.

>> Good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th year, Matters of the Mind is a live call in program where you can choose a topic for discussion.

So if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing 96 97 to zero or you can call any place coast to coast at 866- (969) to set seven to zero now and a fairly regular basis.

>> I am broadcasting live from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFYI dot org.

>> That's Matters of the mind at WFA EDG and I'll start tonight's program with an email I recently received.

>> It reads Due to the fovea I realize this question is philosophical in nature but I'm wondering this is mental illness real or is it more the product of how society views people who are different?

>> So you're talking about the difference between Quirk's and psychiatric condition.

>> So basically Quirk's are well what makes this will be what make us unique so we all will have our unique personality traits and those are perfectly fine.

>> They're not a mental illness until you get to the point where you have symptoms that are persisting day by day by day that cause a impairment in functional and functional interactions at the work with your family socially.

So when you're having difficulty being able to do the kind of things in life that you'd like to do and we can cluster certain symptoms to get together that have a neurobiological basis that in which we can attribute those symptoms that gives you a psychiatric condition.

So we have certain types of depressive conditions anxiety conditions, mood conditions in general we have psychotic conditions.

They have a neurobiological underpinning that have been identified and that way we can address those kind of conditions with psychotherapy of particular types with medications of a particular type quirk's or personality traits on the other hand might not have a distinctive neurobiological underpinning at just how we genetically were were set up initially Quirk's might be based on our past experiences model behavior and looking at the behaviors of other people but they don't cause significant impairment that will isolate you socially or from a job situation and they wouldn't cause you difficulty in school.

So bottom line is a psychiatric illness is not unlike a cardiology condition, a gastrointestinal condition and any other medical conditions.

Medical conditions become problematic where they give you difficulty getting things done in your life and same with a psychiatric condition.

>> A psychiatric condition has to do with the neurobiology of the brain but it causes you distinctive difficulties getting done things you want to do.

>> Thanks for your email question.

>> Let's go to our first caller.

Hello Chase.

Welcome to Matters the Mind Chase.

You want to know how do I administer an IQ test and what do I measure?

I don't do IQ test chase but I can tell you about intelligence quotients test IQ test.

>> Many people have heard about them.

The average rate in the middle is one hundred one standard deviation above and below is basically two thirds of the entire population one third below one state.

One standard deviation above would be between eighty five and one fifteen.

So two thirds of the entire population have an IQ one standard deviation below one standard deviation above two one two thirds of the population have an IQ between eighty five and one fifteen that's considered to be relatively normal IQ will as will an IQ test will basically assess your ability to problem solve to process information memory.

It'll look at intellect, vocabulary, all sorts of different things and it can fluctuate over time to some degree as a matter fact your IQ probably peaks between the age of thirty five and forty five but it's used in many cases in academic settings to be able to determine if people are having difficulty with processing information in school looking for learning disabilities, especially looking for difficulty with reading hearing information and so forth.

>> So as a psychiatrist that's not my field so that's outside of my lane.

I would refer IQ testing to a psychologist who would do that on a regular basis.

>> The testing itself between an hour to two hours and like I said, the scores can change over the course of time.

The biggest detriment in IQ scores that I've heard over the past twenty years and I've mentioned it before will be the use of regular marijuana smoking.

So when people smoke marijuana on a regular basis in their 20s it actually has been shown to decrease IU IQ points as they go into their thirties.

>> Thanks for your email question.

Let's go to our next email question.

>> Our next email question reads Dear daughter father my husband has Alzheimer's and lately I have been feeling more like his mother or caregiver than his partner.

This change in our relationship has made me feel quite depressed.

How should I deal with this and should I go see the doctor about my depression?

Yeah, you're describing caregiver depression.

This is a very common trait.

You identified it very well where you start feeling as if you're his mother and it's an entirely different relationship.

He's not the man you married previously because he doesn't have the same personality traits.

>> He doesn't have the reciprocal interaction with you that you identified earlier.

So it's more of a well, a superior type of position where he's he's in a needy position.

>> He's not able to give back as he did before as a husband.

So the issue of the caregiving is that you can get more depressed if you get depressed and you have trouble with enjoying things or sleeping, concentrating, taking care of yourself that compromises your ability to take care of him.

So you better contact your primary care clinician, let your primary care clinician know that you're having difficulty in the whole role of caregiving.

>> There might be some resources in which your primary care clinician could refer you and be able to give you some help with the caregiving itself.

But you need to keep yourself mentally healthy to be able to take care of your husband in that particular role.

And you know, it's like we all said in the wedding vows for better or worse, richer or poorer in good health and not now that's kind of where you are right now.

He's not in good health and it's a blessing that you're able to still take care of him.

>> Thank thanks for your email.

Let's go our next caller.

Hello, Martha.

>> Welcome.

The mastermind Martha, you want to know are there foods that make you feel better or worse emotionally?

>> It's debatable what direction you could go there, Martha.

Granted, you know, we always hear about a ketogenic or a high protein low carbohydrate diet making many people feel better but everybody is unique.

>> Some people will feel better with that kind of diet.

>> Some people won't.

So you know, people will often crave certain foods when they get more depressed and stressed out and quite frankly many people crave carbohydrates.

>> Carbohydrates will increase the insulin level abruptly.

Insulin levels increasing will increase the transport of tryptophan into your brain.

So if the increase of tryptophan into your brain you'll get a serotonin surge in your brain and serotonin surges in the brain will give you kind of a blissful feeling in many cases and people will feel good momentarily.

>> After a while the insulin level drops and you start feeling lousy and you have a little bit of a rebound there.

So from a dietary standpoint on a day by day day basis I tell people to identify the kind of things that make them feel better, the kind of things that make them feel not so good.

>> So if they go to particular restaurants and they have the rolls here or there and they notice that after they have the rolls in particular places they feel really lousy afterwards identify that might be a gluten intolerance for you in particular because some roles have more gluten than others.

>> So everybody's quite different.

Oh, I hear about some people say that they feel good with if they have a little bit of caffeine especially in the morning early afternoon because it gives them more of an alerting effect but they have to be able to drop that down later on.

Other people will say caffeine will make them feel more anxious.

So you just have to be able to identify what personally makes you feel better and what personally makes you feel worse.

>> Martha, thanks for your call.

Let's go to our next caller.

Hello, John.

>> Welcome to Matters of the Mind.

John, you mentioned you have a history of borderline personality disorder in the family.

>> How do you prepare your child for it?

I'm wondering, John, if that borderline personality disorder or bipolar disorder the same kind of initials there but borderline I'll tell you both with both of them borderline personality disorder is basically a bipolar spectrum condition where people will indeed have difficulty with moodiness but the moodiness with borderline personality disorder will be the kind of moodiness somebody will have where it'll be always in reaction to people around them.

>> The treatment for a borderline personality disorder would be where you have talk therapy and you helped you help yourself sort out the kind of things that trigger your mood so people with borderline personality disorder will have mood swings, ups and downs of irritability, the sense of chronic guilt they'll have difficulty with trust all these different things can be addressed with talk therapy.

Yeah, sometimes we'll address people with borderline personalities with medications it'll be mood stabilizing on either hand bipolar disorder well that's a more classic type mood swings that people will experience.

>> Bipolar disorder itself is about 60 percent genetic if people have bipolar disorder there is a family history of it not uncommonly and people will often wonder what the likelihood will be if they have bipolar disorder symptoms.

If you have bipolar disorder you're more likely to have the initiation of mood disturbances as an adolescent or a very young adult.

>> Rarely does bipolar disorder show itself for the first time either the highs or the lows when you're in the 30s or 40s usually will start up with a depression maybe in the adolescence then you notice you have a period of a high and the high will be where you don't need to sleep as much.

You have racing thoughts your socially intrusive, you're very impulsive, you do things and say things you ordinarily wouldn't do or say those are manic highs and these can last for several days, sometimes for even several weeks in those cases think of as kind of like epilepsy when people have epilepsy you want to be on a antiepileptic medication to prevent yourself from having future seizures.

The more seizures you have with epilepsy, the more likely you're going to have more seizures.

The same is true with bipolar disorder.

The more highs and lows you experience, the more highs and lows you're going to have.

They're going to typically get higher and lower.

So we want to get the mood stabilization as soon as possible so from a family member standpoint, make sure that there's education about the genetics of bipolar disorder knowing it does run in family, knowing what the kind of what kind of symptoms to be observant upon and also don't self medicate many people have bipolar disorder will self medicate with whatever they can get their hands on whether it be alcohol, marijuana, cannabis, opiates, any type of thing at all and if you use different means of self medication it typically will get much, much worse over the course of time.

>> Thanks for your call.

Let's go next caller.

Hello Janet.

Welcome to Matters of Mind.

Janet, you want to know and someone with narcissistic personality disorder change even when there seventy five years of age it's it can't happen.

Janet when people have narcissistic personality disorder by nature it's where they feel very entitled.

They feel like they're special and they often don't consider the needs of others because it's all about them often starts the adolescent years.

>> You see it very prominently in the 20s, 30s and 40s where people will have difficulty with relationship and it can be a big impact in marriage and it can be significantly impactful in a in an employment type of environment where unless they're the boss if if the boss well maybe they can get by if they can if their coworkers can still stand them.

But with narcissistic personality disorder you'd mentioned seventy five years of age.

Well there's things happening at that time.

Many people at 75 years of age might have lost their spouse and they're in a different phase of their lives.

>> Number two , they're no longer working.

They will retired many times.

It's seventy five years of age so they don't have the employment stress that might bring out many of the traits of narcissistic personality disorder.

So yeah, you can change your perspective around other people and you can actually be more caring and giving at the age of twenty five years old because you have different environmental priorities in your life and sometimes it can be an impact so change can't happen even when you're in your 70s.

Thanks for your call.

Let's go next caller.

Hello.

Well let's go to our next email.

Let's go our next email our next email reads Dear dear dear father my friend always says they get the holiday blues in December.

>> What are a holiday blues and what are some tips for avoiding?

>> A couple of things happen in December.

No one the days gets darker.

>> It starts getting light around seven thirty and he starts getting dark around four thirty so no one just the fact that the days are getting darker overall can make somebody a little bit more depressed and give them some of the blues.

>> That's one factor.

Secondly, holiday blues often people get very stressed out and anxious about the obligations of the holidays, especially if they've had long standing traditions with lots and lots of obligations that expected of them.

So it's very important during the holidays to be able to understand that you don't have to accept every invitation.

>> It's helpful to be social because part of getting yourself out of the winter depression is to keep active in doing things and that's part of the winter depression people experience around the Christmas holidays as they will have they will notice that they aren't as active and they don't get outside as much because it's cold and it's snowing.

>> So in those cases it's important to try to accept some social invitations but be aware that you have a limit on how many you can do.

So the best thing for the holiday holiday blues people can experience will be to try to keep it all in perspective, try to find joy in the holidays, try to keep the holidays in a state of gratitude where you can be very thankful about what's happened over the past year and what can happen in the future for you.

There's a lot of studies out there showing that when people anticipate something like Christmas they get really excited about it when they anticipate their level of dopamine go sky high when Christmas actually comes and the exciting day is finally arrived, dopamine actually drops on that day and they've done some studies with addictions showing the same thing is the anticipation that actually is more exciting than the actual event itself.

Same thing happens with addiction where the anticipation of doing a line of cocaine for instance is actually more impactful than actually doing it.

So we hear about that with holiday blues where people get really depressed after Christmas after the holidays end because they felt like they're getting that high with the anticipation.

>> How do you get over that while you try to get yourself to anticipate something else?

So put something else on the calendar in terms of what what you can be doing as we especially go into the late winter and early spring.

Thanks for your call.

>> Let's go our next caller.

Hello David.

Welcome to Mariza Mind David, you had mentioned you've been taking antidepressant medications for twenty five years.

>> Should you stop taking them now that they have stopped working?

I certainly talked that over with your clinician David did the Depression medications ever work for you?

>> Why did they stop working?

Was it a stress in your life ?

I've heard about some people noticing that the antidepressants seem to have stopped working after they acquired covid or they had some kind of medical event in which case maybe you need to go to a different type of antidepressant medications if you don't have depressive symptoms anymore.

>> I saw a person earlier today who had been pretty relieved depressive symptoms.

>> I'm a big fan of D prescribing where you start tapering down medication as long as you're doing well and as long as we can watch you over the course of time.

>> So if you don't need any medication for depression at this point yeah.

>> You take a medication for depression.

You don't need it.

You actually can feel worse.

I saw a lady a while back who was taking an antidepressant medication, was getting more irritable and anxious and was on a really low dosage of the medication anyway.

We just simply decreased it down and she felt much better and the idea will be to probably take her off of it as long as she can tolerate it.

>> So it's a type of discussion you have with your primary care clinician.

Antidepression medication doesn't seem to be working.

That's one thing.

But number two , do you still have symptoms of depression?

>> And number three, was there a time frame when it quit working?

If you identify some kind of medical complication that might have been a factor of that could certainly be the case.

I've mentioned many times on this program how people as they get older could have a higher likelihood of sleep apnea.

>> So a sleep apnea you snore, you pause and you're breathing.

You don't you don't adequately exchange the airflow at nighttime when you're sleeping and that affects the brain.

It makes you tired and depressed and you can't think the next day.

So there might be some kind of underlying medical condition that started up that made the air depressant medications not seem to work anymore.

But on the other hand, if you don't have depression anymore, you might not need the medication and that's a whole nother factor and typically with antidepressant medications we don't want to stop them abruptly.

We might taper off of most of them over the course of two or three weeks.

Some of the depression medications we have will last for several days after you go off of them so we can stop them.

Examples would be Fluoxetine also known as Prozac awardee Occitan also known as Treinta Alex.

You can pretty much stop those abruptly and not have too much trouble but most antidepressant medications we want to slowly taper off.

>> Thanks for your call.

Let's go our next caller.

Hello let's hello Herb.

>> Welcome to the Mind or Herb.

>> You mentioned that your grandmother had just been diagnosed with dementia and how could you help her?

>> Basically, Herb, if your grandmother has been diagnosed with dementia, reminisce with her.

>> She's going to probably have memories from her earlier years and that may be shock you.

How can she remember things from twenty and thirty years ago but she forgets what she did that morning.

That's kind of the course of dementia because if you look at the brain here each side of the brain starts to shrink down when you have Alzheimer's dementia and Alzheimer's dementia is the most common form of dementia.

>> There's also vascular dementia where people have multi infarct strokes.

>> Lewy body dementia is another type of dementia.

So there's different types of dementia but many types of dementia will have disturbance with short term memory and difficulty with knowing where they are geographically.

So that's why people with dementia really shouldn't be driving but reminisce reminisce about past memories.

It's something that can be reassuring for them.

They often like reminiscing about things that happened years ago and keep photographs of the family around the room and remind your grandmother who those people are and don't be surprised if she starts to forget the names with the faces of different people.

That's very with dementia as well.

>> Thanks for your call.

Let's go next caller.

Hello Janet.

Welcome to Mastermind Janet.

>> You had mentioned you have a loved one with post-traumatic stress disorder and what are some general tips for helping them cope ?

>> Number one, Janet, if somebody has post-traumatic stress, make sure they're getting into treatment for it because there's a lot really good treatments for post-traumatic stress disorder if somebody's been in a very highly stressful situation, there's dialectic behavioral therapy that's been use eye movement desensitization and reprocessing is something that is frequently used.

There's a treatment called a rapid resolution therapy are fascinating how that works but there's all these different treatments for PTSD.

I wouldn't simply as a friend or a family member try to help your loved one or your friend with PTSD, try to make sure they get into treatment.

>> We do use medications for PTSD to try to block some of the overactive surges of adrenaline that's coming from the brainstem down here or so when you've had PTSD you have these memories of something awful happening.

It'll cause your brain to overreact in a lot of situations we call it hyper vigilance where you're really jumpy when you smell, see or hear certain type of stimuli that might remind you of the past stress.

>> So it's very important that it get treated if you have post-traumatic stress disorder you are at a higher likelihood for thereby having depression.

Not only this PTSD impact a person's quality of life but the underlying depression can too often cause people to have nightmares.

They have trouble getting to sleep and staying asleep.

Lack of sleep can set you up later on for dementia and memory disturbances.

So there's also long term consequences with PTSD, depression and insomnia and they can include a higher likelihood of cancer, hypertension, stroke, heart disease all sorts of different things that can be problematic .

It's a very stressful event so I'd say as a friend or a family member Janet, try to get your friend or family member involved in some kind of treatment for the PTSD and give them reassurance that there are treatments out there.

>> Thanks for your call.

Let's go our next e-mail question our next e-mail question reads Dear to the father I get a rush of anxiety when falling asleep.

>> Why is that and what can I do to stop it?

I'd want to know what kind of things you're doing right before you go to sleep because sometimes people will be looking at their cell phone and they're scrolling through different social media sites and kind of get some work up a little bit.

So I look at your sleep hygiene first and foremost as you're to see what's going on before you go to sleep to see where you might be getting that rush of anxiety as you go to sleep.

Secondly, there's certain medications that sometimes will cause people to have that little rush of anxiety as they're going to sleep.

So I'd want to make sure your medications weren't contributing to especially looking back to when you might have started certain medications and when this rush of anxiety occurred because that's a that's a real a no brainer a follow up question we're typically going to ask somebody if you say that you've had certain symptoms like a rush of anxiety before your as you're going to sleep we're going to ask when did it start and then we try to piece together OK, that is related to this or that or whatever I mentioned earlier sleep apnea if somebody has sleep apnea and they're just going to sleep right when they start going into REM sleep or dream sleep they might have that pause in their breathing or that choking sensation and all of a sudden wake up and start.

Many people wake up at a start and they think they've had a nightmare but it's actually their first episode of Inability to Breathe at night.

So there's certain medical conditions like that can that can be contributing to it.

So I talk it over with your primary care clinician to have the primary care clinician look at your medications, the possibly if you're having sleep apnea or any kind of any other kind of medical conditions that might be causing you to be kind of jumpy as your first going to sleep.

>> Thanks for your email.

Let's go to our next caller.

Hello Maya.

Welcome to Mars The Mind.

>> Maya, you want to know how does physical and mental or emotional abuse trigger psychosis in otherwise healthy adults?

>> I think what you're describing there my physical emotional physical abuse can cause a loss of reality testing by causing what I'd mentioned earlier post-traumatic stress disorder PTSD or post-traumatic stress disorder sometimes can be associated with auditory hallucinations and can cause you flashbacks.

It can make you feel like you're all of a sudden experiencing the past trauma and some people have the after effects of past trauma to such a degree that they can dissociate.

When you dissociate you kind of go into a dream state and you forget what you've been doing for a few seconds minutes rarely over an hour or so.

>> But when people go into a dissociative state that's kind of looks like a psychosis in many cases but it's not so when people have had past abuse it basically causes the brain to short circuit when you've had when you're involved actively in an abusive situation, the little part of your brain here called the amygdala.

There's one on each side that the amygdala is Allmon Shape and it's the seat of your anger, your anxiety emotions.

>> It's basically the area of your brain that really lights up when you are having really intense emotions when that happens hijacks the rest of your brain and cause you to have difficulty thinking and it will fix memories right here into the hippocampus.

So when you're going through a traumatic situation your memories can be fixed right in your hippocampus very intensely and it can come out periodically with the slightest stimulus at all that you'd ever imagine.

And sometimes it can be simply a smell or hear about people saying that they'll walk by somebody and they'll they'll get a puff of the person's perfume walking by the cologne and all of a sudden it brings back this rush of memories of a possible past abuser who might have worn the same perfume or cologne.

So you hear about that.

But it's not truly a psychosis they're experiencing when they go into the one of those dissociative states but it's related to post-traumatic stress disorder.

>> Let's go to our last caller.

>> Hello, Marge.

Welcome to Matters of mind.

Marge, you want to know how to smoking affect mental health ?

Basically, Marge, it used to be thought that adolescents smoked because they had attention deficit disorder because they had depression.

It might be part of it but smoking nicotine as an adolescent actually set you up later on for depression because smoking profoundly will increase dopamine when you increase dopamine, the effect of dopamine wears off over the course of time and you're more prone to having ups and downs so smoking can affect the mental health by causing a disruption of the way dopamine is processed in the brain.

>> Marge, thanks for your call inforce.

I'm design for this evening if you have any questions that I can answer are on the air concerning mental health issues you can me write me the but the Internet at matters of the mind all one word at WWE Dog I'm psychiatrist J Forward you've been watching matters of mine on PBS for Wayne now available on YouTube God willing and willing to be back again next week.

>> Thanks for watching.

Goodnight