.

>> Good evening.

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

>> Welcome to Matters of the Mind.

Now in his 10th 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 call in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place long distance coast to coast you may be alcohol free at 866- (969) to 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 all one word at WFB org that's matters of the mind at ECG.

>> And let's start tonight's program with a question I recently received.

Dear Dr. Fauver, will artificial intelligence ever have a place in psychiatry?

>> Well, the whole concept of artificial intelligence in medicine is for you to program it so it can gather information for you to give you some clues and give the operator or the clinician for that matter some better ideas more efficiently on what direction to go with treatment.

>> So artificial intelligence and psychiatry what I find is happening in psychiatry is we're gathering information in a different way.

>> It used to be we sit down, talk to a patient for two hours, three hours as long as it took back when I was in training we would have three hour interviews.

Well, that's obviously not really time efficient for the patient or the clinician.

So what we're doing now is we're gathering more information with questionnaires so as we can gather more information with questionnaires, it's more patient generated notetaking as opposed to artificial intelligence.

>> There is a means by which even currently in electronic medical records systems where you can simply put a microphone or a a cell phone in front of the patient and between the patient and the clinician and the data will be received in the cell phone, the smart phone and that will go directly into the node itself and that's considered to be artificial intelligence.

But I think artificial intelligence is for the purpose mainly right now in medicine to be able to gather lots of different symptoms, lots of different information and try to compartmentalize information to make better decisions in psychiatry.

The way I see it occurring will be that it will help us give us better algorithms on what direction we should go.

For instance, would somebody be a better candidate for this class of medication or this class of medication based not only on their symptoms that's called phenotype but based on their past history of treatment, based on their genetics?

Perhaps maybe someday we'll be able to do some brain imaging and determine who's going to be a better candidate for this or that medication based on their medical comorbidities where they have other medical conditions.

We're trying to do a lot of that right now with questionnaires and gathering information and grouping it all together.

But I think in the future will have artificial information helping us in a good way.

As you always have to remember though with artificial intelligence somebody has to program that information to determine what direction the computer takes you in those cases.

>> Thanks for your email.

>> Let's go to our first caller.

Hello, Sophia.

Welcome to the of Mind.

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

Our next e-mail question reads Have over my genetic show that I have a chemical or methyl transference mutation CMT OMT mutation also known as a mutation.

>> What's it mean and can I do anything natural to deal with it?

>> A common mutation is means that you have either slow metabolism for breaking down norepinephrine and dopamine that would be a met met or you have a comment Val Val.

>> Which means you have fast metabolism of norepinephrine and dopamine particularly in the front part of the brain now a slow metabolism of dopamine and norepinephrine.

>> A Copt met Mette occurs in one fourth of all of us.

So one fourth of all of us have that slow metabolism of norepinephrine and dopamine in the front part of the brain.

>> What's that mean?

It means that you might notice that you're a little bit more irritable, a little bit more snappy in some situations you can certainly be more sensitive to pain and we have to take that into account when we treat people for pain because they might have more pain sensitivity if they have met met naturally if you have CMT met, met and you could take magnesium 200 milligrams twice a day, 600 milligrams twice a day if it doesn't give you diarrhea but magnesium supplements, particularly magnesium citrate which is highly absorbable can be helpful for CMT Memet so-called mutation.

But mutations sometimes make people think it's a rare type of phenomenon.

But CMT Memet about one fourth of us have that on the other end of the spectrum CMT Valvo that's where you have fast or high metabolism of dopamine and norepinephrine.

>> You're going to be a good candidate if you have depression or ADHD for a more of a dopaminergic mechanism of action.

For instance with depression people can take bupropion, they can take Vaud Augustine also known as Trin Telex if you have ADHD could have me it may be better luck with a stimulant medication as opposed to a non stimulant so about one out of four people have a CMT Velvel genetic type so one fourth of all people have a genotype of CMT Memet one fourth have CMT Valvo then you have the people kind of in the middle.

>> Fifty percent of people have some TV segment and that's considered to be normal.

But if you hear somebody say that you have a CMT account of mutation it either means you have high metabolism or low metabolism and as clinicians we have to take that into consideration.

People on bupropion or 26 for that matter don't do so well at higher doses when they have CMT Memet they tend to need lower doses of the medication.

People who have CMT met met often don't do so well with a stimulant so we have to use lower doses of that or maybe give them a non stimulant option.

>> Thanks for your email.

Let's go to our next caller.

Hello Sophia.

Welcome to Matters of Mind Sophia.

>> You wanted to can CBD Gumee and or Gumee or CBD oil interfere with your Zoloft possibly it's been studied somewhat Sophea but possibly CBD can inhibit the metabolism of sertraline Zoloft.

>> That means you're going to have higher blood levels of circulators.

>> What's that going to do to you?

It's going to give you a fast heart rate headache, diarrhea, sweatiness is going to give you a serotonin toxicity or serotonin effects because instead of for instance taking 50 milligrams of off your body is going to feel like it's getting 200 or 250 milligrams of Zoloft.

>> So if you use CBD with a medication like Zoloft or for that matter any antidepressant medication, just make sure to tell your clinician because we can adjust the dosage accordingly.

In my practice I just prefer people not use CBD if they're having trouble sleeping or the anxiety.

>> I've got other options for them outside of CBD but my biggest issue is CBD will simply be the when used with any medication it can give a lot of interactions and cause you side effects from the other medication so we try to stay away from that.

>> Thanks for your call Sophie.

Let's go our next caller.

Hello Fred.

Welcome to Matters of Mind.

Fred, do you want to know does alcohol have a negative effect on ADHD alcohol will affect a particular receptor in the brain called GABA and it kind of slows down the brain gabbers the brakes on the brain with ADHD you think?

Oh yeah, that'd be good, right?

You want brakes on the brain with ADHD?

>> Well, if you put the brakes on the brain with ADHD can inadvertently cause your brain to slow its processing.

>> You don't want that with ADHD when people have ADHD they have trouble with this left front part of the brain where it's just not focusing well enough.

It's underactive and you're bouncing all over the place with your thoughts.

>> You can't maintain attention and your easily distractible you want to be more focused and less distractable.

>> Now why would people drink alcohol with ADHD?

Many people will drink alcohol with ADHD if they have a lot of social anxiety which is a common comorbidity of ADHD because when you have ADHD you have a hard time following conversations.

>> You go into a room with a lot of people and you hear all the different conversations.

It's like having a lot of extra sound in your brain and you're hearing it all.

So what do you do in a social situation in those cases while many people will go right to the right to the bar, have a few drinks and calm themselves down because ADHD will often be associated with a lot of anxiety so alcohol can briefly alleviate anxiety but it won't alleviate the underlying distractibility and inattentiveness that you might have with ADHD.

So if you have social anxiety will also often going to want to look at the underlying causes of the social anxiety itself and not uncommonly ADHD can be a reason for that because of the reasons the reasons I cited so we want to treat the underlying ADHD symptoms knowing that alcohol can kind of slow down the brain processing a little by itself and give you difficulty with thinking yeah, alcohol is has been used for centuries as a means of decreasing anxiety for people but it's just not a good means of trying to relieve the anxiety associated ADHD thanks for your call.

>> Let's go next caller.

Hello David.

Welcome to Mastermind David.

You want to know why do you want to be dead all the time?

I'm not sure where you're going with that question, David, but for one thing, if people have this existential existential sense that they don't want to be around, they just wonder about their purpose and meaning in life .

Yeah, from a psychiatric standpoint it can be a sign of clinical depression.

It's one of the classic signs of clinical depression where somebody just does not want to be alive.

They ruminate about dying.

They obsess about what they are thinking about that and it's a means of escaping from life as it is so many people with those kind of symptoms will actually look forward to the time that they might die because their life circumstances may not be as they would choose.

>> What I'd recommend, David, is several different things.

>> No one to keep a diary keep a diary of your day to day activities can just write down week by week if you wish to do so and write down what kind of things you're going through and what kind of things are going well for you, what kind of things are not going so well for you.

You'll notice David, that over the course of several months the things that are not going so well for you really turned out OK. And I point that out because many people when they were thinking about dying and they just can't go on any longer, they feel overwhelmed with their current life circumstances and they're having difficulty coping with their current life circumstances.

>> So if they keep a diary and come to an understanding the several months down the line they look back and they realize things worked out that can be very reassuring to know that OK, you're going through a tough time of your life now know that you've passed you've gone through some tough times and now you have other tough times coming up.

>> You know that you'll be able to get through those as well one way or another.

Secondly, what I'd recommend, David, is try to have some kind of meaning and purpose in your life , whether it be family, whether you have whether it be your faith, whether it be your work, some kind of goals, have something in which you can look forward to and have some meaning for life.

Many people with chronic depression will struggle with just lacking any purpose and meaning in life and those people will often think about death and some people will actually try to take their lives.

Many people who will attempt to take their lives and survive perhaps a suicide attempt will say the reason they try to take their life was because they just didn't see any meaning and purpose anymore and they had a sense of hopelessness.

Hopelessness is a key trigger for many people where they just can't see any hope for their current life circumstances.

>> That's why I'd recommend the diary to try to get you understanding that things that don't seem that like they're going to work out now can work out in the future.

>> Thanks for your call.

Let's go next caller.

Hello Jack.

Welcome to Mars.

The mind Jack.

You want to know about the benefits of Gwon forseen and its many uses Gwon forseen as a medication.

>> It's an old antihypertensive medication.

It's called an Alpha two agonist.

It stimulates Alpha two receptors Alpha two receptors or a type of norepinephrine receptor and basically if you stimulate Alpha two receptors you can have improvement with focus concentration and decrease distractibility.

So on one hand Gwon forseen is used with ADHD type medications intuitive as a medication so long acting one forseen and intuitive as a medication that can be used in addition to stimulate medications or other ADHD medication.

So that's one use of gwon facing another using one forseen will be for flashbacks, nightmares and people who have post-traumatic stress symptoms.

People with PTSD symptoms will often take a medication like one forseen as a means of settling down.

Jumpiness and irritability like that occasionally gone fishing will be used for anxiety and irritability itself but more commonly it's used with ADHD and it's used for post-traumatic stress disorder.

>> Thanks for your call.

Let's go next caller.

Hello Margo.

Welcome to Of Mind Margo.

>> You want to know about the social challenges people might face with high intelligence rate, high intelligent traits, social challenges with people with high intelligence or high IQ can go along with ADHD or autistic spectrum conditions.

People with ADHD often do have high IQ and when you have a high IQ sometimes that can be attributed to other conditions.

>> It's not the high IQ that get you into trouble socially.

It's the kind of conditions that might go along with high IQ for instance with ADHD it's not that people will have higher IQ by nature of having ADHD but when you have attention deficit hyperactivity disorder you can have trouble with attention span, distractibility and focus but you can also have trouble socializing because you're always thinking three steps ahead of a conversation with others and you might want to finish the census of others.

You're thinking about other things because your distractible so you're not really engaged in the conversation itself.

So then you might come across as being forgetful or somebody who lacks tact or somebody who's just uncaring because you haven't really heard the conversation when somebody might have asked you for a particular request.

>> So ADHD can have the comorbid social disturbances that indirectly can be related to the high IQ that people can have with ADHD.

Many other people will have a high IQ with autism spectrum condition basically with people have autism spectrum conditions are right front part of their brain is a bit underactive and as in being a bit underactive they will have difficulty connecting socially with other people because the right front part of the brain is where the mirror neurons are.

We naturally whether you realize or not in social environments will mirror the behaviors and mannerisms very subtly of other people.

>> It's a natural way for us to connect with them so we might use some of the same facial mannerisms, same body language, maybe even the same voice inflection as a means of connecting with other people.

We often don't even realize we're doing it but that's what we do.

People with autism will have a hard time doing that.

People with autism will have difficulty being able to sort out if other people are interested in their conversation, they have a hard time shutting down their conversation and having a back and forth exchange.

People with autism will often have what's called pedantic speech where they talk and talk and talk and talk without really getting the back and forth in the social engagement .

>> So for that reason many people with autism will have trouble with interpersonal relationships who can coach them through it.

And basically people with autism need to be put in social environments where it can be adaptive for them to be able to pay attention to things that other people might not notice.

I've often mentioned the Israeli Defense Forces.

They have an autistic tact force in their intelligence organization of over one hundred and fifty people.

Now from what I last heard, basically these people with high high spectrum are autistic spectrum disorder if you want to call it a disorder itself.

These people have autistic features and they're able to identify things in the face of the intelligence that other people can't notice.

>> So you can often put these people in situations where they can thrive as opposed to considering a disorder.

Autism is something that maybe can be treated in various ways where we get in trouble when treating people with autism will be when we try to treat them for some of these nuances that they might have some of these idiosyncrasies they might exhibit if somebody's having difficulty where they truly need psychiatric treatment with autism, it's where they have explosive rage or they have tremendous difficulties putting up with changes in the brain.

>> There's a there's a central operating system called the thalamus right smack in the middle there and the thalamus it's taking in outside information people with autism and we'll see this with people's schizophrenia as well don't network that information properly.

In other words, it's like an operator who's just randomly sending out signals that people with autism and people schizophrenia just can't be able to network the information is coming in from a sensory standpoint so they become overwhelmed with lights sounds lots of different people talking, lots of changes occurring at one time.

So in those cases we try to treat them sometimes with medication, sometimes with coaching techniques to try to help them adapt to change.

But it's that coping that people can often have difficulty in struggling with autistic spectrum conditions.

Thanks for your call.

Let's go next caller.

>> Hello Chris .

Welcome to Matters of Mind.

>> Chris , you want to know why you're constantly in a sense of fight or flight?

Is that anxiety fight or flight ongoing?

>> Chris , I'm going to wonder a lot of different things there.

Do you have a cardiac condition where you have a cardiac arrhythmia that's causing you palpitations?

Do you have high thyroid?

High thyroid will make you feel really anxious all the time.

Do you have maybe a condition even like sleep apnea?

Sleep apnea especially in the morning will make people feel really anxious.

So I'd want to know more about the medical history in what might be causing you to have ongoing fight or flight.

>> When did it start that a start at a particular time in your life ?

Did it start in social situations?

Did it start when a medication change occurred?

So there's a lot of reasons why people can have this sense of ongoing fight or flight now usually when people have a fight or flight type of feeling from a psychiatric standpoint it can be from a panic disorder.

Panic disorder can often be precipitated by a particular social situation and you get in that kind of social situation you feel like you've got a leaf really quickly or you're you're going to panic.

>> So that's the fight or flight type of phenomenon.

But having an ongoing makes me think it could be some kind of medical issue that potentially could be treated.

But talk to your primary care clinician about that particular condition.

Thanks for your call.

Disconnects Caller Hello Dixie.

Welcome to Matters Mind.

>> Dixie, you had mentioned that in the 1960s you were pregnant and you're having issues with sleeping in your prescribed sleeping pills.

>> Back then you were in the hospital where they used either could that have affected your son's current mental state maybe.

I know back in the 1960s a lot of things like that were used and it's difficult to say Dixie.

I don't think definitively ether was found to cause any brain disturbances with newborns because so many of us who were born back in the 50s and 60s did have mothers who had general anesthesia and various manners.

So I think it comes down to any evidence of what's called brain anoxia for the newborn baby.

So if a newborn baby did not get adequate oxygen to his or her brain, sure that could have been a problem.

>> Many people got a sedative hypnotics benzodiazepines back in those days that we wouldn't give today.

I think a lot of it has to do with the dose relationship effect if you got a really high dosage of either of the sedative hypnotics for sleep that could potentially have caused developmental disturbances early on.

But it's difficult to say going back that many decades at this point.

>> Thanks for your call us your next e-mail question.

Our next e-mail question reads The daughter fovea I'm having trouble concentrating throughout the day.

What might be causing that?

Well, trouble concentrating throughout the day can be a factor where you've had it all your life or every day you've had trouble concentrating or do you have trouble concentrating for the past three years for a year or so it all comes down to when it started.

>> So if it started in childhood you're having trouble concentrating day by day by day.

You don't know is that more than what you'd expect from anybody else?

And that's the whole concept of attention deficit disorder ADHD with hyperactivity that we've been talking about some time.

>> So the attention deficit disorder that will give you difficulty maintaining focus and perseverance on interest and uninteresting type of subjects and subjects that aren't new and exciting.

In other words, you might get started on something and then you go to something else that's ADHD.

>> So depression if it's come on more recently in recent years people who have depression will often have trouble with what's called speed of processing where they can't process information very quickly.

It's like their brain has slow Internet speed.

So it's a kind of phenomenon where depression, clinical depression will cause your brain to kind of slow down its ability to process information quickly.

Many people have medical conditions such as low thyroid high thyroid will do it too.

They'll have diabetes.

They'll have low ion sleep apnea.

I mentioned that before.

Sleep apnea is where you might snore.

You pause and you're breathing at night you're getting not getting adequate oxygen to the brain at nighttime.

That will give you tremendous difficulties with with concentrating the next day.

Many men and women, many women in their late 40s, early 50s will be going through some menopausal hormonal changes.

Now the brain has little all these little estrogen receptors right here in the hippocampus and it's the memory center of the brain.

So when you're going through menopause not uncommonly people will say they have trouble with memory but some people will say it actually affects their ability to focus and concentrate.

So that could be an issue as well.

People will have difficulty concentrating if they've had a frontal head injury.

In other words, they've had a concussion that affected the front part of the brain because distractibility body can be due to an under activity or at least a slightly damaged area the front part of the brain.

So that occurs there are certain ways that we might treat that well let's say you're in your 80s or 90s in your house a having trouble concentrating.

>> I'd want to look at all those aforementioned medical issues that I mentioned but do you have dementia?

We always want to sort out all the other kinds of medical issues themselves but dementia might be a possibility as we get older we're all more likely to have dementia.

Some of us genetic can be worsened, give you more of a likelihood if you have high blood pressure and diabetes.

So dementia has a lot of risk factors that go along with it.

But getting older is the biggest risk factor for dementia.

So if you're having trouble concentrating yeah.

>> Think about when it started.

Could it be related to a medication you've recently been taking?

Talk it over with your primary care clinician to kind of see what kind of options might be available for you.

>> Let's go to our next caller.

Hello, Kate.

Welcome to the Mind.

>> Kate, you mentioned that you've been practicing mindfulness for several years and knows that your anxiety is increased over time.

Is that a side effect of mindfulness?

Actually mindfulness type of meditation, Kate, is technique that people actually use to decrease their anxiety if your anxiety is increasing, talk it over with your primary care clinician to see what kind of options might be available for you.

But if you're doing mindfulness properly, that's actually a technique for decreasing your anxiety.

>> There's other techniques you can use that are natural to decrease anxiety.

What's your caffeine intake?

Some people will notice that if they cut their caffeinated coffee intake by half that makes a big difference in their anxiety but also breathing techniques especially exhale spending some time inhaling but using twice as much time exhaling exhaling actually fires up this particular autonomic nervous system called the parasympathetic autonomic nervous nervous system that will actually slow down your heart rate and can decrease anxiety itself.

So there's a lot of other techniques outside of mindfulness.

>> It might be helpful for you as well.

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

If you have any questions concerning mental health issues you may write me a via the Internet to add to matters of the mind at a dog God willing and PBSC willing to be back again next week.

You've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube.

>> Thanks for watching tonight