.

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

>> Welcome to Matters of the Mind now and as 26 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 if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero.

>> And I'll start tonight's program with an email that I recently received.

It reads Dear Doctor Father my son shoots free throws really well in practice he tenses up and is inaccurate during games.

Can people overthink when shooting free throws?

>> Absolutely they can.

There is a book there was a book titled Flow that was written by a Russian psychologist back in the nineteen seventies 1980s and in that hole in the book it described the ability to focus but you'd be highly productive and athletes can get into the flow and be very productive and I think since that time we've come to understand how the brain works a bit better from from a neurobiological standpoint you tend to use your automatic motor memory when you're relaxed and you're in the moment you're focused but yet you're not overthinking and when your son is shooting free throws in practice he's using this inside of the brains.

This is half the brain looking at you here.

The inside part of the brain is kind of the automatic type of part of the brain that we use when we're walking, when we're breathing.

>> There are some people who overthink their breathing and they start counting their breaths and they think oh no, did I breathe 14 times or did I bring breath 16 times in that past minute?

>> And when they overthink they actually get more anxious and force themselves to exhale and then they inhale and exhale and they think about it and it causes a lot of anxiety when you overthink shooting free throws you use a different part of your brain so in your son's practices he's using the inner part of his brain and it's just automatic he just shooting one free throw after another very relaxed but he's focused but when he's in games he's overfocusing when you overthink you hijacked that middle automatic memory part of your brain automatic motor memory and you start using the thinking part of the brain so you think OK, I've got to hit the middle part of the hoop, I've got to take it over the front part of the rim and you start thinking and thinking and thinking we'll put on top of that the pressure of the crowd.

You might have a home crowd in front of whom you don't want to embarrass yourself and then you have a very a very loud opposing crowd and you might start thinking about them.

>> So in doing this it's distracting you from just the automatic flow of your motor memory when you're shooting free throws.

>> So the best thing to do is peither do at the same time every time so that it's very automatic that way.

>> Steve Alford with Indiana University back in the 1980s Larry Bird back in the 80s and 90s they always shot free throws exactly the same the same motion the same pattern and that's one way to get into this rhythm of flow.

>> But another way is to hum something to yourself or even sing something out loud.

>> Now you can sing something you don't have to think about so much but sing something like Happy Birthday The Star-Spangled Banner something that's very familiar to you because that allows your brain to then not overthink what you're actually doing and that goes for shooting free throws bowling golf putting a lot of people ask about putting because when they are putting they have trouble with overthinking and they get all tensed up.

>> I remember back in the 1980s Purdue had a pretty good basketball team back then Jean Katie was a coach but you could see when they got on the free throw line they get really tense and you can see it in their face they'd overthink and they had a horrible free throw percentage and I came to find out that in practice they were punished for missing free throws.

>> So I was a young psychiatrist at the time and course as a young psychiatrist I perceived that I knew everything.

I've since realized that there are lots there's lots that I don't know and you start to realize that more as you get more experience in general.

>> So as a young psychiatrist I wrote Jean Katie and I said look, you know they shouldn't be punished for missing free throws.

>> They need to be able to relax and talked about some relaxation techniques they could use a Jean Katie, the coach at Purdue wrote me a very cordial letter upon responding and basically said thanks for supporting the Buller's.

>> The boiler's they went on that year and continued to shoot poorly and their free throws.

I don't think he took my advice but the bottom line is the whole idea in shooting free throws is they have this relaxed muscle memory and not overthink what you're doing because we overthink what you're doing.

>> You hijack basically the natural muscle memory that you've developed in practice.

You've already had that muscle memory there.

You shouldn't have to go to the free throw line in the middle of the game or during a pressure situation and think through how you're going to shoot the free throw.

>> And I see this when I watch all levels of basketball whether it's high school, college, pro basketball, I see the player get on that line and you see them focusing on that the basketball rim and they're really concentrating and it might take him several seconds to look at that rim and a lot of times you can just tell they're going to miss because how tense they might be the best free throws shooters are the ones that just go up there, shoot it in a very natural matter and be done with it and run off the run off the line.

>> Thanks for your email.

Let's go to our first caller.

Hello Dean.

Welcome to Matters of mind.

>> Dean, you want to know about flu Voxer mean does Fluevog mean also known as Luvox?

>> Does it cost frequent urination?

It might.

It's a selective serotonin reuptake inhibitor as an SSRI it might cause more frequent urination.

I've heard about that with some people it's kind of rare but if you're the one out of a thousand where you might have more frequent urination with Luvox, I mean you're still the one.

>> So what I'll often advise people to do with a medication like Luvox I mean if you think urination, be aware that yes, it could but be aware that there might be other factors causing frequent urination as well.

For instance, a medication that's commonly used as lithium lithium might be used along with Luvox.

>> I mean lithium is very commonly causes more frequent urination.

You might have diabetes now when people have diabetes they'll have more frequent urination.

>> Perhaps you're drinking more caffeine.

Are more fluids than usual that will give you more frequent urination.

>> Any urinary tract infection will give you more frequent urination.

>> Enlarged prostate will give you more frequent urination because you can't empty your bladder.

So there's many, many, many different things that can increase your your frequency of urination.

Luvox Amien being a medication that if you started it at a certain type time and you had more frequent urination and especially if you're able to go off of it for a particular amount of time it goes away.

That could be attributed to the flu vaccine itself with flu vaccine is a medication that's also known as Luvox and it's used for obsessive compulsive disorder.

>> It's an SSRI was never FDA approved for depression as are its chemical cousins such as Celexa, Zoloft, Lexapro and Prozac and Paxil.

But Fluevog flu vaccine is different from flu Occitan Fluoxetine is Prozac.

Flu vaccine is Luvox.

They're quite different and what they do you got a follow up question why was flu vaccine used as a covid treatment?

Did a lot of people have OKd when they had covered it wasn't used for OKd when people had Koven when people had covered what happened was that the virus would get to their lungs and cause the state of inflammation and that would make their lungs more kind of leaky and they'd actually have more congestion that way.

And that's why people died from covid their lungs got more leaky, more fluid buildup and it was from inflammation flu vaccine has an interesting and fairly unique feature in the sense that it stimulates these receptors called sigma one receptors sigma one receptors basically are in the neurons and they decrease inflammation.

So here you have covered which will cause inflammation of the lungs, a severe inflammation of the lungs in using flu Voxer mean people were able to decrease inflammation in the lung so it wasn't uncommon.

People take fifty milligrams every day and sometimes family members would say why is this person on a medication used for OKd when they have covered it's because flu vaccine was effective in relieving the inflammation used the scene with Ossy with covered infections.

Now it's thought that one of the reasons why flu vaccine is a pretty good medication for OCD is it can relieve the inflammation associated with OCD as well.

So with OCD, with depression, with various psychiatric disturbances there is an inflammatory effect in the brain and when the brain gets inflamed you'll have certain symptoms come out such as slow movements.

>> You'll have difficulty with thinking, concentrating, you'll have difficulty enjoying things and you'll have trouble with fatigue.

So you hear about all these different symptoms that seem to be going along with inflammation and it's suggestive that a medication that has a sigma one agonist effect or a sigma one stimulating effect can help with inflammation Luvox me and being one of them there's a newer medication called Velocity that specifically has this chemical in it called dextromethorphan that also is a sigma one stimulator and that can decrease inflammation as well.

>> So there are certain medications that we use for one reason or another but we might and for other reasons because they have added benefits and that's why so oxygen was used for OCD but it could also be used for covid infection as well.

>> Dean, thanks for your call.

Let's go our next caller.

Hello Bill.

Welcome to my mind.

>> Do you want to know how does Amelda troughing lateral sclerosis affect your mental functioning?

>> Basically, Bill, you can still stay very sharp.

It does not allow us does not tend to cause a dementia.

Unfortunately it's a spinal cord condition where it affects your peripheral body so it affects your arms, your legs, your thoracic movements.

>> People sometimes will then eventually have trouble breathing but people will get depressed with ALS not uncommonly excuse me but they will not have difficulty with psychosis and usually their memory stays very intact.

There is a book that was written Mon's with Morrie I believe it was a long time ago and a very, very good book about forty years ago and basically that was the whole concept of the book reviewing a person's life history while they had gone through the latter stages of ALS.

So ALS does not intend to affect the mental functioning as much as a will the physical functioning overall.

>> Bill, thanks for your call.

Let's go our next caller hello Jane.

Welcome to Arizona mind Jane, you want to know if anxiety can cause rapid irregular heart rate and high blood pressure?

It can to some degree, Jane.

But when I hear about somebody having anxiety and they have an irregular heart rate and they have high blood pressure, I'm always going to think OK, does this person have high thyroid?

Does this person have a medical condition that might be contributing to the irregular heart rate and high blood pressure keeping in mind that high blood pressure and an irregular heart rate when your heart rate's going too fast that's going to make you anxious.

>> You'll feel anxious.

So I'm always trying to figure out chicken or the egg, you know, is that the heart condition that is actually causing the anxiety?

There's a condition called up postural orthostatic tachycardia syndrome.

I just diagnosed it with a person a couple of weeks ago and with Pott's it's happens more commonly with young women but it's a condition where all of a sudden the heart rate will go really, really fast.

>> It's thought to be somewhat of an autoimmune condition but the heart rate goes really fast and goes so fast the blood flow doesn't get to the head or the rest of the body and they get very weak and they pass out.

>> So this is a condition that is diagnosed by a cardiologist using a tilt test.

>> But basically it will come across from a psychiatric standpoint is I'm having panic attacks.

So why would a person with POS come see me as a psychiatrist?

It's because they're having panic attacks.

They're having fast heart rate.

They're passing out.

People think, oh, they're just faking it and some people have been misdiagnosed as having what's called functional seizures or conversion disorder because they just pass out just out of the blue and what they have as a condition it's a cardiac condition that is treatable and treated.

They can have a normal life .

So it's always important that when somebody has an irregular heart rate and thereby high blood pressure in some cases they can have an underlying medical condition that's creating the anxiety.

Now you're right.

I mean the anxiety will cause you to be more tense.

It'll cause you to have a faster heart rate itself.

But I'm very careful to diagnose somebody with anxiety when they have underlying physical symptoms like that.

>> So thanks for your call.

Let's go to our next caller.

Hello, Martha.

>> Welcome to Matters of Mind.

Martha, are you there?

Well, let's go to our next email.

Do we have another email up by chance?

I don't think we do.

OK, Marie-Therese there.

OK, well let's go to our next caller.

Hello Ruth.

Welcome the mastermind Ruth, you had a question concerning locomotor gener lamictal Lamictal as medication that has been around for quite some time for seizures and we now use it for mood stabilizers motion.

Ruth, you want to know how does it work?

Well, basically Lamotrigine or Lamictal works by stabilizing this chemical by the name of glutamate and it's thought that when people have excessive glutamate there will be more moody, they'll be more irritable, they have trouble concentration and Lamotrigine will dampen down the effects of glutamate and decrease the likelihood of seizures and that's why Lamotrigine was originally used.

But Lamotrigine is also used for the purpose of helping with mood stabilization, irritability, basically helping people with stress resilience.

So basically we tell people we give them Lamotrigine or Lamictal as a means of helping them put up with stuff better.

The key with Lamotrigine will be that you have to gradually increase the dosage if you have too much too soon especially the younger people they can have a rash on the chest, neck or face it kind of blisters on the fingers or hands.

It's about a one in four thousand chance that occurring and usually occurring because they're getting too high of a dosage too soon.

So with Lamotrigine we tend to gradually increase the dosage.

>> Many clinicians might be a little bit too impatient to do that takes four to six weeks to gradually increase that dosage to where it needs to be.

But for many people they can get a really good effect from llamo Tajima Ruth, thanks for your call.

>> Let's go to our next caller.

Hello Ted.

Welcome to my mind Ted.

You want to know if electric shock therapy also known as electroconvulsive therapy ECT will it help with tardive dyskinesia not highly.

>> It's not highly effective for tardive dyskinesia, Ted.

I know it can be used.

It's been studied in that manner but it probably wouldn't be the first choice for tardive dyskinesia ECT is a very, very effective treatment for people with depression, for people with mania and for some people who have manic features associated with a psychosis so electroconvulsive therapy ECT has been a therapy that's been around for decades since the 1940s actually and it was a very effective treatment especially when there are very few other treatments available and in nineteen eighties came along and flew Oxnam Prozac came around nineteen eighty seven we've since had seventeen or eighteen oral medications become available since that time so these medications have various mechanisms of action so ECT is a means by which your brain can very briefly get electrical stimulation such that you have a seizure in the brain for up to two minutes or so and you get this treatment typically three days a week for two or three weeks, sometimes a little bit more extended than that for maintenance ECT but ECT has some very strong benefits especially for depression.

It increases this brain fertilizer called brain derived neurotrophic factor.

It can have a profound antiinflammatory effect as I mentioned earlier with Luvox.

>> I mean having a similar type of effect and ECT will do some things the other treatments can't but it doesn't seem to help that much with tardive dyskinesia.

Tardive dyskinesia is basically a condition that affects the middle part of the brain called the basal ganglia and specifically the Negroes Nigra Stryder and that's the part of the brain that will affect dopamine transmission.

>> And if you have prolonged dopamine blockade with antipsychotic medications are very strong dopamine blockers you can actually out more dopamine receptors.

>> So if you block neurons or dopamine receptors for a long period of time you'll have an increase growing and little buds of extra dopamine receptors that occur.

>> So it makes you extra sensitive to dopamine when you're in side part of your brain.

The movement part of the brain is more sensitive to dopamine.

You get twitchy and you'll have twitchiness in the eyes.

>> You'll have hard blinking.

You could have mouth movements, you can have tongue movements sometimes people even have movements in their shoulders that can be problematic for them so that we do use certain medications to reverse that process that have been helpful for many, many people.

So we use medications that help reverse essy or reverse heart dyskinesia to try to reverse that process where there's excessive dopamine sensitivity we do try to get people off.

>> The antipsychotic medication is blocking dopamine to try to gradually reverse the increase flooding that occurs.

But nowadays we'd prefer to use medications that are going to reverse tardive dyskinesia themselves as opposed to using something like thanks for your thanks for email.

Let's go to our next caller.

Hello, Marisa.

>> Are you on the line now?

Yes, I'm on the line.

Oh, Marisa, good to hear from you.

Hi, how are you?

Yeah, doing fine.

Thank no one.

Dr. Farber, I just need to know can you show because I know you use the brain can you please show us how any substance abuse psychosis comes about particulrly with alcohol or opiates?

>> Very much with alcohol and opiates right for that substace use psychosis for instance, what alcohol will do is basically anesthetize the front part of the brain Morissa and when you do that you'd basically take away the judgment part of your brain.

>> So this part of the brain right above the eyeball here it's called the orbital frontal prefrontal cortex and orbital lateral prefrontal cortex is right there and that's the part of the brain that you used to think should I do this or should I not?

>> Alcohol anesthetizes that and people do stupid things when they are under the influence of alcohol.

>> So alcohol is more prone to causing people to have impulsive actions and difficulty with behavior more so than opiates themselves.

Now opiates will affect these little new receptors.

There's different types of receptors.

There's kapa receptors, delta receptors, mue receptors MUE receptors when you stimulate those receptors you have a feeling of bliss.

>> You have a good feeling in many cases people will feel a calming effect and they have a happy feeling in many people procedure done in the hospital or they're given some opiates when they go home to make sure they don't have any pain and next thing you know they really like the opiates now not everybody does for many people myself included.

You know, I'm going to say that the opiates make me sleepy.

They don't do me a whole lot of good.

I don't I didn't feel any happiness when I took my opiates when I had the knee replacement.

But some people will say it was life changing and for that reason with the opiates many people actually were in a research study looking at stimulating these different opiate receptors or blocking some of them for the purpose of helping with depression so opiates can help with depression for some people the key is finding out for whom is going to help who is not right now there are no specific opiate like medications expect in coming years there might be some coming down the pike because depending on how you affect the immune receptors, the kapa receptors and the delta receptors got affect all three of them in a certain way you can get relief with depression and that will be the key to do so in a non ickling matter.

So if you can affect these different receptors and either block or not have any effects on the new receptors, you can have a really good anti depressant effect.

>> So with psychosis itself it's usually because somebody is taking such a high amount of these different different-meg track with reality on that basis Morissa but usually alcohol makes you just not have very good judgment when you're drinking high amounts when somebody is withdrawing from alcohol or when somebody is withdrawing from opiates.

>> You bet.

Then they can have psychotic features.

So a symptom of alcohol withdrawal when you have been drinking very heavily and you've been off of it for two or three days, you can start seeing things and you can start having difficulty with maintaining contact with reality and basically that part of the brain that's affected there is this part the brain outside here and called the limbic system.

>> So the limbic system when it's getting disrupted it'llphae and that will cause you to have hallucinations when you're withdrawing especially frompalce withdrawing drawing from opiates when people withdrawal from opiates they feel terrible .

They feel they feel like they're really cold.

That's why they're called cold Turki's when people goes go cold turkey off of their medication it's not that they're feeling cold and they feel like a cold turkey.

They're called a turkeypbut thad that and they can get the hair raising up on their skin.

They can get pupillary changes in their eyes and many times they can have diarrhea.

So that's those are symptoms of withdrawing off of an opiate itself.

Thanks for your call, Koritha.

>> Let's go next caller.

Hello, Donald.

Welcome mastermind Donald, you mentioned your wife is healthy but having some trouble her memory what can do to help her with memory loss?

Donald I'd have her assessed medically by her primary care clinician first because of your wife is having memory problems.

>> A lot of things could be going on.

>> Donald, I don't know the age of your wife, but let's just start with menopausal symptoms.

When women go through menopause, the estrogen levels will decrease to this little hippocampus area of the brain.

That's the memory center.

The brain with less interest in estrogen stimulating that part of the brain.

It will affect a woman going through menopause with her memory.

>> Now the average age of menopause is 51 years old but as the estrogen is going down, that can be a factor also especially with women Donnel Low thyroid classic for causing difficulty with memory functioning.

pSo I want to make sure the thyroid is OK low ion if you also perhaps has restless legs that could be a symptom of low ion but low iron will make a person really fatigued.

They can't concentrate diabetes, high blood sugars or low blood sugars can all be a factor with the memory itself.

>> Now as a psychiatrist sure I'm going to make sure a person doesn't have all these medical conditions.

>> Depression can be a factor but I want to make sure these other conditions are ruled out before I would treat somebody for depression.

Many people when they have depression they'll have difficulty with speed of processing.

They'll feel like they have slow Internet speed in their brain so the brain feels like they're having difficulty going from one thing to another.

>> But I'm going to look at all these different medical conditions sleep apnea being another condition if she snores or pauses in her breathing a nighttime thereby decreasing the oxygen transmission to her brain and that will give a person difficulty with memory.

So I didn't want to have a checkup with her primary care clinician first and foremost.

>> And if depression is there, it's a possibility but there's a lot of reasons why people can have poor memory, especially women.

>> Donna, thanks for your call.

Let's go to our last caller.

Hello, Shannon.

>> Welcome to Matters of the Mind.

Shannon Ude wondered if you're able to check yourself into a mental health facility or does it require a screening from a doctor mental health facility, Shannon aren't like they were really proposed maybe three or four decades ago where they're kind of like health spoors or >> Mental health facilities will directly treat specific medical conditions such as depression, psychosis, severe anxiety, profound difficulty with sleeping and yes, you would need a medical doctor to be able to admit you to a mental health facility.

But you know there are different facilities out there that are available for people to relax and these are more health spoors and that might be something where as when people say checking themselves into a place they want to stay usually for three or four weeks and that's OK if you could that that wouldn't be a psychiatric hospital the way they are set up in the 21st century.

So there are health spores out there where people can relax and you do yoga and you do get massages, all these different things and it's great if you're willing to pay out of pocket and your insurance would not pay for that kind of experience.

Shannon, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues, you may write me over the Internet at matters of the mind all one word at WFYI Big.

You can also watch matters of mine on YouTube as well short segments.

I'm psychiatrist Jeff Offering you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

>> Night