good evening.

>> I'm psychiatrist J Forfar live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now as twenty 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 (969) 27 two zero or if you're calling any place coast to coast you may dial 866- (969) 27 to zero now and 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 Pardoo Fort Wayne Campus.

>> 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 away Doug that's matters of the mind at WFA ECG and I'll start tonight's program with an email I received this week.

>> It reads Dear Dr. Fauver I'm sixty five years old and I've had tinnitus since a young age means ringing in the ears.

>> I've tried many supplements with no relief and was recently diagnosed with spatulas eustachian tubes.

>> That means they're kind of spread apart so it's very difficult to concentrate on any other sounds to mask the tinnitus.

Do you have any other ideas on how to concentrate on other soun tinnitus used to be thought to be a mental health issue.

>> Now it's not so I want to stay in my lane in my scope of treatment and scope of practice and what I do it's an ear, nose and throat issue where it's a physical disturbance on the inner ear and that will cause a tinnitus sometimes there's disturbances in the brain itself which is where the neurologist will take over.

But as a psychiatrist what I will hear about with tinnitus will sometimes the anxiety that's related to it and I don't want to give any advice that would be ill advised compared to what the ear, nose and throat doctors would do.

>> But basically what we will often do in psychiatry is give people medication that will decrease anxiety.

But you got to get to underlying problem.

What will people do to help them with the outside noise?

Sometimes they'll use extraneous sounds or use sound machines.

They'll do various things to distract them.

But I would certainly talk to your ear, nose and throat doctor about ways of helping you be able to block out that outside ringing that you get with the tinnitus itself.

>> Thanks for your email.

Let's go to our next email.

Our next email reads Dear not to favor my 16 year old autistic grandson has an IQ of 150 six.

>> He gets bored with homework but scores near perfectly on his tests.

He is very direct in his opinions or comments and his social skills are lacking.

His autistic rating is level one.

How can I better relate or communicate with him?

>> Well the advantage of having autism is they're going to see things from a different perspective compared to people without autism or what I mean is there are some advantages from a cognitive standpoint of having autism.

I say that because in the Israeli Defense Forces, the adolescents and young adults in Israel they want to be part of the Israeli Defense Forces.

But for years if you had autism you were excluded from being being a part of IDF.

>> About ten years ago they started a specific oh team of of intelligence agents within the IDF and these this team of intelligence agents had autism and they have over 150 last I heard of people with autism specifically on the intelligence teams because they can pick up signals and signs that a lot of people don't notice.

So with autism is is it an abnormality of the biggest abnormality with autism will be that people have difficulty with socializing and there's a reason behind that if you have autism this right front part of your brain, for instance, it lacks these particular neurons called mirror neurons.

Mirror neurons are where you can actually mirror the behaviors and the mannerisms of other people and whether we realize it or not when we're talking with someone we're often mirroring their mannerisms as a way of connecting and with autism you're having difficulty being able to pay attention to what other people are saying because you're kind of in your own world and that's where people with autism will have pedantic speech.

Pedantic speech means that they will often speak a little bit of a monotone but they'll talk and talk and talk and they'll often talk over another person because they will not have that social connectivity where they can maintain a conversation with somebody.

So the best thing you can do is somebody with autism is try to help them with a autism specialist.

Autism specialist for adults will help people with communication and can help you be able to communicate with your grandson.

But keep in mind he has some special skills.

It's just that in our society they might not be that a parent and again in Israel they actually found ways to actually integrate them into very highly specialized field and intelligence.

I think we should be able to do the same thing in United States but that socialization aspect is often what they lack and people with autism as your grandson is seeing often have very, very high intelligence.

We just have to figure out how to tap that intelligence and put them the right spots.

>> Thanks for your email.

Let's go next caller.

Hello Gary.

Welcome to Matters of Mind.

Gary, you want to know what's the best book for nonclinical person to read concerning mental health ?

>> The easy answer, Gary, is the Bible the book of Ecclesiastes, a really marvelous, marvelous book written by Solomon pretty smart guy concerning mental health .

So I'm going to go with a secular book on mental health issues I'd recommend Victor Frankel's book called Man's Search for Meaning.

Victor Frankl was a psychiatrist before he went into the concentration camps during World War Two and a lot of people think he became a psychiatrist after words but no, he wrote Man's Search for meaning in nineteen forty six after he got out of the concentration camps but he had a very controversial theory concerning mental health that being that most have mental health and lies not in basic instincts which was all the rage at the time.

That was all the thinking with Sigmund Freud and Carl Jung.

It didn't stop based on instincts but it's based on meaning and man's search for meaning is basically introducing the public to this particular therapy called Logo's Therapy Logo's therapy basically is just saying that your whole well-being is based on having meaning being able to cope with stresses as they emerge and being able to enjoy life and be able to see things around you.

We've seen that in the past ten, twenty years in psychiatry we've been paying attention to this symptom called anhedonia.

Anhedonia means no fun and when people are having no fun and not involved in pleasurable activities and they don't have meaning in life , they're more prone to getting more and more depressed.

Now it was thought in the concentration camps that people would become more animalistic as they lost more of their daily provisions for survival.

>> They didn't the people didn't become more animalistic in the concentration camps the ones who lost meaning and lost hope were the ones who typically died and Victor Frankl noticed this while he was in the concentration camps and it was kind of a way of using that environment as a lab for what he had theorized prior to going in the concentration camp.

So that's why he wrote about it thereafter very, very fascinating book.

I've read it a couple of times but I was first introduced to it way back when I was in my twenties.

So it's something that kind of reminds you that you got to have some kind of meaning in day to day life .

You have to enjoy and appreciate things around you and when bad stuff does happen to you because it will happen to you, you need to adapt.

>> You need to be able to cope and you need to be able to get through it and that's the whole idea behind man's search for meaning because it reminds us that we have to have some kind of purpose for what we're doing every day but also some kind of meaning behind it.

>> Gary, thanks for your call.

Let's go next caller.

Hello Darlene.

>> Welcome to Of Mind.

Darlene, you ought to know about how does loss of vision affect mental health ?

It's it's a loss of sensory input, Darlene, that will affect people in different ways if you're losing vision gradually.

>> Yeah, Basically it can cause you to be more isolated but you cope and you adapt to the loss of vision if you're blind it abruptly that can be a whole nother matter but it's a matter of somebody's ability to cope with the sensory the sensory input they otherwise are experiencing now while they're able to adapt often people who have a gradual loss of vision they'll notice that their hearing is actually more clearer.

>> Stevie Wonder, the composer and singer is a good example of that.

He has exceptional hearing and he can pick up on tones that people with vision will not be able to pick up upon and we hear that a lot with people who have lost vision.

>> So it's a matter of adaptation but obviously if you lose your vision abruptly and you don't have time to cope with that loss of his and that's more difficult and it goes for a lot of different things when we have an abrupt loss.

For instance, if you have a family member who dies in an automobile accident suddenly overnight and all of a sudden they're gone versus another family member who has a gradual terminal illness where you've had two years to say goodbye to them.

>> Basically it's it's a different type of impact on you.

So an abrupt stress where you don't have the time to cope will often be much more detrimental for people.

But the loss of vision well it all comes down to whether it's correctable, whether it's abrupt, whether it's gradual.

They can all have an impact on a person's mental health .

Let's go to our next caller.

Hello, Saul.

>> Welcome to Matters of Mind.

>> Saul, you're on a prescription by the name of Reller Compazine and you're having terrible insomnia.

You want to know about the question should you ask for another prescription or is there an over-the-counter medication that could help a very large a medication that at one point five and three milligrams can be very effective in helping with the mood and being added on to another antidepressant antidepression medication Frailer has some side effects.

Some people can have difficulty with restlessness, irritability.

They can have pacing.

We call it extra pyramidal symptoms.

Akathisia is another word for it but those symptoms can be problematic for people sometimes even at low doses.

>> And I wonder in your case did you have the insomnia, the difficulty with sleeping before you took the very long and it's just the very is not helping that much or did you take a very large and all of a sudden you started to have difficulty with sleeping if you took the very large and it caused you to have difficulty sleeping, no one will always consider a decrease in the dosage or going off of it.

But I don't want to know is helping you if Raila is really helping your mood we're going to work around it.

So if Raila let's say one point five milligrams tiny dosage is really helping your mood with the antidepressant for instance we might add something for sleep over the counter medications.

A lot of those are merely antihistamines.

I'm not a big fan of antihistamines for helping people sleeping because basically it's just blocking histamine as the name implies.

Histamine is what keeps us awake.

The problem with antihistamines is blocked histamine but keeps you sleep at night but sometimes will carry over to the next day.

Now there is a particular over-the-counter supplement that it's an antihistamine called Doxil.

I mean it's the active ingredient for instance and UNISOM it's not too bad it doesn't last as long as something like Benadryl might diphenhydramine some of these longer acting type of antihistamines.

So Dock's El-Amine is a little bit more tolerable for a lot of people if they're going to take something to block histamine overnight.

But we might consider prescribing some fairly inexpensive, not addicting medications just to help you sleep better overnight if frailer is actually helping you, if it's not helping you so much and is causing you difficulty with insomnia, that's a whole nother gamut.

>> That's where we might have you go off the radar and try something else.

>> Thanks for your call Esguerra.

Next caller.

Hello Winter.

Welcome to Of Mind Winter.

You had mentioned you don't typically get upset and you're says what your husband says that is not normal.

Is that something you need to get checked out?

Should I get mad at things more?

>> That's a good question.

Winter I guess the question is are you normally stoic or are you having difficulty with emotional numbness?

>> We call that alexithymia where people don't feel happy, they don't feel sad, they just kind of feel blah.

It wouldn't be normal if you're emotionally numb and you don't have a normal valence of emotions.

>> So we should all have based on the situation happiness, sadness, anxiety, anger, apathy for that matter.

>> Those are all normal emotions.

But if you lack emotions that could be a problem and especially if it's accompanied by something that I mentioned earlier called anhedonia where you don't enjoy things so lack of emotions not enjoying things that could be abnormal, not getting upset with things on one hand could mean that you have exceptional coping mechanisms which is OK also I'd want to know how you did with your growing up.

>> Did your family members express their emotions?

>> The issue would be if you don't get angry overtly is are you getting angry internally and are you holding in your emotions that's not good for your physical health .

So I think that could be your husband's concern if your if your husband perceives that you're holding your anger in sometimes that'll come across in various physical capacities such as headache, skin conditions, bellyache backache when you hold your emotions in it can be detrimental to you physically and that's where it could be a concern if you're having any physical problems.

But he could always talk things over with your primary care clinician and see if there's any concerns there but especially if you're having physical problems.

>> But yet you don't get angry about things that would normally be expected to cause a person to be angry.

>> That's where you'd want to get checked out overall.

Thanks for your call.

Let's go next caller.

>> Hello June.

Welcome to Matters of Mind.

Yes, hi.

Dr. Farber.

I just wanted to ask you my mother is in the hospital right now and we've been going through some issues of her seeing images as well as a projection of bright light over the top of her head and seeing red dots in the wall colors of green designs.

But especially dark and images.

They went through all kinds of bloodwork no bacteria.

Nothing was found in the blood first we thought maybe she had a UTI urinalysis came back fine.

I had taken her to the family doctor as well as the eye doctor and the optic nerve and everything checked out fine.

Good.

So I'm just curious as to what you have to say regarding the images that will just not go away.

She did have a mild stroke in the cerebellum.

They said that they thought that the symptoms that she was having had nothing to do with the stroke because it was just the images other than the dizziness, the off balance.

She seems to be fine balance and no no stroke symptoms as far as the face the hands she's very strong in the legs and the arms and so forth.

>> Jun, you gave an excellent history there depicting what your mother endured.

She had the stroke back here in the cerebellum which can affect balance the eye the vision areas right above it and you say in that part wasn't affected correct.

>> Correct deviation is is fine as far as the eye doctor says the optic nerve was checked there was no problem whatsoever there she has 20/20 vision.

She had that little Doppler check with the little dots that come across and she got that one hundred percent the pressure in both eyes was at sixteen.

So when they test her for the glaucoma that's really good.

>> That's better than mine with the images that she's seeing as she bothered by them.

>> Do they bother?

Yeah, they the the yes.

>> Yes.

OK, is she confused in any way?

Does she forget where she is?

Does forget about the people are not at all confused sharp as a tack with her concentration good so that's her as a tack.

>> Yeah.

So if she's sharp that would kind of rule out the whole concept of delirium they were pursuing that delirium is where you would be.

>> It's kind of like a an alarm system in your brain if your brain is perceiving that you have a urinary tract infection ,an infection of any type for that matter or you have something that's not working.

>> So on the body you'll have confusion, you'll have disorientation, you can have visual hallucinations with all that.

So the good thing is it doesn't sound like that's the case.

>> Here's what here's what I'd speculate.

Was it related to the stroke?

Not directly.

>> Was it a hemorrhagic stroke or is a bleeding stroke or was it a blockage of a blood vessel?

Did they tell you?

I think there was a little bleeding little bleeding that would be a hemorrhagic stroke.

So there's hemorrhagic strokes where there's bleeding out and there's occlusive strokes where there's a blockage of the blood vessel.

>> They work a little bit differently.

But if it's a bleeding stroke, OK, what happens is OK, it's in the cerebellum down here and the bottom part of the brain what can happen is when you have a stroke you have damage and damage to the brain which releases an excessive amount of this chemical by the name of glutamate glutamate is the excitatory chemical and the gray matter of the brain on the outside if you have too much glutamate released you can have things happen where the brain just gives you too much information and sometimes give you perceptual disturbances such as visual hallucinations or visual illusions.

>> An illusion is where you kind of see something but it's not really there you see it of the corner of your eye.

She's having kind of distinctly sensations.

>> If they were not bothersome for her I'd say try to wait it out but she might need something along the lines of something is going to stabilize that chemical called glutamate will use anti seizure medications to do so based on her age being an older adult she might need something is going to be a little bit more gentle and give her fewer side effects and that could be a medication like Lamictal or LaMotte's Rajin.

>> It stabilizes glutamate.

We use it a lot for people who have had head injuries because we'll notice that when people have head injuries sometimes June they'll have the same experience.

>> They'll kind of see the sparkling lights they might actually emerge into experiencing migraine headaches which will often be preceded by these visual disturbances like that.

>> But it's all related to glutamate.

So if you tone down glutamate that can be helpful.

It's tempting and I know it's a tempting for a lot of clinicians to give her an antipsychotic medication.

I don't think she needs that.

I mean for decades we've always thought oh, we give these people who are having perceptual disturbances like those visual disturbances as you've described given antipsychotic that might not be so helpful and she probably even have more dizziness and lightheaded.

>> So I wouldn't want to go that direction.

I'd suggest no one waiting it out as best she can but she's bothered by it.

>> So maybe something that could block glutamate transmission or at stabilize it and that's a medication.

>> Oh like Lamotrigine or Lamictal Depakote also known as valproate does a really nice job doing that.

It is it's kind of harsh.

It makes you kind of sedated but in tiny doses sometimes that helps out not only with the visual sensations but also with anxiety can be associated with that sometimes we'll use other medications like Trileptal also XOX Curbers carbamazepine.

>> Those kind of medications are basically stabilizing the excessive electrical activity that not uncommonly happens following a hemorrhagic stroke .

>> That's kind of what you've described Eun OK now I want to tell you also she had been sleep deprived for about a month.

It seemed like she was not getting very good sleep also and I think they put her on something called I think see sequel or is that sound familiar.

>> I've pronounced it wrong not Zech well that's no over-the-counter no no no not Vizquel no it starts with the C with an S Sarah or Seroquel Seroquel Ebiquity opined is that sound familiar?

>> I don't know about that.

Yeah Seroquel low doses helps with sleep gives you a greater depth of sleep at higher doses just antipsychotic medication.

A higher dose of Seroquel can give you lightheadedness and some side effects of its own so lower doses could be helpful.

>> However you mentioned she hadn't been sleeping.

Was that prior to her stroke Junoon was that after her stroke?

>> Yes.

No, it was prior in the month of December she is having trouble.

>> Well, if she wasn't sleeping well that can actually precipitate some neurological disturbances.

A self lack of sleep is a big stress for the brain and body.

So lack of sleep could have maybe triggered some different things and not that that would have directly affected caused her to have a stroke but it would have given her a greater likelihood because it's a stress on the brain.

So is she still having difficulty sleeping now?

>> She's had the hemorrhagic stroke.

Is she still having difficulty sleeping?

>> Yes.

Yes she is.

It's like the images will not go away.

>> They keep her up.

Oh, poor thing she she might at a low dosage do well with a medication like Depakote or valproate.

>> Again you're getting double bang for your buck there.

>> It's sedating and she needs something going to be sedating but it's also stabilizing or blocking glutamate in its excess and that there are options out there and you can always talk to her neurologist about what kind of options might be the case for seeing those kind of images because the onset of the images were when she had the stroke, correct?

>> Correct.

I mean that's correct.

I they think that stroke has happened within the last couple weeks but the images, you know, just started shortly after that we are dealing with at approximately 10 days now.

So with the images well we're taught in our second year of medical school Jundah tracked back to win some kind of symptoms happen and if they happen correlated with a medication change or some kind of medical change overall it's probably related to that.

>> So it might not be directly affect related to this cerebellar hemorrhagic stroke in that area but it might have affected the other parts of the brain to cause her to have these visual disturbances.

But it sounds like you've done the right things.

You've checked her for glaucoma.

You've checked the optic nerve.

You looked at all the different factors that could be related to a visual disturbance.

>> But I still think whether it's a head injury or any kind of traumatic experience for the brain in her case the hemorrhagic stroke that probably is having something to do in her case I think a little bit higher glutamate transmission that could give her too much of an excitatory type of stimulation on the visual network and that might be causing her to have some of those symptoms.

So I'm thinking more along the lines of at least the temporary use of an anti seizure medication like Depakote Lamictal she needs her sleep.

>> We might use something like Gabapentin or Neurontin for her to get her to be able to calm down at night to be able to sleep because sleep is healing for the brain and she needs to be able to heal that brain over these next six months.

>> OK, OK.

Thank you so much.

My pleasure.

Pleasure.

Pleasure talking to you.

Take care.

>> Thank you.

Thank you.

Let's go to our next caller.

Hello Yolanda.

Welcome to of Mind Yolanda.

>> You want to know about REM sleep behavior disorder?

Basically it's where you're in dream sleep and or dream sleep.

>> You're supposed to be paralyzed.

All right.

So when you're in dream sleep you're not supposed to be acting out your sleep because there's a chemical that's released while you're in dream sleep that just shut everything down and you can't move.

>> And that's why for some people when they awaken during their dream while they're dreaming I've had this happen myself.

I imagine most people have.

But you're awakening for a few seconds.

You can't move and it's kind of scary but then you can bitz because that chemical still floating around for a few seconds so you're supposed to be paralyzed as your dreaming and REM sleep disorder is where you're not paralyzed and you're acting out, you're flailing, you're hitting your bed partner, all those types of things.

>> So it's happening during dream sleep now people often will confuse Dream REM Sleep Behavior Disorder with sleepwalking night terrors entirely different phenomenon sleep walking and night terrors where you are screaming and you're very confused.

>> That's happening in non REM sleep or a very deep sleep REM sleep behavior disorder like the name implies is happening just during REM sleep just when you're dreaming and it has to do typically with your body not being paralyzed during that time and you want to know if you should see a doctor if neurological issues run in the family.

Yeah I mean REM sleep disorder disturbance can sometimes be a precursor to Parkinson's disease.

It's not diagnostically related to Parkinson's disease, Yolanda.

But if you have Parkinson's disease in your family for instance, you might have more a greater likelihood of having REM sleep disturbance because it has to do with the dopamine network in your brain itself.

>> Yolanda, thanks for your call.

Unfortunately I'm out time for this evening.

>> If you have any questions concerning mental health issues you may write me via the Internet at matters of the mind.

You have a dog and I'll see if I can get you a question on the air the next week.

God, William PBS willing I'll be back again next week.

>> I'm psychiatrist offer and you've been watching matters of the mind God willing and willing.

I'll be back.

You take care.

Good night