.

Good evening.

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

Welcome to Matters of the Mind now in its tenth year Matters of the mind 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, feel free to give me a call here in the Fort Wayne area by dialing (969) 27 two zero.

If you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero.

Now on a fairly regular basis I am broadcasting live every Monday night for my 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 a via the Internet at matters of the mind all one word at a dog that's matters of the mind at WSW a dog and I'll start tonight's program with an email I recently received.

>> It reads Durata father.

My brother sixty eight years old is diagnosed with schizophrenia.

He's on medication and has regular doctor visits.

>> He's up one day and then down for a couple of days.

What he stays in bed and doesn't eat.

>> He takes his medications when he is down.

I am his caregiver and worried about this pattern.

Any suggestions for this?

Thanks.

Well, I'll tell you what it sounds as if your brother was schizophrenia might also have a phenomenon called schizoaffective disorder.

You might have heard that term.

It's where he's having bipolar symptoms, where he's having highs and lows in his mood.

>> The bipolar symptoms by refers to two polar means one extreme or another and you can indeed experience bipolar symptoms in the midst of having schizophrenia.

Now schizophrenia as you're probably aware as a condition that's a day to day phenomena where you'll have difficulty processing thoughts, difficulty communicating, socializing, even taking care of yourself to some agree with schizophrenia.

>> People often have hallucinations when they're not well and they'll see things and hear things other people cannot see or hear and they'll often have difficulty with with the perception of the reality around them.

We call that delusions where they'll have fixed false beliefs and they will insist things are happening.

It can't possibly be happening.

This is schizophrenia part that's a day to day phenomenon now you have on the other hand bipolar symptoms that can come and go.

>> The highs are characterized by decreased need for sleep racing thoughts, impulsivity, feeling on top of the world and perhaps perhaps elated or even irritable.

Then you can crash into the big lows, the big lows characterized by extreme fatigue, social withdrawal, wanting to sleep all the time.

>> It's indeed during the big lows that people often are most troubled and that's when they sometimes will take their medication.

>> You know, if somebody is having schizoaffective disorder they're having the highs, the lows, they're having the schizophrenia symptoms day by day.

They might want to be on a long term injectable if they're having trouble remembering their medications.

A long term injectable medication will be a shot anywhere between once a month every three months for that matter.

>> We have some medications will go every three months and there are medications indeed in development that can go even less frequently than that.

>> But these long acting injectables will basically give you an ongoing blood level of antipsychotic medication in your system.

It'll be a lower level than typically given when you're in take oral medications.

So with oral medications, with oral antipsychotic medications you'll get blood levels that are really high causing you more side effects.

>> The side effects typically are directly related to the blood level of the medication.

So with oral medications you'll have high blood levels and they go down a bit then higher and then going down when you take the day to day dosing when you have a long acting injectable it'll stay in your system at a therapeutic amount but not going so high that you can have side effects so many people will say No one the long acting injectables are more effective in the sense that you're keeping a medication in your system week by week, month by month for efficacy.

>> But number two , they'll be more tolerable so the long acting injectable medication will be more tolerable typically.

So if your brother is having difficulty remembering to take his medication especially when he's feeling on the high side he might need to have a long acting injectable and for many people it's tolerable and there are many means by which it can be affordable for individuals who need those kind of medications.

>> Thanks for your email.

Let's go to our first caller.

>> Hello Carson walking about matters of the mind.

Carson, you had mentioned that your anxiety won't allow you to push through difficult situations so you wonder how can you push though those feelings like you're stuck in the mud?

Well, the first thing you ought to do, Carson, is try to find a peer, a colleague.

>> Somebody can kind of go along with you in those difficult situations and give you emotional support or at least get you started in those kind of difficult situations never to start with thinking OK, if if I don't do this pursue this difficult situation that and indeed by the way is a decision if you don't do something that's a decision No.

>> One, you might have regrets if you don't do it.

But OK, so what if you do it?

What's the worst thing that can happen?

So if you are to speak in front of a bunch of people, you know, think about the worst case scenario and think through that and consider OK, that happens, you typically will conclude so what and you move on and it's a matter of just getting started giving it a try so many times what people take on a difficult situation they'll find that other similar situations in the future become easier and easier.

>> That's called coping mechanism and in your brain you have a phenomenon called neuroplasticity when you take on a difficult situation Carson it actually changes the structure of certain areas of your brain in a good way because you're learning how to cope with that next time you tackle a difficult situation it becomes a little bit less anxiety provoking provoking for you.

So try to achieve one thing at a time.

Not only does it give you confidence but it physically is changing your brain for the better.

So Carson, I'd recommend trying to have a peer or colleague trying to get you going along with it.

No to thinking about the worst case scenarios if you happen to fail, keep it in mind the not starting on something like that as a means by which people fail but number three, just realizing that trying to try to do something is kind of challenging is actually good for the brain and it's a good exercise for the brain not unlike going out there and trying to run a five k you know maybe you're not very good at running.

You don't feel like you're in the physical shape yet to do it.

Go out there and give to try you muddle through it and next thing you know you start want to train four more five case and get better running.

So the same thing is with a challenging situation.

Carson You'll notice that when you take on challenging situations and you overcome them you get more confidence.

But hey from my perspective you're also changing your brain structure.

>> Thanks for your call.

Let's go to next caller.

Hello Diane.

Welcome to Mars.

The mind.

>> Diane, you know you want to know what's the diagnosis of someone who laughs at everything and thinks that everything is funny?

>> Diane it's not a psychiatric condition unless it's causing what we call functional impairment.

Other words, if you're laughing inappropriately particularly episodically where it's causing trouble with socialization, it's actually getting you terminated from your work situation.

>> Maybe you're laughing out loud in school in totally inappropriate matters.

It all comes down to the context of the laughing itself people who are in good spirits so to speak and they're laughing different things.

Hey, that's partly a coping mechanism if they find that things are funny but it's not a pathological psychiatric condition unless it's causing them trouble with school, with work or socializing.

>> So I take that all in the face of context.

Diane, some people will find humor in situations and again, humor is great to see in situations as a means of coping with with a horrible situation sometimes.

But when you find humor in inappropriate situations and it's getting you into trouble, that's where it becomes a diagnostic condition.

>> Diane, thanks for your call.

Let's go to our next caller.

Hello, Jenny.

Welcome to Matters of Mind.

>> Jenny, you want to know what is food addiction and is it a matter of pure willpower basically food addiction is a real phenomenon, Jenny.

People will notice that they get somewhat of a high when they eat certain foods.

>> These are foods that will increase dopamine many times they are sweets, refined sugars .

>> People kind of differ in different and various ways on how they respond to foods.

But basically if some foods give you a little bit of a high it's a dopamine surge in the dopamine surge comes from this middle part of the brain called the nucleus accumbens right smack in the middle there.

>> It's the front part of the brain looking at you.

>> That's the inside part of the brain and the nucleus accumbens can give you a little bit of a surge in dopamine with certain types of foods and usually it's sweet high sugar foods.

What happens then?

Well, you get the tryptophan fired up in your brain.

>> Tryptophan will then lead to the production of serotonin and from some people they can actually get somewhat of a calming effect if you if you blast yourself with a bunch of carbohydrates, you can get an increase in insulin very, very quickly in your body.

Insulin will increase the transport of tryptophan into the brain and that leads to increased serotonin in the brain.

So for many people they get actually a neurochemical change when they're undergoing this type of food, this type of food addiction now any kind of an addiction means by definition that you're craving something and you need more and more of it to get the same effect and if you don't have it you can start feeling really, really lousy.

And to some degree, for instance, people can have a caffeine addiction where they need a higher and higher amount of caffeine to get the same effect and if they don't have that kind of effect, they will they will notice that they use higher amounts of it and and without it they feel worse.

That can happen with some kind of foods.

Is it willpower?

Yeah.

The main willpower aspect would be to try to avoid those type of foods, identify which foods cause you to feel worse and be very careful using those kind of foods in moderation and be aware that they can be triggers for you to make you feel lousy.

>> So if you notice that when you every time you eat cupcakes you feel worse, that could be the sugar, could be the gluten, whatever.

>> But if you identify that the cupcakes make you feel worse, you probably need limit if not eliminate the consumption of cupcakes.

But if you do eat them, make sure that you commit to only eating a half or a very small amount because you need to remember a certain foods will trigger you feeling worse.

>> Thanks for your call list for next email.

Our next email reads Dear Dr. Fauver, my friend from another state called me excited and just a little nervous but not distressed saying they were getting messages from aliens and they said they were still taking their medications not to be sakwa with other medications.

Did they have a psychotic break?

What could have caused this?

Will it resolve itself?

How can you help?

Well, here's the deal.

Get that friend of yours in to see in their clinician if they're comfortable using the Seroquel or various other medications.

These medications can be used for individuals who are having trouble with loss of reality.

If it's an ongoing condition, it might be somewhat of an exacerbation.

Thank goodness they did call out to you and your friend feels enough trust in calling out to you but sometimes mentioned to your friend that aliens OK, we're not going to get in a debate whether aliens exist or not but in the context of their having concerns about aliens, my next question for your friend would be how do you did you get this idea?

>> Do you perceive that they're talking to you in your house?

You know, people have seen the drones in the sky.

They've seen all these new satellites coming up the sky.

>> So they might have perspective, a perspective that might not be entirely unrealistic because they see things that possibly could be the case.

>> Now a true delusion is where it's not possible for these type of things to happen.

>> But if you if aliens has been part of their delusional process when they were ill in the past, that's where they can see their clinician.

So the thing you can do as a friend make sure they are taking their medication because the Seroquel for instance, can help people with schizophrenia and psychotic disorders to stay in touch with reality if they merely say they're seeing aliens because of all the drone encounters that have been occurring and they perceive the drones are aliens and that's been their interpretation that not necessarily is a psychotic type of condition you'd want to consider that might just be a not an unusual interpretation the reality around them.

So I think it all comes back to their past history.

Are they taking their medications and make sure they get in to see their clinician at this point and try to encourage your friend to do so?

>> Thanks for your email.

Let's our next caller hello Noah and welcome to mastermind Nolin.

>> You want to know if irritable bowel syndrome can lead to anxiety disorders?

>> What's the relationship between the gut in the brain?

Irritable bowel syndrome can be either constipation, diarrhea or a combination of those type of things and as you can imagine we do indeed care about people with irritable bowel syndrome having anxiety because if you could imagine having the abrupt onset of diarrhea just out of the blue, that's going to create a lot of anxiety.

So on one hand the anxiety will make the irritable bowel worse and that's where I often hear about irritable bowel as a psychiatrist and when I treat somebody for anxiety or depression and I always want to know do they have other medical remedies like irritable bowel syndrome because if they have irritable bowel syndrome I want to try to address that the best I can for instance, if they have severe diarrhea as part of their irritable bowel, I want to give them a medication for their anxiety or the depression that might be somewhat helpful in decreasing the diarrhea.

Same will be with constipation.

There are some medications that are very good for individuals with severe constipation in the midst of their having depression or anxiety.

So I'm going to try to tailor my medications to try to help them with that because you're exactly right irritable bowel anxiety they will go back hand in hand and each will make the other much worse.

>> Thanks for your call.

Let's go our next Hello Mark.

>> Welcome to Matters of Mind.

Mark, you want to know about how you approach your doctor about micro dosing of psilocybin for anxiety depression?

>> It's not Food and Drug Administration approved at this point.

Mark, keep your ears open to the news over the next year or two it might be FDA approved for a condition like post-traumatic stress disorder .

I think we're probably five years away perhaps to see psilocybin being used mainstream but you had a right when you use the term micro dosing it's being used a tiny, tiny, tiny little doses for the purpose of indirectly affecting affecting serotonin in fairly unique ways.

And what's different about Selous even compared to a medication like bravado or is ketamine will be psilocybin.

>> The intention of the treatment over the course of three and four hours in a session will be No one to get a hallucinogenic type an effect and during that time you are to be accompanied by a therapist and a therapist will take you through different exercises during that hallucinogenic experience that psilocybin with centimeters bravado it's a nasal spray where people might have what's called dissociation kind of have an out of body experience anywhere between twenty inutes and one hour after getting the first spray they're monitored over the course of two hours.

>> The dissociation is not hallucinogenic necessarily.

It's not intended to be associated with its effectiveness.

>> So if you don't have dissociation during Salvato treatment that's not a bad sign.

So the dissociation hearings provided treatment is a side effects adverse event that is not needed for effectiveness with psilocybin.

On the other hand the hallucinogenic experience is expected as part of treatment.

That's why a therapist sits at your side and guide you through some guided imagery during that time.

>> Thanks for your call.

Let's go our next e-mail.

Let's go to our next e-mail.

Our next e-mail says Do not favor my mom got me a journal for Christmas to help with my anxiety and journaling really help with anxiety.

Journaling and journaling is phenomenal for anxiety and often recommend that people keep a worry diary also a worry diary a worry diary is where you write down preferably early in the evening or late afternoon not right at bedtime but you write down your main worries for that day or even for that week.

If you're just doing weekly journey journaling and you write down your main worries, you take a look at your main worries that you have at this current time and you sort out OK, here's what I can do about them and you have a little plan on how are you going to do about them tomorrow I'm going to do this, this and this to address this worry this worry a lot of worries you have no control over and Mark Twain once said I have known a great many worries and 90 percent of them have never happened.

>> So if you think about your worries, it's a waste of of brainpower to to worry and ruminate and worry about things if you don't have any control over them, if you have control over them, OK, do something about them anxiety actually is a normal reaction to your brain and body trying to get you nudged to do something about your current life searching circumstances or anxiety is not all bad.

>> Anxiety helps motivate you to get going and get started on getting something addressed.

But if you're worrying about something about the future, about things you can't control, that's a whole nother matter.

So no one journaling will help you keep track of what your current worries are and have a plan for how you're going to dress those.

But what's great about journaling is after about three months or six months or one year look back on your previous worries.

Look back on the worries that you had a few months ago.

You'll typically see that they were addressed.

>> The worries you poor are enduring at the time never happened.

They just worked out and that could be very reassuring to people.

>> If you can look back on your worries that you had in the past and thought oh that that was no big deal this or that happened, you'll find that the worries you had a few months ago and especially four and five years ago they worked out you know, God took you in a different direction and that's what's so commonly happens for all of us and it's just part of our life's plan and things were don't work out necessarily the way we expect them to do.

But you'll find out you can get great reassurance knowing that you know, things work out if you just kind of you tackle different challenges the best you can and based on your current awareness and don't worry about the things you can't control.

>> Let's go next caller.

Hello Shaun.

Welcome to Matters of Mind.

>> Shaun, you want to know what's happening in a person's brain when they switch in the handwriting style in midsentence is like starting with an open number four and moving to a closed number for it might be part of normal handwriting where people do have a variation.

>> As a psychiatrist I'm going to look at that a little bit more in detail, Sean, because there is a rare but significant syndrome called dissociative identity disorder does happen used to be called multiple personality disorder where people when they used to write back in the old days when people used a pen and paper and they wrote they could change their handwriting in mid sentence or toward the end of the page as their personality change.

>> So as you might infer, dissociative identity disorder is where somebody is under stress.

They have a trigger that might trigger them into a different personality.

It's a real phenomenon.

I have seen it occur with some people it's quite rare but they will actually change their handwriting in the midst of their writing and they'll might go to a more childish handwriting or it might be more loopy based on their personality so their handwriting will follow their personality.

So that's the worst case scenario.

But otherwise if somebody is having pretty much a normal mood and they just have a change in their handwriting in one sentence, I wouldn't think much of it.

I think I think that would be a normal variant.

But as a psychiatrist know when somebody asked me a question like that, I'm always thinking about the worst case scenario and then we move back from that.

>> Let's go to next email question.

Our next e-mail question reads Dear Doctor Father, how can I prioritize my mental well-being this year and what are some good habits or new routines that I can implement to support my mental well, number one, you want to try to identify habits and routines that you are motivated to truly pursue and most importantly, what are you going to get out of it?

What's going to be the outcomes?

Track the outcomes and secondly make yourself accountable to other people.

>> Let other people know you are going to do this or that and have them check in on you every now and then on how that's doing or bring it up to them on how you're doing with it.

So number one, you want to have a goal, a routine that's achievable.

Don't do something that's outrageous.

You want to do something within your capacity otherwise you just set yourself up for failure but do something within your capacity and something that's achievable.

But track how you're doing with it and we believe in tracking outcomes on how you're doing small steps at a time.

>> It's not an all or nothing type of phenomenon with a routine let's say you are trying to get into exercising three times a week.

Well gee you got busy one week.

You want a vacation you missed a week.

That doesn't mean you totally failed.

Just get started on it again so it doesn't mean that you have to have the same routine every single week more often the better.

But you're going to have times when you don't have that routine many people will have a vow toward quitting smoking and that's a great goal to to try to achieve to quit smoking.

But with quitting smoking you want to try to realize what are the benefits, talk to other people about your goal to quit smoking and why you know you might slip up every now and then have a cigaret or another cigaret once in a while.

That doesn't mean you're a total failure.

Just go back to trying to stay off of it.

The more you stay off of a bad habit the more likely your brain will actually change again, it's called neuroplasticity.

Your brain changes in the midst of your performing new habits, new routines and your brain gets used to those routines and the more you stay with it, the more likely your brain will just notice it being something that's expected.

>> So you want to try to get into that routine on a regular basis but realizing if you miss out on doing that routine once in a while it's not that big of a deal just get back on the horse.

Thanks for your call.

Let's go our next caller.

Hello Tammy.

Welcome to Mars.

My Tammy you want to know about a lucid dream?

>> What's a lucid dream like for someone with Parkinson's disease is a really bad dream or is it more realistic?

I'd say both of the those phenomena can occur when somebody has Parkinson's disease.

They have a disruption of dopamine and they're substantia nigra and it's thought that the dopamine transmission decreases by as much as 30 30 to 70 percent substantial Niagara's as little dark body right in the middle of the brain there and it's responsible for spewing out dopamine and in doing so it gives you smooth body movements.

>> People who have Parkinson's disease will often walk without much of a arm swing.

They might have a little bit of a tremor.

They might have a little bit of slurring in their speech.

People with Parkinson's disease might eventually start to have some cognitive disturbances but not always so with Parkinson's disease people can have difficulty with various types of symptoms such as when they walk and there's swiveling to turn around they might need to kind of have a shuffling gait we called a fascinating gait but it's where they have a change in gait when they're trying to turn around so they walk almost like their feet have concrete in them as they're walking along now a symptom of early Parkinson's disease can be bad dreams and the bad dreams can be on one hand part of the Parkinson's coming boler hand.

>> People can have bad dreams or lucid dreams as you had mentioned related to the medication.

>> So they're taking medications, increasing dopamine sometime increasing dopamine can give you the very clear vivid dreams and yes they can be perceived as nightmares especially if people aren't accustomed to having dreams prior to their medication treatment are part of those particular symptoms but Parkinson's itself early on can be associated with such collateral symptoms as bad dreams, lucid dreams or even restless legs.

>> We hear about that not uncommon so it can be related to the Parkinson's itself but sometimes the very clear distinct dreams can be related to the treatment for Parkinson's as well.

>> Thanks for your call.

Ask our next caller hello Grace Walker matters of mind Grace.

>> You want to know what are the side effects for medications that are used for obsessive compulsive disorder?

>> The best medications for obsessive compulsive disorder grace are these so-called serotonin reuptake inhibitors.

>> Those have been the most thoroughly studied for OCD and these medications include medications like Fluevog Ambien also known as Luvox.

>> We typically use Searchinger, Zoloft, Fluoxetine or Prozac will often be used for OKd medication.

It came out in the early 1990s was clomp remain anaphora no works a little bit differently on a national Klimov as an old tricyclic antidepressant medication.

I mean it's going to give you a really bad dreamhouse sometimes lightheadedness and waking but the serotonin like medications can make you feel a little bit mentally dull and emotionally dull.

They might you might notice you don't feel happy or sad.

You kind of feel blah and sometimes people have sexual disturbances and sometimes restlessness from those everybody's a little bit different on the kind of side effects they might have a serotonin medications but for OCD we're often cranking that dosage up a little bit higher than we would for anxiety depression.

>> So that's the big difference.

Thanks for your call.

Unfortunately I'm out of time for this evening.

Do you have any questions concerning mental health issues that I can answer on the air?

You may write me via the Internet at matters of the mind all one word at WSW eg I'm Psychiatrist Ja'far and you've been watching Matters of mind on PBS Fort Wayne now on YouTube.

Thanks for watching.

Have a good evening