.

>> Good evening.

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

Welcome to Matters of the Mind now entering its twenty eighth year matters 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 here at the Fort Wayne area PBS thirty nine by dialing (969) 27 two zero or four calling any place coast to coast you may dial toll 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 mind all one word add egg that's matters of the mind at we're going to start tonight's program with an email I recently received.

>> It reads during a I used to be very creative and emotional what does Koban Feed treat and could that help could benefit treats schizophrenia as a main mechanism of action.

>> Now for the past six decades the main treatment of schizophrenia has been for the purpose of blocking dopamine in the temporal lobe in the limbic system which basically is responsible for people having hallucinations and fixed false beliefs which we call delusions.

If you block dopamine you can help all those symptoms Thorazine chlorpromazine was inadvertently discovered as an anesthetic medication in which it was originally intended but it was found in nineteen nineteen fifties that it could be used to block hallucinations and improve the ability for people to think generally the problem with just blocking dopamine is that if you block dopamine the front part of the brain you can cause a worsening of the concentration difficulty with motivation and difficulty enjoying things.

So about twenty five years ago medications came out that that blocked dopamine still in the limbic system they increased dopamine in the front part of the brain.

These are called the second generation antipsychotic medications, the so-called atypical antipsychotic medications.

We predominantly been using those for the past 25 or 30 years.

However, envy entirely different medication.

>> It's the one mechanism mechanism of action that is different than anything we've been used for using for the past several decades.

In a sense it is blocking.

It's it's blocking dopamine indirectly by increasing acetylcholine which sounds odd but if you increase acetylcholine you can indirectly decreasing the firing.

So if you think about dopamine firing being like shooting pellets from a shotgun toward a target historically the way we've been treating schizophrenia is by blocking the target.

The bullets are still coming out but the targets getting blocked now what's happening is the guns not even firing.

So if the guns not firing in that gun previously was firing excessive dopamine, you can decrease the symptoms of hallucinations and delusions and a whole different way now CO is two medications.

>> The first one is Xenome Zano Malign Zano Marlyn is a chemical that was created by Liley right here in Indiana.

Liley created an animal line way back about 30 years ago and it was created for Alzheimer's dementia and it worked pretty well for Alzheimer's dementia did help with concentration because if you stimulate a couple receptors that will affect acetylcholine, there's five different receptors that affect acetylcholine.

Number one.

Number two .

Number three.

Number four.

Number five Xenome a line will affect number one and it stimulates number four.

So by stimulating number one and number four, it can number one improve the concentration and indirectly decrease hallucination and delusions.

The problem was the animal line when it was studied on older people with Alzheimer's dementia is it it caused people to have intolerable nausea, diarrhea because if you similarly muscarinic receptors or acetylcholine receptors and the peripheral part of the body especially in the gut, it'll cause you to have all these intolerable gastrointestinal effects.

So all those and all those animal line did help with Alzheimer's dementia symptoms thirty years ago it was not pursued in any further research until just a few years ago.

A very astute young scientist thought let's try this only added a medication to it to make it more tolerable for the gut and that's called SBM Serros traceback is a medication that will block acetylcholine actions in the periphery and that's why you with Koban for you get this interesting set of side effects where some of them are related to excessive acetylcholine and some are related to blocking acetylcholine because animal line will increase a little coaling in the rest of the body whereas Trotskyism will block it.

So you got this blocking effect like a teeter totter.

So the reason why people benefit now is more tolerable is because of the presence of spam which will block the excessive acetylcholine effects in the periphery so you have less nausea, less diarrhea but those are side effects people can have and are urinary bladder retention is another problem where if people already have older men for instance, have benign prostatic hypertrophy and they have trouble urinating already Koban we can make that worse because of the terrorism that's in that.

So the bottom line is Confi has an entirely different mechanism of action of any antipsychotic medication we've had in the past because it works entirely differently and we've had some really good luck with it over the past year in using it.

It's a medication.

It's number one side effect can be the nausea and if you take it on an empty stomach you have less nausea.

There are medications that you can use temporarily to offset the nausea that typically occurs early on but that often goes away.

>> Thanks for your email.

Let's go to our first caller.

>> Hello Doug.

Welcome to Matters of Mind.

Doug, you mentioned that your family has a genetic history of depression.

What are the early signs you can watch for your children?

Depression, Doug, is about 30 percent genetic so it does run in families and you be careful about their risk factors for depression will be any kind of physical emotional sexual abuse, any kind of trauma especially before the age of eight years old.

The brain is very, very active in growing and developing between the ages of two and eight years old and during that time the brain is very sensitive to significant trauma and that can lead a person later on to have a greater likelihood of depression.

So early childhood experiences like trauma can be a big factor.

We actually use a questionnaire called the Adverse Childhood Experience Questionnaire.

It's called ACS Adverse Childhood Experiences Questionnaire and that's questionnaire has ten questions and if you have over four of those questions if you answered yes, that can be a factor for you having a greater likelihood of having depression later on.

>> So depression does run in families genetically but can be predisposed by early childhood trauma.

What kind of signs would you watch for with children in adolescence?

The number one factor you might see would be social withdrawal whether or not interacting as much as you'd expect over the course of time and they're not enjoying pleasurable activities.

They're less motivated to do things.

Be very careful with the child and adolescent with social media and social media.

It's frightening how much that does affect the brain.

>> There's actually brain scans showing that social media use proportionally and even exponentially more likely to cause depression with regular use because you get hooked into the algorithm and you have a hard time getting away from it actually causes a reconnection of the brain.

And when you think about the brain, yeah, it's very susceptible between the ages of two and eight years of age for trauma but all the way up to age of twenty four years old, the brain is still growing and during that time if you're in hindering its development with social media, with marijuana, all these factors that can be detrimental to it, you can sometimes have long term effects.

So I'd say No one be aware of any early childhood trauma for a child who has a genetic history of depression but also number to keep the child active, try to keep them away from social media physical activity at a young age is remarkable for helping with depression.

They've done studies in high school kids and middle school kids showing that if they're physically active that not only helps with their concentration but it helps with their mental attitude as well.

>> Thanks for your call.

Let's go to our next caller.

Hello Lance walking the mastermind Lance.

>> You want to know if there's depression anxiety or do they worsen over time if left untreated?

Possibly Lance if you have unmitigated depression and anxiety, what happens is you have this imbalance of glutamate and gabb in the brain itself and it's kind of like a seizure disorder in that regard where if you have an ongoing seizure disorder and the seizures do occur, there's physical damage that occurs in the brain.

I remember a study that was done 25 years ago on women who had untreated depression and they went on for over four or five years with untreated depression.

They actually did a brain scan of this area right here in the temporal lobe of the brain called the hippocampus.

That's the memory center of the brain, the library center of the brain.

It got smaller and smaller and smaller so there can be less branching of the neurons with chronic untreated depression.

>> So if you have chronic untreated depression, you know you have about 80 billion neurons in the brain in each of those individual neurons have between twenty thousand and fifty thousand individual branches or connections.

>> So it's thought that with chronic untreated depression you're more likely to have difficulty with less branching.

So it's kind like a bush in your backyard.

>> It's not getting adequate fertilization or water it wants to do it kind of shrivels up over the course of time.

>> That's what can happen with people with untreated depression.

They can have their individual neurons especially in the memory center of the brain kind of shrivel up over the course of time and it's not uncommon to hear about people who have ongoing depression.

It's not been treated.

They'll say they have trouble with memory and many older people think they have Alzheimer's dementia used to be called pseudo dementia but it's where you have depression and you're an older adult and you're having trouble with memory and concentration because the hippocampus area your brain is shrinking up and when that shrinks up it can be brought back to life again.

We're finding that medications that increase glutamate transmission you might heard of ketamine as ketamine also known as bravado of these are medications that increase glutamate transmission and in doing so they very quickly can increase that branching and basically make the neurons more fluffy.

>> Thanks for your call.

Let's go next caller.

Hello and welcome to Matters of Mind.

And if you want to know about what I thought about managing Misophonia is where you have difficulty with anxiety, with loud chewing and crowds and you feel like it gets triggered.

I think Misophonia and I don't think it's a psychiatric condition at all.

I think it's increased sensitivity to noises and social in the social context as well.

I think we're going to know more about it over the course of time.

It's more of an ear, nose and throat issue I think for right now kind of like tinnitus where people will hear ringing and buzzing in their ear.

So misophonia is a means by which you'll hear noises and the way it gets processed in the brain can be disturbed.

I don't know a lot about the research on Misophonia right now were you know, people hear the chewing and they hear noises from other people and it causes them a lot of anxiety.

So that's where we might hear about it in psychiatry.

But in terms of the root cause of it, there might be a couple things going on in the front part of the brain.

You've got the dorsal medial prefrontal cortex is right on the top here.

The side took the brain apart.

This is the front part of the brain looking at you the top a little strip of the brain up here is called the dorsal medial prefrontal cortex is basically a part of the cortex that gives you a sense of identity and with social interaction.

So it helps you emotionally interact with other people in this dorsal medial prefrontal cortex is very important to understand how you can relate to other people when you're having a conversation with another person.

This is the part of the brain that helps you try to understand their feelings and their perspective on things and if this is working really well, I would think that you could have difficulty with getting excessive sensory input when you hear noises from other people but that's just a speculation.

But the dorsal medial prefrontal cortex is very, very important with the emotional overtone of an interaction with another person.

>> And when you hear another person making noises with chewing and various different types of interactions like that, I think this part of the brain might be overactive in that case I think there's going to be a time where we learn more about that but it's a real phenomenon.

But I think right now we're treating it more like an ear, nose and throat condition.

>> Thanks for your call.

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

Our next email question reads over Multiple generations of my family have had issues including extreme anger, deep depression and delusions.

Can a person have multiple mental disorders such as bipolar schizophrenia, borderline personality disorder?

What's the difference between schizophrenia and schizophrenia affective disorder?

How can this be generational mental illness be broken?

>> Yeah, you can dilute it with genetics as we can with many, many medical conditions if you are marrying someone and you partner with somebody and you conceive children and your spouse does not have those kind of medical condition that can dilute the genes to some degree.

So that's what we've seen with schizophrenia.

If you marry someone with schizophrenia and let's say both your parents have schizophrenia, your chance of having schizophrenia would be about 12 to 16 percent if both your parents had schizophrenia it's not guaranteed but you'd have a higher likelihood of schizophrenia.

Schizophrenia is not entirely genetic.

It's thought to be about 50 percent genetic.

So if you have an identical twin with your exact same genes ,you have a 50/50 chance of having schizophrenia if your identical twin does so it's not guaranteed that you're going to have schizophrenia if if even if your identical twin has schizophrenia.

>> So I mentioned the parents if you have a brother or sister with schizophrenia, you have about an eight percent chance of schizophrenia and the genetics can be diluted such that across the entire population right now the likelihood of having schizophrenia is about one percent.

So it's much more likely if you have a family history schizophrenia but it's not guaranteed by any means.

So schizoaffective disorder is basically a combination of schizophrenia where you also have bipolar symptoms.

Bipolar symptoms include manic symptoms where you might go for several days not needing to sleep.

You're hyped up, you're impulsive.

You're talking very, very quickly going from topic to topic to topic.

Those are manic symptoms and intermittently these people can crash into depressive symptoms.

So it's a mood disturbance on top of the day to day symptoms of schizophrenia which can include symptoms of hallucinations, fixed false beliefs like delusions, difficulty with processing information and socially reading the conversations of others.

So schizophrenia is a day to day phenomenon and bipolar disorder can be on top of that.

That's called schizoaffective disorder.

It's not guaranteed that people will inherit those kind of conditions.

But the first thing we always will examine, as I mentioned earlier, will try to mitigate the trauma itself.

If you have early childhood trauma it can trigger a lot of emotional disturbances later on so you can kind of be hard wired if you have a lot of trauma especially up until the age of eight years old.

>> Those are very, very sensitive years but up until eight years of age if you've had trauma in your household where there have been parental problems, you've had a parent with a mental illness, drug abuse, a parent went to jail.

There's a divorce separation a of a lot of drama in your childhood that can cause you to have a greater likelihood later on to have depression, anxiety and it can actually trigger some psychotic and serious mood disturbances overall.

So there are things that trigger the genetics and that's what you always have to be watchful in examining and try to maintain good mental health .

How do you maintain good mental health while a lot of very simple things you can do no one have something to do every day then one of the number one reasons why people will struggle with depression and anxiety is they it's a vicious cycle but they will lose purposeful, meaningful activity day by day by day.

So you have to have a reason to get up every day.

It'd be nice to have a schedule hour by hour that schedule often will be changed based on life happening and things going on.

So you have to be lenient and be an adaptive to that schedule changing but you need to have things to do on a regular basis .

It's a vicious cycle because when people get depressed and anxious what happens?

They get less motivated.

They lose their energy level and they tend to withdraw when they withdraw into their household.

They're not socially active.

That also is a factor for feeling more depressed and feeling more anxious and having more mental health problems.

There are apps available for those people willing to use them where they can actually have an app on their phone and their clinician can monitor how active they are now that's fairly intrusive in some ways but they've done this in research settings where people who are willing to have an app on their phone that monitors their movement, their steps and how much they're getting around a clinician can monitor that and determine if they're going to be more likely to get sick.

>> Two things happen before you get more ill with depression or schizophrenia or a bipolar disorder.

>> Two things happen.

Number one, you become less active but on the other hand you become more active in a tight environment.

Other words, you start pacing more so you get out of the house less number one and then while you're in the house you're pacing more.

>> Those are two very high predictors for somebody getting sicker and it's thought that that might even be a predictor for suicide.

So who knows, maybe someday people will be tracked with their willingness by their clinicians to see what their movements are like day by day by day and kind of like what we have now with the cardiologist.

They have people monitoring their heart rhythm on a day to day basis and they're all alerted if there's a heart rhythm disturbance in psychiatry movement disturbances can predict you're having mental health issues overall.

>> Thanks for your call.

Let's go our next caller.

Hello Sarah.

Welcome to Matters of Mind.

>> Sarah, you want to know how can you support your partner in his drug recovery when they seem to lash out?

I think Sarah, with your partner in his drug recovery try to be supportive and going to any rehabilitation programs.

For instance, there's Al Anon where you have the partner of the person with Alcoholics Anonymous attending that type thing.

Try to understand the condition itself to try to identify your partner's individual needs if your partner has a reason for drug use such as anxiety and depression because many people with drug use will be self medicating, be aware of those kind of triggers and try to be supportive with your partner in that particular area.

Some people will notice the their partner will get more irritable and more moody as they're coming off the drugs of of abuse.

>> So it's very important to look at those triggers as well.

So understand the condition very well.

Try to understand the perspectives of other people who have also endured those kinds of conditions and that's what's been the beauty of Alcoholics Anonymous since nineteen thirty nine .

I think I came out Alcoholics Anonymous has been around for a long time where people basically are sharing their experiences and their loved ones are also sharing their experiences with how they've dealt with that.

We have National Alliance on Mental Illness National Alliance on Mental Illness is also called NAMI.

>> NAMI is a very supportive program particularly for family members who have individuals in their household or family members with mental illness and it kind of as a way of sharing as a group how they've dealt with those kind of conditions.

>> Thanks for your call this or next email question.

Our next email reads Oh I thought we had another email.

>> Let's there's another email I reads Dr. Fovea is poor grooming associated with depression or anxiety.

When people get depressed or anxious they tend to not care.

In many cases they don't tend to process information.

So let's go look at depression anxiety.

Anxiety is often a precursor to depression.

People will ask how do you tell if somebody has depression or anxiety they often go hand in hand.

>> Many people will get anxious in their brood and ruminate and worry about different things that will lead basically to increased activity in the amygdala, the front part of the brain and the temporal lobe amygdala it's lit up and it gets fired up.

The amygdala will cause you to have difficulty with sleeping not uncommonly lack sleep will often cause people to have difficulty with coping and being able to process thoughts adequately.

>> And when you have difficulty with disturbances in the front part of the brain where you are using your judgment that will cause you to have depression so you know logically won't look at the world around you as you should.

>> So anxiety will often lead to sleep disturbances.

Sleep disturbances often lead to depression.

It often goes hand in hand.

So when people have depression and anxiety they often will just not care anymore.

Lack of caring is a prefrontal cortex disturbance up here in the dorsolateral prefrontal cortex where you just don't care so much anymore and people often have difficulty with grooming because of that because I mentioned earlier the dorsal medial prefrontal cortex up here at the top part of the brain that's when you kind of look at your sense of self and you you compare yourself to other people around you and you try to understand how they are perceiving you.

>> So if you don't care about how other people are perceiving you, it's typically due to a decreased activity of the dorsal medial prefrontal cortex.

So this part of the brain is disturbed when people have depression you don't care about what other people think of you because you start to lose that social activity and that's a disturbance people will often experience when they have trouble with depression.

So not uncommon.

>> You'll hear about that.

Thanks for your email.

Let's go next caller.

Hello Blake.

Welcome to the Mind.

>> Blake, you want to know what does lack of sleep damage your brain and if so, how can you reach a deeper sleep or possibly repair the damage?

Blake the number one thing you need to do with sleep is try to get on a regular sleep cycle.

>> That means going to bed the same time every night and getting up the same time every morning.

Ideally you should not need an alarm clock if you've had enough sleep and if you get on that regular cycle now that sounds wild for a lot of people and I get it you still want to set an alarm clock if you have morning obligations if you have to go catch a flight you have to get up for work.

>> You don't want to oversleep but you should wake up before your alarm clock goes off because you've had an adequate amount of sleep.

>> You know you've had enough sleep if you don't need the alarm clock to awaken.

So sleep hygiene where you're getting the bed every night same time you're getting up the same time every morning is number one for sleep efficiency can lack of sleep damage the brain can disrupt the brain's processing because basically Blake, when you have lack of sleep this prefrontal cortex that I mentioned earlier doesn't work so well.

So you can't concentrate you can't think through things.

You can't cope as well and you can't judge as I mentioned with the dorsal medial prefrontal cortex you can't judge interpersonal connections so well.

So lack of sleep does have an effect on the brain.

It is reversible.

You can't have a sleep debt debt over the course of several days where you're not getting adequate sleep and then if you sleep in for two days and you get excessive more sleep than usual maybe on the weekends, perhaps Friday, Saturday, whatever it would be that can actually reverse some of the problem.

But the ideal thing to do for sleep where you get a deep sleep you get the dream sleep as well.

>> The best thing for that is adequate sleep hygiene.

>> How else can you get a deeper sleep?

The best way to get a deep sleep is to exercise especially in the morning if you can if you exercise before about six p.m. it'll actually deepen your sleep whereas deep sleep important if you get a deep sleep you're more likely to have more energy during the next day deep sleep when you're in that deep sleep when you're awaken and you're very confused for a few seconds when you wake and that's a good thing.

That's a deep sleep.

Deep sleep increases growth hormone increasing growth hormone is very, very good for the brain.

So you want to get into that deep sleep.

But one of the best ways to do that would be to exercise 30 to 45 minutes more days than not especially in the morning, sometimes in the afternoon but probably not after six p.m. evening workouts often will keep people awake a bit.

>> Thanks for your call.

Let's go next caller.

Hello, Carol.

Welcome to the Mind Car.

You don't want to know are there any side effects of taking Valium with Mozambique, Mozambique is a whole different type of medication, very large a medication that is specifically going to affect the brain with four concentration and focus does not usually cause people to have increased appetite or weight gain.

But Frailer is notorious for sometimes causing some restlessness.

Raila and Mozambique are entirely different medications but they should not cause any significant interactions directly.

Raila is often used for mood stabilization, can be used for schizophrenia and actually sometimes is used as an add on for depression as well.

But the nice thing about Varella with Mozambique raillery doesn't usually cause the weight gain that people are often trying to avoid by taking Mozambique.

>> Thanks for your call.

Unfortunate out of time for this evening.

If you have any questions that I can answer on the air you may write me a via the Internet at matters of the mind all one word at WFYI Egg and I'll see if I can get to them next time I am on the air God willing and PBSC willing I'll be back again next week.

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

>> Thanks for watching.

Good night