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Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

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Good evening.

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

Welcome to Matters of the Mind now in its 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 here in the Fort Wayne area by-f you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero not 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 Purdue forming campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me at the via the Internet at matters the mind at WSW big if that's matters of the mind at WFYI a dog and I'll start tonight's program received.

It reads You're not a favor.

Can you tell by a person's facial expressions that they are having an episode of mental illness?

I often note changes in facial expressions when my grandmother's dementia is particularly bad.

>> Actually you can tell by a person's facial expressions especially if you know that person well.

>> So if you're familiar with that person because they're a family member or friend.

Yeah, facial expressions are of the brain which will also affect your emotions.

So for instance as your emotions grow more dark and dismal and depressed you'll have a tendency to have a crease above your nasal bridge and that vertical line will be there.

>> It's called the Omega Sign and the Omega sign is an indication somebody's severely depressed, not uncommonly somebody's eyes will tip back a little bit when they get desperately depressed.

>> That's called vagus folds.

So we'll look at somebody's facial expressions especially if we know them well.

You had mentioned you have a family member with dementia and they will have changes in their facial expression based on their moods.

>> That's not uncommon at all and many people with dementia will have difficulty with not showing emotion and we call it a flat affect where they just don't look happy, they don't look sad these kind of look blank.

We see that commonly with people especially with Parkinson's disease associate with dementia.

But when people have dementia they have Parkinson's disease, a social dimension.

>> Many times they'll have a flattening of their facial expression where they have lack of facial expression in general.

>> Now some people as they get older when they have Botox and injections in their face, you won't see that much difference in their facial expression because Botox by nature will paralyze the muscles.

So it's often sometimes difficult to really gauge how somebody's emotions are doing if they've had Botox in the past.

>> But for a lot of people you can tell a difference in how they're doing based on their facial expression, especially if you're very familiar with them.

>> Thanks for your email.

Let's go to our first caller.

>> Hello Jess.

Welcome to Matters of Mind.

Jess, you want to know about mental health disorders and which ones disguised themselves as attention deficit hyperactivity disorder?

>> ADHD by definition is a condition where somebody will have difficulty with focus concentration.

They're more distractible, they have difficulty with impulsivity.

And if you just tell a doctor I'm having trouble with distraction, I'm more impulsive.

>> I'm not getting this.

I'm I'm not getting to sleep at night.

>> A lot of clinicians might put two and two together and say oh that's bipolar disorder and they give you a mood stabilizer, a mood stabilizing medication like lithium or an antiepileptic medication or an anti psychotic for that matter will often make ADHD symptoms worse.

>> There's a big difference there and you got to sort it out with ADHD.

It's a day to day phenomenon and it goes back to when you were a kid.

So more days and not almost every day you're always having trouble with attention span concentration focus.

>> Now you can keep your mind on things with ADHD if they are interestig, challenging or a new and exciting.

>> But in general you're having trouble with day to day nuances of being able to focus and concentrate.

Bipolar disorder is quite different with bipolar disorder people have a few days in a row where they don't need to sleep .

>> They'll be more impulsive just on those days they'll talk really fast and go from topic o topic just on those dd then if anything they crash where they get really slowed down and they want to sleep all the time.

>> They're not wanting to socially interact and they have trouble concentrating on the low side as well.

>> So bipolar disorder has to be differentiated from ADHD very, very carefully.

We have another condition of hypothyroidism with low thyroid will often have symptoms that look like ADHD and people will say, you know, they're on their mid forties and they'll say I've been having these ADHD symptoms just for the past two or three years.

Well, that's ADHD works.

ADHD has to be typically a lifelong phenomenon.

It's more days than not pthroughout your entire life that affect you in different ways.

But with hypothyroidism when you're thyroid's on the low side you'll have trouble the concentration focus your skin will be dry.

You might be more constipated.

You notice that you have some difficulty with hair falling out.

>> Those are all symptoms of low thyroid diabetes, similar type of thing.

>> If your glucose is are high or low that will give you difficulty with concentration.

We go back to when it all started and try to sort things out from there from a psychiatric standpoint depression well sometimes give people difficulty with speed of processing of information.

In other words, it's like their brain has slow Internet speed and we call it speed of processing with depression.

But it's a classic symptom of depression and many people will say I have adult onset ADHD when in fact they really have depression that started in the more recent years.

>> Perhaps they will have difficulty with concentration.

So when we hear about somebody having difficulty with concentration or attention span, we're trying to sort out are there any medical problems?

Are there any psychiatric problems?

What kind of things might be contributing to those?

ADHD is very classically there day by day by day and it goes back to childhood.

Many people can't remember details of their childhood but if they can remember back to middle school or so, that's when a lot of those symptoms will have started.

But you know, as we get to be adults will have different reasons for having difficulty with concentration, sleep apnea, something else from a medical condition if somebody is snoring or they're having difficulty with the exchange of airflow at night such that they're getting decreased oxygen into the brain, decreased in the brain will give you difficulty fatigue, concentration, sleepiness the next day that will often give people symptoms like ADHD.

So get simply giving somebody a stimulant when they have ADHD symptoms is not the way to go.

>> We need to sort out like with any medical condition what is the true etiology and the underlying problem that we need to treat.

Always give the example if you have chest pain you need to sort out is that chest pain from a heart attack?

>> Is it from bronchitis?

Is it from your getting a peanut caught in the esophagus?

Are you having gastric reflux?

What's causing the chest pain?

We need to sort that out because our treatments are going to be entirely different even though the chest pain from all those types of condition can feel similar.

You can have a pulmonary embolus giving you a chest chest pain so all these different conditions can give you symptoms of chest pain in the same way you can have symptoms of ADHD with poor attention span, distractibility and impulsivity that can be related to other kind of conditions.

>> Very important.

We we sort those out.

Jess, Jess, thanks for your call.

Let's our next caller hello Shaun.

>> Welcome to Mars of mine.

Sean, you want to know about the importance of structure and activity for somebody with dementia?

It can't be more critically stated, Sean, that when somebody has dementia try to keep their environment and their activities around them very consistent and very much the same day by day because people with dementia, they have trouble with short term memory and they need to have predictable consistency day by day by day when you try to devastating for them.

That's why many people with dementia when they get medical conditions as can happen as medical complications, they go into a psychiatric hospital, they go into a medical hospital ,they go into a different environment and they get very agitated to the point where they can get delirious delirium where you forget where you are, you start to hallucinate, you see things and even hear things sometimes that aren't there and people with delirium are very, very confused and it's often because you've taken somebody from a previously familiar environment to a very unfamiliar environment.

>> So structure activity sameness is great for people with dementia.

It's nice to allow them to reminisce about their past, get photographs of their prior lives and people who are involved in their lives all around them but try to get them in the same environment day by day by day.

That's really one of the best things you can do for them to decrease the agitation that so commonly is associated with dementia.

>> Sean, thanks for your call.

Let's go our next caller.

Hello Tom.

Welcome to the mind.

Tom, you want to know why our mental health emergency detention's for 72 hours?

>> Tom, they are 72 hours of weekdays so it gives a clinician 72 hours to evaluate them if a patient comes in on a Thursday, they'll be Thursday.

There'll be other Thursday, Friday the week end doesn't count so they'll be there until at least Monday 72 hours arbitrarily has been determined to be a reasonable time to assess somebody's mental status during that time they often are not treated during the 72 hours unless they need to do so on an emergency basis due to agitation, aggression or maybe the potential for harm to others so they can be treated as needed during those 72 hours.

But after the 72 hours it's determined well do they understand they need to be there voluntarily or do you have to get a court order to keep them for a long period of time or can they release them after 72 hours because the crisis in which they were admitted has resolved so 72 hours a three day time period is thought to be a reasonable time to be able to observe somebody's mental status to determine how they're doing.

>> If it was just 24 hours and there is something called a twenty four hour hold where they come in it's called an immediate detention.

It's a very brief observational period often that's not long enough to really determine how somebody is doing in 72 hours if they're going to withdraw from any drugs or alcohol for that matter you're going to notice that in that time period but that's historically been the case for several decades now Tom, were the 72 hour hold has been a means by which somebody can be involuntarily assessed, not necessarily treated but involuntarily assessed in a psychiatric hospital?

>> Tom, thanks for your call.

Let's go our next email question we have another email there.

It's read your daughter Fauver.

>> I'm thinking about giving up sugar.

How does sugar affect the brain and what kind of withdrawal symptoms can I expect?

Well, it's interesting sugar can't have an effect on your overall mental status but there are no insulin receptors in the brain so insulin doesn't affect the brain so much directly but glucose can get right across the brain blood brain barrier and affect the brain.

>> So if you have fluctuations in your blood glucose it's going up and down.

>> OK, you can have difficulty fatigue, poor concentration if you give up sugar.

Yeah, you might notice you might have a little bit of withdrawal from it initially not drastically.

If you give up sugar entirely it's very difficult to give up all sugar because keep in mind sugar is simply a combination of glucose and fructose so you put that combination together and you're going to see a lot of different means in the with fruit and even with vegetables for that matter.

>> You can have a lot of carbohydrates out there.

So I think what you're saying is that you'd like to give up carbohydrates and go on a low carbohydrate diet.

So let's backtrack there if you have a low carbohydrate diet initially non undoubtable you'll feel kind of tired and you'll feel kind of weird.

>> You're wonder that first week if you can get by with it.

But if you hang in there on a low carbohydrate diet, it's an interesting phenomenon that I've observed with other people and myself for that matter a low carbohydrate diet will often be more energizing for you if you can keep your insulin levels suppressed by having a low carbohydrate diet, it actually is good for your mental health .

>> So a low carbohydrate diet by suppressing insulin levels can in many cases actually help your mood and help your concentration difficult to do.

>> You've also heard of it as being a ketogenic diet and extreme form is a carnivore diet where you primarily eat meat but a ketogenic diet simply where you're trying to limit carbohydrates.

>> And in doing so you're the whole premise of doing so is to suppress the insulin and not the glucose is dangerous to the body.

>> It's the high insulin levels.

A high insulin levels can be very toxic to much of the body and the insulin will regulate how much glucose does get to the brain.

So if you can suppress those peaks and valleys of glucose going up and down you'll often notice you have better concentration and a better mood.

>> Thanks for your email.

Let's go to next caller.

Hello Diane.

Welcome to Mariza Mind Diane, you'd mentioned since you've started Paxil also known as paroxetine for your obsessive compulsive disorder, you've noticed getting easily agitated with people.

>> Why is this happening and should you avoid crowds?

>> Paxil, Diane, is a medication that does increase serotonin fairly potently more potently than the other serotonin reuptake inhibitors such as Lexapro, Zoloft, Prozac, Celexa those are all medications that will increase serotonin Luvox being another one Paxil is probably the most potent of all of them.

But Paxil will have a breakdown product that can increase agitation for some people so you can actually have more anxiety especially as you go to a higher dosage with Paxil.

So the breakdown product of Paxil can give you some difficulty with agitation and irritability.

So in those cases, Diane, I'd recommend talking to your clinician about the possibility of possibly decreasing the dosage some going to another serotonin medication other than Paxil.

>> Paxil is a medication and has several drug interactions for one thing.

>> So it could be another medication that you might be taking.

It could be problematic but Paxil also is fairly notorious for causing people to be fatigued, for causing them to have weight gain and also having horrific withdrawal if you miss a dosage or two missing a dosage or two or with Paxil can give you zings and zaps in your hands and feet, give you a burning sensation in your scalp, make you more agitated.

>> That's why Paxil does have a controlled release form the where it kind of is a smoother release but Paxil does have som liabilities and one of them will be increasing agitation.

I wouldn't consider that a good outcome for you.

Diane, I want to go another direction.

If I was treating you with Paxil.

>> So talk to your clinician about that.

Diane, thanks for your call.

Let's go next caller.

Hello, Francis.

Welcome to Matters of Mind.

Francis, you want to know are there a mental health exercises that can improve your memory and mental reflexes?

I think what to which you're referring Frances, is the importance of keeping your brain active.

>> So as we go throug life we want to keep our brains active.

So when we talk about something like retirement I thought I find it interesting in the Hebrew language there is no word for retirement.

So as you get older you shouldn't just quit working and quit socializing with getting out of the house because you hit that magic age of whatever you wanted to retire at would it whichever magic age you should keep yourself busy and you should do so intellectually, socially when people talk about mental exercises they often perceive that they should do puzzles and different games and there was a study involving a large group of nuns several decades ago and if it was found that these nuns lived to an older age and they had a lower risk of dementia compared to people that were living their age who were not nuns and it was found that the nuns were very, very active doing puzzles and different intellectual and brain activities day by day by day and they had less dementia so that is a factor in helping somebody.

But I think when it all goes back to what happened with the numbers nun study, it really looked at their keeping their minds active and they were socializing and we often overlook the importance of socializing when people socialize it actually helps the brain.

So during the covid pandemic with all the lockdown's and all of social restrictions, it was devastating for so many people who already had preexisting mental health issues because now they were socially isolated and for young children and young adolescents who were at a critical age for learning social skills when they were restricted from going to school, many of them are having mental health consequences from those kind of decisions that are that were made at that time.

They're having depression or having more difficulty with anxiety especially in social situations.

>> So it's extremely important to our through our lives.

>> We have some kind of social network that we maintain.

We keep our brains active with reading the news, keeping yourself active with puzzles if you have them available but simply doing The New York Times crossword puzzle every day won't prevent you necessarily from getting dementia.

You have to have a wide range of different intellectual activities that you maintain so stay socially active, keep your brain active.

Those are the main things you could do to help your brain over the course of the year.

But very importantly exercising some kind of physical activity will affect this particular neurotransmitter called brain derived neurotrophic factor BDNF and BDNF goes up when you're exercising and you want to exercise on a regular basis.

Exercising is like brain fertilizer so socializing keeping the brain active intellectually and exercising those are the main three things I could recommend.

You know, you're wondering why I didn't mention nutrition, the importance of nutrition.

>> It's OK but it wouldn't be a top of my list nutrition it helps to some degree with a brain functioning but I don't think it helps as much as socialization brain activity with intellectual exercises and exercises.

>> Those are the three main things that I think are even more important than nutrition at this point.

>> Nutrition is good for everybody.

You know you shouldn't eat the refined foods fats out of a box or out of a bag.

>> You should really limit that go easy on the on the on the carbohydrates as I mentioned before, a ketogenic diet where you're basically eating a low carbohydrate that's good for the brain but it's not going to be as impactful as socializing intellectual activities and exercising for the brain long term.

>> Thanks for the email.

Let's go to next caller.

Hello Will man is the mind well you mentioned you're struggling with drinking alcohol too much.

You're smoking cigarets and you're depressed.

>> You don't know where to start.

What should you do when we look at somebody who's drinking alcohol, smoking cigarets and having depression?

>> I'm often going to really focus first on trying to get you to back off the alcohol.

Now the first I'm going to ask you, Will, is why do you drink?

>> Some people will drink alcohol as a means of helping them sleep.

>> Some people will drink alcohol as a means of decreasing their anxiety.

It kills them out.

Some people drink alcohol because they feel happier when they're drinking alcohol.

>> Now why would you feel happier and to drink and alcohol it's a bad sign if you do feel happy if you're drinking alcohol.

>> But alcohol for some people will go to this middle part of the brain called the nucleus Cummerbunds.

>> It's the happy joy center of the brain and really fire that part of the brain up if you notice with your three first drink as an adolescent or a young adult that you felt really happy.

>> You didn't feel just buzzed, you felt happy.

That's a big a bad sign that later on you could have trouble with alcohol.

So the first thing I'm going to do is try to sort out why you're drinking and let's do something about back it off the alcohol.

That's the first goal.

Secondly second will probably be to do something about the depression itself which quite frankly probably contributed to the drinking of alcohol anyway to some degree.

So did the alcohol itself cause you to be depressed?

More often than not you're drinking alcohol because you feel more depressed without so we're probably going to give you an antidepressant medication in the midst of all this get you an alcohol or some kind of substance use rehabilitation and get you involved in counseling but from a neurobiological standpoint we're probably going to start with getting you off the alcohol, helping you decrease into depression, smoking cigarets.

That's important but I don't often recommend that somebody try to quit drinking and stop smoking at the same time.

I know it's controversial.

You'll have some clinicians some counselors insist that you stop drinking and stop cigarets all the same time.

>> It's a different neurochemistry of the brain.

I wouldn't argue with them if they say they're successful with the approach of getting people to stop drinking and stop smoking at the same time my preference is to stop drinking which quite frankly is has more dangers involved with it than smoking.

Cigaret smoking cigarets is terrible for the physical health of the body but drinking will get you involved in automobile accidents, give you more social disturbances with get along with other people, give you extreme impairment with the mood and cognition being able to think so drinking alcohol if I was to weigh their risk versus smoking cigarets I'd say let's get you off the alcohol first now smoking cigarets that might influence which antidepressant I give you because some antidepressants like bupropion or Wellbutrin can be more likely to help you get off the cigarets than others.

>> So I'm going to look and see how much of an issue for for will be the smoking in the cigarets.

>> If you're smoking more than two packs a day we might give you a nicotine replacement of some type a patch, a gum, an inhaler, some type of to try to get some type of nicotine replacement to get you off the cigarets.

But usually the cascade of treatment will be deal with the drinking alcohol, help with the depression, then help with smoking the cigarets.

So start with your primary care clinician will see what kind of suggestions he or she may have and then go from there.

But I wish you the best because all those conditions can be treatable and for many people once they've recovered from the drinking, the depression and the smoking and cigarets they'll say they feel like they have a new brain because they can concentrate are actually calmer and they sleep better.

I mean nicotine is terrible for sleep because nicotine wears off after a couple hours and you wake up and you feel like you have you're going a nicotine withdrawal after a couple hours.

So nicotine is terrible for the sleep and not uncommonly people will drink alcohol as a means of helping them sleep because the nicotine so it's kind of a vicious cycle when it goes round and round.

>> Well, thanks for your call.

Let's go our next email.

Our next e-mail reads Dear Dr. Fauver, I'm thinking about giving up.

I've already answered that one.

I'm thinking about giving up sugar so we've already talked about sugar.

>> Do we have another email out there?

There we do, yes.

Should a patient with mental illness set goals for themselves while they're doing therapy or taking medication?

>> Does it help to have goals?

>> Absolutely positively.

I believe strongly that everybody should have goals.

>> In fact when I first see a patient for initial assessment I always ask what are your main goals if I could help you in three ways what are your three top priorities because I need to know that as a clinician because after talking to you after you've completed all these questionnaires and I might give you I want to know OK, I've got some ideas on how I can help you but I want to know what's important to you and sometimes I might be surprised.

>> So I want to know from your perspective what are your main goals for treatment in many times with car questionnaires we'll we'll ask actually ask people what are your goals for treatment?

>> How would you want to feel better if you could feel better this way, this way in this way how would you want to feel better?

Secondly, we want to know what would prevent you from staying on a medication.

>> That sounds like a silly question but the bottom line is some people will have minor side effects and they'll stay on the medication because they feel better.

>> Other people will have an aside the effect of any kind and they'll go off the medication.

>> So we want to know how tolerant you would be to any side effects especially early on the treatment.

Many treatments will give you some side effects early on the first month or so and will often diminish over the course of time.

>> Many people will insist they don't take a medication.

It might be addictive, a medication that might cause this or that problem because they would never take a medication that had those kind of side effects.

>> So we want to know about that.

We also want to know when we see somebody initially not knowing what your goals might be, what side effects you want to avoid.

>> But we also want to know when's the last time you felt really good for a month or two ?

That's very important because I want to know how long you've been feeling lousy.

It's going to be a more challenging treatment if you've been feeling lousy for years and years versus that if it's just been a bad year for you for the past year.

So we want to know what goals you have, what side effects you want to avoid and when's the last time you really felt good for a whole month or two ?

Those are all very important questions that your clinician should be asking you and you should consider even before seeing a clinician for mental health treatment.

>> Thanks for your email.

Let's go to our last caller.

Hello Milton.

Welcome to Matters of Mind.

Milton, you want to know if there's anything you can do to stop sleep paralysis and waking up feeling anxious and afraid what's happening in your sleep?

>> Sleep paralysis.

Milton is occurring because when you're going into dream sleep it's also known as rapid eye movement sleep.

>> It affects the front part of the brain.

It shuts down the front part of your brain rapid eye movement or dream sleep will paralyze the body and that's a good thing because you don't want to be acting out and you don't want to be having what's called a sleep behavior disorder where you're punching and flailing your arms and you're running and jumping all around while you're sleeping so your body naturally will go into a paralytic mode while you're sleeping.

>> Here's what's happening, Milton.

You're awakening while you're still dreaming and you can't move for a few seconds.

>> No one I'd say don't worry about it because it is something that's not considered dangerous.

>> It's kind of scary when you first experience it.

But just remember to tell yourself, Milner, you've been dreaming and it's something that can happen while you're dreaming now sleep paralysis is occurring during the day and that's called narcolepsy with cataplexy.

So people with narcolepsy, with cataplexy it's a whole nother phenomenon where your brain goes into REM sleep.

It goes in a REM sleep when you're wide awake and then you have paralysis and you can't move your arms and legs.

>> So sort out Melun is that happening during the day that's narcolepsy with cataplexy or is it happening just at night that sleep paralysis nilton thanks for your call.

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

If you have any questions that I can answer on the air you may write me via the Internet at matters the mind at WFA ECG I'm Psychiatrist Ja'far and you've been watching Matters of Mind on PBS Fort Wayne now available on YouTube God willing and PBS will be back again next week.

>> Thanks for watching.

Good night Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.