.

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

>> Welcome to Matters of the Mind now in its 25th year of Matters of the Mind is a live call in program where you have a 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 dialing (969) 27 two zero or if you're calling long distance you may dial toll free at 866- (969) 27 two 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.

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 atwa org that's matters of the mind at WFYI dot org and I'll start tonight's program with an email I received this week.

>> It reads during our revolver how do you know if someone is manic depressive?

>> Is that the same thing as bipolar disorder?

What tests are there to determine if someone has it?

>> Have there been any new developments in treatment?

Bipolar disorder is also known as manic depressive disorder.

Manic depressive disorder was a term given to it prior to about nineteen seventy nine .

>> Then they started talking about bipolar disorder by refers to poller refers to one extreme or another.

>> So what you're talking about here is a mood disturbance that varies between one extreme to another though one extreme is called a manic episode.

Manic episode is characterized by decreased need for sleep, impulsivity, racing thoughts, social intrusiveness.

People when they're manic will often do things and say things they ordinarily wouldn't do or say and that would go on for a while and people will have a lot of energy.

They'll get themselves in trouble doing things and it causes functional impairment with social interactions and work and they'll be on the high side for a matter of days sometimes two or three weeks but then they crash not uncommon lead to a low and that is when they often will end up seeing me because when they crash a low they've been to the mountaintop and here they are crashing into this terrible depression where they want to sleep all the time.

They're more socially withdrawn.

They don't want to talk to anybody and they're miserably depressed such they become more suicidal.

>> So a risk factor for suicidality will be if somebody has not just depression but bipolar depression where they've been to the mountaintop on the high and now they're crashing into a low when they crash into that low, that trajectory and that great nation to that deep, low dark depression will often cause them to feel suicidal.

>> Now many people have bipolar disorder will self medicate their highs and lows.

For instance, they might use marijuana as a means of sleeping.

Many people will drink alcohol to settle their nerves as they say to slow down the racing thoughts and help them sleep.

Some people will use opiates when they're on the low side so we'll often hear about people trying to self medicate these highs and lows they're experiencing and what causes it.

It's about 60 percent genetic so it's about twice as genetic as major depressive disorder which is where you just have depressive episodes about 60 percent genetic and with it it tends to be caused by a brain inflammation.

>> There's evidence of certain proteins that are elevated in the brain, especially during the manic episodes a protein called S1 goes sky high in the brain while you're having a manic episode.

>> So we talk about bipolar disorder.

>> We're talking about basically an inflammation inflammation of the brain that can be remedied by certain medications that are mood stabilizers.

>> We know that lithium for instance and Depakote are very powerful medications that will tend to settle down brain inflammation.

They do have some side effects so we often will use alternative mood stabilizers that might be more tolerable and may be as effective.

So the idea with bipolar disorder is to stabilize the mood.

>> Are there any new treatments?

There are more treatments coming out for bipolar disorder that are allowing people to stay on them for longer periods of time.

For instance, there are injectable medications now that you can take for bipolar disorder.

It might stay in the system for three months.

>> These are long acting antipsychotic medications.

There are medications such as Liebe Alvie which is basically Olanzapine which has been around for twenty five years but it has an added medication on board with it to mitigate the weight gain.

>> So if you decrease the weight gain olanzapine more people are willing to stay on olanzapine olanzapine be around for a long time it's been found to be a very, very effective mood stabilizing medication so the medications coming out you're going to be hearing about are either medications that are staying in the system longer medications that are decreasing side effects of prior medications but also medications that might specifically target that inflammatory effect that we often hear about with bipolar disorder itself.

So a lot of research being done about it.

>> It's thought that bipolar disorder can be partially due to dysfunction in the so-called glial cells.

Glial cells are these pit crews around each individual neuron.

>> Each individual neuron has about ten glial cells around it.

The glial cells are the pit crews that basically manage and nourish and help clear away all the junk away from that neuron and so many different conditions are thought now to not be problems with the individual neurons.

>> There are problems with the glial cells just being unable to clean up the junk and clear out the extra excitatory chemicals that might be associated with some of these conditions.

>> So as we can fix the glial cells which are a pit crews, we can hopefully help the neurons function better and that's going to be a focus of treatment in itself over the course of time I'm expecting the medications like ketamine and ketamine will also be used more consistently especially for the bipolar depressive phase for patients because it seems like it's ketamine and ketamine are more mood stabilizing for a lot of people.

They do tend to help with anxiety and they don't tend to worsen the highs and lows like some of the traditional antidepressants might might have cost.

>> Thanks for your email question.

Let's go to our first caller.

Hello, Lou.

Welcome to Matters of Mind.

Hi there, Dr. Hello, Lou.

I am calling you about dementia.

My father who is around probably seventy five when he developed dementia what ended up being Lewy bodies he had three siblings out of eight that also developed dementia and my sister who's now fourteen years older than I am also has Lewy bodies.

So to be honest I'm very frightened every time I forget something I'm 66 and I was wondering if there's any vitamins or supplements or care that I can take to maybe ward it off.

>> You know, I just don't I'm I'm terrified of it and that's all I have to say.

>> You bet, Lou.

Lewy body dementia is basically where you have an excessive number of these little Lewy bodies which under the microscope with a particular a like stain will look like little red blobs of jello.

>> Normally we only have about eight point five percent of our cells having these Lewy body.

But when you have Lewy body disease your brain becomes more infested with little Lewy bodies Lewy body dementia tends to have somewhat of a connection with Parkinson's disease because people with Lewy body dementia as you're likely aware will see things often small furry objects and little children and little people.

>> So they'll see these what are called Lilliputian hallucinations that may or may not be frightening for them.

>> People with Lewy body disease will often have a decrease in blood pressure upon standing and they will often have difficulty with Parkinsonian symptoms where they have a shuffling walk now the first thing is to know that you have those type of symptoms and recognize them as soon as possible.

>> There are more treatments for the type of hallucinations people might have with Lewy body disease.

So if you have those kind of symptoms you want to be treated as soon as possible.

I'm not aware of any particular supplements or vitamins for Lewy body disease or even Alzheimer's dementia that I could recommend otherwise I think we all should be taking those type of things.

There's always been specular on different supplements but in terms of actually taking one to give you definitive proof that it's going to decrease your likelihood of developing at I can't say one way or another but I think with all types of dementia, Lou, the best thing we can do is try to keep our blood pressures in control, try to keep our blood sugars in control because Alzheimer's disease is known as diabetes type three where it seems to be kind of an offshoot of blood sugar disturbances.

>> We want to be able to exercise on a regular basis, try to keep socializing.

But I think the key for you, Lou, is to recognize the symptoms if they are occurring there.

>> There is a genetic component but like with all genetics you have to have environmental impacts to trigger the genetics to actually kick in.

Now age is one of those environmental impacts but we haven't really identified the other environmental impacts that I think you could definitively say will predict Lewy body disease one way or another but is more likely as you get older like with any types of dementia you're more likely to experience it if you if you have a head injury.

>> So you want to do the best you can to try to avoid head injuries.

But as you get older like I said, the main thing you want to do is keep the blood sugar and good control, keep the blood pressure in control, try to exercise on a regular basis.

>> Those are probably the three best things you can do and to try to exercise your brain more often than not try to learn new things, keep your brain functioning.

I always warn people as they go into the retirement years that if you go into retirement you want to be careful about having something else to do for this new chapter in your life because when you're in the workplace you're around people not uncommonly you're using your brain.

>> You're being productive day by day by day when you go into retirement years it's often easy to sit back and be more passive socially and intellectually.

So you want to maintain that degree of intellectual stimulation.

>> That's probably the best thing to do far better than any supplement that I could recommend.

People will recommend supplements with omega three fatty acids they might help but how well could you say that definitively help?

>> We just don't know.

Lou, thanks for your call.

Let's go to next caller.

>> Hello Alex.

Welcome to Matters of Mind.

Alex, you want to know if our bodies are paralyzed during sleep?

How do people sleepwalk?

Our bodies aren't paralyzed during sleep.

They're paralyzed during rapid eye movement sleep which is dream sleep so rapidly movement sleep is dream sleep.

>> That's when you're dreaming about different things.

You can have vivid dreams.

You can have dreams that you may or may not remember.

>> The dreaming tends to start about an hour to an hour and a half after you go to sleep depending on how sleepy you are at the time.

>> So your dreams kick in your little eye movements start fluttering, your brainwaves get very, very active.

>> Your brainwaves during a dream sleep are as active as if you were wide awake and during dream sleep.

>> Fortunately our bodies get paralyzed and when our bodies get paralyzed it's because or Rexon or Hypocretin which is a chemical in the brain released from the brainstem the brain looks like a big cauliflower head.

>> The brainstem is right down the middle so Eareckson or Hypocretin two different names for the same thing will decrease substantially during that time you start dreaming in your body is paralyzed when people have sleep paralysis this is what's happening.

>> They awaken and they can't move.

>> It's because of Rexon and Hypocretin has dropped but yet they're wide awake.

>> Sleepwalking occurs in an entirely different time.

When you're sleepwalking you're typically not dreaming when you're sleepwalking it's occurring during during non REM sleep during non REM sleep you'll have these big deep high brain waves on an electroencephalogram.

>> So it's an entirely different phase of sleep concerning dream and compared to dream sleep dream sleep your body is paralyzed so you can't act out your dreams.

>> Ideally when you're sleepwalking it's during your non REM sleep and that's also when you can have sleep terrors.

Younger children often have sleep terrors where they awaken screaming they're very confused and that occurs during non dream sleep during andreyev sleep you're going to notice that you are when you awaken during that time period you're very confused for two or three seconds you don't know where you are, what you've been doing.

So non dream sleep is where you would also sleepwalk.

So why do people have more non dream sleep?

Why would they sleepwalk?

Fever can be a factor that's growing and developing brain of a young child would not uncommonly lead to non REM sleep and more sleepwalking sleep terrors for that matter younger children babies especially when they are developing you bet they will have a lot of non REM sleep whereas as we get older we have less of it.

If you're overly exhausted or if you're sleep deprived you'll have more non REM sleep when you're sleep deprived you'll have more of a likelihood to sleepwalk or awaken in the middle of the night being very confused and not knowing where you are.

That's during on where I'm sleep during REM sleep.

>> Your body's paralyzed if you happen to awaken during a dream what you can do for two or three seconds it can be kind of scary because you can't move if you're in a dream and you're wanting to scream and yell out you'll notice that you can't do it and you try and you can't do it as because your body's paralyzed during the dream sleep itself thank goodness.

Otherwise you'd be waking up the rest of the household so when you come out of that dream then you're able to get up and walk around and do what you want to do.

>> So non dream sleep you are sleepwalking during that time in when you've had difficulty with sleep deprivation fever or you're just having a growing brain as a young child but with dreams sleep that's when your body gets paralyzed and has to do this chemical called Hypocretin or Rexon or Rexon hyper reteam they drop substantially especially during dream sleep and that's when people have narcolepsy for instance with narcolepsy you could be wide awake and you have this particular phenomenon where all of a sudden your rexon level or your oxygen level will drop profoundly when even though you're wide awake when it profoundly all of a sudden your knees buckle because your body's starting to go into paralysis briefly and you go into dream sleep very, very quickly.

>> That's called narcolepsy.

Thanks for your call.

Let's go to our next caller.

>> Hello John.

Welcome to Mars the mind.

John, you mentioned you are experiencing episodes of dizziness and headaches since the smart meters were installed as your connection symptoms with electrical electromagnetic field.

You might have to ask a neurologist about that particular question.

John, as a psychiatrist I don't usually deal with electro magnetic fields and dizziness and headaches as a psychiatrist we are dealing more and more with transplanting transcranial magnetic stimulation and you hear about TMS or transcranial magnetic stimulation as a means of applying it to the brain cortex and thereby stimulating certain parts of the brain to help with depression, obsessive compulsive disorder.

>> And now you can use TMS as a means of decreasing the likelihood that somebody is going to smoke cigarets so you can selectively stimulate the brain with magnetic fields.

>> Now whether you'd have those kind of symptoms being exposed to smart meters and things like that, I don't know.

>> But the brain is tissue the cortex, the gray matter which is the outside thinking part of the brain that just has a few centimeters or just a few a couple inches in depth overall and you can penetrate certain parts of those.

But keep in mind the brain is surrounded by this thick skull that might block out some of those electro electro magnetic fields that you're wondering about.

But I certainly wouldn't rule it out because we know that TMS transcranial magnetic stimulation can be effective for mood disturbances, obsessive compulsive disorder and stopping smoking.

>> John, thanks for your call.

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

>> Our next e-mail question reads Dear today, Father, if I get diagnosed with attention deficit disorder as an adult, should I start medication or is it too late ADHD or attention deficit hyperactivity disorder by definition starts in childhood before you're about 12 years of age.

>> Some of the symptoms are there.

It's kind of like nearsightedness.

Rarely do people all of a sudden get nearsightedness later on as an adult and you'll have trouble with accommodation and seeing distances and seeing close up and things like that as you get older but having nearsightedness where you have difficulty seeing things are far typically will occur in childhood.

>> You get corrective lenses, eyeglasses, contacts or later on lens replacements.

>> The case may be that you get that corrected over the course of time in a similar manner with ADHD it often starts in childhood.

>> It goes on day by day by day.

You don't have good days with your focus and concentration on bad days with your focus and concentration.

>> Every day is about the same unless with ADHD if you unless you have an enjoyable activity, if you have a exciting type of activity, if you have a challenging activity you're more likely to keep your mind on those kind of activities because ADHD is a phenomenon where the left front part of your brain that gets fired up during boring monotonous type of intellectual activities that part of your brain's about five percent underactive now the part of your brain that's highly active with ADHD as middle part of the brain, that part of the brain can focus really well if you're excited about something, there's an area in there called nucleus accumbens and that part of the brain can get really fired up if you're excited or challenged by something and that's the part of the brain that you're using in many cases when you have ADHD to try to focus on something that's exciting and novel and something is very interesting for you.

>> But the more mundane type of things, the things that you can't focus on that's the left front part of the brain called the dorsolateral prefrontal cortex a little bit underactive with ADHD.

>> So if you go into the adult years about three out of five people will take ADHD into the adult years.

>> They become less hyperactive ,less hyperactive, they become less impulsive.

>> But the difficulty is attention span and focus might still be there.

>> Here is the issue are where do you get it treated to get it treated just on the basis of your having it or you do you not you get treated if it's problematic with your marriage, with social activities and especially work or your school activities.

>> So think about attention deficit disorder being comparable to near-sightedness with nearsightedness you might not need eyeglasses all of time but you might need them in certain situations with attention deficit disorder like nearsightedness there's different gradations of severity.

You might have severe attention deficit disorder where day by day by day you need to have something to focus and concentrate upon.

>> On the other hand, you might have added to a milder degree where you only need that particular treatment when you're at the workplace or you're studying for and an examination that will eventually be behind you.

The good thing about attention deficit disorder was we now have stimulant medications and non similar medications.

>> We have various types of treatment.

It can be used.

Some people insist that well they'd prefer to take something, maybe use more commonly for depression that can also help with attention deficit disorder that would be like medications like Wellbutrin or Trin.

Those medications can help with perhaps processing speed of the brain and can help you with concentration and thinking, especially if you have a depressive condition.

So for people who have a depressive condition who also have attention deficit disorder will use specific medications that can help with focus and concentration but also help with the mood itself.

>> Thanks for your call.

Let's go to our next caller.

Hello Valentin Volante.

>> I'm sorry.

Welcome to Matters of Mind.

>> Valenti, you had mentioned that your husband has weird sensations when he sleeps he quivers and then it's like he's fighting.

It happens four or five times a week.

Is it a chemical or something else happening?

The first thing I wonder about Volant about your husband Valenti's I'd question is he having any alcohol at night because many people will drink alcohol at night to put them to sleep.

But when the alcohol wears off after two or three hours they get more jumpy, they get become more restless and their sleep is really impaired.

>> That's one thing I'd wonder about.

>> He quivers and then he's kind of shaking and it looks like he's fighting OK. >> He might be having some difficulty with dreams sleep where his body's truly not paralyzed.

>> I mentioned before the there's a disturbance during REM sleep or dream sleep where your body gets is not paralyzed and you start to act out your dreams and when that's happening often it's because you're having difficulty getting into that dream sleep and actually getting the paralysis of the body going and in those cases you're probably not getting adequate suppression of all Rexon or hyper create and we use medications for instance like or it's been along for around for a long time to actually block the Block or Rexon or Hypocretin and in doing so it'll get you into that dream sleep a little bit more efficiently.

So there's various ways to get around that and get that treated.

But I first wondered is he taking any medication or taken any use in any alcohol before he goes to sleep?

>> I'd also wonder if you're having disruptions in sleep to that degree maybe you're getting some lack of sleep efficiency and there could be a possibility for sleep apnea with sleep apnea.

That's where you'll have difficulty with getting adequate air flow to the lungs at night.

You snore not uncommon.

>> You might pause in your breathing periodically but you don't get adequate air flow to the lungs that decreases the oxygen to the brain with decreased oxygen to the brain.

You don't get adequate sleep.

You're persistently sleep deprived and that leads to inadequate sleep efficiency the next night and you're going to have trouble with acting out your dreams in those cases.

So talk it over with his family physician first and just go from there in terms of what directions you can go.

>> Thanks for thanks for your call us your next caller.

Hello Jerry.

Welcome to Matters of Mind.

>> Yes, I had a question about drunk driving movement first couple fashions.

I've had a couple of different therapists a few that's what they're called I guess.

And then it turns into basically talk therapy.

I already have a talk therapist .

I wonder if there's something more that supposed to be included in that drug right movement I guess.

>> Yeah, it's called Eye Movement and Desensitization and Reprocessing Eye Movement Desensitization and reprocessing MDR is what they probably did for Jerry.

It's a very good treatment for conditions like post-traumatic stress disorder and basically where you probably watched the therapist finger and in doing so it sounds like hypnosis or it sounds like something that doesn't make a lot of sense.

>> But with MDR or eye movement desensitization and reprocessing you're firing up the front part of the brain that's biologically it's happening and it's been a very well standardized type of treatment.

>> You're firing up the thinking part of the brain as a means of overpowering your emotional volume control.

>> In other words, when you have anxiety disturbances, PTSA being an example, you'll have triggering events where all of a sudden you get really jumpy, you're hyper vigilant, you're always on edge wondering about what's going to happen around you and your amygdala down here in the temporal lobe gets really fired up.

>> That's the anxiety volume control.

That's the volume control for anger and irritability that gets fired up but it kind of hijacks the thinking part of the brain with MDR.

What you're trying to do is get the front part of the brain working again.

Then once it's working and you have a logical part of your thinking part of the brain working again, you can start working through therapy at that point.

So not uncommonly people will do a few sessions of MDR then they'll move into the talk therapy or counseling thereafter.

>> So that's not uncommon that people will go that direction for a post-traumatic stress disorder.

We're also using medications like ketamine and ketamine ketamine IV can be used for post-traumatic stress disorder disorder with very dramatic effects just sometimes with one or two IV treatments sometimes up to four to six.

But PTSD being treated in various ways, MDR being one of them, ketamine injections being another way.

>> We've been using medication over the course of time for post-traumatic stress disorder with variable success we'll use what forseen prazosin sometimes the serotonin medications and there are kind of OK for a lot of people but MDR seems to be one of the more effective treatments out there.

But you're right, Jerry, it's not an ongoing treatment.

It's for the purpose of getting the front part of the brain kind of fired up to get the thinking part of the brain the logical part of the brain working again so that we call a top down thinking where the urological part of the brain is doing the work and kind of controlling your emotional side of the brain so you don't overreact to different situations.

>> Jerry, thanks your call.

Unfortunately I'm out of time for this evening if you any questions concerning mental health issues you may write me via the Internet at matters of the mind all one word at WFYI dot org and I'll see if I can get those questions with the next episode.

I'm psychiatrist Fauver and you've been watching matters of the mine on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight