Good evening.

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

Welcome to Matters of the Mind now in its 20th 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, you may call me in the Fort Wayne area by dialing (969) 27 two zero or if you're 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 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 wag that's matters of the mind at WFB and I'll start tonight's program with an email I received this past week.

>> It reads Dirt under former what our dopamine and acetylcholine and what do they do in the brain?

Do they interact with each other?

Is it possible for a person to get addicted their own brain chemicals if they have an imbalance?

Well, let's just go back to the whole roles of a coaling and dopamine acetylcholine as affecting what's called muscarinic receptors.

There's five different muscarinic receptors.

Muscarinic receptor number one is the receptor if stimulated by acetylcholine can help with concentration and memory in the hippocampus area.

The brain it can also give you some increased salivation sometimes you'll notice that you might have more increased elevation with muscarinic receptor type one muscarinic receptor type two affects the heart.

>> So if you increase the acetylcholine in the area of the heart and stimulate muscarinic type two receptors it'll slow down the heartbeat muscarinic receptors Type three involved this the smooth muscle such as the bladder and gut for that matter muscarinic receptor type four is affecting the inside part of the brain as does muscarinic receptor type five affecting dopamine.

>> So muscarinic receptors if stimulated can indirectly decrease dopamine transmission.

So if you stimulate muscarinic receptor with acetylcholine you can decrease dopamine in the middle part of the brain and that's why there's a medication called KOLBEINN Fee that will have an effect just on the muscarinic receptors number one number four and in doing so can help with concentration but indirectly decrease dopamine and doing so you don't have to block dopamine receptors like we used to do.

>> Dopamine also has five or four receptors.

>> They're less studied but dopamine will often enhance reward motivation energy and get up and go for people they do interact with each other.

Can you get addicted to them naturally?

Well, usually, you know, if you're going to get addicted to a pattern of behavior or a substance, it usually does affect dopamine in some way.

>> Dopamine doesn't give you a ongoing high level of transmission.

>> It gives you pulses and it gives you little sprays of transmission.

>> So you'll get this little spray of dopamine periodically and the issue can be the more sprays of dopamine you get with a certain type of behavior or with a drug of abuse, the more sprays you need eventually because you kind of get used to that spray.

So something is new and exciting will give you a spray adopt me.

But if you keep doing that exciting type of behavior over and over again it becomes less interesting so you get less dopamine release over the course of time.

So the whole concept of addiction will often come back to dopamine and the idea will be to try to dampen down dopamine such that you can get enjoyment and act and energy and enthusiasm and doing things without the need to do some kind of behavior again and again and again that's going to get you into trouble.

>> Thanks for email question.

Let's go to our first caller.

>> Hello Christine.

Welcome to Matters of the Mind.

Christine, you want to know my recommendations for insomnia?

There's different types of insomnia, Christine.

There's a type of insomnia where you have a hard time getting to sleep.

It's called initial insomnia.

There's middle insomnia where you awake in the middle of the night and there's terminal insomnia where you awaken at the end of the night and you wake an earlier than you'd like.

>> So with initial insomnia often the issue will be that you're having trouble with sleep hygiene and ideally you should try to go to bed every every night at the same time and thereby get up the same time every morning ideally and it sounds really strange for some people but ideally you should not need an alarm clock to awaken.

You should naturally awaken at a particular time without needing alarm clock and if you're really getting good sleep you need to awaken in a certain time in the morning let's say 7:00 a.m. and you awaken at about six fifty.

So you're awake in a few minutes before you really have to get up.

You could set an alarm clock to make sure you don't sleep over but you should awaken just before that alarm clock goes off.

And if you do that night by night by night you get in a beautiful cycle.

People often have trouble with getting to sleep and that's called initial insomnia because they often are on their smartphones.

They're on they're watching television.

They're on the computer too late at night.

The brightness of the screen has an influence.

>> But more importantly if you're on social media, if you're on different venues that are watching the algorithm of what you are observing and it's keeping you interested and engaged, 45 minutes can go by very quickly and your brain goes to sleep in cycles.

In other words, it's like catching a bus.

>> The bus comes by every hour and a half.

If you miss that bus, next thing you know you're going to be awake for another hour and a half.

That's why when people are awakened for whatever reason at one o'clock in the morning and they have some difficulty getting back to sleep, not uncommonly they're going to be awake for a good hour, an hour and a half before they do go to sleep.

So your brain kind of goes in cycles where if you don't get to sleep at a certain time you will have difficulty going to sleep thereafter.

Exercising in the morning is fantastic for sleep exercise late at night though can keep you awake so often recommend to people especially as we all get older try not to exercise after six p.m. or so because I can keep you awake.

Of course we've all heard about caffeine.

Some people are extremely sensitive to caffeine.

They cannot have it after five or six p.m. Other people can have caffeine as late as 7:00 p.m. or eight p.m. and be OK. >> But those are the rare exceptions.

Most people have trouble with caffeine later into the evening and some people even can't have any caffeine after noon or 1:00 p.m.

So be aware of the caffeine intake that you might be taking.

>> You know, it's important to try to wind down at night time perhaps by reading a book as opposed to looking at any social media or watching TV.

So that's really important as well.

So for a regular ongoing sleep hygiene it's important to try to get to bed same time get up at the same time.

Some people do need a little bit of over-the-counter melatonin to help them get that brain signal to help them go to sleep.

Melatonin is kind of like a puff of smoke.

It's there for about 30 minutes or so.

It helps your brain get the signal to go to sleep but it doesn't give you any lasting effects.

So it's good for initial insomnia.

Adolescents and young adults by nature have what's called delayed circadian rhythm disturbances were by nature their brains want to go to sleep later on in the night.

>> So that's why adolescents and young adults not uncommonly want to go to bed at midnight or 1:00 a.m. but they want to sleep until nine a.m. or ten.

>> They still need their eight or nine hours of sleep especially when they're younger.

They need longer hours of sleep but their brain naturally doesn't want to turn off so much and that's why a lot of school systems about twenty years ago they backed up their start time.

It wasn't uncommon years ago for school systems to start very early in the morning and then they backed up by an hour and that helped a lot of the students with their daily functioning.

So you know, if you can have an adolescent or young adult be able to sleep in, that's always going to be advantageous.

There's a myth and misconception that as we get older we don't need as much sleep.

That's a horrible because we need as much sleep.

>> It's just that we don't sleep as well.

So as you get older unfortunately you tend to get less deep sleep and it's called impaired sleep efficiency.

You don't get as good of deep sleep.

You don't have as good of REM sleep or dream sleep.

When you lack deep sleep and REM sleep you'll have difficulty with getting your body refreshed and you'll have trouble with memory and concentration.

>> We still need that deep sleep and REM sleep as we get older and unfortunately not uncommon we get less of that as we get older.

Thanks for your call.

Let's go to our next caller.

>> Hello Edwin.

Welcome to Matters of Mind everyone you don't know what are some preventative measures to take for your children when your family has a generational history schizophrenia.

>> If you have a mother or father with schizophrenia, your chance of having schizophrenia is about two percent if you have a brother or sister was schizophrenia your chance of having schizophrenia is about eight percent.

If you have an identical twin exact same genetics with schizophrenia your chances to 50/50.

So it's thought to be about 50 percent genetic.

It has a genetic influence if you don't have any family history of schizophrenia, the chance of schizophrenia is about one percent.

>> So it does run in families.

So what can you do to maybe try to catch it early on and do something about a socialization at an early age is very, very important.

Many people with schizophrenia will have difficulty at an early age with social anxiety.

So learning how to socialize at a very early age is very, very important.

>> Getting regular sleep hygiene is very important.

Keep an eye on the children as they go into the adolescent years.

>> You'll hear about pre morbid schizophrenia symptoms when they have these pre pre morbid symptoms.

You know if they have difficulty with social anxiety, if they hear things in the background, if they have sleep disturbances, if they're getting more socially isolated and they have this quasi psychotic thinking where they kind of have strange thoughts, about 80 percent of those people can go into the development of schizophrenia later on but 20 percent of them don't.

So if you have a family history schizophrenia, watch out for that social anxiety type of spectrum of symptoms that can occur but also, you know, as they get into the adolescent years and this is becoming more and more research you might have heard even more about it in the news this past week.

But the whole concept of cannabis marijuana use can dramatic really impact the likelihood of somebody developing schizophrenia if they have a family history of it?

>> Of course this past week there are studies that came out that showed that that marijuana has extremely detrimental effect on the brain and it can affect a person's IQ long term.

It decreases the white matter development the brain especially when you're in your adolescent and young adult years up to twenty four years of age.

So marijuana is something it's very, very detrimental and some studies have shown that it increases the risk of schizophrenia for somebody who has a genetic predisposition, increases the risk of developing schizophrenia by two hundred times.

It's probably one of the biggest risk factors for schizophrenia we know of today and it's a concern for a lot of us in the mental field because we've seen this happen in Colorado since they legalized recreational schizophrenia back in 2012, I believe.

But when they recreationally legalized marijuana, the mental health impact on adolescents and young adults just blossomed and in a bad way.

So it's very detrimental to the mental health of young adults and adolescents.

>> So part of that reason is because marijuana has such a detrimental impact on the brain itself.

Thanks for your call this core next caller.

>> Hello Craig.

Welcome to Matters of Mind.

Craig had mentioned that since beginning your anxiety medication Zoloft also also known as sertraline you feel less creative as an artist.

What's the what's happening to your brain?

Basically what you're noticing there, Craig, is that Zoloft does help with anxiety.

It increases serotonin but indirectly it decreases dopamine.

>> Now Zoloft fortunately has a little bit of an effect on dopamine in a good way as well.

>> But it's can and predominately increase serotonin and indirectly decrease dopamine and that's why people who take the selective serotonin reuptake inhibitors can sometimes feel a little bit emotionally dull.

>> These medications include sertraline or Zoloft, Fluoxetine or Prozac, Paxil, Lexapro, Celexa, Luvox those are all medications that increase serotonin and as you increase serotonin you can indirectly decrease dopamine.

>> When you decrease dopamine you don't have as much joy.

Perhaps it actually makes your ability to experience pleasure worse.

It can make you feel emotionally dull and if you're an artist it can decrease your creativity.

So what do you do about will you decrease the dosage and your clinician supervision and try to find the least little dosage you absolutely, positively need?

And secondly, sometimes we'll add a medication and enhances dopamine to it such as Wellbutrin to be appropriate.

>> That's enhancing dopamine and sometimes we'll go to whole different medication.

We have Trents also known as Vaud Occitan.

We now have authority which is a combination of dextromethorphan and bupropion or Wellbutrin.

So we have these other combinations that don't directly impact serotonin selectively.

So it has to do with the serotonin effect and that's why you're feeling less creative undoubtably since you've been on the Zoloft.

>> Thanks for your call.

Let's go our next caller.

Hello Dr. Barber.

Welcome to Matters of Mind we had mentioned as an eighty six year old person with a slight memory loss.

You wonder if the brain if brain pills would help your condition.

It depends on what kind of memory loss you are experiencing.

I'm not a big fan of a lot of the over-the-counter memory supplements because I just haven't seen them in controlled trials be that effective and I haven't heard anecdotally from people taking them saying it just made a big impact long term on my life .

>> Now we've used to hear about ginseng for instance and we thought ginseng was the miracle cure back in the 1990s.

Now you mentioned ginseng nowadays the people most people don't even know what it is.

>> So you'll have these fads of herbs occasionally they're supposed to help the memory and they just don't long term I would say keep a close eye with your primary care clinician on factors that can be affecting your memory.

Sleep apnea is something we always will examine for older adults because as we get older we're more likely to snore and pause in our breathing.

>> That is a huge factor for having memory disturbances.

>> As you get older you can have other factors such as blood glucose disturbances, low iron from a slow leak in your gut and leaking blood in your gut will give you a lower iron.

>> Some people will have disturbances where they will they will have other rheumatology conditions.

>> So there's various medical reasons why you can have difficulty with your memory as a psychiatrist I'm always supposed to be looking for what's called pseudo dementia where people have depression.

Depression can give you difficulty with memory disturbances but I don't typically jump right on that reason right off the bat I'm looking for sleep apnea, low iron thyroid disturbances, glucose disturbances.

I'm looking for various medical conditions that might explain some of the memory disturbances in older Dolz and then if we rule all those out, yeah, there are medications that are used specifically for Alzheimer's dementia.

They're predominantly affecting serotonin.

They're affecting acetylcholine transmission.

>> So by increasing acetylcholine transmission that can basically sustain and and prolong the memory trajectory loss over the course of time.

>> So a medication like donepezil Aricept for instance, it doesn't cure Alzheimer's dementia and doesn't necessarily improve your memory just slows down the trajectory of the memory impairment.

>> So it's kind of like rust proofing your patio furniture, rust proofing your patio furniture won't prevent the rust from ever occurring.

It just slows down the likelihood the rust is going to occur.

That's what we have predominantly with Alzheimer's medications now however, the next few years we're hoping and I've been hearing this for years though but we're hoping over the next few years we're going to be having some medications are going to be more definitively helping with Alzheimer's and maybe even more curative.

>> Thanks for your call, this guy our next caller.

Hello, Mary.

What can the mastermind Mary you want to know if loneliness in seniors makes them more prone to dementia, Alzheimer's dementia or Alzheimer's disease itself?

>> Yeah, loneliness is one of the biggest factors why people can have memory disturbances because interacting with others having a conversation with other people is one of the better ways as an older adult to stimulate your brain.

So what ways can we stimulate the brain and decrease the likelihood of memory disturbances as we get older while exercising is phenomenal any kind of exercise resistance training, walking aerobic activity, any kind of exercise has a very good effect on the brain overall.

Number two socialization of the conversations can be very good for the brain.

>> Number three having meaningful, purposeful activity on a day to day basis.

In other words having something to do on a regular basis that's not just good for the older adults but it's good for anybody having something to do and having some spontaneity in your life but basically having a reason to get up every day and having purposeful, meaningful activity to give you some reason to live on a day to day basis.

One of the best mental health tips I can give anybody is to have something to do that's meaningful and purposeful.

>> You don't have to have an hour by hour schedule for your day but you need to have some things to do.

Older adults, they often retire.

They might lose a spouse.

They have fewer friends because the friends might be dying.

>> They often lose things to do.

So it's important to try to have some kind of routine in your life where you have things to do overall.

>> Thanks for your question.

Let's go to our next email question or an email question reads Deirdre Farber Why do some people have different opinions on a topic despite hearing the same information?

It's called cognitive dissonance where cognitive dissonance is where you hear the same information as somebody else but logically you just don't process at the same there's a little part of the brain called the ventral medial ventral being lower part medio on the inside ventral medial prefrontal cortex.

Right.

This little strip right here is that's a brain looking at you this the inside of the bird part of the brain here this will emotionally process information that's coming in.

>> So if you have a particular emotional bias toward a particular topic or an opinion, it's going to go through this emotional center here when you get new information that particular center is going to be very resistant to you having a different type of an opinion than you already are experiencing.

>> So the ventral MediaPro frontal cortex basically gives you an emotional overtone on information coming in and it causes people to have a bias.

And this is why it's very difficult to convince people of different opinions because if they are set on one opinion, their emotional center here is processing this information.

So the information comes into the thalamus.

Your thalamus is like an operator who that will process information.

It goes to the emotional center of the brain called the ventromedial prefrontal cortex.

Then it goes the thinking part of the brain over here in the dorsolateral prefrontal cortex and that's where you pay attention and you're thinking about the information and so forth.

>> So it goes to this networking of processing the information.

So your emotional tone can significantly affect how you process information.

>> Now we see that in psychiatry not uncommonly because if somebody is depressed for instance, they're depressed mood will affect how they process information and how many many times it'll cause people to brood so they'll have this emotional tone of depression and feeling badly about themselves.

They get information people might even compliment them.

>> They take it the wrong way.

They think they're being sarcastic.

They think the other person making fun of them they can't process information even though it's positive when you're depressed.

>> So when you're depressed it affects many parts of the brain and that ventromedial prefrontal cortex is significantly affected when people are depressed overall when people are manic on the other hand and there's higher than a kite, hey, they will process information as being positive in such a way that it's exaggerated so they might be very flirtatious with other people who aren't really interested in interacting with them but they will process the world around them in an entirely different way as somebody would normally.

>> Thanks for your call.

Let's go our next caller.

Hello Vicky.

Welcome to Matters the Mind.

>> Vicky, you want to know if I can explain the whole concept of hypervigilance in post-traumatic stress disorder when people have a traumatic experience what'll happen is this this part the brain on the stem it's on the brain stem will fire off a bunch of norepinephrine and that norepinephrine will get fired off.

>> It'll go to the memory center of the brain over here in the hippocampus and if people have a very traumatic experience that occurs, they will always be on the lookout for something else to occur as well.

We see this not only with people, we see this with animals.

You'll see with animal trainers for instance where they'll say the animals will be extremely alert if they've been previously abused.

The same thing happens with people if people have experienced childhood abuse prior to especially prior to the age of eight years of of age childhood abuse, childhood abandonment, childhood trauma, part of the age of eight years of age can make your brain more sensitive to stuff happening around you and you can be hyper vigilant which means you're always on guard and you're expecting something bad to happen.

So in other words you're jumpy and people are hyper vigilant when they've had traumatic experiences.

It is a symptom of post-traumatic stress disorder where somebody is more jumpy and they kind of expects things to happen over the course of time.

The way you treat that jumpiness is to reprocess the traumatic experience itself and convince your brain that doing things even though they might somewhat simulate the past traumatic experience with the environment, it's not necessarily going to be putting you in danger again.

So hyper vigilance is basically where your brain is on the hyper alert side and you're always expecting something to happen and it makes you a bit jumpy.

>> Thanks for your call.

>> Let's go to the next caller.

Hello Gloria.

Welcome to Mars the mind.

Gloria, you mentioned that you work in customer service and feel overstimulated at the end of the shift.

>> What are some things you can do to calm yourself down without self medicating?

Well, Gloria, number one, you don't want to use alcohol.

You don't want to use marijuana to wind down.

What's the best thing you can do at the end of the day?

No one you can socialize with people and who are friends and people who might not be confrontational as you often are experiencing in customer service.

You know, customer service is great work.

It's needed work for a lot of people.

But the best thing you can do at the end of the day is to socialize in a friendly manner with with trusted friends.

>> But also I mentioned it before but exercising exercising at the end of the day is a much better way of winding down than using alcohol or marijuana or substances of abuse exercising whether it be resistance training, whether it be some kind of aerobic training.

Thirty minutes or forty five minutes at the end of the day would be fantastic for you get away from the kind of environment and know that you can that you need to turn off your cell phone, turn off the work environment stimuli that you have.

>> Some people will take their work home with them.

You've got to be able to turn the work off at the end of the day, do something recreational, do something for fun and if it simply means taking a brisk walk at the end of the day, putting your earbuds in, listening to something that's enjoyable, get your mind off the work itself you've had a lot of stimuli during the day.

It'll really fire up your dorsolateral prefrontal cortex here.

That's the thinking part of your brain.

>> You're thinking part of the brain at the end of the day is is pretty much fried.

So you're tired at the end of the day you have a hard time thinking so do something that's fun where it doesn't involve a lot of thinking.

>> Some people quite frankly end of the day if you can wind down take a brief 15 to 20 minute nap, it doesn't sound like much but it can give you a lot of benefit if you're dorsolateral prefrontal cortex has been working all day because you've been thinking, thinking, thinking taking a brief 20 minute nap at the end of the day can fire up that area of the brain, allow you to feel refreshed.

>> I like to think and one way to be able to do that would be to kind of combine it with exercise.

So getting a nap, exercising, socializing in a friendly manner, they can all be helpful.

>> Let's go to our last email question.

Our last email question reads Dear Dr. Fauver, I have a loved one who is finally ready to see a psychiatrist.

I have a worry although she has an appointment I don't think she will be forthcoming about all of her symptoms or concerns.

Are there ways to spot mental health concerns even if the patient isn't ready to be completely open up and tell people yeah, we can look for mannerisms behaviors but I don't want to overpromise what a psychiatrist or a mental health clinician can do.

>> We are not mind readers and many people expect us to do that.

So in my practice for instance, I ask a lot of people questions through questionnaires and our patients might spend 20 to 30 even 40 minutes completing questionnaires before they see us because we can't read their minds.

We need to know based on questions and they have to answer them honestly.

We need to know what kind of problems have been there now as a trusted family member, if your loved one is willing to have you accompany them, that's a good start.

So accompany them to the appointment because quite frankly a lot of people with depression have a difficulty being forthcoming.

Thanks for your question.

Let's on I'm out of time for this evening.

>> If you have any questions concerning mental health issues that I can answer on the air you may write me via the email Internet at matters of the mind all one word at WFB Edgard I'm psychiatrist ForFour and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Goodnight