.

Cameron Psychiatry.

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

More information available at CameronMCH.com.

Good evening.

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

Welcome to Matters of the Mind now in its 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, you may call me here in the Fort Wayne area by (969) to seven to zero or if you're going anyplace coast to coast you may dial toll free at 866- (969) 27 two zero nine on a fairly regular basis.

>> We are broadcasting 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 via the Internet at matters of the mind all one word at WFA Egg that's matters of the mind at WFA Egg and I'll start tonight's program with an email I recently received.

>> It reads During a followers sometimes I get suddenly afraid and I'm stuck with fear but nothing is happening to cause it is this stress or my subconscious could be either quite frankly.

>> I mean when you feel like you're overly stressed and that simply means you're having difficulty coping with your current life circumstances you can sometimes get paralyzed and paralyzed when you're paralyzed with fear.

>> What's happening is your anxiety volume control over here in the front part of your brain on the temporal lobe that will sometimes cause your thinking part of the brain in the front to shut down and basically it's hijacking the front part of your brain which is the judgment thinking and doing part of the brain.

>> And if you get overly stressed out you can kind of freeze up and you can get stressed out in that regard.

>> On the other hand as your subconscious sometimes if you get in a situation that was previously extremely traumatic talking to people or people who remind you of others that will sometimes cause you to have a lot of anxiety and you might wonder why am I thinking like this?

>> That's the whole concept of therapy to try to help you understand situations and situations where you might have difficulty dealing with certain conversations and you might try to relate, OK, why am I having difficulty with this interaction or conversation?

How does it relate to stuff that's happened to me in the past and thereby you can overcome the fear and concern of what's happening in the present.

>> Thanks for your email.

Let's go to our first caller.

Hello George.

Welcome to Matters of Mind.

George, you wondered if a vitamin deficiency can cause mental health issues and if so, what vitamins would I recommend George to the two vitamins that come to my mind rather bad from a deficiency standpoint can be vitamin D D as in dog and B twelve so vitamin D vitamin D deficiency can be seen especially in northern latitudes where there's less sunlight.

>> Vitamin D is manufactured in the skin.

>> It's actually a hormone that goes to the brain and it can help with mood depression.

Low vitamin D levels actually been associated with higher likelihood of psychosis with adolescent people in Denmark where they've done studies on vitamin D so vitamin D deficiency where it's low under 55 typically is where they would measure that but if it's low it can give you a higher risk of depression.

Some people have more trouble with concentration.-It was inteh covid-19 infections it was thought that vitamin D was actually a risk factor if it was low it was a risk factor for acquiring vitamin for acquiring covid infection.

So it was important for people to get their vitamin D levels up because not only can it help you from a mood and concentration standpoint but it might actually decrease the likelihood of infection.

>> So vitamin D would be the first thing.

>> How do you acquire vitamin D?

Well if you got it in the sunlight for about twenty minutes every day and got adequate sun on your skin that's going to help you with vitamin D manufacturing on your skin.

>> But an easier way to do it and possibly even a safer way to do is simply taking a vitamin D supplement on a day to day basis.

>> Two thousand units is considered to be frequently safe.

Some clinicians will actually prescribe five thousand units every day and sometimes you'll hear about a big dose of fifty thousand units once a week for a few weeks and that's to get your vitamin D level up quickly.

But as a psychiatrist I will indeed recommend people take the two take vitamin D levels especially in the wintertime when it gets dark and are having less exposure to the sun.

We can do vitamin D levels easy to do but there often no longer coveredby insurance so they would be something that people would often pay out of pocket.

So B 12 is another type of vitamin.

If it's low it can cause you trouble with concentration depression you'll notice that you can have numbing and tingling in your hands and feet and sometimes even paralysis for that matter.

But you'll notice it's a neurological phenomenon with low vitamin B 12 levels now low vitamin B 12 could be caused by getting older those of us over 65 years of age we have less of an ability to transport vitamin D are vitamin B 12 from our stomachs to a small intestine.

Now vitamin B 12 gets transported like a bus from your stomach to small intestine by something called intrinsic factor is comes from parietal cells in your stomach and it's thought as we get older we have fewer parietal cells in our stomachs and it gives you less ability for the intrinsic factor which is the bus to carry the vitamin B 12 to the small intestine where it gets absorbed because of that older dalts are more prone to having low vitamin B 12 levels and that's why it's important for us to get checked out for vitamin B 12 levels periodically.

Secondly, a medication for instance like metformin commonly used for a lot of people with pre diabetes or Type two diabetes.

>> Metformin is a medication that's very, very effective in decreasing insulin production and decreasing blood glucose is for a lot of people but it can give you a slight decrease in vitamin B 12 level over the course of time because it decreases the absorption of vitamin B twelve.

So metformin as a medication sometimes will warrant getting a vitamin B 12 level yearly if we have somebody on that particular medication.

So medications sometimes can contribute to low vitamin B twelve levels you can have low vitamin B 12 levels as you get older or maybe you've had a a bariatric surgery where they cut out part of your stomach in those cases we always want to make sure the vitamin B 12 level is adequate because that will give you a greater likelihood for depression itself.

Now what I recommend any multivitamins on a regular basis for people?

I think it depends on the circumstances.

I frequently recommend vitamin D for people especially in the wintertime but I don't so much anymore recommend vitamin B complex for everybody.

>> Vitamin B complex is where you get vitamin B 12 but also B six B one which is thymine B B two which is riboflavin.

>> All these different B vitamins are in there and then Thurrock.

>> But I don't really see good evidence that vitamin B 12 supplementation in the absence of a vitamin B 12 deficiency would be that helpful and the same with the other B vitamin with supplementation.

>> I mean your urine will be a nice pretty gold color from the riboflavin which is vitamin B to but otherwise you're not going to get a lot of benefit by taking excessive amounts B vitamins in general if you don't have distinctive deficiencies in them there is a particular kind folic acid.

>> We need this particular enzyme in our systems Mtkvari Methylene transferee tetrahedral folate and its enzyme that breaks down folic acid vitamin folic acid is vitamin B nine .

>> Folic acid is important for our ability to manufacture serotonin, norepinephrine and dopamine which are important chemicals for our mood and concentration and anxiety.

>> If you don't have adequate enzyme from which about one out of three of us don't you will not be able to manage.

>> You will not be able to break down folic acid, methyl folate and for those people it's recommended that they take Almatov folate.

That's what's happening with a lot of women when they are pregnant they're often now not given just folic acid.

They're given MFL folate as a final breakdown product.

But genetically some people are more at risk than others in terms of having a deficiency on of it there's twelve ninety eight and there six seventy seven and these two different types of enzymes will break down folic acid to different degrees and that's what genetic testing will often tell us who needs elements of folate and who could get by a regular folic acid.

But if you don't have the adequate breakdown of folic acid to almatov folate you could have a deficiency in serotonin, norepinephrine and dopamine that can give you a higher likelihood of anxiety and depression.

So the vitamins that are most likely to be contributing to depression and concentration difficulties will often be vitamin D B twelve and A deficiency in Vrvar which breaks down folic acid which is vitamin B nine to elemental folate.

Its final biproduct.

>> Thanks for your call.

Let's go to our next caller.

Hello Laura.

Welcome to Mastermind Laura.

>> You had asked could I explain body dysmorphic disorder and other science that are different in men and women?

>> Body dysmorphic disorder is where people are often perfectionists and they will see a particular part of their body that just doesn't look right often it's a facial malformation in their minds.

>> Other people will say I say anything that unusual about that particular part of your body or your face in these people will be extremely preoccupied often they will go to plastic surgeons to get correction.

>> Often they'll try to hide the particular malformation that they perceive with cosmetic X men will often have more difficulty with body size the more they don't think they're muscular enough and men will get very preoccupied with that whereas women will have more difficulty with size and body weight in general.

So body dysmorphic disorder is where you have an over preoccupation of a perception that a particular part of your body doesn't seem right.

It often is associate perfectionism, obsessive compulsive disorder.

>> It's thought to be kind of a type of OCD where some people have a tendency toward having OCD features where they're obsessive, where they're having unusual unnatural thoughts about something and then they have compulsions where they have to do something over and over again to try to relieve themselves of that particular obsession itself.

Many people a body dysmorphic disorder will have other family members who have similar symptoms and it's thought that to some degree there might be a biological component to it.

But on the other hand some of the behavior is learned.

But body dysmorphic disorder is where you have over oversensitive a sensitivity to particular part of your body that just doesn't look right to you.

>> Laura, thanks for your call.

Let's go next caller.

Hello Cindy.

>> Welcome to Matters of Mind said.

>> Do you want to know the difference between a psychologist, psychiatrist and a therapist and why would somebody need all three for treatment?

It's not unusual, Cindy, that people might have at least a psychiatrist or maybe a psychiatric nurse practitioner or a family nurse practitioner and I think commonly somebody's prescribing the medication because number one, you want to get the biological aspect of the brain on track.

>> All right.pSo the idea of haa psychiatrist, a psychiatric nurse practitioner, a family nurse practitioner, somebody who's prescribing medication itself will be to allow the brain to biologically function normally.

>> Now here's a therapist kind of fit in if you're a therapist will help coach you to go the particular direction you need to go.

A psychologist in today's day might do some therapy but a psychologist does a really nice job us diagnosing and determining treatment plans that need to be completed so psychologists are PhDs.

>> They've done a doctorate level training where they started out maybe with a psychology degree.

They got a master's degree then they got a Ph.D. or a side.

Those are psychologists.

Psychiatrists went to medical school and after medical school a psychiatrist goes to psychiatric specialist training for an additional four years and then a psychiatrist gets that M.D.

into twenty four .

>> Psychiatrists are primarily involved in psychopharmacology which is a fancy term for meaning that they're specializing in medications that will change for the better brain chemistry.

>> So if you think about an analogy here, Sandy , here's kind of the way it works out.

If you think about a psychiatrist treating using an automobile analogy, the psychiatrist is actually treating the mechanics of the automobile itself so the psychiatrist is helping with the with the brakes, the accelerator making sure that the filters are all working properly.

The psychiatrist has worked working more with the mechanical aspects of the automobile itself.

The therapist on the other hand is helping you with more navigation and steering where you need to go with your overall goals.

>> So when you get in your automobile you have a goal to get somewhere often that's what a therapist will do now a psychiatrist or somebody who's prescribing the medication like a nurse practitioner will be more involved in helping you with a mechanical aspect of getting to those goals.

>> But a therapist will help you get to those goals now what will a psychologist do?

A psychologist is kind of like the car mechanic I'll say who will say I think this or that's wrong and this needs help and a psychologist will often make recommendations one way or another but many times not uncommonly a psychologist will also help you to navigate those particular goals.

Why would somebody need all three as psychologists would often be there for the purpose of helping diagnose an underlying conditin?

Looking at the whole picture in general a psychiatrist would be somebody who would prescribe medication also making diagnoses because you really can't prescribe medication unless you have a clear understanding of the diagnosis using an analogy a different way if you have chest pain the chest pain could be coming from a heart condition, a lung condition, a stomach condition.

>> Chest pain can be caused by a lot of different things and based on the diagnosis of what's causing the chest pain, you're going to have different treatments.

That's what a psychiatrist will do when you say to a psychiatrist I have trouble with my memory or I have trouble with my mood, you have to determine why a person's having trouble their memory or their mood from a biological standpoint to determine what medication might be appropriate.

>> And then of course the therapist is somebody who's going to be helping navigate you to the goal and where you want to go so that often give you specific tips they'll give you life circumstances ideas in terms of what direction you can go in in your counseling.

>> So a therapist is going to do more counseling and psychotherapy for a lot of people.

So there can be a reason why people would use all three a psychologist, a psychiatrist and a therapist.

>> But usually it's a medication treatment in combination with some kind of therapy or psychotherapy in therapy and psychotherapy can be done by a psychologist and or a therapist.

>> Senate, thanks for your call.

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

E-mail question reads your daughter Fauver I have a friend who seems to check out or dissociate when confronted with conflict.

What is happening that they cannot stay present if somebody's checking out or associating with conflict not uncommonly that particular person has endured not that it's diagnostic and definitive but many times that that person has endured some kind of trauma in the past.

>> So if you dissociate or you check out very readily with a lot of conflict, it often means that you've endured some kind of traumatic experiences the past it could have been emotional trauma.

>> It could have been sexual physical trauma, some kind of trauma in the past that caused your brain to kind of learn to check out as a defense mechanism when you're under stress.

So let's say and classically it occurs when you're a child before the age of eight years of age you've had difficulty with emotional sexual physical abuse.

>> You've had abandonment, something happen during that those early childhood years where you get the little anxiety center, the amygdala up here getting all fired up.

>> The amygdala is right beside the memory center of the brain and sometimes to endure all that trauma as a child to where you get over it is by just tuning out and your brain checks out in such a way that your brain can't remember that it all happened.

>> So many people who have endured traumatic experiences whether in childhood or later in adult life forget some of the details of the traumatic experiences because their brain was so fired up with fear and anxiety, even anger for that matter that it just caused the memory center to just check out later on when you endure any kind of stress, sometimes your brain can biologically go back to that mode of checking out so let's say you have a boss who raises his or her voice toward you that can cause you all of a sudden to have kind of a freezing episode or an episode where you check out or dissociate where you basically don't realize what's happening around you so the brain can sometimes use those old defense mechanisms not in a good way necessarily but that's how you learn to deal with stress.

You check out and you kind of forget what happened over the past few minutes.

So it's called dissociation some people have what's called depersonalization.

Some people have what's called derealization depersonalization is where you can't remember who you are.

The realization is where you can't remember what's happening around you in reality.

>> So you kind of tune out from that very briefly and it can occur under times of stress and the whole treatment approach with that would be to help you deal with the stress itself and improve your coping mechanisms so you don't have to fall back on dissociation as a means of trying to help you with the stress itself.

There is a particular kind of dissociation called dissociative identity disorder.

Did dissociative identity disorder used to be called multiple personality disorder?

>> But it's a real phenomenon.

People who typically will be women who have been traumatized in their younger years will go to one personality or another or another and some people can have dramatically several different personalities or as a book decades ago by name a Sybil the describe this whole phenomenon.

>> It's a real phenomenon but it's where as a as a coping mechanism you go to one personality or another or another and you dissociate during a time where you tune out and it's a way of getting through stress and if you learn as an early child, as an early child you often end up doing those kind of techniques and tactics later on as an adult when you're trying to deal with stress.

Thanks for yor call.

Let's go our next caller.

Hello Daniel.

>> What can the mastermind Daniel, you had mentioned that your wife has recently been diagnosed with mental health disorder.

You have two young children.

What age is appropriate to explain that is what's happening with your kids, Daniel?

It depends on how your children how old your children might be right now and how long they've been dealing with the mental illness of your wife.

>> In other words, they if your wife is there a mother they've been around your mother for a period of time.

They realize there's something different about her that they might realize that she can tolerate so many different stresses.

Children after the age of eight years old have a pretty good understanding of what's happening in the household and even younger than that in some cases.

>> So it depends on what they've noticed about their mom where if their mom gets really upset about certain things often the children will react accordingly.

You don't have to go into the neurobiology of the diagnosis or the treatment of your wife with the children necessarily.

But as they get older you can help them understand that her having difficulties with mood or anxiety disturbances for instance, can be not uncommon in such a way that it's kind of it's a biological medical condition like with your heart or your kidneys or any other kind of medical type condition.

>> So I think it all depends on how much they are aware of what's going on and how they've reacted to it.

>> Daniel, thanks for your call.

Let's go to next email question.

Our next email question reads Dear to discover how do I know if I need something or if I'm addicted to it?

People often ask about that with coffee .

They wonder if they have a coffee addiction for instance because they'll notice when they awaken in the morning they feel the need to have some caffeine in their inner system to be able to have more mental clarity and to awaken.

>> So if you're addicted to something something I learned decades ago in my early training was that when you're addicted to something number one you lie about it numberptwo.

So if you're lying about your coffee consumption or you're hiding it from other people that means you're addicted to it now addiction by nature means you can have physical types of addiction where you need to have it and you need to have higher and higher amounts of it.

We call that tacky flaks but you need to have higher doses to get the same effect.

>> That's an addiction.

Number two , you have an addiction if you withdraw from something because you need you stop it you have a lot of physical type of symptoms that can be suggestive of an addiction.

But when you have an addiction you're using something inappropriately at a higher amounts than you really should and you're lying about it to other people.

>> Other people are noticing it's a problem for and you're hiding it from them.

>> So that's where you cross the line from needing something to an addiction.

Now some people will say well gee, I don't want to take an antidepressant medication because I don't want to get addicted to it.

People don't get addicted to antidepressant medications because what antidepressant medications do is they replace something in your brain that you will need.

>> So getting addicted to an antidepressant medication would be like getting addicted to your eyeglasses.

>> If you wear eyeglasses to correct your vision it means you need the eyeglasses to correct your vision.

You're not addicted to your eyeglasses.

>> So the same thing can be true with antidepressant medications you can need the antidepressant medications somewhat like a person with diabetes will need medications to help them with.

>> Normalizing a blood sugars doesn't mean you're addicted to your diabetes medication.

You need them just to correct the underlying problem itself.

Thanks for your call.

Let's go to the next caller.

Hello Shannon.

Welcome to Mastermind Qiana.

>> You mentioned that you're on Zyprexa also known as olanzapine and a side effect is having a stroke.

>> My father just recently had a stroke.

Would you should you be concerned about having a stroke with Zyprexa since you have a family history so that's not the way it usually works.

And I'll tell you how the stroke risk with Zyprexa occurred in the early 2000s we're talking about twenty five years ago they did studies using Zyprexa also known as Lance Pain and Risperdal also known as risperidone on people who had trouble with dementia and with the dementia there had agitation and some some of them had difficulty with reality maintaining reality.

So they tried low doses of these antipsychotic medication on elderly people who were having some agitation.

>> Well, some of the elderly people had higher risk of strokes and in some cases they had trouble with respiratory depression.

>> But when you look at the data involved in those people, they were already at a higher risk for stroke anyway.

But the people who had strokes versus people who didn't have strokes were more likely to have Ativan, Valium, Klonopin or or some kind of benzodiazepine medication added to the Zyprexa itself.

>> So would Zyprexa if you don't have dementia, if you don't have psychosis related dementia put you at higher risk for stroke?

>> No, it doesn't look like it would.

So if you're not being treated as an elderly person that means you're not over over 65 years of age and you're not being treated for dementia with psychosis related dementia.

>> Those are the risk factors.

It's elderly people over 65 years of age having dementia who are being treated for agitation at that age group.

>> So those are the people that are high risk for a stroke if you're younger than sixty five ,especially despite having a family history stroke, no Zyprexa wouldn't give you that high risk for stroke necessarily again emphasizing that the people who had strokes in those studies were more likely on additional medications such as Ativan, Valium, Klonopin.

These are the so-called benzodiazepine medications that in today's world twenty five years later we wouldn't give those medications with Zyprexa or Risperdal risperidone anyway .

>> Qiana, thanks for your call.

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

Our last email question region favor our coffee .

Knapp's legitimate they don't seem real actually coffee naps can be very legitimate.

Coffee basically will and we'll give you caffeine content when you're tired and you drink a coffee cup of coffee takes about twenty minutes for that coffee to kick in caffeine in the coffee will go to this little adenosine receptor adenosine is kind of like fumes from exhaust fumes in a car so you drive your car you have exhaust fumes.

>> Well we our brains will do the same thing because adenosine will be like the exhaust fumes that make us tired as the day goes on.

>> If you have a nap no one that will tend to decrease the adenosine level in your brain.

But secondly the caffeine in coffee will go to the adenosine receptors and knock off any it unseen that's there so the nap will help and the coffee will help over the course of twenty minutes upon getting absorbed.

So a coffee nap is basically where you drink a cup of coffee take about a twenty minute nap when you wake up you're refreshed so it is legitimate.

>> Thanks for your call.

Unfortunate I'm out of time for this evening.

>> If you have any questions concerning mental health issues you may write me via email at matters of the mind all one word at WFA a dog God willing and PBSC willing.

I'll be back again next week.

Thanks for watching.

>> Have a good evening.

Good night Cameron Psychiatry.

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

More information available at CameronMCH.com.