good evening, I'm psychiatrist Jeff Alver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now entering its twenty eighth year Matters of the Mind is a live call and 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 four calling you a place coach to coach.

>> You may dial toll free at 866- (969) to seven to zero now a fairly regular basis.

We are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which 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 dog if that's matters of the mind at a dog and I'll start tonight's program with an email I recently received.

>> It reads Your daughter Fauver I have high functioning autism and anxiety.

>> Sometimes my anxiety gets so severe it turns violent.

>> My family thinks it could be traces of bipolar disorder or a post-traumatic stress disorder from a traumatic event I experience as a teenager is there any testing for bipolar disorder and if so where can I go to get tested?

The testing for bipolar disorder would basically be to have a thorough diagnostic interview and that would often include questionnaires.

So how do we test for bipolar disorder?

>> We look at somebody's historical past.

We look at the symptoms they've been experiencing with bipolar disorder.

We're looking specifically for manic highs and possibly depressive lows but characteristically the manic highs will be manifested by decreased need for sleep, impulsivity, racing thoughts, intrusive behaviors and a social and social interactions impulsivity where you do things and say things you ordinarily wouldn't do or say and these would be unnaturally evident for anywhere between three up to seven or more days.

So you'll have these spells just out of the blue.

>> You'll have these highs and lows so we'll look for symptoms and we'll look at the symptoms being episodic on occasion now with high functioning autism, you bet you can get irritable with changes in your environment.

>> So if there's a change in your environment and you have a change in people with whom you're interacting, for instance, you can get stressed out and we call that diminished stress resiliency and with that you can have trouble with getting irritable and very angry very quickly.

That can happen with bipolar disorder but it occurs during the fluctuations of the mood.

So you have the polarities of the mood with bipolar disorder where you have the manic highs and often depressive lows will follow that.

And if you have irritability associated with the polarity of those moods that can be a factor associated with bipolar disorder.

You'd mentioned post-traumatic stress disorder PTSD often as a symptom of irritability.

It'll include irritability, hyper vigilance where you're always on edge, you're kind of jumpy and you're always expecting bad things to happen.

You're on guard looking all around you not uncommonly people with PTSD will often have intrusive thoughts where they have reminders of past bad events that occurred that were traumatic to them.

Again, having those memories come back and sometimes feeling like they're in that situation once again upon visual olfactory auditory reminders of those past type of things and many people with post-traumatic stress disorder will have avoidance of doing anything or being in situations that in any way, shape or form remind them of past events that were traumatic for them.

>> So the key with autism bipolar disorder PTSD is to have a thorough diagnostic interview and during that interview the clinician will look at current symptoms.

>> The clinician will look at past history to see what when the traumatic event occurred, how it affects you now and often will look at family histories of anxiety or mood disturbances.

>> So if you have a family history for instance of bipolar disorder where someone in your family member or family has had manic highs, depressive lows and especially if it's a first degree relative mother, father, brother, sister you have a sixty five percent chance of inheriting that kind of condition if you have family members with bipolar disorder, PTSD is less genetic but women are more prone to having post-traumatic stress disorder thought to be related somewhat to their estrogen fluctuation estrogen will actually make women apparently more likely from a biological standpoint to have symptoms of PTSD upon experiencing traumatic events.

>> People who have experienced traumatic events prior to the age of eight years old are more likely to be impacted by anxiety later on compared to people who did not have significant traumatic events part of the eight years eight years of age so will often use a scale such as the ACS the adverse childhood experiences scale it's a ten item scale if you have over four of those items checked, yes, that gives you a higher likelihood that you will have more anxiety as an adult upon exposure to traumatic events.

Now we all experience traumatic events whether it be social interactions, whether it be a motor vehicle accident, whether trauma can be traumatic for people.

>> So there's all different types of things that can cause trauma for all of us.

But we have different of susceptibilities based on our early childhood experiences and based on our genetics.

>> So we're looking at all these different factors to try to sort out diagnostically what might be causing a person their anxiety and irritability.

>> Now the reason that's important is because if you have PTSD symptoms versus bipolar, the symptoms the treatments entirely different with post-traumatic stress disorder for instance, we might use such techniques as eye movement and desensitization and reprocessing MDR.

We might use rapid resolution therapy r t as a as a means of treating that we might use certain medications that actually dampen down the blast of adrenaline that occurs when you get an anxiety provoking situation that's a treatment for PTSD for bipolar disorder.

You're going to use mood stabilizers, medications that kind of act as cruise controls for the mood.

>> So it's an entirely different treatment whether you have PTSD or bipolar disorder.

That's why a very thorough diagnostic assessment is so important and often make the comparison if you have chest pain you want to know if that chest pain is due to acid reflux from your stomach is a chest pain from bronchitis?

Is it from lung cancer?

Is it from a heart condition?

What's causing the chest pain?

And then you treat the chest pain accordingly based on the underlying etiology and we see and do the same thing with treating the networking of the brain.

The networking of the brain is disturbed with PTSD and bipolar disorder in entirely different ways.

>> Thanks for your email.

Let's go to our first caller.

Hello Carmen.

Welcome to Arizona mind Carmen, you mentioned you heard me mention autism there and you want to know is there a connection between caller and autism?

Historically we've thought that people with autism prefer the primary colors in my granddaughter always reminds me the three primary colors are red, blue and yellow however are more recent study with oh two or three dozen people said that people with autism might not prefer yellow.

They prefer green and browns.

So I think the jury's still out on that.

And which colors people with autism will prefer.

>> But I think with autism it's more associated with facial appearances.

>> So some people with autism will say red bothers them because they think of red as being an angry type of color.

When people get angry their face can turn red so they might not prefer that.

So I think it's deterministic on which type of color is associated with type what type of emotions for somebody with autism but with autism it's a condition where people will have excessive sensory input and they have difficulty processing information and interpreting what's happening around them.

>> So sometimes and they will have sometimes an overstimulation and sometimes colors in certain ways can do that.

>> Carmen, thank you.

Your caller call let's go to next caller.

Hello, Eric.

Welcome to of Mind.

>> Eric, you don't know about avoidant attachment disorder and how is it treated avoidant attachment disorder Eric is also known as avoidant personality disorder and as you can infer by the name Avoid Attachment Disorder, people with avoiding attachment disorder will have difficulty attaching or having any kind of relationship with another person and they'll avoid relationships.

>> Here's the issue, Eric.

A lot of people with avoidant attachment disorder or avoidant personality disorder won't see the problem with themselves.

They just say well, you can't trust other people and they will prefer to stay away from other people.

It's not a psychotic disturbance so they don't have a paranoia necessarily.

They just have a sense that they don't really care to have any other relationships.

Now the issue will often evolve where they also had depression with that and with depression with avoiding attachment disorder, people will have low self-esteem and they'll feel badly about themselves and because of that they don't want to be around people.

So sometimes we have to sort out what the patient really wants to treat because quite frankly they won't come to me saying I have avoidant attachment disorder and I have difficulty with attachment to other people if that's truly what they have they'll have trouble with the task with other people when they find that life is no longer as enjoyable as it used to be and they have a clinical depression.

Clinical depression will cause you to have difficulty finding joy in social interactions you have difficulty with with anticipating fun activities.

>> You don't have fun.

>> It's called anhedonia and means no hedonism.

It's fun.

So people with difficulty with depression often have difficulty with social interactions.

People with avoidant attachment disorder will have difficulty truly with relationships because they just don't care to be around other people because of trust issues or difficulty with just wanting to have that relationship itself.

>> Eric, thanks for your call.

Disconnects Hello Brooke.

Welcome to Matters of mind, Brooke.

You want to know about obsessive compulsive disorder and ADHD?

>> How do they mirror each other?

They do go hand in hand sometimes, Brooke, but obsessive compulsive disorder is where people have unnatural ruminative thoughts.

They can't get them off their mind.

They don't they don't make any sense.

We call them ego dystonic thoughts but they have these round and round thoughts is kind of like the old record players where the needle would get stuck and when the needle would get stuck.

>> The you have the record player sticking on the same type of thing.

>> That's what happens with these ruminative thoughts.

They'll have thoughts about contamination.

>> They'll have thoughts about doubt.

They'll have thoughts about something going wrong and it'll be exaggerated and ruminative and basically with OCD the inside of the brain here that's the front part of the brain over here inside the brain just has this network that goes round and round and round like a needle getting stuck many times those obsessions will become compulsion compulsions or behaviors.

>> So you have the thoughts, the obsessions becoming behaviors which are compulsions, the behaviors are trying to mitigate the thoughts themselves.

So if you have this obsession about the possibility of contamination, what do you do?

>> You clean, clean, clean, clean and you clean excessively if you have a compulsion about safety you might check locks over and over and over again.

You might check your stove over and over again and you know, you already checked it but you keep doing it.

That's OCD now word is ADHD come at attention deficit hyperactivity disorder also involves racing thoughts but the thoughts are going from one thought to another to another and it's always there.

That's a big differentiation between that and bipolar mania where people will have racing thoughts periodically but with ADHD, with attention deficit disorder will have difficulty maintaining their focus for a long period of time because they are very frequently going to be daydreaming and kind of thinking outside the box.

>> Now if you treat ADHD sometimes it can make OCD worse.

>> If you treat OCD it can make ADHD worse.

The treatments are entirely different ADHD the treatment will be typically more dopaminergic and nor adrenergic .

>> So you're increasing dopamine and norepinephrine to try to get the front part of the brain up here fired up to be able to focus more.

However, if you increase dopamine and norepinephrine it can sometimes make the obsessions worse then sometimes people will notice their worsening of OCD if you only treat the ADHD now in other hand, if you treat OCD with a certain urging medication a medication it increases serotonin increasing serotonin excessively can make ADHD worse because it will actually decrease indirectly dopamine transmission.

>> So it's important that we kind of balance that out often as a patient if they truly have symptoms of OCD and ADHD, I'll ask the patient what's worse.

What would you like to prefer to treat first and we'll carefully treat one condition first twelve very closely observing the other condition and we might initiate treatment for the other condition commonly if it's still problematic for them.

But OCD and ADHD not uncommonly will go hand in hand for some people.

But the treatments are entirely different and the networking in the brain is entirely different as well.

>> Thank thanks for your call.

Let's go.

Our next email question are next email question reads You're not a favor.

>> How do you build empathy and understanding when a parent believes the child has control over all ADHD related behaviors?

It sounds like this question came from a therapist, maybe a teacher and you wonder OK, you have these parents who just don't understand ADHD and I would compare ADHD what analogy do I want to use for that tonight?

>> How about heart disease?

If you have a heart condition and you might notice all your friends and family members are able to go out and walk extended periods of time they might even be signing up for five runs and they're saying why don't you join us and you say well you know, get tired pretty easily.

>> My ankles swell up and I run out of breath very quickly.

I can't walk more than about four hundred yards and when I hear about people lacking empathy for other people they'll often preface their remarks with why don't you just so you'll hear comments like why don't you just go out and walk and keep working at it and doing it doing more and more and try to gradually build up your endurance?

Well what you might need to do is go see a cardiologist and see if the cardiologist can actually enhance your ejection fraction and make sure your heart's stronger.

>> So when I hear about ADHD there's different degrees of ADHD.

>> ADHD is highly genetic as a medical condition.

It's only it's only are passed by psoriasis a skin condition that is more genetic.

So ADHD is highly genetic.

It tends to run in families but there's different degrees to it just like there's different degrees of heart conditions.

So some people have a mild heart condition.

>> Some people have more severe heart conditions.

Same with ADHD.

So with ADHD it's a condition where people have trouble focusing on something that's not very interesting.

It's challenging and they have difficulty paying attention for a long period of time and they're easily distracted now.

>> Gee, from a historical standpoint if you were a hunter and a gatherer perhaps and you had ADHD that would actually be advantageous for you because you'd be the one to spot the bird and you'd be able to spot the edible plant before anybody else because you're able to focus on a lot of different things at one time but you can't focus on one thing for long periods of time that might not be that interesting for you.

>> People with ADHD often have higher IQ compared to people without ADHD so it's a matter of being able to work with it.

>> But if you have ADHD and you're in a setting that requires sustained attention span and lack of distractibility that could be problematic for you and that's where treatment becomes necessary.

>> And to use another analogy, I often use eyeglasses analogy .

>> Some people need eyeglasses for reading or even looking off a distance.

Other people don't and if you need eyeglasses because you just can't see very well, you know, they can improve your quality of life.

>> Can you squint can you sit closer to things?

Of course.

But your quality of life does improve if you can wear eyeglasses now looking back decades ago I remember when eyeglasses were a social stigma it was considered to be a weakness if you wore eyeglasses oh back in the 1960s and early 1970s back when I was a kid.

So if you wore eyeglasses back then there was a social stigma that people caused you called you derogatory names.

>> Well, fortunate we've gotten over all that now and now you can see kids wearing eyeglasses.

They don't have too much trouble with it.

Yeah, they might be uncomfortable but if they're really improving the quality of life if you can clearly see better with eyeglasses you want to wear them well that's the same way with ADHD if the ADHD is significant enough where it's impacting your ability to focus and concentrate on the things you need to do either in school or work or later on even in your marriage because wives will get very frustrated their husbands husbands can get frustrated or wives if this spouse has ADHD because they are perceived as being inattentive and they often will lack tact, people with ADHD will often say what they think before thinking it through and they will be so unfocused they'll be thinking three steps ahead of in conversation they'll finish sentences and it can be very annoying to be around them.

>> So in the marriage, in the workplace, in a school environment if you have a degree of severity with ADHD that can be problematic.

>> So I think in terms of established empathy for ADHD same as establish empathy for a heart condition, nearsightedness that needs to be understanding of what it really is and how it affects somebody.

It used to be thought that everybody grew out of ADHD by the time they became an adult.

>> Now we know that about 90 percent of people do carry some symptoms of ADHD into the adult years usually inattentive symptoms.

>> The hyperactivity impulsivity will often settle down in childhood but now we know there are some symptoms of ADHD that can go under the adult years.

But in your adult years you can choose your job environment and you can choose your environment more so than you can when you're a kid where you have to sit in the classroom and maybe study and learn things that you don't find that interesting as an adult you can choose to be involved in different environments where there are more interesting.

Thanks for your email.

Let's go to next caller.

Hello Felix.

Welcome to Matters of Mind.

Excuse Felix.

>> You want to know what are the benefits of taking Bew Spirent for anxiety abuse spiritism medication that will affect one of the 14 different serotonin receptors so there's 14 different serotonin receptors in the brain.

>> There are identified by letters and numbers and abuse.

Birhan will have a partial effect on serotonin one A receptors.

>> What that means is partial agonist effect.

It means that if there's too much serotonin in the area it will block serotonin if his too little serotonin in the area it makes the brain fooled into thinking you have more serotonin.

>> So the bottom line is you power kind of works as a thermostat for serotonin and it's particularly good for worry.

It's not that good for panic.

It's not that good for social anxiety.

Certainly not that good for postpartum stress disorder, not that good for obsessive compulsive disorder.

But if you have what's called generalized anxiety and are prone to worry and ruminate about stuff that can happen in the future and then what if what if what if yeah.

>> that's where Abuse Biron works out really well.

I treat a lot of college students who worry excessively now I'm always telling college students do not drink alcohol, do use marijuana as a means of mitigating your anxiety because they'll often make your concentration worse.

>> But if a little bit of anxiety is really good a little bit of anxiety sharpens you up, sharpens your concentration, sharpened your motivation, it makes you want to get stuff done.

>> A little bit of anxiety is great but when your anxiety becomes overwhelming and you find yourself worrying to the point where you can't study, you can't concentrate, you can't sleep you Spirent is a non sedating medication that's typically taken twice a day anywhere between five milligrams twice a day up to thirty milligrams twice a day typically it doesn't have too many side effects.

Some people will get these weird side effects early on where they can have dizziness and double vision but most people will find that it's a non sedating means of relieving anxiety without any addiction potential because it's affecting serotonin receptors and it's very selective in what it's doing there.

If you give somebody a serotonin reuptake inhibitors like Zoloft, Lexapro, Prozac, Celexa, these medications are spraying serotonin in the entire synapse and stimulating all 14 different serotonin receptors.

>> Some of them you don't want to stimulate.

They'll give you side effects with these byroade it's very selective in just going to one of those fourteen serotonin receptors and in doing so gives you fewer side effects and it's very specific in what it does.

>> Felix, thanks for your call.

Let's go to the next caller.

Hello Deb, welcome to Errors in Mind.

Deb, you want to know if I could explain the difference between bipolar disorder and just being high and low?

Well, bipolar disorder by definition Dabb means that you have functional impairment.

It means that you have problems when you're getting on the high side and or the low side.

>> So by definition, you know, it's great to have a good day.

It's great to have a high energy it's called hyperthermia and some people have more energy and more get up and go and motivation in the air than the average bear.

>> So that's good.

>> But when it's causing functional impairment where you're having trouble getting your work done, being able to sleep, being able to concentrate, being able to interact with other people, that's where by definition it's a disorder.

>> A disorder means you have a functional impairment.

So if the highs are causing you to have difficulty with being able to get done what you need to get done every day that's a problem some people, for instance, could get by on four and five hours of sleep a night excuse four and five hours sleep a night.

>> You think that's not very much?

Well, if they are consistently getting by on four or five hours of sleep a night and they're feeling refreshed and they can concentrate and they have energy the next day great .

But if they notice that they get by on four or five hours a night for about three or four nights then the crash and they need ten hours of sleep thereafter they're having these highs and lows and when you're having highs or lows and they're getting you into trouble during the highs, for instance, people will often get into trouble with doing things and saying things they ordinarily shouldn't do or say they regret it afterwards they think oh I'm so embarrassed.

Why did I do that?

For whatever reason, a lot of people go off to Las Vegas when they are on the high side.

They spend money, they get involved in relationships that they later regret.

Those are manic highs that are abnormal, natural, high and low.

>> It's called a vicissitude of your mood.

A vicissitude is is where you just have these normal fluctuations.

>> You might have a good day because things are going pretty well for you.

It might be sunny or that day there might be influences why you feel better on some days many people will feel better.

>> For instance when they exercise on certain days they're just feeling pretty good then other days they can kind of feel disappointed their favorite basketball team loses a game.

They are having some difficulty with the boss.

They're having trouble with their relationship with their kids and they're kind of disappointed but they're not incapacitated by that.

>> So we should have normal vicissitudes of mood where we have natural highs and lows based on our circumstances in life .

But when you have this unnatural polarity of your mood where you're going sky high or really low, that's called bipolar disorder and that's what needs to be treated with the mood stabilizers in which I referred earlier.

Deb, thanks for your call.

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

Our next e-mail question reads over My doctor has prescribed medication for depression and anxiety even with a medication I worried that I'm getting worse.

What should I do?

I'd be very concerned about that as if as your doctor because if you're feeling worse on a medication you're going in the wrong direction.

The medication should help you feel better.

That's the number one priority.

The number two priority is the medication to be tolerable.

Now granted it needs to be tolerable enough for you to take it but quite frankly a lot of people who I see who say they feel better with their medication dramatically better they're able to put up with a few side effects here and there .

>> So the number one priority is to get you feeling well and help you feel normal if you are feeling worse and you're on a medication for anxiety depression I'd wonder is if the diagnosis is appropriate.

For instance, some people will have bipolar disorder.

We've mentioned that several times a night if you have unnatural highs and lows and you take an antidepressant by itself it's like pushing on an accelerator without having any brakes.

You do this will get worse.

>> You'll feel more anxious.

You'll go into the high and the high might not be very pleasant.

You might notice you get more irritable, you have more trouble with sleep, you have racing thoughts, impulsivity not a good experience.

>> So if you're feeling worse with any medication, contact your clinician, try to go back and sort out OK, what's really going on here?

Why are you feeling worse now?

Some people just don't do well with certain classes of medication because it's not a good genetic fit for you if you have any family members who have had similar symptoms let your doctor know that not only have they had similar symptoms but what kind of medications they've taken good or bad over the course of time.

Deb, thanks for your call.

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

Our last e-mail question regional to favor is a relationship between having low energy and instances of depression sometimes I'm feeling especially tired when I also feel depressed.

Yeah, depression and low energy can go hand in hand if you have depression and low energy.

I want to make sure you don't have low thyroid.

I want to make sure you don't have sleep apnea.

I want to make sure you don't have diabetes or low iron so I want to make sure you don't have these medical conditions.

>> But if you're tired that can be a symptom of depression itself.

Thanks for your email.

Unfortunately 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 Internet at matters of the mind.

Oh one word at WFA Egg I'm psychiatrist offer and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing and PBS willing of available next week.

>> Have a good evening.

Good