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Cameron Psychiatry.

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

More information available at CameronMCH.com.

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Good evening.

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

Welcome to Matters of the Mind now in its 10th year Matters The Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if we have if you have any questions concerning mental health issues, you may call me in the Fort Wayne area by dialing nine seven or (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) 27 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 at WFA EDG that's matters of the mind at WSW ECG and I'll start tonight's program with a question I recently received by email that reads Dr. Fauver, could you please explain the difference between obsessive compulsive disorder and obsessive compulsive personality disorder?

>> They sound very similar, don't they?

Well, I don't like the terminology but that's the terminology we have in our Diagnostic and Statistical Manual that we use in psychiatry.

Obsessive compulsive disorder is an anxiety condition.

Obsessive compulsive personality disorder is a personality disorder that causes a degree of functional impairment and getting along with other people.

>> So let's break them down.

OCD obsessive compulsive disorder as a condition where the brain's circuitry kind of gets stuck in this loop here and it goes round and round and it's kind of like the old record player is where the needle gets stuck and you have obsessive thought on your mind and obsessive thought being a thought that's unwanted.

You don't want to be there.

You think it's silly for it's there and you get annoyed by that obsessive thought being there and sometimes people them progress to having compulsions to try to get rid of a thought by Washington washing and washing because they perceive unnecessarily that they are unclean.

>> Some people will check things over and over again because they have this unwanted thought that the doors are locked or they left the stove on even though they remember turning the stove off but they go back and check it again and again and again.

>> It causes them problems because they're late to getting to different events.

That's obsessive compulsive disorder or OCD obsessive compulsive personality disorder an entirely different phenomenon which basically is a fancy term for perfectionism to a degree that it causes to haveh other people.

>> So people with obsessive compulsive personality disorder will have perfectionism where they want things done their way.

>> They want them done in just the right manner and they do not want to delegate it to anybody else.

>> They are often list makers.

They are very good with schedules but they get on everybody else's nerves because they can't allow other people to do some of the work that needs to be done and they get upset because the work's not getting done because the person with obsessive compulsive personality disorder can't do it all him or herself.

>> So they get more and more irritated about that.

But these people are perfectionism individuals.

>> So when you think about obsessive compulsive personality disorder being a perfectionist is necessary to a degree if you're a physician, if you're an attorney, if you're a carpenter, you know, measure twice, cut once.

>> I mean you've got to be a perfectionist.

You wanted to have it done right.

But people with a OCD or this type of perfectionistic disorder go to a certain degree where it's got to be done their way only and they can't see gray areas where the project can be done successfully with other ideas or maybe with other different approaches.

>> So people with obsessive compulsive personalities or don't appear to have disturbers is and brain circuitry.

It's a trait that progresses to a disorder because they have trouble with getting along with other people and it causes them to have difficulty with interpersonal relationships.

>> It's difficulty in a job environment and sometimes people don't want to work with them.

>> So there's different treatments there.

You know, people think well gee, what do we have to have all these diagnoses in psychiatry?

>> Well, it's the same reason why another medical conditions you need to have diagnoses if you just say I have chest pain, the clinician has to understand OK, is this chest pain from a heart attack?

>> Is the chest pain from a pulmonary or pulmonary embolism where you have a clot in your lungs is the chest pain from heartburn?

What's the chest pain?

What's the origin of this chest pain because you're going to treat it entirely differently based on the diagnosis and that's important with OCD versus OCD with obsessive compulsive disorder we are going to use a certain type of therapy to help a person address the unwanted thoughts and we're going to use medications with OCD that are primarily serotonin medications often in high doses because it seems that the serotonin medications will dampen this circuitry going around and around around that's causing those unwanted thoughts that are just hanging on, hanging on, hanging on with obsessive compulsive personality disorder.

>> If a person is receptive to therapy, the whole purpose there will be to help them understand how their perfectionism and their rigidity and doing things their way all the time is getting on other people's nerves and calling them out on certain circumstances where it's caused them problems.

So with OCD is going to be more of a psychotherapeutic approach and we only use medications with obsessive compulsive personality disorder whereas we certainly do with absolute obsessive compulsive disorder.

>> Thanks for email.

Let's go to our first caller.

Hello Carmen.

Welcome to Mastermind Carmen.

>> You want to know what are the benefits of a support animal and what mental disorders benefit from support animals?

I'm going to broaden your question there, Carmen initially here and just talk about pets in general.

>> Pets are fantastic for mental health in general because whether you're a dog or a cat person I have one of each so I can speak in an unbiased manner.

>> They give you responsibilities, they give you company, they give you a reason to get up every day not uncommon.

>> You need to feed them dogs especially need to take them for walks.

>> So there's emotional benefits from having a pet in a lot of different ways as long as you get past the allergies, the expense associated and so forth.

>> So pets can be very helpful and emotional support animal you get extra benefits, extra privileges there you have to have the proper training for these animals and you have to have somebody who's willing to assume the liability that your animal has been properly trained to get the extra benefits that you could get with an emotional support animal.

>> But just in general, pets can be especially helpful when we talk about people who are we are especially likely to recommend that they obtain pets.

>> It'll be people with autism, post-traumatic stress disorder not uncommon, not uncommon people with chronic depression when you have chronic depression, one of the issues you'll have is you don't want to get out of the house and you don't want to have duties and responsibilities in those cases maybe a dog might be helpful because a dog requires that you get up in the morning and walk him or her, get him outside, make sure they are fed dogs often are going to be more in your face whereas cats are going to be more passive so people with depression might do better with a dog and a lot of cases although there's going to be a lot of people that be willing to argue with me on that that cats can be more comforting with people with depression but with any pet the whole idea that they give you a responsibility, they give you interaction and many people that have difficulty interacting with people will indeed have very good interactions with pets.

We see this not uncommon with people with autism.

>> Thanks for your call.

Let's go to next caller.

Hello, Tim.

Walking to matters of mind.

Oh yes.

Dr. Faulkner, I had a question regarding a pharmaceutical drug for depressed.

This kept Leida and one of the side effects was suicidal thoughts.

I just how can you prescribe something like that if it gives you suicidal thoughts?

One part of the brain has those thoughts.

>> Tim Yeah.

Tim kept light as a medication.

It was approved for the purpose of treating not only psychotic disturbances but also depression.

All of the medications that will affect the brain have that warning on them and it's not the nuts.

>> The Food and Drug Administration is not necessarily saying that their drug is causing suicidal thoughts.

>> It's just that if you're taking a medication that has a mood component to it, including depression, the mood component will often be accompanied with suicidal thoughts and because of that they put that package labeling on any medication being used for depression, bipolar depression in the case of supply to the whole ideas it's not that the medication is causing suicidal thoughts.

>> We have to watch for those kind of conditions now word of the war is the suicidal thoughts precaution and warning originate well where that originates is twenty five years ago they did studies on children, adolescents and young adults with certain serotonin antidepressants and a serotonin and norepinephrine antidepressant by name of the vaccine and with some of these children, adolescents and young adults up to twenty four years of age with some of them that increased suicidal thinking and even suicidal behaviors as they started on the antidepressant medication they were studying these medications and these young people and what they were noticing was that some of them had an activation of racing thoughts they didn't need to sleep.

They were impulsive nowadays looking back twenty five years ago we'd say well gee, those children, adolescents and young adults, they didn't have depression per say they had more bipolar depression that was being activated by the antidepressants.

>> So we know as health care clinicians that if an antidepressant medication is activating you excessively that increased activation excessively can actually-incread quite frankly that suicidal thinking is in the front part of the brain.

If you have a if you have disturbances and serotonin functioning in the front part of the brain so as you have decreased serotonin functioning in the front part of the brain, that's where you will have increased suicidal thinking.

>> Will these medications are affecting serotonin in a good way.

So the studies have actually shown just the opposite of what the Food and Drug Administration precaution showed in the package inserts the studies are showing that if you take an antidepressant for depression you're three times less likely to become suicidal compared that if you don't take a medication for depression.

So it confuses a lot of people understandably you'd wonder about that.

>> But with Cap Leida it's a medication used more has a mood stabilizing medication when you're using it for mood disturbances but all medications used for depression are going to have that precaution on there.

>> Just informing us that when we assess somebody for depression we always need to ask about thoughts of death or sorts of suicide and your clinician might do what's called a patient health questionnaire not with nine questions.

It's called a Q nine nine.

The ninth question has to do with have you had thoughts of death or thoughts of harming yourself?

>> And if you say yes to question number nine then we'll go ahead and follow up and ask a lot more questions about the nature of those thoughts.

>> So the whole idea of taking any medication for mood disturbances will be that we as clinicians have the responsibility to follow up to ask about suicidal thoughts or behaviors.

Now do some people have suicidal thoughts or behaviors with while taking some of these medications for mood disturbances?

>> Sure, but the cause and effect relationship is controvert Cassiel and as the twenty five years have progressed I think on occasion the Food and Drug Administration actually speculate that they might they might need to take that warning off of the package labeling of all these medications because as you can expect because of that concern a lot of primary care physicians especially decreased and even eliminated the prescribing of antidepressant medications to children, adolescents or young adults and you might think, oh, that's great.

>> Well, the prescribing for antidepressants to children and adolescents and adults, the young adults decreased by 20 percent within years after that warning was put on the label and that sounds wonderful let's say antidepressants for these younger people.

Well, the problem is their suicide rate increased by 20 percent direct relationship possibility.

A lot of other things are going on in our society right now but the suicide rate is increasing despite the antidepressants ascribing to that population under twenty four years of age being decreased.

So right now there's speculation of whether that warning should actually be on there or not.

>> But the bottom line is as clinicians we need to be vigilant in watching for anybody having difficulty with agitation, irritability or decreased need for sleep anytime we start any medication for the mood.

>> Thanks for your call.

Let's go to next caller.

>> Hello John.

Welcome to Matters of Mind.

John, you'd wonder if magical thinking is a real thing and how disruptive can it be into your life ?

I'm not really clear what you're referring to as magical thinking, John.

Magical thinking can be considered to be if it's a delusion where it's a fixed false belief.

>> Yeah, that can be problematic.

A fixed false belief, John, is where you perceive that your neighbors are are putting something in your automobile to make it knock and do things inappropriately even there's no evidence of that and people who have delusional thoughts have fixed false beliefs or fixed in sense.

You can't talk them out of it and they're false because they're not true and they can't possibly be true.

So fixed false police are delusions that can be problematic for many people that is indeed a psychiatric disturbance which is affecting this part of the brain over here by the hippocampus.

The hippocampus is on top of the temporal lobe here on the yellow part of the brain.

The hippocampus is thought to be disrupted when people have delusions with fixed false beliefs.

>> So it's a neurobiological disturbance and some people refer to that as magical thinking but perceiving that you can do magic and you can do things that are extraordinary could be a delusion.

We call it a grandiose delusion in some cases.

But again, if it's a fixed false belief there's no evidence that of a happening.

Yeah, that would be a psychiatric disturbance John.

John, thanks for your call.

Let's go to our next caller.

>> Hello, Tim.

Welcome to Matters of Mind.

Tim, you want to know if there are alternatives, natural alternatives to anxiety medication?

>> Well, let's take the herbal medications off the board then because you know certain herbal medications like Theunissen which is the natural ingredient in green tea that can be used for some people as a natural alternative to prescription anxiety medications.

But the best way to treat anxiety, Tim and from a natural perspective will be to increase your aerobic exercise and actually your weight resistance exercise would be good for that too.

So resistance exercise anaerobic exercise can both be very helpful for anxiety.

It's thought that aerobic exercise is actually better for depression and weight resistance training might be better for anxiety in general because when you're lifting weights you're tensing your muscles and as you're tense your muscles you make your muscles tired.

When your muscles are tired it's more difficult to tense them.

So that often is a means by which people can get relief of anxiety.

So exercise by all means is the best way to naturally relieve anxiety.

There are a lot of different breathing exercises, breathing techniques people can use.

>> I mentioned earlier having a pet in the household having a dog or a cat can be helpful for many people with anxiety.

But the main thing about anxiety you want to remember is to try to get your sleep on a night by night basis and if you need pharmaceutical means of helping you at least get on the right track that can be helpful because many people with anxiety they get in this rut where they will stay awake at night worrying and they start thinking and ruminate about things when the lights go out with a lack of sleep.

What you'll notice is the front part of your brain doesn't work so well so you need to have sleep to give your front part of your brain a reset and allow it to rest and be able to function better the next day the front part of your brain, your judgment part of your brain, the front part of the brain is you're thinking part of the brain, the part of the brain that allows you to make good decisions if not sleeping the front part of your brain will not work and that's where it's really helpful for people to get a good night's sleep.

>> Sometimes it's a matter of them getting a two or three week time period where they're able to sleep better but very importantly if you're having difficulty with sleeping and pthat's resulting in anxiety, it's important for you to get up the same time every day even though you might not want to get up at that same time every day and go to bed the same time every night.

>> And in general people need about eight hours of sleep.

People ask me that all the time.

Seven to nine hours of sleep is the range.

& If you awaken in the morning and you're pretty awake and you are waking without an alarm clock, that probably means that you've got enough sleep.

>> Thanks for your call.

Let's go next next caller Hello Kitty.

>> Welcome to the Mind.

>> Katie, you ought to know about your daydreams.

You're making it difficult to complete it, making it difficult for you to complete task.

What can you do to stop drifting off and stay focused while Katie sometimes people daydream excessively and when you daydream excessively it often means that the challenge ahead in front of you might not be to your liking and you are often going off in a different world.

Obviously you catch yourself with daydreaming.

Many people with attention deficit disorder will daydream excessive because their brain is well like a squirrel.

>> It's going from one area to another to another to another and that's a phenomenon that occurs with attention deficit disorder.

>> So if it's a medical condition like 8D that can be a factor otherwise it's a matter of trying to catch yourself in the daydreams and making sure what you have in front of you is challenging enough to keep your mind on it.

Let's go to the next email our next email reads Dear Dr. pFauver, is it beneficial for my wife to attend appointments with me when I see a psychiatrist?

>> Are there things that she may learn that may be helpful in my treatment having a spouse accompany you during your treatment sessions with a psychiatrist is fantastic.

>> Now granted, sometimes there might be instances where you want to see the psychiatrist one to one but in many cases we call this collateral.

We call this collateral information where we're getting the spouse or a family member just give us extra information about how a person is doing as long as that person the patient is having a trusting relationship with that family member and is willing to have them on the line during a video visit or during the appointment itself in person.

So having a spouse come in is really helpful because as a patient you're with yourself all the time so you might not notice how things might have changed day to day, week to week and your spouse is going to notice things about you and if your spouse is don't you for a matter of months or years or decades.

Sure they're going to have a perspective on knowing your full potential and knowing that you're not right where you need to be and your spouse is also or family member for that matter is going to notice when you do have improvement they will often be the first to know you'll notice it eventually but the spouse or the family member will often notice the improvements.

So we find the spouse, a family member, a company accompanying the patient during the visit itself can be very, very helpful.

>> Thanks for your email.

Let's go to next caller.

Hello Tasha.

Welcome to Matters of Mind Toshie want to know about heat exposure.

>> How does it affect your brain?

Basically if you have excessive heat exposure and you you have heat stroke for instance you'll have differences in the density of the brain difference since and the fluid retention sodium in the sodium flow of the brain.

So it could be a very dangerous kind of phenomenon when the brain gets overheated the brain is very sensitive to change including glucose and temperature changes so you can get delirious first and you can die from excessive heat.

But that's there's a lot of different factors going on there.

But it has to do with with fluid balance has to do with sodium how the glucose is being able to be metabolized in the brain so there's a lot of different factors there but the brain can be very, very sensitive to heat and it's important to get enough fluids especially in these hot days of summer.

>> Tasha, thanks for your call.

Let's go next caller.

Hello James.

Welcome to Matters of Man James.

You ought to know about the causes of schizophrenia.

James, we'll start with a genetic component of it.

>> It has a slight genetic component if you have a first degree relative, a mother or father especially you have about a 12 percent chance of developing schizophrenia yourself whereas the general population is about one out of 100 chance or a one percent chance of developing schizophrenia.

So having a parent with schizophrenia increases your likelihood by about 12 times having a brother or sister was schizophrenia increases your likelihood by about eight times.

>> So for one thing there's a genetic component.

>> Secondly, there's a environmental component if you're raised in a loving environment where the family was very close, emotionally bonded, a lot of communication going on within the family that will help.

But the problem with schizophrenia from a neurobiological standpoint it often develops in the to some degree.

>> So as a child who is prone to having schizophrenia, you might naturally be somewhat emotionally aloof and detached and there are autistic features that occur with people who are predisposed to having schizophrenia such that they have a difficult time with social interactions and social cues from other people So we hear about these pretty morbid symptoms of schizophrenia occurring during childhood and adolescence and over the course of time we see that about 80 maybe seventy five percent of those people can go on to schizophrenia having& schizophrenia but yet twenty to twenty five percent of them don't.

>> But those early morbid symptoms can include the socially socially awkward type of experiences more so than you'd expect during the child and adolescent years.

You might notice that these people with pretty morbid symptoms are much more anxious.

They have difficulty just taking care of themselves to a greater degree than you would expect.

>> They will have difficulty with kind of hearing things in the background.

They'll have these very soft or quasi psychotic type of symptoms that we have to watch very carefully so you can see some of that developing in adolescence.

Well, what happens if an adolescent is kind of anxious and they feel socially awkward if they gravitate more toward try and marijuana marijuana can trigger those symptoms of schizophrenia which can be a lifelong condition.

Marijuana can increase the likelihood of developing schizophrenia by some studies by as much as 200 times.

So this is why I'm very apprehensive as a psychiatrist to advocate for the legalization of cannabis in the state of Indiana.

We have surrounding states that are very openly legalizing the recreational use of marijuana.

The problem with that is if you're under twenty four years of age, especially if you have a sensitivity or a family history of having schizophrenia that's a big, big trigger for you.

>> So I'm telling a lot of high school kids kids going off to college don't use marijuana especially before the age of twenty four because it can trigger a lot of emotional and cognitive disturbances and catastrophically it can actually precipitate a psychosis such as schizophrenia that might not have developed had you not used marijuana.

>> So it's a very easily preventable way of eliminating schizophrenia.

>> If you don't use marijuana it's going to be a factor that could possibly decrease the likelihood of people developing schizophrenia over the course of time.

>> Thanks for your call as your next caller.

Hello Shannon.

Welcome to Matters of Mind.

>> Shannon, you want to know about the benefits of a support group versus individualized therapy for the nice thing about a support group?

Shannon will be you'll be able to hear the perspectives of other people who have endured circumstances such as yourself and that's very comforting and it's a way of understanding what other people have gone through and how they've dealt with certain situations in a good way or a bad way.

In other words, if they've had regrets on certain things they did, they're going to tell you so a support group is a way of connecting with other people who've who've had shared experiences that's not only for grief but that could be for a lot of different kind of conditions.

Individualized therapy is where a therapist is going to talk about all of your issues and you're going to try to break down things and you'll go back into a very personalized history and how you dealt with things in the past coping mechanisms, different stressors going on in your life now and you're going to try to break those down one by one by one and try to deal with things individually but as a support group like the name implies gives you support from a lot of other people.

Shannon, thanks for your call.

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

If we have another email question possibly no, we don't have another email question.

>> We have a oh well in that case I'll go ahead and shut her down for tonight then I'm psychiatrist Jeff Offer and you've been watching matters of mine on PBS Fort Wayne.

If you have any questions concerning mental health issues you may contact me via the Internet at Matters the Mind at WFB org and I'll try to answer your question on the air God willing on PBS willing.

>> I'll be back again next week.

Thanks for watching.

Have a good night Cameron Psychiatry.

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

More information available at CameronMCH.com.