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

Welcome to Matters of the Mind now in its twenty seventh year matters 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 give me a call in the Fort Wayne area by dialing (969) 27 two zero or four calling any place else coast to coast you may call toll free at 866- (969) to seven to zero now a fairly regular basis.

I am broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

And if you'd like to contact me with a question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFYI Vague that's matters of the mind at WFYI Eigg and I'll start tonight's program with a question I recently received.

It reads Dear to the Father my grandson who is 21 years old has been diagnosed with ADHD Attention Deficit Hyperactivity Disorder and has had difficulty holding the job.

He's used marijuana and alcohol and had scrapes with the police.

He's not been willing to stay on medication, seek counseling or life coaching.

Currently he seems to self medicate with alcohol.

Is there anything that can help him?

There's a lot of things that can help him and it's always the chicken or the egg phenomenon alcohol and marijuana will typically make underlying ADHD worse.

>> But you might wonder well why does somebody use alcohol marijuana when they have ADHD?

It's because of the underlying anxiety because ADHD will cause people to procrastinate.

They get behind their misplacing things.

It creates a lot of anxiety.

So many people at a young age often as an adolescent will start using marijuana which makes people not care.

>> And so they don't care.

>> They just feel better and sometimes ADHD will actually help people feel happier.

It's the ADHD treated with marijuana will actually make people feel happier.

>> It's not a good phenomenon to have because when you have ADHD and you use marijuana it actually slows the growth of the front part of the brain.

>> So marijuana suppresses the white matter, the growth of the brain white matter is like the brain's natural insulation and the bottom line is it will cause ADHD to be worse especially if you're under twenty four years of age at the age of twenty four years old.

That's when the brain is fully developing in front.

So is the brain still growing?

If you're using marijuana it suppresses the growth so it's twenty one years of age.

Your grandson is not helping his brain out by using marijuana or alcohol.

So the key would be to try to help him get proper treatment to deal with the anxiety that is leading to his being self medicating with the alcohol and marijuana and marijuana.

>> Now I wonder if he doesn't stay on medication.

Chances are he's not been on medications that have helped him.

It's the same with nearsightedness.

If somebody can't see things at a distance, if they get the right eyeglasses or the proper corrective lenses, they want to wear their glasses.

They want to wear the corrective lenses.

You don't have to remind them if you give them eyeglasses that are uncomfortable they don't fit well.

They don't have the proper lens strength and they can't see that much better.

They don't want to wear eyeglasses the same for ADHD if somebody is on a treatment that's not helping them that much for their focus and concentration and they're still thinking a lot of anxiety they're often going to medicate themselves with alcohol and marijuana once they've reached out and tried those different things.

At least they don't care about things so much so the anxiety they're experiencing doesn't bother them so much.

The problem is in the long run it's not a good long term solution.

>> So we have medications for ADHD that are non stimulants that actually do a particularly good job for anxiety.

There are medications that are stimulants that if you help with the focus and concentration often the anxiety will subside.

So there's a lot of different medication treatment options out there.

There's coaching options that your grandson could have in terms of helping with the anxiety itself.

But I would really emphasize he so that hey up the age of twenty four years old, his front part of the brain is still growing and alcohol and marijuana can give him detrimental outcomes such that he might have difficulty with brain development long term.

>> We used to think that if somebody simply stopped marijuana and alcohol before the age of twenty four years of they wouldn't have long term difficulties.

Now it appears that you can still have long term problems if you used marijuana and alcohol extensively before the age of twenty four years old because your brain is extensively growing at that time.

>> Thanks for your email.

Let's go to our first caller.

Hello Cheryl.

Welcome.

The mayors of mind I'm sure you had mentioned you're a teacher, you're out of school for the summer but you're still having a lot of anxiety.

Can there be underlying issues, Cheryl, as a teacher, you know, I'd like to thank you for your service just like I would think somebody in the military because I know it's tough being a teacher now as a teacher I'd wonder are you a relatively new teacher?

>> Are you a teacher who's very experienced?

Your source of your anxiety was the anxiety due to this particular group of students and sometimes that anxiety will carry over.

>> It's kind of like a traumatic event where if you've had a lot of anxiety due to ongoing trauma for a period of time, sometimes even in the trauma is has been eliminated or no longer exposed in your life you will still have anxiety that will kind of carry over.

So that could be some of the issue there issue here with teachers will be they will be kind of anxious in the summer because they're wondering what they're going to do.

It can be a relief that they're out for the summer but they're kind of uncertain and they have that lack of structure during the summer months and then some teachers will start to feel anxious even in the month of June about what's going to happen next August and September with a new school year and they start feeling anxious about the plan about the new class of students and so forth.

So I think the key would be to try to identify the source of the anxiety right now and try to deal with that the best you can knowing that next school year will be hopefully different with experience with your wisdom of the years of experience you have year by year by year that should help mitigate the anxiety because you'll have that experience behind you.

I would strongly suggest that you contact and stay in close communication with other teachers over the summer and kind of share war stories and share coping strategies to try to maintain all their stress.

Resilience is to get through the summer and be able to better cope with next fall.

Cheryl, thanks for your call.

Let's go to our next caller.

Hello Craig.

Welcome to the Mind.

Greg, you want to know what's the treatment for poor impulse control?

I think the treatment for poor impulse control Greg Craig would be to try to identify what's causing the poor impulse control.

There's many different things that will cause people to do things and say things that they ordinarily shouldn't or wouldn't do or say.

So if the poor impulse control is due to a street drug, that's kind of a no brainer if it's due to alcohol, if it's due to a stimulant, if it's due to narcotics and when you use those substances of abuse you get yourself into trouble.

>> OK, you need to address these substances of abuse that might be causing the poor impulse control if the poor impulse control is very episodic just here and there and it's not related to drug use, the poor impulse control could be related to a mood disturbance like bipolar disorder.

Bipolar disorder will be manifested where people have manic highs and then interaction lows during the manic highs people will speak faster.

>> They'll won't need to sleep.

They'll have poor decisions during that time and during that time they'll have the impulsivity with the bipolar disorder itself.

>> There's also a phenomenon called ADHD.

We talked about that earlier with the twenty one year old grandson with ADHD ADHD that means hyperactivity and also alludes to poor impulse control.

If you have ADHD on a day to day basis you can have impulsivity.

There's a phenomenon that's a mood disturbance they call borderline personality disorder.

It's where people will have moodiness and impulsivity kind of on a day to day basis but it's very much provoked by environmental and interpersonal stimuli.

So when stuff is happening in the environment or you're having interpersonal relationships that are that are stressful for you that can cause a person to be more impulsive if you have borderline personality disorder and finally there's a psychotic disturbance schizophrenia for instance, that will cause people to lose contact with reality and during that time or they're psychotic and they're losing contact with reality, you can have more impulsivity and at that time do things and say things that are out of the ordinary for you.

So there are various types of disturbances with impulsivity and it's based the type of those disturbances that we would try to address the actual problem itself.

>> Thanks for your thanks for your time.

>> Thanks for your call.

Let's go next e-mail question our next e-mail question regional to favor my anxiety level has increased dramatically recently to lower my anxiety in addition to my medication would help at all to try essential oils.

I've seen them advertise on TV and the people claim they've gotten good results.

The issue with essential oils is they are difficult to study and it's very much anecdotal reports like you're hearing on the TV advertisements because people will say essential oils will give them a calming effect lavender, lilac, all sorts of different smells peppermint can be helpful but how would you study it?

>> How do you get a placebo essential oil because it's very difficult to do that.

You know that you're getting the scent or not.

So if it's medication in development for instance, you get the medication versus placebo that looks just like the medication and you have half a group people take the real drug and other half take the placebo.

You figure out who's going to do better with essential oils is difficult to study.

So it's very anecdotal and the bottom line is if you feel like it's giving you benefits not only short term but long term, that's great.

And the good thing about essential oils they often aren't harmful unless you're using a delivery system that is getting you a toxic effect on the lungs.

>> My biggest concern about essential oils will be the oils themselves if you breathe them in they can give you a very toxic effect on the lungs.

>> We used to think oh my goodness 30 years ago that vaping seemed like it was relatively safe and then it was discovered that the vaping devices themselves could release chemicals into the lungs.

>> It literally would coat the lungs and cause you to have significant respiratory problems.

>> I've heard the same issues on occasion with essential oils so it's just very important to be careful about the delivery device of the essential oils but otherwise is very anecdotal .

If it seems to help you that's great.

A placebo effect will last for maybe four to eight weeks at the most.

In other words, something that has a placebo effect might help you for a while then it kind of fades in its effect.

If it's not a placebo effect it should give you long term benefits.

So that would be where you'd use the essential oils themselves.

But if you use them appropriately and they don't give you respiratory problems, they can have potential for anxiety and giving people a calming effect.

People will use them sometimes for sleep as well.

Thanks for your call.

Let's go our next caller.

Hello Tracy.

Welcome to the line.

>> Tracy, what you you wanted to know what's it mean to have no childhood memories?

It's difficult to say, Tracy.

>> I wouldn't make that a diagnostic implication.

You could always speculate that if you have no childhood memories you must have had bad stuff happened in your childhood and maybe but maybe not.

So you can't make that a diagnostic assessment if you have no childhood memory sometimes because things happen in your childhood where you couldn't articulate those memories well enough in your brain for instance, if you had difficulty with verbal development, it's your verbal development and your ability to articulate thoughts that lead to memories as a child.

That's why typically you won't have memories of a child as as a child before you're able to speak.

So as you're able to speak you're able to have verbal articulations of those memories verbally.

>> You can then download those memories into your memory center so perhaps you wouldn't have that many memories as a child because you didn't you couldn't think through the memories to be able to download them into your brain.

Also something else that happens as your brain grows.

There's a phenomenon called apoptosis where you actually have a shriveling up of neuron branching that's no longer necessary.

So does your brain perceive that those memories you had as a child weren't that important to be able to retain?

If that's the case, those little neurons kind of shrivel up and you don't have those memories anymore.

That's not a problem necessarily.

That just means your brain's trying to free up more space for current memory.

So for some people they won't have that many memories of events that might have occurred that other people in their family or their friends might have recalled very well.

You might not have recalled those types of memories because your brain didn't perceive that it was important enough to be able to to retain.

So some memories we just kind of push aside.

They can sometimes be stimulated with certain recollections to to come back but it's not a diagnostic issue if somebody doesn't have memories.

>> I remember thirty years ago there was a phenomenon called false memory syndrome where people were talking to therapists about these very issues either not having memories as a child, having dreams about family members who were might have been abusive to them.

Therapists inadvertently back in the 1990s were telling patients at that time, oh, you must have been abused.

You must have experienced trauma that is really irresponsible and was found to be irresponsible and that's the whole phenomenon of false memory syndrome.

It's where your memory might be symbolic of something else that happened but it's not necessarily deterministic that something did happen and it was very harmful to a lot of families when these therapists were telling patients at the time that because they didn't have memories as a child they must have been traumatized because they were having violent nightmares, they must have been traumatized.

You can't make that kind of assessment.

Your brain will do things very abstractly and very symbolically sometimes and lack of memory.

It's not diagnostic at all.

It just means that for whatever reason your brain has thrown those memories aside for the purpose of clearing up extra space.

Our computers we do the same thing when we try to free up space on our computers.

What do you do?

You free up the space by getting rid of stuff you don't to use don't need anymore.

So if you don't need to utilize past memories from childhood to a great detail yeah your brain will pretty much delete them and put them off to the side.

>> Thanks for your call.

Let's go our next caller.

Hello Donald.

Welcome to Matters of Mind.

>> Don't don't you want to know what are the signs of clinical depression and what ways can you intervene with early intervention?

>> A clinical depression is a phenomenon where you'll have either sad mood or difficulties enjoying things day by day by day for at least two weeks and along with that you can have various symptoms such as difficulty with sleep, energy, concentration, motivation, enjoying things, self esteem and even having suicidal thoughts.

Some people when they get depressed will overeat.

Some people under some people will get really slow down their movements.

>> Some people get really agitated.

The bottom line is you have these kind of symptoms day by day by day for at least two weeks and if they cause you problems in your daily daily life such as going to work, socialize, getting along with other people if we're causing you problems in your daily life we call that functional impairment.

So having symptoms with functional impairment will give you what's called a clinical depression.

Now what's the significance of a clinical depression?

>> It means that it's probably worth treating treating either with psychotherapy or with medication.

There are advantages to either of them with psychotherapy you can hopefully identify underlying problems that might have contributed to the underlying clinical depression.

However, I always want to warn people that there's not always a reason.

>> Back when I was in training in the 1980s it was always thought OK, we've got to find a reason why somebody depressed somebody sometimes people are just just depressed because they wake up on a Tuesday morning and they're getting depressed.

They're they're they stay depressed for a period of time.

About 30 percent of clinical depression is genetic.

So some of it will come on based on genetics.

Some of it will come on because you have underlying medical comorbidities that will often contribute to depression like sleep apnea, low thyroid, low iron diabetes, other medical conditions can contribute to depression.

We will often try to sort out other things that might have led to the clinical depression if you've had some worries in your life , the worries often will lead to insomnia because you're staying awake thinking about stuff and then insomnia will often lead to depression.

So you often see this cascade of anxiety, insomnia and depression for many, many people.

So clinical depression is serious enough where you want to do something about it.

Why do you want to do something about it?

Because if you have ongoing clinical depression where it's functionally impairing, not only does it affect your whole life but affects your brain if you have ongoing depression for instance as part of the brain here called the hippocampus which is a memory center, the brain starts to shrivel up.

>> We've got 80 billion neurons in our brain and each individual neuron has between 20 and 50 thousand connections.

>> So you've got this extensive network in your brain and hippocampus you have about fifty thousand connections on each individual neuron and you have clinical depression.

It's going on day by day by day.

It's those little neurons start to shrivel up so it looks like a plant that hasn't been adequately fertilized or water .

The little neurons start to shrivel up and then they don't communicate as well and that's why older people people over 65 years of age with a clinical depression are four times more likely to develop dementia because dementia the source of it is right here in the hippocampus.

It starts to shrivel up for various reasons depression will do that as well.

So a risk factor for dementia for older people will be depressions.

That's why it's very important for older adults to be able to get treated for depression so it doesn't cascade into clinical depression itself but clinical depression does tend to shrink up certain parts of the brain.

We used to think that that was because neurons were dying.

Now we realized neurons aren't dying.

It's just that they're getting inadequate fertilization from the natural brain fertilizer and the shriveling up with less branching.

So under some scans it looks like certain areas of the brain are shrinking.

They're shrinking because there's less less fluffiness to the individual neurons and making the actual size of that particular part of the brain appear to be shrinking.

>> Thanks.

Your call is growing next caller.

Hello James.

Welcome to Matters of Mind.

James, you want to know what happens to your brain with dissociative identity disorder and how can a person be cured?

People can be treated and controlled with dissociative identity disorder.

It used to be called multiple personality disorder James and it's typically provoked in early childhood with a traumatic event.

So a traumatic event that led to a person kind of what kind of needing as a coping mechanism to zone out from what was happening around them will often occur.

Dissociative identity disorder will occur when somebody is having differences in their personalities based on adult stressful events that might not having to do with stressful events as a child.

So as a coping strategy that's kind of retained in the brain and it's probably has its source in the hippocampus and the parahippocampal area, the hippocampal area beside there this is where dissociation appears to be occurring for people and when you're under stress the stress itself might fire up this section the brain that cause you will cause you to zone out from your current reality and go into a different identity so people who have dissociative identity disorder it's very rare but they'll go into this the for a few seconds or a few minutes ago and is entirely different personality that might be unlike their usual personality and it's a coping mechanism to be able to deal with stress and again the stress might be entirely different as an adult versus a child, but that's how they will automatically kind of zone out and go into that particular personality.

When people go into that personality they'll often say they lose track of a few seconds or a few minutes.

It'll be very transient for a lot of people.

Rarely will people have a change in personality that will go on for hours at just a few minutes at a time typically and it's basically where their brains briefly zoning out.

>> Thanks for your call.

Let's go next caller.

Hello Karen.

Welcome to America mind Karen.

You want to know why does your brain hyper focus on small things but you often miss the big picture.

I find it difficult to refocus on task.

>> There is a phenomenon, Karen.

We've talked about it a couple of times tonight called Attention Deficit Disorder or ADHD with hyperactivity when you have ADHD or attention deficit disorder you can hyper focus on things that are interesting, challenging or exciting for you.

>> They're relatively small but you can really hone in on those different things.

>> So when you children when children have ADHD or add for instance, they can focus for hours on computer games, they can focus on tasks that are interesting for them but they'll often miss the big picture and have difficulty with overall tasks that might not be that interesting for them.

So there's a possibility you might be describing ADD or ADHD here.

Another phenomenon will be with depression with people who have depression.

They have a difficult time shifting their focus.

They'll have trouble with being able to process information.

They'll get stuck in this so-called default mode of the brain default mode.

The brain will be where you're really not focused on the things happening around you with great clarity.

You're just kind of in a zone and you're just kind of daydreaming.

>> People will often have that experience when they're driving on a highway.

It's it's called highway hypnosis where you're not thinking real real carefully about things.

Yeah.

You're aware of the traffic around you but you're not highly focused on it and next thing you know, you've driven several miles.

You might have missed your exit just because your brain was kind of in this zone and it's called the default mode of the brain where you're not highly focused on something now the default mode will be it's like going from first gear to third gear, third gear being the executive functioning mode where the executive function of mode is when you're thinking very intensely on something and you're very focused on something to get to the executive mode from the default mode you got to go through the ceiling mode and the salient mode is basically the shift that takes you like an old manual shift takes you from the default mode into the executive mode when people have clinical depression they will have difficulty shifting their focus from that daydreaming zoned out type mode of thinking called the default mode.

They have difficulty shifting from that to the executive mode where they can concentrate on more things with greater clarity that are around them.

So there are various reasons for that.

But the thing the reason that comes to my mind right off the bat would be if you're having trouble with hyper focusing and focusing on relatively minor details without being able to see the big picture that's more indicative for a lot of people with ADHD.

>> Thanks for your call as your next caller.

Hello Denise.

Welcome to Mars The mind disease.

>> You want to know what it means when a person gets excited then they space out and go into a tremor like seizure from early childhood.

>> I wonder in that kind of case, Denise, if you truly did have a seizure disorder or that person to whom with whom you're describing might have a seizure disorder because with a seizure disorder flashing lights or excitement can cause somebody to kind of briefly hyperventilate.

When you hyperventilate you can be more prone to having a seizure.

The tall complex partial seizures, temporal lobe seizures are very, very common for people in those kind of situations.

There's also a phenomenon called narcolepsy.

Narcolepsy with cataplexy is where somebody will have difficulty.

They get excited.

They laugh about something all of a sudden their knees buckle on them and it's a phenomenon where there's a disturbance with Hypocretin is chemical or Rexon is another name for that .

But it's a chemical that basically will be disturbed if somebody has narcolepsy and basically if you have narcolepsy your brain goes into dream sleep very quickly and it does so when you are laughing or you have a very strong emotional response to something so your brain's going into REM sleep very quickly and you buckle at the knees and for some people they'll say it looks like a seizure because they will indeed collapse.

So I'd want to be assessed either way by a neurologist with those kind of symptoms to determine if it's a seizure.

Is it narcolepsy which is where you would have sleepiness not in comany but that can be assessed.

There's actually various blood tests and cerebral spinal fluid tests that can determine if you have narcolepsy or not.

But I'd want to get that checked out if somebody was having those kind of symptoms I wouldn't say that getting excited about somebody something and having seizure like activity that's not a psychiatric condition.

>> That's more of a neurological condition from what you're describing.

Thanks for your call.

Let's go our last email our last email Regidor revolver I have really low self-esteem.

What are some steps that I can do to build my confidence?

I think it depends on how you define your self-esteem and who is your measure of self-esteem.

Many times we will compare ourselves to other people so you need to compare yourself to yourself, determine what your own goals might be and you know, go for a little Lewin's to develop your own self-esteem.

Look at the things that you're accomplishing as opposed to things that you're not accomplishing and the last thing you should ever do is compare yourself to other people.

That's where social media has been very destructive to the self-esteem of younger people because everybody on social media is doing fantastically well and they're all doing better than you.

>> So it's important to not compare yourself to other people in social media if anything try to avoid social media as much as possible, work on your own individual wins and compare yourself to yourself and your own progress in life as opposed to others.

>> Thanks for your email.

It's unfortunate I'm out of time for this evening.

If you have any questions I can answer on the air you may write a via the Internet at matters of the mind all one word at WFYI EDG I'm psychiatrist Fauver and you've been watching matters of mine on PBS Fort Wayne God willing and PBSC willing.

I'll be back again next week.

Have good evening.

Good night