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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 and it's twenty 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 give me a call the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis I am 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 via the Internet at matters of the mind all one word at dog that's matters of the mind at WFA Dog and I'll start tonight's program with a question I recently received.

>> It reads Do have over is there a difference between addiction and self medication for stress?

I have a loved one who does not use alcohol regularly but will often use it during stressful episodes in her life .

>> That is always the million dollar question when we hear about somebody using excessive amounts of substances of abuse whether it's alcohol, marijuana, amphetamines, you name it when people are using excessive medications inappropriately or other than prescribed for that matter we're always asking OK, are you doing it because it makes you feel better when you do it and you might think well gee, that's why everybody gets high or they get drunk.

>> They feel better not necessarily some people will use substances even though they don't want to.

>> They know it's ridicue to use them but they feel like they need to and when they need to they will often take higher and higher amounts to get the same effect.

If they don't use these substances they feel worse not because of their life stresses they feel worse because they're not under the influence of the substances.

>> So alcohol being a good example so people will drink only when they get under stress they're anxious they can't sleep.

>> Many, many people get in trouble with alcohol because they can't sleep and they use it as a means of giving them a sedative for nighttime relief with insomnia so insomnia can be treated with alcohol very poorly.

>> However, because of the help you get to sleep then it gives you a terrible sleep efficiency thereafter.

So if somebody is using a drug of abuse or alcohol or any prescription medication inappropriately and they're using for the purpose of self medicating symptoms, we're always asking OK, so how would you like to feel better if you didn't have that substance?

How are you going to feel what's it doing for you?

So if somebody says are using marijuana to calm their nerves if you use marijuana to help with depression, we're going to try to give them something for depression, overcome that.

Same with alcohol.

Many people use alcohol not only for relief of insomnia but also for anxiety.

>> But many people feel happy when they drink alcohol.

It's actually a bad sign if you notice when you're an adolescent or a young adult and you have your first drinks ever if you have your first drinks ever and the alcohol makes you feel really happy and on top of the world that's a bad sign because it means that biologically alcohol for you is affecting this middle part.

>> Your brain called the nucleus accumbens the pleasure center of the brain and for you it can cause you to crave it over the course of time for that joy and happiness.

>> So if somebody is using alcohol, marijuana, any substance of abuse, we're always going to ask them are you using it because you're trying to relieve some underlying symptoms are problematic for you or are using it because it's gotten out of hand and now you have to use it, feel normal many substances opiates for instance, alcohol, benzodiazepines like Xanax and out of animal and Valium they will cause you to go into withdrawal if you stop them so you have to keep using them.

That's an addiction you're often needing more and more you going into withdrawal when you stop them that's an addiction.

So the first thing we want to do for those folks is get them off the medication in a comfortable manner so that they can get their lives back otherwise some people will use substances of abuse for the purpose of self medicating symptoms.

In those cases we try to take care of those underlying symptoms.

>> Thanks for your email.

Let's go to our first caller.

Hello Ben.

>> Welcome to Mariza Mind.

>> Ben, you wanted to know if you miss a day of your sertraline also known as Zoloft ,do you double up the dosage the next day or do you take your usual dosage?

It really depends on some people.

If they miss a dosage of sertraline or Zoloft they will start to feel zings and zaps and their hands and feet they get this this heavy feeling in their in their scalp and they feel kind of irritable and sometimes just taken the usual doses the next day will not allow them to get over that kind of feeling and sometimes they do double up.

It really depends person to person then some people need to double up on the doses the next time.

As a general rule for all medications we advise people to not double up if they miss a dosage because of the double up they're going to get more side effects with double the dosage on that day.

>> So if you're taking a blood pressure medication for instance, you probably don't want to double up on the dosage the next day if you missed the dosage because you might at two lower blood pressure.

>> Now there are some medications where you can actually take it two or three times the usual dosage if you missed two or three days, one of them being levothyroxine a thyroid medication Levothyroxine stays in your system for six days and some people will take it just a higher dosage every three or four days because they can't remember it or that's how it's prescribed.

>> So Levothyroxine or T4 it's also known as a thyroid medicatin.

>> You can take it directly one big dose each about every six days.

So there are some medications where you can stretch out the dosage like that, take higher amounts on some days but for many of them you want to take them day by day by day.

Now Ben, if you were taking an anxiety medication like I mentioned before Xanax, Ativan, Valium, Klonopin, these kind of medications, you don't want to double up on those if you missed a prior dosage, get way too sleepy by doubling up on them.

Often your body will tell you that you missed a dosage with those kind of medications because if you're taking them on a regular basis you'll feel kind of anxious without it.

>> Ben, thanks for your call.

>> Let's go to our next caller.

Hello Elaine.

Welcome to Matters of Mind.

Elaine, you want to know if there's a diagnosis for people who talk constantly and monopolize a conversation and speak on hours having a one way conversation?

>> A couple different things could be going on there, Elaine.

And just speculate speculating here.

Some people will have attention deficit disorder with ADHD or attention deficit hyperactivity disorder.

>> Some people will talk and talk and talk and talk and they have so many things on their on their mind.

They go from one topic to another to another and it's a day to day phenomenon for them.

Second scenario Elaine will be somebody who has bipolar mania and during the manic state they're not sleeping.

They don't need to sleep.

They're impulsive, are overly socially intrusive and they go from thought to thought to thought very, very fast and very quickly and they just do this episodically when they're on the manic side when they get depressed they actually withdrawal.

So bipolar mania would be a possibility for people who talk and talk and talk.

>> A third issue would be where somebody has what we call pedantic speech.

These people have autism.

When people have pedantic speech they will often talk without picking up social cues that other people are not interested and they will talk and talk and talk and go from one thing to another and almost have a conversation with themselves so to speak because they're not picking up social cues from other people and then you have individuals who may have narcissistic personality disorder.

These people are only thinking about their own needs, their own desires if somebody brings up an issue about themselves, a person with narcissistic personality disorder will always bring it back to their issues.

>> So there are various reasons why somebody may talk incessant without picking up the social cues from other people that the other people might not be interested in what they're saying.

>> Elaine, thanks for your call.

Let's go to next caller.

Hello Shelly.

Welcome to Of Mind.

>> Shelly, you want to know if someone suffers from hallucinations ?

Does that mean they have schizophrenia?

Not necessarily, Shelly.

When we think about hallucinations basically hallucinations are a false perception.

>> It can be a visual hallucination or an auditory hallucinations.

>> They can be a tactile hallucination.

There's the most common one.

Some people will have an olfactory hallucination where they're smelling things that other people cannot smell.

So with all those things going on, basically it's a perceptual disturbance.

The brain is misfiring and making you interpret things that aren't really there and other people aren't discovering themselves.

So if you have a hallucination and it's going on day by day by day, especially auditory hallucinations where you're hearing voices especially condemnatory of voices that are telling you really bad things those can be indicative of schizophrenia but not always if it's going along with other symptoms such as social withdrawal, difficulty processing information problem with showing your emotional valence.

I mean these are all symptoms of schizophrenia.

It's a big cluster.

It is going on for a long time starting in men at the age of sixteen, starting in women and at the average age of twenty four.

So there's a cluster of symptoms we will identify with schizophrenia hallucinations being one of them.

>> However people who have hallucinations can also have hallucinations under the influence of drugs of abuse.

Alcohol can be an example there if you stop drinking alcohol in three to five days you can have what's called delirium tremens where you are having difficulty with hallucinations among other type of factors.

>> You hear the old stories about people seeing pink elephants myself.

I've never heard of anybody seeing seeing pink elephants when they're going through alcohol withdrawal but they will have visual hallucinations and they'll have tactile hallucinations where they feel like there's bugs all over them and some people going through amphetamine withdrawal will notice that too is a very uncomfortable situation not uncommon when somebody loses sleep they can have hallucinations, visual hallucinations especially once in a while auditory hallucinations.

>> But if you're lacking sleep it has some effects on the brains where you just don't process information adequately and you can actually see things that aren't there and you can hear things that aren't there.

So that could be a factor once in a while, Shelley, we'll hear about somebody who has a severe depression and with that severe depression and only during the depressed time they will hear voices telling them really bad things about themselves.

>> You know, when you have auditory hallucinations, Shelly, basically it's because this little band of tissue going from the front part, the front part of the frontal lobe to the hearing part of the brain back here and the temporal it's called the Arquit physicalist the argued forsook fiscalis lets the hearing part of your brain know that those are just your thoughts.

So if you have thoughts and you think about something you'll think about them often in words.

Those words sometimes can turn into voices if this argument physicalist is not working properly.

>> So a problem with people we're having difficulty with hallucinations especially auditory hallucinations will be this argue physicalist as impaired and in doing so the thoughts that are in your brain will turn in to voices and when they've done on these people brainwave tests they've actually identified the yeah the hearing part of the brain is firing up when people are having auditory hallucinations .

>> So it's an interesting phenomenon but you can have losing patience for various reasons schizophrenia being only one other reasons can be factors as well.

>> Shelley, thanks for your call.

Let's go to our next caller.

Hello, Jonathan.

Welcome to Matters of Mind.

>> Jonathan, you want to know why is a person at greater risk of developing a mental illness if their parent or grand parent experienced trauma?

>> It's hard to say, Jonathan.

If you're a parent or grandparent experienced trauma, you can be at a greater risk for mental illness if that trauma related to the parent or grandparent cause the parent or grandparent to have mental disturbances themselves.

>> And if that those mental disturbances were conveyed to you as a child in various ways such as emotional detachment from the parent or grandparent or irritability, anger, emotional abuse from the parent or grandma that could put a greater risk for you to have that kind of trauma.

>> So this is why emotional abuse, physical abuse, sexual abuse it's often multigenerational because it will go down the generations part of that's genetic.

>> But part of it is because if you've experienced abuse yourself that's what you've learned and that's how you will often interact with other people.

>> People are instructed that they need to break that chain of abuse.

If you've had a grandparent, a parent who is emotionally sexually, physically abusive, you need to block that chain because often there's a cascade multigenerational of those kind of problems.

So you'll hear about those kind of issues going on if you're a parent, for instance was a Vietnam veteran or maybe a grandparent was in World War Two even.

>> Yeah, they can have post-traumatic stress from those kind of experiences and that can be passed on sometimes to the children and as a child up until the age of eight years old, you're really, really vulnerable to any emotional, physical or sexual abuse in the after effects of those.

>> If you've had emotional abandonment, abandonment or any kind of traumatic experience prior to the age of eight years old especially that can be devastating for you later on.

It's not necessarily deterministic that you will have emotional problems if you had a tough childhood but it certainly increased the probability.

John, thanks for thanks for your call.

Let's go next email question our next e-mail question read your daughter Fauver.

What type of things should I prepare before my first deployment with a mental health caregiver?

I do have a list of my medication but what else should I have ready?

>> We have at my clinic for instance the questionnaires that go through all these different things that we want to know and just to go through some of these things you're on the right track there.

What medications have you been on?

>> What doses have you been on?

How long were you taking them and why did you go off of them or how do they do for you?

Some people go off their medication because they felt a lot better.

Great.

We want to know this so we want to know all the details about past medications.

We want to know about your past childhood and I'm not talking about some Freudian stuff here.

I'm just talking about what traumatic type of things might have happened during your childhood, what kind of things were really bothersome for you?

How do you think you got to where you are now?

You know, if you have depression now, anxiety now how do you how did you get here?

So we look at the past emotional type of things your childhood we often want to know what kind of coping strengths you have.

>> Can you recall situations where you had really bad stuff happen to you and you got over it and what kind of coping strengths did you have from that?

>> I want to know OK, the obvious questions with whom do you live?

>> Who are your main supports?

I want to know about your pets and animals because pets and animals can often be a good source of support.

I'd like to know what kind of what are the main stresses you're going through right now and what are your goals for treatment?

>> People come to me with all these different goals for treatment and I always ask them what are your three main >> How would you like to feel better overall because I might hear their story and look at their questionnaires which we will provide for them.

>> Then I'll ask them what are your main three goals and the three goals might be entirely different than I would have maybe thought.

>> So I always want to know what are your main three goals and what are the main apprehensions about treatment in general if we're to give you a medication, what kind of side effects do you really, really want to avoid now we try to avoid all side effects but are there any game changers where you would not take a medication if it did this, this or this?

>> We want to know about that right up front.

It's very important if you can obtain it to know how your family members did if they were on any medication for your similar type of symptoms.

So if you had family members who took medications for depression and here you're coming to see us for depression, I want to know whether any medications your family members took, how they did with them, what side effects that they have that they have success, they fail.

>> I want to know as much detail about how the family members did on medications because that's kind of an indirect means of looking at your genetics.

>> We do genetic testing and it helps to some degree looking at how quickly you metabolize medications and what medications might have a good mechanism of action for you.

But I think in many ways it's very predictive predictive if a family member did really well on a particular medication for the symptoms you're now experiencing, it's very predictive that you could do well with that as well that that too.

>> So we want to look at a lot of different type of factors out there.

I want to know what kind of medical conditions you're you'd been experiencing and how the medical conditions are not only affecting you emotionally but what medications you're taking for those.

So there's a lot of things you can get together before that first appointment but I think you're on the right track.

>> The first thing you need to do is get together your list of past medications because the last thing we want to do is go round and round and keep giving you medications in which you've already failed.

So we want to see if there's a pattern of medication treatment responses.

So if you failed on three medications that mainly affects serotonin well we don't want to give you medication is going to affect serotonin.

We want to go a whole different direction.

So that's why it's very important for us to get the medication treatment responses as well as your family members are treatments treatment responses as well.

>> Thanks for your email.

Let's go to our next caller.

Hello Marsha.

Welcome to Matters of Mind Marsh you want to know about medications, trend telex and Trazodone trend toxins also known have already been out for about 11 years now you want to know about how they're used and what other side effects turn toxin Trazodone are different medications trend telex has some ability to enhance serotonin at five milligrams a day.

>> It's going to enhance serotonin reuptake by about fifty five percent ten milligrams a day it's going to increase serotonin reuptake inhibition by sixty five percent that a twenty milligrams a day it's going to give you about eighty five percent reuptake inhibition.

So the higher the dosages the more of an SSRI effect you're going to get SSRI are the mechanisms by which we refer to Prozac, Lexapro, Celexa, Zoloft, Paxil these are the medications that are blocking the vacuuming of serotonin back in the firing neuron and in doing so they allow serotonin to bounce around in the periphery for a long period of time to intox has that effect.

But there are 14 different serotonin receptors.

So if you think about the serotonin preece synaptic or firing neuron as being like a shotgun, it's firing out these little serotonin bullets.

All right.

So no one with an SSRI effect, a serotonin reuptake effect, you're blocking the vacuuming of the bullets coming back in the firing neuron.

>> But secondly, those little bullets are going out there and they're stimulating 14 different types of serotonin receptors which all do different things.

>> In the case of Trenton, you're affecting five of those fourteen receptors very specifically and directly.

>> In doing so you're enhancing serotonin but indirectly affecting dopamine, norepinephrine glutamate and even GABA.

So there's a lot of different chemical effects you're getting out there with Treinta.

So it's an antidepressant medication that Yazd serotonin to some degree but it specifically will improve the speed of processing of information.

>> So it helps the processing speed in your brain similar to increasing the increase the broadband speed of your Internet.

>> So you want to increase the speed of your Internet.

That's what's happening with Rintel from an antidepressant standpoint.

It's improving the processing speed of your brain.

So that's Rintel biggest side effect of transduction be some nausea.

The nausea occurs over the first couple of weeks or so.

Typically you take it with food it's often lessened especially at a lower dosage.

Triacetone is a whole different medication triacetone willpspect doses up to two hundred milligrams at bedtime mainly affect serotonin 1A and serotonin 2A receptors and in doing so can give you a good quality of sleep.

>> In other words it'll help you get to sleep within about thirty minutes last for about eight hours and actually will increase the depth of sleep.

It might give some people strange dreams because it will allow some people to dream more but it's a medication.

>> It was originally Food and Drug Administration approved back in nineteen ninety five nineteen ninety five I think it was and in nineteen ninety five FDA approved for depression but we found that for depression you needed doses of three hundred to 600 milligrams a day.

Trazodone was not FDA approved for sleep but that's how we've been using it for the past 25 30 years now for sleep you use doses between twenty five up to two hundred milligrams at bedtime just at bedtime biggest side effect of Trazodone people will be fine, will find annoying will be about one out COVID 19 people will get a stuffy nose.

So about nineteen people will get a stuffy nose there used to be concerned that men would get painful prolonged with Trazodone but that occurs in about one out of five thousand cases, maybe one of the 7000 cases by some reports but it's related to the doses on the higher end.

>> We don't use those kind of doses for sleep so we rarely hear about that.

>> Marcia so twenty six is used for depression.

Trazodone used for sleep.

A common combination will be used in that manner because 26 might not help you with sleep initially and maybe never.

>> But Trazodone can be used as needed just for sleep.

>> It's considered to be off label use but it's been used extensively for over thirty year.

>> Thirty years now.

Marcia, thanks for your call.

Let's go our next caller.

Hello Jane.

Welcome to Mastermind.

>> Well Jane, you mentioned you take Levothyroxine for your thyroid.

I mentioned that earlier but you wonder if it's also an antipsychotic medication.

Will that affect you and why does a medication have multiple uses?

>> Levothyroxine Jane is not an antipsychotic medication.

Levothyroxine will increase thyroid thyroid levels naturally.

Now you can take your thyroid out it you can have it surgically removed because a thyroid cancer and you can replace all your thyroid with an oral medication.

>> The tricky thing about Levothyroxine for is also known as the name of a T for stays in the system for days and it breaks down into T three so T three is allow authorities and T three is something very short acting for energizing and it's been used for years as an augmentation agent for depression so t for break down a T three T four stays around for a long time now if somebody has difficult with fatigue depression they can't concentrate.

>> We're always going to check the thyroid level of your thyroid levels low.

You can take Levothyroxine and help with that.

But generally Levothyroxine is a medication that is something that is taken on an empty stomach.

You got to take it either an hour before you eat or at least two hours after you eat or have any beverages.

It can't be used with coffee .

Coffee inhibits its absorption so you have to take it on a totally empty stomach and for many people on Levothyroxine for instance, we'll have to take it at bedtime just keep it at bedside and if you happen to wake up in the middle of night or before you go to bed if you haven't eaten for a couple of hours.

Yeah, That's when you want to take it.

>> Thanks for your call.

Let's go next caller.

Hello Laura.

Welcome to Mars the mind.

Laura, you recently found out that you dated someone who had paranoid schizophrenia and stopped taking their medication.

What are the warning signs that should be evaluated before things escalate when people have schizophrenia and they stop their medication lorem it's kind of like somebody with epilepsy who stops their medications for seizures over the course of time.

It's very likely those seizures will resume with paranoid schizophrenia.

The first thing you'll often notice when somebody is having trouble will be they get a little bit more anxious and they start to lose some sleep once in a while they'll indeed hear about voices talking to them or having some really bad thoughts.

We call them fixed false beliefs also known as delusions.

>> Delusions are fixed false beliefs where they start having some beliefs about other people or things that they see in their environment that don't make a lot of sense to you but they insist that they are true.

>> That's why they're called fixed false beliefs.

Those are indeed delusions and that's a symptom of schizophrenia.

But often early on we'll hear about people having difficulty with sleep and having more anxiety and that's where all off and be able to encourage somebody to take their medication, Laura because even somebody with poor insight into her illness or schizophrenia and part of schizophrenia, part of the manifestation of that is that they have poor insight.

>> They don't know they have an illness that's part of the illness itself.

>> But they do realize that a lot of anxiety and feeling uncomfortable in social situations and not sleeping are reasons to take a medication.

>> So sometimes we get people back on their medication with schizophrenia because they don't like to feel anxious and they don't have they don't like to have a lack of sleep.

Lack of sleep makes everybody feel lousy and they realize that.

So we try to get them back on the medication on that basis with the intention in the long run to help with the ability to process thoughts and be able to feel more emotionally engaged.

Now Laura, fortunately nowadays we have a lot of long acting antipsychotic medications that lasts for weeks if not months.

>> So you give somebody antipsychotic medication a long acting formulation and stays in our system for a long time.

That's nice for somebody who has an illness where they don't realize they have an illness.

>> Laura, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues, you can email me here at PBS Fort Wayne by emailing me at matters the mind all one word at eight dot org.

I'm psychiatrist Jeff Offer and you've been watching matters of the mind now on YouTube God willing to be at PBS willing I'll be back again next week.

>> Thanks for watching.

Good night Cameron Psychiatry.

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

More information available at CameronMCH.com.