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

>> Welcome to Matters of the Mind.

Now in his seventh year Matters The Mind is a live call in program where you have the chance to choose a 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 zero or if you're calling outside the Fort Wayne area you may dial toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis we are broadcasting live from our fantastic PBS Fort Wayne studios at the shadows of the Fort Wayne campus every Monday night.

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 WSW Egg that's matters of the mind at WFA Egg.

>> I'll start tonight's program with an email I received this week.

It reads during the fall for my 15 year old adopted granddaughter has always dealt with anger issues.

>> Now as a freshman she is failing her classes.

She has explosive outbursts and threatens her parents when they try to talk to her.

Her birth mother was a drug user.

Could a support group help the support group could help perhaps you as adoptive parents but also her and the whole idea of a support group will be based on the need for that particular community.

In other words, a therapy group will identify that they have several people within their practice who have similar problems and on that basis they'll get a support group together.

Now one of the best support groups ever created in the history of mankind was Alcoholics Anonymous back in the nineteen thirties.

>> It's still going strong.

Alcoholics Anonymous Alcoholics Anonymous did it right because they identified a need with a large group of people.

They started with a core group of people and then as they progressed through the program they call them steps in Alcoholics Anonymous.

>> Some of them became mentors and they mentored people who are newer to the group and it continues to be one of the best means of alcohol rehabilitation we have now we have some really cool medications nowadays that help people decrease their craving for alcohol use it quite frankly that supportive environment can be very, very helpful.

So in your case, a support group for an individual who was conceived and developed in the under the influence of drugs of abuse by the mother?

>> Yeah.

You could identify perhaps other parents who had similar difficulties but quite frankly that particular child who's been in that situation sometimes and do well in groups themselves now adolescents you have to be careful.

>> You have to be very controlling over that group and make sure it doesn't get out of hand because adolescents sometimes will model bad behaviors from others.

So you have to be aware of that in group therapies but with a group therapy or a support group in general.

Yeah, you have to find a group of people who have similar interests and maybe a therapist or a practiced practice that deals with those kind of problems.

But if you could develop your own support group just be by networking among family and friends that can be very, very helpful for somebody like that.

Nami, which is a national alliance on mental illness has been formed over the past several decades.

>> NAMI basically is a group of parents and family members and now some people who have mental disturbances that they gather together to try to support each other to help them deal with their loved ones who are going through severe emotional problems and help them kind of navigate how to get the best treatment.

>> Thanks for your email.

Let's go to our first caller.

Hello Janet.

Welcome to Matters of Mind.

>> Janet, you want to know what it means to have a chemical imbalance?

Chemical imbalance is kind of an old term used just to say that OK, you have a condition that would possibly benefit from psychiatric medications.

Now what's the difference between gee, getting counseling and getting psychiatric medication?

Well, quite frankly if you use an analogy of an automobile all right, you've got a couple of chemicals one called glutamate and one called Gaba Glutamates like the accelerator and gabbers like the brakes glutamate GABA sit out here in the gray matter of the brain, the outside part of the brain, the thinking part of the brain, the emotional part of the brain, the impulse control part of the brain glutamate in GABA or in that fine balance so glutamate the accelerator gabbers, the brakes and that's about ninety five percent of how this gray matter works now down deep inside the brain in the so-called brainstem area right down here you're going to have a squirting up to the gray matter giving advice serotonin, norepinephrine and dopamine.

Then you have this on the receptor that gets stimulated called Sigma 1A receptors and Sigmon receptors will modulate how serotonin norepinephrine, dopamine and glutamate are all being.

So here's the bottom line if you think about the accelerator for glutamate and Gabb for the brakes are in fine balance.

Serotonin, norepinephrine and dopamine are kind of in the passenger seat giving advice right.

Serotonin is kind of telling you to calm down, slow down a little bit whereas norepinephrine and dopamine are telling you to speed up to get more motivated to get more energy.

>> Then you got the back seat got the back seat driver back there.

That's be the second one receptor because a single one receptor is then trying to modulate how much activity the serotonin norepinephrine dopamine as well as the glutamate are being used in the course of the travels.

Now where does psychotherapy play into all this psycho therapy is more like the GPS.

You don't probably use GPS everywhere you go but sometimes you're really needed if you drive in through Chicago for instance, you really need GPS typically some people don't.

>> Most people do and it's the same with psychotherapy.

>> Some people have the skills to be able to navigate through life's challenges.

They don't need their GPS of the counseling or psychotherapy to get through their life challenges other people do because they're having trouble navigating through coping strategies.

>> They're having difficulty with past life experiences that certainly influence how they're feeling now.

>> So in those cases it can be helpful to have that psychotherapy.

So with a chemical imbalance that's inferring that somebody could benefit from a psychiatric medication for their current symptoms whereas with GPS it means OK, they just need some guidance and maybe some awareness and insight into the kind of difficulties they're having to make the best decisions.

>> Thanks for your call.

Let's go next caller.

Hello and welcome to Matters of Mind.

>> Your Honor.

She's 58 years old and she's fearful of strangers mood disorder, anger and totally obsessed about living with mom and dad again and almost constantly talking to herself about living with us again.

She's on 26 10 mg gabapentin.

One hundred milligrams biddy's lithium.

One hundred and fifty I'd Seroquel fifty at night.

I feel she needs meds for obsessive thoughts.

That tends to have been a pattern for her for years and nothing cognitive works for her but I am fearful of you know TV she so far she hasn't shown any signs of that.

>> Well let me interpret some of the very good point you're making there and for other viewers you'd mentioned obsessive thoughts.

Those are thoughts that don't make a lot of sense.

But she's ruminating and dwelling on them unnecessarily.

Now if you worry about things in the future and you're brooding and about things that might happen in the future and you have a lot of doubts about the future that can be what's called generalized anxiety, a whole different phenomenon.

Obsessive thoughts would be where you have thoughts that don't make any sense but you kept going over and over and you get anxious if you quit trying to think about them.

So obsessive compulsive disorder can include obsessive thoughts where you have these thoughts that don't make any sense at all but you can't get them off your mind and many times people convert these thoughts into behaviors which are called compulsions, compulsions would be such behaviors as checking and rechecking, counting compulsively over and over and over again.

Compulsions can include obsessively cleaning and feeling like things just aren't clean enough.

>> So you've got the obsessions going on there.

You're concerned about TRD that's tardive dyskinesia.

Tardive dyskinesia is indeed a phenomenon that could occur for people who have Non's psychotic condition such as a mood disorder and anxiety condition and they're using a so-called antipsychotic medication.

You'd mentioned she's on Seroquel also known as Quartier Pain 50 milligrams at bedtime.

It's a very, very small dosage at that kind of dosage you're primarily getting some effects on serotonin and histamine so you're not getting a lot dopamine blockade the dopamine blockade over the course of time for somebody especially with a mood condition can potentially cause an increase budding of more dopamine receptors.

>> So it's kind blocking something and then you have as a reaction to something getting blocked more growth of something else in the same category.

So tardive dyskinesia basically is where you're butting out too many dopamine receptors gives you twitches and ticks and that's seen for people who are on strong potent dopamine receptor blockers of which Seroquel is not one.

So Seroquel we now have Cap Leida which has very minimal dopamine receptor blockade.

We have a lot of other medications.

Sarfaraz snappin being another one.

They don't have as much dopamine blockade as the old medications did such as haloperidol risperidone is a strong dopamine blocker Geodon Jidan the president is a strong dopamine blocker now how do you deal with this with the obsessive thoughts quelque with typing can be an option to intellichoice you mentioned that's also known as Vaud Occitan ten milligrams kind of a medium dose each about three out of five people on Trin talks will take it at ten milligrams but at a higher dosage perhaps twenty milligrams it can sometimes relieve some of the obsessive thoughts but from a medication standpoint and there are some changes that can be made lithium hundred fifty milligrams twice a day that's a good dosage for a lot of people because it can improve impulse control.

>> Lithium at a relatively low dosage interestingly enough is anti suicidal.

So for people who have these ruminative thoughts about taking their own lives lithium at very low doses can be very helpful for those people.

And of course you mentioned Gabapentin Hutner milligram doses are great.

We'll use gabapentin nowadays as an alternative to Xanax, Klonopin, Valium, Ativan, so-called benzodiazepine medications unfortunately especially for somebody who has special needs, it can cause a inadvertant worsening of their impulse control.

So if somebody who has developmental conditions who takes if they take a benzodiazepine which you'd think would calm them down, sometimes it makes them a lot worse.

Gabapentin is an old anti seizure medication approved back in the 1980s and has been around for a long time now used more for anxiety, for pain and for sleep and it can be used as needed for somebody who's having intermittent outbursts like that.

>> There is a medication sometimes can be helpful and you might have heard of these already and but one medication is called Gwon Forseen has been used to help with distractibility and focus for attention deficit disorder as an add on medication was originally approved as an anti hypertensive so it can bring down the blood pressure a little bit but many people will notice a little bit of gwon forseen can be helpful.

So it's a matter of figuring out OK how's the trend Alex doing?

How's the gabapentin doing?

How's the lithium doing houses Arakwal doing looking at all those and finding the ideal dosing and sorting out OK what's doing what and trying to figure out do I really need all four of them or are all four of them at a low dosage.

>> You doing OK now it used to be thought and you know if you take four medications that's a bad thing.

>> Well now we realize it's kind of like vegetable soup if you have vegetable soup you have a little bit of a lot of things in there that's really OK. >> And if you take a low dosage of several medications it's actually safer sometimes than take at a high dosage of a medication like Seroquel by itself.

So back in the 1970s 1980s when I was trained as a pharmacist, you know, we were always trying to figure out how we could decrease, decrease decrease the number of medications people were on and that was a very noble try type of attempt.

>> But we came to find out the low doses of medications that have different mechanisms.

>> Action can actually be safer for a lot of people.

And thanks for your call.

Let's go to the next caller.

Hello Phil.

Welcome to Matters of the Mind.

If you want to know what is marijuana induced psychosis marijuana tetrahydrocannabinol Dayal is a is a chemical that can sometimes induce psychosis by accelerating dopamine in the brain and causing people who are particularly prone to losing touch with reality to get initially paranoid.

I talk to a a young man earlier today who noticed that every time he used marijuana he got more paranoid so he realized it probably wasn't the best thing for him.

So some people are prone to getting more paranoid with marijuana.

The potency of marijuana makes a big difference.

Back in the 1970s the potency of marijuana was quite miniscule.

Now it's several times more potent because of the hybrids of the plants.

So with a higher potency of tetrahedral cannabidiol it's more likely to cause psychosis compared to the weaker strains in the past.

So it's basically a condition where you'll all of a sudden get paranoid, you get agitated, you might even start hearing voices.

>> You don't perceive the world around you as being in as it is to other people so you lose touch with reality.

That's the whole concept of psychosis.

>> Sometimes marijuana induced psychosis can be permanent especially if you have a family history of psychosis, especially if you have a family history of mood disturbances but quite frankly film in the past ten years I've seen individuals develop marijuana induced psychosis that's tends to be permanent in some cases where they don't have the family histories.

Now back in the 1980s and 1990s when I was first practicing typically if somebody out of marijuana and do psychosis I could usually identify a family member as they described him to me who might have had some of those kind of features of psychosis and I could relate to the family history.

Now I'm seeing people who have no family history of schizophrenia, bipolar disorder, no psychosis at all and I'm seeing people develop marijuana induced psychosis that is long lasting.

So it's something we need to be very careful about especially as many states are now recreationally legalizing the use of marijuana.

For some people that's sanctioned its use and especially for younger people people under twenty four years of age marijuana can be very, very dangerous for them not only in suppressing their white matter development in the brain.

I mean the brain has this white matter isolation throughout it.

It's called white matter.

You suppress the white matter of growth and that will affect your ability to retain memories over the course of time.

It also appears to change the networking in such a way that it can cause you to lose touch with reality.

So we have to be very, very careful with the use of marijuana especially for anybody under 24 years of age.

Why 24 years of age?

Because it's up to that time that the front part of the brain especially is still growing.

So is the front part of the brain is still growing.

You don't want to do anything that's going to really disturb that.

>> That's includes marijuana, alcohol use.

I know alcohol is legal for individuals before the age of twenty four years of age but people need to be very, very careful with alcohol use during that time because the brain is still growing up until the age of twenty four and quite frankly that's why auto auto will be insurance premiums are much higher until you get to be twenty four so you start driving at sixteen between 16 and 24 years of age.

If you notice the automobile insurance premiums are higher for that age group after twenty four years of age automatically most automobile insurances will go down if you've not had a lot of accidents previously but they take into consideration that before the age of twenty four your impulse control your ability to concentrate is somewhat compromised compared to after twenty four years of age.

>> Thanks for your call.

Let's go our next caller.

Hello Shannon.

Welcome to Of Mind.

>> Shannon, you mentioned that your daughter recently began on birth control pills to manage periods and you're noticing a change in her mood and she seems depressed.

>> Is that a common side effect?

Should you ask for a change?

>> I absolutely positively would talk to her clinician and talk about a little bit of a change.

On one hand she had a birth control pills.

Oral contraceptive medications can be dramatically effective for helping the mood because they stabilize the hormones of estrogen and progesterone and in doing so can decrease the premenstrual symptoms, the symptoms that some women will have anywhere between three days and two weeks before their periods and then they have their periods and they feel fine.

So if you stabilize the hormonal status of estrogen progesterone throughout the month that's less likely to be problematic for the premenstrual symptoms.

Many young women will often also use the oral contraceptive medications for the use of controlling acne.

So there's a lot of benefits for that.

But estrogen and progestin are in different quantities in different formulations and if the formulation of your doctor is using is causing more depression by all means that's not considered to be normal and that's not a normal side effect that needs to be adjusted sometimes it could be adjusted with the current medication being used and sometimes it she needs to go to something else.

So talk to a clinician depression with oral contraceptive medications is not a normal side effect that can be adjusted.

>> Thanks for your call us go next e-mail question our next e-mail question reads Dr. Fauver I am on anxiety medications but I still feel anxious throughout the day.

>> What are some lifestyle changes that could make to supplement my medication?

Well No one I'd wonder what medications are taken for anxiety because some medications for anxiety.

Yeah.

They get in your system.

They get out.

They get in, they get out.

I talk to a woman earlier today who's on a pretty good amount of alprazolam or Xanax and this first time I had seen her so I was wondering OK how she feels throughout the day and that's what's happening.

It's kind of a roller coaster of mood swings.

So we try to get people off of the so-called benzodiazepines Xanax, Ativan, Klonopin, Valium, Klonopin and Valium last longer.

But it's still it's nice to get people off those medications because you can kind of get used to them and as they wear off you can feel exceptionally anxious.

So the benzodiazepines if you're taking those it could be an on off effect from those medications if you're taking a so-called serotonin medications .

Serotonin medications are Lexapro, Prozac, Celexa, Zoloft, Paxil.

These are medications that will all increase serotonin and give you somewhat of an emotional numbing effect now emotional numbing effect it's kind of tricky.

You don't want too much of it but if you want enough of it so you can put up with things so if you get the emotional numbing effect that's all right.

So what can you do to really help yourself naturally with anxiety being around people doing things that normally would make you anxious believe it or not, the more you do those kind of things well less anxious you can become so practicing social situations that might make you anxious will always tip and typically help anxiety the more you do it exercising is something I can't emphasize enough for people exercise as a remarkable means of helping the mood the concentration and the anxiety itself.

>> So if you exercise especially with anxiety, resistance training, weight training appears to be very, very good for anxiety and weight training especially for older adults.

Those of us over fifty five or so older adults really respond well to weight training especially for sleep.

So weight training can help with anxiety, can help with sleep.

I don't typically recommend a lot of natural supplements for anxiety because I'd prefer people try to deal with things more naturally as you mentioned.

But a natural supplement would be theunissen and thinning people will use that that's the natural ingredient in green tea and sometimes that can be helpful for naturally helping with anxiety but preferably I'd rather see people exercise and try to get enough sleep and getting enough sleep will kind of reset your brain and recalibrate your ability to put up with things because as you're sleeping the reasoning center of the brain is able to rest and if your reasoning center your brain is able to rest at night that's the left front part of your brain called the dorsolateral prefrontal cortex as that rests at night you're able to think through and cope with things better the next day.

>> What if you don't get enough sleep night by night by night?

>> Well, that part of the brain's not resting so much and you can't think through things as clearly.

So is kind of like recharging your battery when you are getting enough sleep.

So sleep hygiene where you're getting the bed the same time every guy you're trying to give same time every day getting in that natural cycle of sleeping well is going to be very helpful for helping you with anxiety.

Now some people will notice they sometimes awaken in the middle of the night.

>> That's OK every now and then but about you know, four out of four to seven nights a week, four or seven nights of the week if you're getting a good night's sleep, that's pretty good.

If you don't get so much sleep one night you might notice you have a little bit of a sleep debt and you're repaying that sleep debt the next night where you're sleeping more and that's perfectly normal as well.

>> Thanks for your call.

Let's go our next caller.

Hello Carlos.

Welcome to Matters of Mind.

>> Carlos, you had mentioned that you're studying with college level exams.

How can you train your brain to be a better taste test taker to be a better test taker?

>> You probably want to practice taking tests.

Carlos.

>> A lot of oh booklets do have practice tests in them and you want to take the tests that are similar to the actual tests that you'll eventually be taking for the college level examinations.

So for instance, SATs a lot of SAT booklets out there.

They give you a lot of practice exams and that's the best thing I would suggest whether it be examinations or any particular kind of anxiety provoking situation.

Carlos, the best thing to do is to practice similar type of feats and in trying to decrease the anxiety.

So in your case fighting some practice tests to be able to take where they have a similar structure, similar type of answer responses.

Some tests will have questions where the last is at A, B or C or is it airs and C is a none of the above is that all the above?

You want to have those same kind of answers available to you when you're in the practice test?

Thanks for your call.

Let's go next caller.

Hello Tammy.

Welcome to Matters of Mind.

>> Tammy, you want to know is it possible for your brain not to store small details?

Is that a thinking trait or disorder taxe advantageous Tammy if your brain does not store small details that aren't relevant and it's called neuroplasticity it's a remarkable phenomenon, Tammy, because each of our individual little neurons especially in the hippocampus here they have all these different branches on them in the hippocampus that's the memory storage part of the brain.

They have fifty thousand branches on each individual little neuron.

And if if you're trying to remember every single minute detail of your day, you know, just be overly fluffy and there just be a hodgepodge of all these thoughts in your head.

You don't want that.

You want to be able to pay attention to things that you need to pay attention to.

So our brains have this remarkable ability to prune off all the excessive neuron branching just like putting off a tree.

>> So if you have a tree it's got some dead limbs on it.

You're not using those limbs.

They're not doing much.

Just print them, print them off.

Rose bushes are classic for this because if you prune down your rose bushes you'll actually get more roses.

>> The neurons do the same thing.

Your neurons will be able to naturally prune down some of the areas that are not useful and then build up.

It's called synaptic genesis but they build up the branching in areas that you really need so your brain is naturally able to identify all of that type process.

So the pruning down is called apoptosis.

The increased branching is called synaptic genesis.

A healthy brain is able to naturally figure out what it's got to expand upon and what it doesn't focus on as much.

But what if your brain's not healthy?

Walts means you're going to be holding on to details that aren't relevant and it's thought that that it's part of the process of obsessive compulsive disorder where you're focusing on things that you really shouldn't focus upon.

Thanks for your call.

Let's go our next caller.

Hello Brook.

>> Welcome to Matters of Mind.

Brooke, you had mentioned you're on Zoloft, also known as sertraline found out you're pregnant.

Should stop your medication.

>> Zoloft is also known as sertraline.

It's a serotonin based medication has been around since nineteen ninety two .

>> It's a medication quite frankly that in my practice we are using in during throughout pregnancy during breastfeeding Brooke.

>> We can't say that about a lot of medications now you might think well gee was it very well studied you don't proactively study medications during pregnancy you're not going to get a bunch of women to sign up who are pregnant.

Sanok be studied with this medication to see if it's safe during pregnancy.

So what you do is during pregnancy you happen to find women who were have been exposed to Zoloft and see other babies did not only in their early years but in the adolescents.

>> Zoloft is one of those medications that has been found throughout all three trimesters pregnancy to be safe and not causing neurodevelopmental disorders even when the baby grows up to be in adolescence.

>> So in off in my opinion is something that can be used during pregnancy always talk it over with your obstetrician to see if that's a possibility and of course the pediatricians are really up on these things too.

>> Thanks for your call.

Unfortunate amount of time for this evening.

If you have any questions concerning mental health issues, you may write me via the Internet at matters of the mind all one word at WFA a dog and I'll see if I can answer that on the air.

I'm psychiatrist offer and you've been watching Matters The Mind on PBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching tonight