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

Welcome to Matters of the Mind now as twenty six 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 here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial 866--(969.

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 via the via the Internet at matters of the mind all one word at WFYI dawg that's matters of the mind at WFB a dog tonight's program with our first e-mail that we received over this past week.

It reads at regional or Fovea Psychiatrists ask people a lot of questions during interviews is there one question that is important to ask and what would it be?

>> Well, the one question I would suggest any psychiatrist ask somebody who is being treated would be what does feeling normal mean to you?

>> How would you define feeling yourself?

>> What kind of goals of treatment do you have?

And many people they're not to say I want to feel less sad.

They won't say I want to feel less anxious.

They're going to say I want to be able to do this and this and this again or I want to be able to attain these levels of achievement.

>> Sigmund Freud one hundred years ago set up some things that didn't make a lot of sense but some of the things he said were brilliant and one of them was that the cornerstone of humanness which is means being who you want to be will be to love and to work and it just means having meaningful relationships with other people and to be able to be productive and having something to do in a meaningful manner every day.

>> So having relationships to love to work meaning having something to do where you're productive throughout your life whether you're an adolescent years all the way into your senior year, we need to be able to love and to work and if you can maintain that perspective on OK what is successful living, that's what it's all about.

So as a psychiatrist, yeah, we look at a lot of symptoms and we're looking at symptoms that are hindering a person's development.

But we always need to remember we need to ask a person what their main goals are of treatment and what a success mean to them if treatment was moving along.

We have some scales that can assess that.

For instance, a and disability scale but it's copyrighted that's difficult to use in the day to day practice.

So we'll often use other scales such as the shapes scale, the shape scale is the Osia Snaith Hamilton pleasure scale and it basically looks at different dimensions of having pleasure in life looking at your ability to think and having pleasure, your sensory pleasure and having social pleasure.

>> So it looks at different dimensions of of experiencing pleasure because if you are not enjoying things, if you are having trouble having fun, if you're not having any thing that really get you motivated and gives you passion in your life , you're going to have more and more difficulty with your mental health .

So it's very important that we address all these different dimensions trying to get people to the point where they can love and socialize.

We want them to be able to be productive but especially we want people to be able to enjoy the whole experience and be able to have and fun a lot of fun in life .

It might sound like that's a stretch of the imagination to be able to tease those type of things.

But that's the main goal that we're trying to achieve in psychiatry when we're treating people.

>> Thanks for your question.

Let's go to our first caller.

Hello Ted.

>> Welcome to Matters of Mind.

Hey Dr. Farber, how are you doing today?

I'm doing all right.

Good, good.

My question is a timely one.

We just went through the time change yesterday and I have grown to dislike it.

>> I don't like either one of the changes.

I generally like the light in the evening but I wish we would just stick with one or the other and I wondered what kind of an effect the time change does have on people with the light, with the sleeping, with mental health even is there any study that's been done about that?

>> There have been ten and that's a great question because for many people they notice that with the time change they're just kind of off for a few days and the studies have shown that you're more likely to have difficulty with concentration and wakefulness for about a week following the time change and there's actually been some studies showing there's more automobile accidents during that time.

So your concern is valid Ted.

So from what I understand, you know, it's the type of phenomenon where it's still getting debated whether we should do it or not.

I understand the pros and cons from a sociological standpoint but quite frankly as a psychiatrist I'm always telling people go bed the same time every night, get up the same time every morning the best you can try to get in that routine.

>> Well, what happened with the time change it throws off for an hour and it happens again no twice during the year.

>> So we have these two times during the year where basically we're being thrown off by this hour where you're not going to bed the same time every night and you're not getting up the same time because the time is changing.

>> So it takes about a week to adapt to that.

So what we often was try to have people do is try to adjust their time in terms of going to bed especially by about fifteen minutes each day.

So try to gradually warm up to it but just losing that hour that we do in the month of March can be tough for a lot of people and they'll often feel more tired but it takes about a week to adapt not uncommonly and yup you get more evening time so you can use that to your advantage obviously with Daylight Savings Time where you have more lightpe prone to exercise when there is light being aware that this time of year the sun's coming up about eight and starting to get light at that point a little bit later than before.

>> So it's a means of adapting to it but it takes about a week for most people.

But you know, it's kind of messing with the melatonin in our brain.

Melatonin is what keeps gives you somewhat of a circadian rhythm throws us off a little bit.

So I know there's ongoing debate about that and they're valid and there have been some studies showing it's not the best thing for your mental health .

>> But the good thing is it's usually transient lasting no more than a than a week.

Ted, thanks for your call.

>> Let's go to our next caller.

Hello Becca.

Welcome to Matters of Mind.

>> Becca, you want to know if childhood abuse trauma could affect you as an adult?

You bet, Becca.

We cannot overlook that.

Matter of fact, I've been using the scale in my practice.

It's questionnaire called the ACS the adverse childhood, the adverse childhood experience scale and the adverse childhood experience scale basically is ten questions looking at childhood trauma, those looking at things such as where you emotionally abuse, where you physically abused as a child were you neglected did one of your family members have a mental illness today or family members go to jail?

Did your parents get separated or divorced?

These are all different traumatic experiences for a small child and beat up until the age of eight years of age.

>> People can be very, very susceptible to these kind of traumas.

So it's so important that our young children are not exposed to those kind of traumas.

Why?

Because if you're exposed as kind of a traumas especially four or more based on the ACS scale that has been studied and validated, if you've had four or more of those traumas as a-se likely to have anxiety and depression as an adult and at least for depression you might pnot respond to the so-called serotonin medication so well.

So if you have depression and you've been exposed to a lot of traumas as a child, you might not respond to the medications like Zoloft, Prozac, Lexapro, Celexa, Paxil or Luvox.

You might not respond to those so well for depression.

I saw a lady earlier this morning who had tremendous numbers of childhood traumas and I did have her take Zoloft because she didn't have that much depression.

Thank goodness.

But she had a lot of anxiety.

Now Zoloft has a serotonin medication will still work for post-traumatic stress disorder symptoms if somebody does not have depression.

So it could still work in some ways for anxiety but not for depression.

So it's one of those things that we kind of use as a means of tipping the scales on what type of antidepressant medication or antianxiety medication we might use if somebody had a lot of childhood trauma.

Now what does childhood trauma do to the brain?

Basically when you have childhood trauma it rewires the circuitry of the brain such that you're more likely to be stuck in a ruminative state where you reflect on past bad events and you become basically more negative mystique.

And that's all from a neurobiological standpoint.

So your brain your brain's hard wiring does change when you experienced childhood trauma.

>> Now our brains continue to grow until we were twenty four years of age.

>> But you're especially you're especially prone to the after effects of the trauma when you're a young child because you've not developed the coping skills yet.

I mean you're just a small kid and you're having all this stuff happen to you that's something that can be highly, highly stressful for you so you can't change the past obviously .

>> So if you've had those kind of childhood experiences in childhood trauma, it's something that it's important that you can convey to your clinician who might be prescribing medication or doing psychotherapy because a psychotherapist might go a different direction based on your having a lot of different childhood trauma.

What we don't find that is helpful with people who have experience childhood trauma will be hypnosis.

Hypnosis was very popular about twenty years ago and it's used for a lot of different things for relaxation especially but it actually can make the whole concept of memory the memory and recollection.

They can come back and you can have a lot of traumatic experiences from that so we don't go the direction of if hypnosis if you've had childhood trauma.

But it's very important that we educate adults of the impact of having having a any traumatic experiences that are conveyed toward their children.

>> If you are mostly neglect them, if you're emotionally abused them, if you berate your children it's more likely to affect them later on now that often is a repetition phenomenon where if you had those experiences yourself as a child you are more likely to want to have those experiences repeated in the authority figure as an adult.

So in other words, if your father was emotionally abusive toward you, it's kind of a means of normalization with some people where you might think well that's how I'm supposed to raise a child.

That's how I was raised.

That's how I'm going to raise my child, keep in mind it might have had some impact on you and if it had some impact on you, you don't want to convey that to your child.

Becca, thanks for your call.

Let's go to our next caller.

Hello, Shane.

Welcome to the Mind.

Shane, you had mentioned you just started clozapine and you're getting headaches.

Is that something normal or should you ask your doctor for a change if you're getting headaches from clozapine is probably a serotonin effect from the clozapine self.

Shane, you should talk to your clinician about that and might not need to change it.

It might be a dose relationship type of phenomenon.

Some people are really fast metabolism of clozapine.

It goes to this particular enzyme called Cytochrome P4 fifty one a two and if you're a fast metabolism well you'll have lower blood levels and that might be where most people half the people are fast metabolism and clozapine but the other half are not so fast metabolism and if you're not so fast of a metabolism you'll get higher blood levels.

And the nice thing about clozapine also known as Clozaril is you can get blood blood tests and blood levels on it so you can see precisely where your blood level should be.

So if you're getting a headache eater it's because you're on too high of a dosage or you're just more sensitive that particular medication I wouldn't necessarily recommend that you change medications if something else were off the bat unless you really examine if the dosage is the problem overall and it may well be sometimes all the time symptoms such as headaches from clozapine will decrease over the course of time and that's something that can be examined as well.

>> Shane, thanks for your call.

Let's go let's go to our next caller.

>> Our next caller is asking DirecTV over our coffee .

Knapp's a real thing.

Do they have any scientific validity?

Oops.

There we go.

OK, our coffee naps a real thing.

>> Do they have any scientific validity?

Coffee naps are a phenomenon where you drink coffee really fast and then you take a nap.

>> Now it sounds like that's something that would be entirely that would be an oxymoron.

>> You drink coffee then you take a nap where you can get by in doing that if you drink the coffee within a matter of ten or fifteen minutes coffee needs about twenty minutes to get absorbed efforts after it's consumed so you can take a nap right after drinking coffee .

Now why would you do this and when would you do this?

Typically people will take a coffee nap early to mid afternoon as the day goes on you'll have a sense called homeostasis but as the day goes on you'll naturally get more tired and your brain gets a little bit more foggy and a little bit more fatigued.

So what's happening there where you've got this chemical in the brain called ATP?

You might remember that from high school biology ATP is adenosine triphosphate and with ATP it clips off a phosphate as the day goes on and as you're using energy it's the energy source of the body and the brain.

So ATP turns into ATP and it kind of sends off and exhaust fume that's called adenosine.

So adenosine is basically the exhaust fume of ATP.

>> So if you think about ATP as being fuel it's got an exhaust and that's ATP that's adenosine.

So adenosine goes to the adenosine receptors and when they get more and more filled up morning and afternoon goes on.

You get more and more tired.

You can't think you can't concentrate.

You don't have much energy.

So as the adenosine receptors in the brain are getting all filled up, you're just getting tired now there's two ways that are really practical that you can fire those adenosine receptors back up and clear them out.

Number one is by sleep getting a nap and during the day a twenty minute nap is often enough during the afternoon you sleep for thirty minutes if you sleep for an hour or two hours sometimes that's a bit too much and you won't sleep well at night.

So even if you slept well at night a twenty minute nap no more than thirty minutes during the day can do a remarkable job in clearing off the adenosine receptors from the adenosine.

>> It's kind of like clearing the area of smoke and in doing so you'll feel more energized and awake.

>> However what also clear is off those little adenosine receptors will be caffeine a caffeinted coffee beverages the beverage consumed within about ten or fifteen minutes before you take a nap can get in your system.

Coffee requires about twenty minutes to really get absorbed and what coffee will do?

>> It's caffeine.

This can't be decaffeinated coffee .

It's got to be caffeinated coffee .

>> So the caffeine that's in the coffee caffeine to the body looks just like adenosine so the caffeine goes these little adenosine receptors knocks off the adenosine over the course of within twenty minutes or so of drinking coffee .

>> So when you awaken from a twenty minute nap number one you clear off a lot of the adenosine that's clogging up all those little adenosine receptors.

But secondly you have filled those adenosine receptors with caffeine.

It's a very awakening, a very alerting feel feeling.

So there is scientific validity to the so-called coffee naps.

It's where you drink coffee fairly quickly within about twenty twenty minutes or so.

>> Then you while you're still tired take a nap but then try to get up after about 20 or 30 minutes and that's about when the coffee will be kicking in anyway the caffeine from the coffee and you'll be wide awake.

It's something that I've discussed over the course of time with medical students who are always looking at ways of trying to get their brain working better and when you're in medical school you're studying all day long and you're really firing up this front part of the brain called the dorsolateral prefrontal cortex.

It's in the front left side of the brain primarily.

But this the thinking part of the brain and your brain is just getting exhausted as the day goes on and you can't think and you can't focus.

That's because getting all cluttered up with adenosine which is the byproduct of ATP in ATP has been for getting fired up all day.

So what do you do ideally you take about a 20 minute nap but using some form of low dose caffeine no more than one cup of coffee ought to be fine.

>> But using Ludo's caffeine just preceding that that nap can fire up your brain for the rest of the day and not only will you be more awake and alert but also you'll be able to retain information better because as the day goes on, as your brain is getting exhausted and fatigue, you can't retain information, you can't think as well and you can't download memory and the data you're trying to study when that you're in school.

in the mid maybe late afternoon is fine if you nap after about five o'clock or so and you're trying to go to sleep around ten thirty or eleven that can interfere with your sleep.

As I'm always telling people be careful of drinking caffeinated beverages after about six p.m. because if you drink caffeinated beverages after six p.m. that can be problematic for your sleep and for some people they can drink caffeinated beverages after three p.m. or so.

So we're all different.

>> You have to find out what works for you.

Thanks for your question.

Let's go to our next caller.

Hello Carter.

Welcome to Matters of Mind.

>> Carter, you want to know about the average recovery time after a concussion and what happens to the brain following a concussion?

Carter depends on what degree of concussion you have experience if you had a concussion where you're knocked out you were unconscious, it might take you months to recover from that particular concussion if you had a concussion where you're just kind of dazed a little bit where you know, back in the 1970s the coach would say how many fingers do I have?

Then you go back in the game, OK, a mild concussion.

You might be able to be OK over the course of a couple of weeks but everybody's different based on the severity of the concussion and also very importantly, Carter, it's based on how many concussions you have experienced if you've had one concussion you'll typically recover pretty quickly.

But as many football players have experienced, if you've had multiple concussions with each concussion it takes longer to to recover and we've seen that in the National Football League where they've actually started studying the brains of football players who have died looking for chronic traumatic encephalopathy, which is a condition that is a dementing condition that follows multiple concussions.

A lot of offensive linemen especially had this kind of phenomenon that occurs but wide receivers who have the head to head contact can be at risk.

But it has to do with the severity of the concussion itself and how many concussions you've experienced over the course of time.

So those are the two main things we'll examine.

So everybody's a bit different in that regard.

>> But the bottom line is with concussion is a brain injury.

What happens?

Well, basically your brain has the consistency of jello.

So if you take your brain right now out of your skull it's going to be kind of mushy.

Your skull is rock hard.

So when people say you have a thick skull you should say thank you because your skull is supposed to be thick and it's rock hard.

pBut the problem with the skull, it's there to protect this really gelatin consistency of the brain, this gelatinous type of brain.

>> But when the when you have a concussion and your brain is sloshing around inside or inside your skull, you'll have difficulty with what we commonly will refer to as a brain bruise.

It won't show up on an MRI of the brain.

It won't show up on a CT of the head but it's a brain bruise where your your brain has quickly hit the side of the skull and in doing so there's a huge release of glutamate.

>> Glutamate is what drives this outside gray matter of the brain the gray matter I've got a lot of colors here to my outside part of the brain but it's actually gray when you look at it and the gray matter of the brain is the thinking part of the brain.

It's outside part of the brain and when the gray matter of the brain gets hit against the side of the skull you get this increased glutamate increases in glutamate.

No one can give you a seizure glutamates and excitatory neurotransmitter.

It's consists of about 80 percent of all neurotransmitters and the great gray matter of the brain.

But when glutamate is increased excessively and abruptly it can overwhelm the braking system in the gray matter of the brain causes you to have seizures and cause you to have problems with focusing concentration and temporarily it can give you some frying of the branches of the individual neurons.

And what I mean by that is if you have excessive glutamate it decreases the brain fertilizer effect of the brain that we all naturally possess.

And in doing so instead of having 10 instead of having ten thousand to fifty thousand branches on individual neurons, you might have no more than four thousand branches so you might lose your branches and your neurons following a head injury.

>> That's why many people following head injury can't concentrate their irritable.

They're moody, they can't focus, they're not energetic.

They're motivated.

These are all symptoms of somebody who's had a head injury and it takes time for people to recover from that.

>> But in the meantime we're trying to find better and better treatments and we're there out there for the purpose of reversing this.

For instance, if I hear about somebody who's had a recent head injury, I'm often going to place them on a medication called Lamotrigine, also known as Lamictal y Lamictal.

>> Well, it will decrease the firing of glutamate and that's part of the pathology of a traumatic brain injury.

Lamictal or the motor gene.

As a psychiatrist I have found that it's a good medication for somebody who had a head injury and they had a lot of irritability, moodiness.

They have trouble with impulse control.

They have trouble with anger management.

These are symptoms people can have from a head injury.

And when I'm thinking about the networking of the brain following a head injury, I'm thinking that person is struggling with excessive So we need to settle that down and Lamotrigine as a means by which we can do that.

>> Carter, thanks for your call.

Let's go to our next caller.

Hello Kim.

Welcome to Matters of Mind.

Kim, you want to know if if there is a depression specific to seniors you've knows that your elderly mother is becoming more withdrawn the depression that's more likely to occur with seniors, Kim will be the type of depression where they do become more withdrawn.

They will struggle with their sleep and there's a myth saying that older people need less sleep.

That's not necessarily true.

It's just that older people often get less sleep and part that's a natural phenomenon.

It can be problematic where if you get less sleep you're more likely to have memory problems or even depression.

So lack of sleep for an older person is not a normal type of thing.

It's the type of thing that should be corrected if at all possible.

So the type of depression seniors will often have will be the social isolation.

I'm always warning people about the whole concept of retirement and going to that next chapter in life if you retire by golly you need to have something to do and you need to be prepared to be around people and find a way to continue socializing again.

>> I mentioned earlier in the program about Sigmund Freud whole idea of successful treatment being to love and to work.

You need to have the social connections you need to still have productive work activity.

You don't necessarily have to be employed as an older adult.

You just need to be doing something.

So having meaningful connections doing something will be very important in many older adults lack that part of the reason will they physically have trouble with it?

They physically have a hard time getting out and about so you have to find ways to be able to connect with other people within your physical capacity to work be productive.

Same concept you might have trouble physically being able to do that because you've had some ailments over the course of time you need to within your capacity, within your physical capacity find things to do but we all need to have things to do that's one of the most important things that I can always advise for people.

So with your elderly mother starting to become more withdrawn.

>> Yeah, as you get more withdrawn and more socially isolated you are more likely to get depressed.

>> We saw this during the covid pandemic and it was something frighten me as I saw it occurring that with all the lockdown's and all the restrictions that were going on during covid pandemic OK early on some of those restrictions might have been life saving for a lot of people.

But as a continued over the course of months and even a year or so with with those restrictions and the social isolation, it was having a huge impact on the mental health of a lot of people as people got more socially isolated, they got more depressed.

We saw the suicide rate increase during the covid pandemic restrictions.

We saw the rate of depression triple.

We saw opiate abuse going off the chart during that time.

A lot of that had to do with social isolation and people starting to lose that meaning and in life for them and they lost that passion for what they wanted to do and what they wanted to be.

>> Kim, thanks for your call.

Unfortunately I'm 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 at WFYI ECG I'm psychiatrist J Forward.

You've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing and PBS willing.

>> I'll be back next week.

Thanks for watching tonight