.

Good evening.

>> I'm psychiatrist GF Verlie live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 25th year are 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) to seven to zero or if you're calling any place coast to coast you may dial 866- (969) to seven to zero now on a fairly regular basis I am broadcasting live every Monday night from our spectacular Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an e-mail question concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at a dog that's matters of the mind at FWC Dorgan will start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver, my husband likes to have a white noise generator going on at night while he sleeps.

>> Why does such thing help him sleep?

>> Basically a white noise generator just gives you a background sensory input sensory input goes to the thalamus which is in the middle of the brain and the thalamus will regulate sensory input overall the reticular formation is in the brainstem down here and that's what is responsible for helping you sleep.

So basically when you have this white noise going on the background you basically will block out outside distractions and quite simply that helps you sleep a little bit better.

>> Many people will notice that when they have background noises let's just door slamming, people talking especially in a hotel environment it'll cause them to awaken so that white noise in the background can be very helpful, something that we often will recommend to people who have traffic noises and they have dogs barking outside.

We recommend it to people so they don't have that intermittent awakening throughout the night due to those outside distractions.

>> You really want to be able to sleep ideally seven to eight hours every night.

Some people can get by on five or six hours but if you can get deep sleep which also includes dream sleep you'll get a better night's sleep where your brain gets better recharged you're able to remember things better the next and you feel physically and mentally more awake.

So you need that deep sleep throughout the night that also will include dream sleep as well.

>> Thanks for your email.

Let's go to our first caller.

Hello Kim.

Welcome to Matters of Mind.

Kim, you want to know about your adolescent son?

He has trichotillomania which is a big fancy word for hair pulling.

Should I look for self-harm behavior with trichotillomania, trichotillomania as a condition where you'll pull out here often it's Suhair on top of the head.

For many people it might be eyelash his eyebrows and it's kind of a nervous condition and it would be considered more of a habit.

>> Can it be considered to obsessive compulsive behavior?

>> Well, it's a compulsion if you're doing something over and over again, you don't mean to do it but you feel like you need to do something to prevent harm.

Now Turker mania people often won't even notice knows they're doing it.

They will do it somewhat unconsciously.

They'll do it somewhat as a habit.

>> They'll do it sometimes for stress relief and they'll do it as they're thinking about something and it's kind of in the background.

So many people trichotillomania have historically worn cotton gloves for instance when they're at home and they're studying or they're on the computer if if they don't need to use the touch pad but they need to know where their hands are, what their hands are doing and where their hands are located and they don't even realize they're pulling that their hair until the next day they have patches of hair that's pulled out or they've missed the they're losing their eyebrows or their eyelashes and many people will pull their hair in that manner.

>> Now how do you try to come to trichotillomania?

Number one behavioral treatment is something that can be very helpful when we use medications we might use a B vitamin by the name of Atoll which is a means by which people can take three to six milligrams or three to six grams up to twice a day is not an uncommon dosage for some people think he's really, really high doses sometimes doses as low as 600 milligrams twice a day can be helpful but I've seen various ranges in doses for it.

But it's basically a natural means of trying to treat Beatlemania.

>> We'll also use the so-called SSRI, the serotonin reuptake inhibitors.

These are medications that by increasing serotonin can decrease anxiety, especially if people are pulling at their hair as a means of trying to give themselves some relief with anxiety or that self soothing effect.

>> Now does trichotillomania lead to self-harm behavior that usually trichotillomania is a condition in itself with the hair pulling it doesn't usually have a direct association with cutting oneself or making suicidal gestures or anything like that.

Now when people cut it themselves that's kind of a different phenomenon.

They'll cut it themselves when they're emotionally distressed and when somebody cuts at themselves they will often not being aware of doing so but they're releasing their own opiates from their skin.

We have opiates in our skin and when you cut it yourself it releases these natural pain relievers.

The natural opiates in the skin will go to the brain and give your brain a feeling of bliss and a sense of calmness.

>> So when people cut it themselves it's not a healthy thing to do but they'll do that as a means of trying to relieve anxiety and stress and in doing so they are in such a way self medicating.

>> Now that's an entirely different type of behavior intricate mania.

The self-harm behavior concerning cutting at oneself is entirely different than what somebody will do its work until a mania with hair pulling with trichotillomania people will do that as a means more of a self soothing or a relief of anxiety type of sensation.

But they're not trying to harm themselves.

Matter of fact they regret doing it and many people will seek treatment for trichotillomania because they're losing their hair on their eyebrows, their eyelashes or the scalps of their heads not uncommonly.

>> Kim, thank you for your call.

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

>> Our next e-mail question reads Dear Dr.

Favor, when do I know when to seek help for grieving?

>> Grieving is a natural response.

Grieving is something that people should noticeably endure after the loss of a loved one.

>> Grieving will sometimes be day a day initially as time goes on it comes in waves where every now and then you'll notice that you have profound sense, a profound sense of sadness for losing your loved one and over the course of time it should be alleviated to some degree.

Now that comes in different in different fashions with grieving.

If you are grieving the loss of a child that will impact you for a longer period of time than if you're grieving the loss of a parent.

If you're grieving the loss of a spouse as some somewhere kind of in between.

>> But depends on how long you been married to the spouse if you've lost because your spouse is somebody who's been in your life day by day by day, not only are you grieving but you're trying to adjust to well, getting your daily routine back on track and filling in the void that your spouse has left and many times that's a significant void that they're very much a partner for you.

So grieving will be different types and different durations and they'll have different features based on who you've lost now with grieving, don't be surprised if you do see the loved one periodically.

Some people get really apprehensive about being able to visualize their loved one periodically especially as they're starting to go to sleep.

As people start to go to sleep they'll have what are called hypnagogic hallucinations where they're going to sleep and they might see their loved one all of a sudden standing in the room or sitting at the bedside.

That's a normal means of grieving because when you're grieving the little hippocampus area in your brain over here, that's the memory center sometimes that'll pull back memories such that you'll feel as if your loved one is right there, especially when you're letting your guard down and that happens not uncommonly when you're just starting to go to sleep and it's considered to be a normal phenomenon but you might see your loved one periodically as you're grieving.

It's kind of a means by which your brain is letting go of the memories .

So it's allowing you to kind of transition to being able to let go of the memories of your loved one.

So visual elucidations will not be uncommon difficulty with sleep nightmares even or bad dreams can be somewhat problematic if they cause you to be fatigued and tired the next day.

>> So when do you know you need to seek help for the grieving is when you're having trouble with with eating you're having trouble asleep, you're having trouble getting your day to day activities done on a day to day basis.

>> Now there's no magic time frame for grieving.

>> It used to be thought 30, 40 years ago that six months is how long you should be grieving after six months it's all over.

It doesn't work that way.

It comes in different phases for people in different waves but it's clinically significant where it turns into a what's called a major depression if for two weeks straight, two weeks straight you're having difficulty enjoying things, you're not socializing, you're withdrawing your having trouble with eating, you're having trouble with sleeping and you're just not being able to do the kind of things you need to do.

That's when you want to seek help and will often do initially is we try to treat the insomnia if you're having trouble sleeping it will impair your judgment.

It'll affect how well you're able to concentrate and make decisions and do what you need to do the next day.

>> So lack of sleep is what we often see initially occur for people and if it goes on for more than more than a week or two , that's where you want to talk to your primary care clinician and get some help at least for the sleep and possibly for ongoing depression if it's a problem.

>> Thanks for thanks for your email.

Let's go to our next caller.

Hello Joyce.

Welcome to Matters of Mind.

Hi, Dr. Farber.

>> It is Dr. Fauver.

Hello, Joyce.

Hi.

Hi.

Hi.

I'm calling I'm wondering I am a senior and doing crosswords and puzzles.

Does that actually help with memory and if it does or doesn't what what are good things to do to help with memory or what if it causes dementia or anything like that?

>> Can you answer that?

You bet.

Joyce, are you participating in puzzles and crossword puzzles specifically now?

>> No, I'm not.

That is a social is it something to be doing but I'm active otherwise.

>> Yeah there is a big study done.

>> Oh my goodness.

About forty years ago with nuns in U in s nuns and these nuns were very active participating in puzzles in keeping their minds active and socializing with one another and they actually looked at their chemical with their physical structures of their brains and it was found that nuns who participated in puzzles and games and they were socially active throughout the day they had a larger hippocampus compared to people who were not doing those kind of things.

>> So the so-called nun in you in study was a classic study that found that puzzles and keep in your mind mentally exercising was a means by which your hippocampus could continue to maintain its size.

>> Now that's one thing that people can do.

What else can people do to preserve this memory center here and thereby decrease the risk for dementia socializing as I mentioned is a big factor.

Exercising on a regular basis is likely a factor if people were get 20 30 minutes of exercise in we're just talking walking for a brisk walk periodically exercise of any kind can increase this particular chemical the brain called brain derived neurotrophic factor of BDNF.

>> That's the brain's natural Miracle-Gro.

It basically fertilizes the brain and keeps the brain more fluffy and makes you have less memory difficulties over the course of time.

>> So some kind of exercise can be helpful avoiding clinically significant depression as you get older now people get older, they retire, they have changes in life I mentioned earlier sometimes you'll be mourning the loss of a spouse when you have depression that's overwhelming for you and you're having trouble coping that will increase your likelihood of dementia by five times.

>> So we take older adult depression very, very seriously because they're at a higher risk for experiencing dementia over the course of time depression clinically significant depression for at least two weeks on end you're having sadness.

You're not enjoying things.

You're having trouble with self-esteem, appetite, concentrate on sleep disturbances, all this cascade of symptoms.

If you have those kind of symptoms, you're more likely on the long run to have dementia as an older adults.

So it's something that we look at is a somewhat of a clinical crisis for older people in general if you're wanting to prevent the likelihood of dementia, you want to make sure your blood sugars are in good control, your blood pressure is in control because high blood sugars and high blood pressures will be risk factors for dementia in general people are at a higher risk for dementia if they have family members with dementia.

Now there are evolving some so-called biomarkers which mean blood tests where you can test somebody's susceptibility for dementia.

But one of those biomarkers is the apolipoprotein E three and E four genes.

>> And if you have those particular genes particularly E three and four genes, they identify those particular subtypes.

>> You could be calculating how much of a higher risk for dementia you might have.

So if you have a particular kind of genetic profile that might increase risk for dementia but it's not entirely deterministic, it gives you a higher probability of dementia but it's not more it's not probabilistic but there are gene studies that can be done.

But the other biomarkers that are coming out are actually looking at the risk for having junk gunk in the brain.

>> I mean dementia is thought to be caused partially due to too much amyloid along the neurons themselves and amyloid is basically trash that gets deeper around the neurons and it's a protein trash amyloid plaques or what they're called the same amyloid plaques get deposited in the pancreas for somebody who's prone to type one diabetes.

So type one diabetes, that's where you don't produce enough insulin in the pancreas type and it will give you amyloid plaques.

The same can happen with people with Alzheimer's dementia, with Alzheimer's dementia.

There's also tau proteins.

Tau proteins are little tangles that are in the brain itself.

So there's particular kind of things that can be identified but there seems to be more to it than that the sense that dementia is is indirectly related to inflammation seems to be very valid.

>> The brain can get inflamed.

>> Part of that can be due to depression itself but inflammatory effects in the brain can be a factor and what causes the brain to get inflamed long term obesity can be an inflammatory event.

>> So if you have a lot of fat deposits and a lot of adipose tissue in the rest of the body that could increase inflammatory proteins which thereby could put you at risk for heart disease, stroke, diabetes, all these other medical conditions.

But one of the medical conditions that obesity can cause will be the inflammation of the brain and thereby dementia.

>> So there's all these risk factors that people can can consider having a head injury earlier in life put you at higher risk for dementia.

That doesn't mean we should have to wear helmets as we walk around life .

But you know, if you're doing something that might be prone to causing you get hit the head, you might want to wear a helmet and obviously they're doing a lot of football player studies right now with chronic traumatic encephalopathy CTE where football players and have repeated concussions are more likely to have chronic traumatic encephalopathy which in the long run gives you the symptoms of dementia and that's why a lot of these football players who are retired are having trouble with memory and some of them have personality changes that lead to them unfortunately doing things and saying things they ordinarily wouldn't do or say including taking their own lives.

>> So we hear about that occasionally.

So Jois, the best thing we can do is what we can do to to prevent dementia.

We can't change our genetics, our genetics or how we're hardwired but we can do what we can to try to keep ourselves from having head injuries and protect ourselves from that.

We can exercise, we can socialize, we can seek help if we're having any difficulty with such medical conditions as depression, high blood sugars, high blood pressure, those type of things.

And if you're one to watch your weight, it's pretty important to keep your weight down because the higher weight the higher a body mass index somebody has that is a risk factor for dementia as well.

So these these are all different factors but now original questions if you keep your brain active you bet that has a lot of impact on decrease the risk for dementia because keeping your brain active is like keeping your body active and thereby keeping yourself physically healthy.

Keeping your brain healthy is is going to be related to keeping your brain busy not only doing puzzles especially crossword puzzles but also perhaps learning new things, studying something you haven't studied before.

>> Many people when they get older and they're going to retirement years, they're finally able to start doing studies that they didn't do previously.

>> I've heard of a lot of people once they get into retirement years they finally have time to do seriously study the Bible at and they haven't been able to to earlier in life because when they are involved with their career they were involved in all these business decisions and trying to do all these different studies for their business and doing analytics.

But when you're retired you have the freedom to be able to study history and study things that you haven't been able to study before and when you're learning new things including a new language which is very difficult to do but if you're learning new things it actually stimulates the brain chemistry in such a way that you can lay down the scaffolding for new neuronal growth and that's called synaptic genesis and neurogenesis.

So that's what we're always trying to do for people when they're depressed, when they're having trouble with memory disturbances.

We're trying to keep their brain active somehow some way.

>> Joyce, thanks for your call.

Let's go to next caller.

Hello, Dean.

Welcome to Matters of Mind.

Yes, I had a question on the medication dappling.

I went to get it filled in on this rather expensive.

Was there any other substitutes and also I have lately said in my phone at best I can understand it has something to with your folate levels.

>> Yeah.

Did I could explain that for you.

Duplin is elemental folate.

It's among other things but elemental folate is a it's called a food product.

It's called a nutritional medication.

I think it should be covered by insurance but unfortunately it's not and it's not uncommonly sold at around sixty dollars for a three month supply but if you have an all methyl folate metabolism disturbance by all means you need to take an methyl folate substitute.

Here's how it works.

Elemental folate is the byproduct of folic acid, folic acid is vitamin B nine .

Vitamin B nine needs to get broken down into elements of folate.

So it's like going to a football stadium or this time of year basketball stadium.

>> But you're going into the stadium and you've got to go through a turnstile.

Folic acid is like on the outside the turnstile is called methylene tetra hydrophilic ductus F.R.

This if if this enzyme is not as active as it should be, the turnstile doesn't work so well so the folic acid gets left on the outside.

What you want to do is get the folic acid converted to elemental folate.

Why is that important?

Elmsford folate is a means by which you can help build norepinephrine serotonin and dopamine.

Those are important neurochemicals in the brain so you want elemental folate to get into the brain itself.

So if your folic acid is not getting metabolized adequately as it is problematic for up to twenty five to thirty percent of the people to some degree you need the end biproduct Elmau for folate.

>> If you had genetic testing you'll notice two particular genes that were tested twelve ninety eight and six seventy seven.

These are our genes and we like to look at both of our six seventy seven will convert about thirty five percent of the folic acid to elemental folate twelve ninety eight about twenty five percent so that's kind how it's divided up so six seventy seven is the most important gene to see.

>> I like to also see the twelve ninety eight gene to really determine if somebody needs DeBelin now should we all just take that one.

We could because if you don't need it necessarily just get urinated out.

The B vitamins are urine they get excreted by by the urine so it's easy to get rid of them but if you don't necessarily need methyl folate you can get simply B complex vitamin that would include folic acid.

The problem is if you have the mutation and you don't know it and you take folic acid, folic acid accumulates and it increases this level of homocysteine homocysteine can give you an inflammatory effect and it can be dangerous.

So you don't want to take folic acid unless you know you're a good metabolize or of it and you don't want to take too much of for that reason.

>> So elemental folate is the byproduct of folic acid.

So what are the cheaper versions?

Well, you can get enlight which for some people is covered by their insurance n debelin and in Leider two of the more prominent brands of prescription elemental folate and then sometimes people can get reliable brands by the Internet and Internet versions are not prescription grayed necessarily but for many people they find them effective.

So we might recommend Elmsford folate at fifteen milligrams through a product like metabolic maintenance which is a brand name of a generic over-the-counter folic acid.

So methyl folate through the metabolic maintenance version at fifteen milligrams would be helpful for somebody that has a more severe mutation of folic acid disturbances and that would be called homozygous mtkvari mutation heterozygous if our mutation might be able to get by 10 milligrams of the methyl folate, 15 milligrams is the usual recommendation if you have a homozygous empty EGFR mutation, if you happen to see that on your chart when you're with your physician sees you.

>> Thanks for your call.

Let's go next caller.

>> Hello John.

Welcome the mastermind.

Hello.

Hi John.

Hi.

My question is I have a son who had schizophrenia for 24 years.

He hears voices negative all the time and they used to have this shock treatment procedure and they have a different name for it now I'm just wondering if he'd be able to take that since he has schizophrenia.

>> Yeah, John ect electroconvulsive therapy used to be called shock treatment basically ECT is where your stimulating is particularly the right front part of the brain and sometimes people get on both sides of the front part of the brain but basically it causes the brain to go into a seizure for somewhere between twenty seconds up to 90 seconds.

Typically people are induced into a very with a very short acting anesthetic so they're totally asleep during that time and they are ventilated because they are given a medication that shuts off their breathing.

The whole treatment lasts no more than an hour or so.

It's done typically in a recovery room.

ECT has been around since the 1950s.

It was found that people with seizures back in the nineteen fifties had if they had depression as well as epilepsy when they had a seizure they felt more alive, they felt less depressed.

>> So the thinking was well gee if we could induce them into having a seizure they could actually get some relief for depression.

So ECT is particularly effective for what's called a melancholic depression where people will awaken in the early morning hours.

They'll have trouble with being able to find joy in life .

They'll have not only difficulty with eating disturbances and they might be quite agitated in a lot of cases.

So people with depression particular type of depression will often do quite nicely with ECT where else could be used ECT can be used for somebody who's floridly manic for for instance if somebody is pregnant you can use it for somebody who's pregnant if they're manic and they're causing harm to the baby due to the mania itself they're not sleeping.

They're not they're doing things impulsively.

They're so hyper they're all revved up.

>> That's very stressful for the baby.

So during mania they can have some relief with ECT ECT with schizophrenia can be particularly effective if it's a type of schizophrenia called Shishko with schizoaffective disorder it's where they have schizophrenia but they also have a mood disturbance on.

And so the bottom line is this is particularly helpful for people that have some kind of mood disturbance along with the possibility of the psychosis there John.

>> John, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at a dot org.

>> I'm psychiatrist Jeff Aubrey .

>> You've been watching Matters of the Mind on PBS for Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

>> Goodnight