.

GOOD EVENING.

I'M PSYCHIATRIST JAY FAUVER LIVE FROM FORT WAYNE, INDIANA.

WELCOME TO MATTERS OF THE MIND.

NOW IN THIS TWENTY SECOND 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 AT PBS FOR WAYNE BY DIALING IN THE FORT WAYNE AREA NINE SIX NINE TWO SEVEN ZERO OR IF YOU'RE CALLING COAST TO COAST YOU MAY DIAL TOLL FREE AT EIGHT SIX SIX NINE SIX NINE TO SEVEN TO ZERO 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 UNIVERSITY FORT WAYNE CAMPUS.

AND IF YOU'D LIKE TO CONTACT ME WITH AN EMAIL THAT I CAN ANSWER ON THE AIR, YOU MAY WRITE ME OVER THE INTERNET AT MATTERS OF THE MIND ALL ONE WORD AT WFA A DOG THAT'S MATTERS OF THE MIND AT WORK.

AND I START TONIGHT'S PROGRAM WITH A QUESTION I RECENTLY RECEIVED.

IT READS DEAR DEAR FATHER MY MEDICATION FOR ANXIETY AND DEPRESSION HAS WORKED PRETTY WELL FOR THE MOST PART.

ONE CONCERN I HAVE IS THAT EVERY ONCE IN A WHILE IN A LONG WHILE I MISS THE DOSE.

WHAT'S THE PROPER WAY TO HANDLE MISSING A DOSE?

IT REALLY DEPENDS ON WHICH TYPE OF MEDICATION YOU'RE TAKING.

THERE ARE SOME MEDICATIONS THAT HAVE SO-CALLED LONG HALF LIVES.

THAT MEANS IT TAKES A LONG TIME FOR THEM TO GET OUT THE SYSTEM.

OTHER MEDICATIONS YOU'RE GOING TO NOTICE IT IF YOU MISS A DOSAGE AND YOU'LL HAVE SUCH DISCONTINUATION SYMPTOMS AS TINGLING OR NUMBNESS IN THE HANDS OR FEET YOU MIGHT HAVE THE SPINNING SENSATION IN THE HEAD.

SOME PEOPLE WILL HAVE ZINGS AND ZAPS THE CAN OCCUR IN THE HANDS AND FEET AND WITH THOSE KIND OF MEDICATIONS YOU'RE GOING TO WANT TO TAKE THE MEDICATION ON A REGULAR BASIS ABOUT THE SAME TIME EVERY DAY THOSE MEDICATIONS INCLUDE MEDICATIONS LIKE EFFEXOR, PAXIL, PRESTIGE TO SOME DEGREE AND CYMBALTA THE MEDICATIONS THAT HAVE EFFECTS ON SEROTONIN AND NOREPINEPHRINE TO SOME DEGREE SOME MEDICATIONS LAST A LONG TIME AND YOU CAN GET BY WITH MISSING DOSES EVERY NOW AND THEN EVEN THOUGH WE DON'T ENCOURAGE IT.

BUT MEDICATIONS LIKE PROZAC TELEX HAVE SO-CALLED LONG HALF LIVES AND SOME PEOPLE WILL MISS THE DOSAGE AND NOT REALLY MISS A BEAT IN DOING THAT.

SO IT REALLY DEPENDS ON WHICH TYPE OF MEDICATION YOU'RE TAKING.

TALK TO YOUR CLINICIAN WHO'S PRESCRIBING THE MEDICATION TO SEE WHAT YOU SHOULD DO WITH THOSE PARTICULAR MEDICATIONS IF YOU HAPPEN TO MISS A DOSAGE BECAUSE WE'RE ALL PEOPLE WE MISS DOSES ON MEDICATIONS, WE GET IT AND THE KEY WILL BE TO BE CAREFUL IF YOU DOUBLE UP ON THE DOSAGE IF YOU MISS IT, NOT ALL MEDICATIONS YOU WANT TO DO THAT.

SOME YOU CAN BUT NOT ALL OF THEM YOU WANT TO DO THAT.

SO TALK TO YOUR CLINICIAN ABOUT THE POSSIBILITY OF OF YOUR JUST SKIPPING A DOSAGE IF YOU MISS IT OR SHOULD YOU TAKE A SECOND DOSAGE DEPENDING ON WHICH MEDICATION YOU'RE ON.

THANK YOU FOR YOUR EMAIL QUESTION.

LET'S GO TO OUR FIRST CALLER.

HELLO LOUIS.

WELCOME TO MATTERS OF MIND.

LOUIS, YOU'RE 70 YEARS OLD AND YOU'RE ON AMITRIPTYLINE 10 MG FOR 18 YEARS AND FIVE MILLIGRAMS MORE RECENTLY FOR THE PAST TWO YEARS AND AMITRIPTYLINE OF MEDICATION IT IS ALSO KNOWN AS ELLISVILLE AND END UP BACK IN THE OLD DAYS IT'S BEEN AROUND SINCE THE 1950S.

AMITRIPTYLINE AT LOW DOSES HAS BEEN USED FOR MANY, MANY YEARS TO HELP WITH SLEEP, TO HELP WITH ANXIETY.

WHEN YOU GET TO DOSES AROUND SEVENTY FIVE OR 150 MILLIGRAMS A DAY IT STARTS TO HELP WITH DEPRESSION.

THE DRAWBACK OF AMITRIPTYLINE LOUIS WILL BE IF YOU TAKE HIGHER DOSES SOMETIMES IT'LL CAUSE YOU TO HAVE DIFFICULTY WITH DRY MOUTH CONSTIPATION, SOMETIMES DIFFICULTY WITH YOUR BLADDER IN TERMS OF BEING ABLE TO URINATE PROPERLY.

DRY EYES WILL BE NOT UNCOMMON AND SOME PEOPLE CAN GET A LITTLE BIT LIGHTHEADED ON IT.

SO WE TEND TO BE VERY CAREFUL WITH AMITRIPTYLINE AT HIGHER DOSES.

YOU'RE SAYING THAT YOU'VE BEEN OFF OF IT NOW FOR TWO WEEKS AND YOU'RE NOTICING YOUR HIGH HAVING HIGH BLOOD PRESSURE AND ANXIETY AND YOU'RE WONDERING IF THOSE ARE WITHDRAWAL SYMPTOMS?

THE GOOD NEWS IS, LOUIS, IF YOU'VE BEEN TAKEN AMITRIPTYLINE VERY LOW DOSES JUST TEN MILLIGRAMS A DAY AND THEN FIVE MILLIGRAMS A DAY FOR THE PAST TWO YEARS.

SO IT'S NOT LIKELY THAT YOU'RE HAVING WITHDRAWAL FROM THE MEDICATION AS OPPOSED TO HAVING THE EXPERIENCE OF WELL, NOT HAVING THE MEDICATION BECAUSE AMITRIPTYLINE CAN LOWER THE BLOOD PRESSURE JUST A LITTLE BIT BECAUSE THAT'S WHY WHEN YOU STAND UP YOU CAN GET A LITTLE BIT LIGHTHEADED AND IT CAN'T HELP WITH ANXIETY A LITTLE BIT .

SO I THINK INSTEAD OF HAVING WITHDRAWAL RIGHT NOW YOU'RE NOTICING THE IMPACT OF NOT BEING ON THE MEDICATION.

SO AS YOU STAY OFF THE MEDICATION ANOTHER WEEK, ANOTHER TWO WEEKS, ANOTHER THREE WEEKS, YOU MIGHT NOTICE THAT YOU KIND OF ADAPT TO NOT HAVING THE MEDICATION OVERALL.

BUT THERE ARE A LOT OF OTHER OPTIONS OUT THERE BESIDES AMITRIPTYLINE FOR ANXIETY OR DEPRESSION SINCE NINETEEN EIGHTY SEVEN WE'VE HAD 16 DIFFERENT ANTIDEPRESSANTS BECOME AVAILABLE AT AMITRIPTYLINE WAS ONE OF THE MEDICATIONS THAT WAS AVAILABLE A LONG TIME AGO.

WE JUST DON'T USE IT SO MUCH ANYMORE BECAUSE HAS A LOT OF SIDE EFFECTS AND FOR OLDER ADULTS IT CAN CAUSE TROUBLE WITH MEMORY AND CONCENTRATION.

THAT'S WHY WE DON'T USE IT AT THE HIGHER DOSES AT LEAST.

HOWEVER, AMITRIPTYLINE CAN BE HELPFUL FOR PAIN AT REALLY SMALL DOSES LIKE TEN MILLIGRAMS AT BEDTIME CAN BE VERY EFFECTIVE FOR PAIN FOR A LOT OF PEOPLE.

SO SOME PEOPLE WILL USE IT FOR THAT PURPOSE AND STILL GET AWAY FROM NOT HAVING ALL THE SIDE EFFECTS YOU CAN HAVE AT THE HIGHER DOSES.

LOUIS, THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT CALLER.

I'M SORRY.

LET'S GO TO OUR NEXT EMAIL.

OUR NEXT E-MAIL READS DO NOT FAVOR I FIND THAT MY SLEEP PATTERNS CAN BE VERY UNPREDICTABLE UNPREDICTABLE WHEN I'M GOING THROUGH DEPRESSION SOMETIMES IT SEEMS LIKE I CAN SLEEP ALL DAY.

SOMETIMES I HAVE INSOMNIA DURING TIMES OF DEPRESSION.

WHAT CAN EXPLAIN THESE TYPE OF SWINGS NOW USE A VERY INTERESTING WORD THERE SWINGS YOU MIGHT BE HAVING MOOD SWINGS WHERE YOU'RE HAVING HIGHS WHERE YOU MIGHT NOTICE THAT YOU'RE THINKING MORE WELL QUICKLY AND GOING FROM TOPIC TO TOPIC YOU'RE MORE IMPULSIVE.

YOU'RE NOT NEEDING TO SLEEP AS MUCH.

THAT'S CALLED A HYPOMANIC OR A MANIC SPELL IF IT GOES ON FOR AT LEAST A A WEEK HYPOMANIC SPELL GOES ON FOR FOUR TO SIX DAYS.

BUT IF YOU'RE HAVING THOSE HIGHS THEN YOU CAN CRASH INTO LOWS AND WHEN YOU HAVE THE LOWS YOU WANT TO SLEEP A LOT OF SOCIALLY WITHDRAWAL.

YOUR MIND IS NOT VERY SHARP DURING THAT TIME AND YOU'RE VERY TIRED.

SO IF YOU'RE HAVING SWINGS AS YOU MENTIONED AS A VERY LAST WORD OF THAT QUESTION AND YOU'RE HAVING SWINGS WITH HIGHS AND LOWS, WE CALL THAT BIPOLAR SPECTRUM CONDITION AND WHAT A BIPOLAR SPECTRUM CONDITION WILL BE IS WHERE YOU HAVE HIGHS AND LOWS THEY CAN LAST FOR A DAY OR TWO.

WE'D CALL THAT MAJOR DEPRESSION WITH MIXED FEATURES IF YOU HAVE DEPRESSION GOING ALONG WITH IT ,IF IT LASTS IF THE HIGHS LASTS FOR FOUR TO SIX DAYS, IT'S CALLED BIPOLAR DISORDER TYPE TWO IF YOU HAVE THAT FOLLOWED BY TWO WEEKS OF LOWS AND THEN IF YOU HAVE A BIPOLAR SORT OF TYPE ONE, IT MEANS YOU'VE HAD AT LEAST SEVEN DAYS OF MANIC SPELL A MANIC EPISODE WHERE DURING THAT TIME YOU JUST DON'T NEED TO SLEEP AS MUCH.

YOU'RE MORE REVVED UP, YOU'RE MORE ACCELERATED IN YOUR MOOD.

YOU'RE SOCIALLY INTRUSIVE.

YOU WANT TO TALK TO EVERYBODY YOU SEE AND THAT'S TYPICALLY OUT OF CHARACTER FOR YOU.

SO THE IMPORTANCE IN DIAGNOSING BIPOLAR DISORDER VERSUS MAJOR DEPRESSION AND HAVING THAT DIFFERENTIATION IS BECAUSE WE TREAT THE CONDITIONS ENTIRELY DIFFERENTLY.

IN OTHER WORDS, IF YOU TELL YOUR CLINICIAN I'M DEPRESSED AND I NEED TREATMENT FOR DEPRESSION BUT YOU DON'T MENTION WHAT YOU JUST SAID THERE WERE THERE ARE TIMES WHERE YOU'LL NOTICE THAT YOU SLEEP MORE AND YOU SLEEP LESS AND OTHER TIMES WELL THAT MIGHT BE A LITTLE BIT OF MEANS OF JUST GETTING IN AND DEPRESSANT.

AND IF YOU JUST GET AN ANTIDEPRESSANT AND YOU HAVE THOSE MOOD SWINGS WHERE YOU HAVE THE HIGHS AND LOWS, IT'S KIND OF LIKE PUSHING ON THE ACCELERATOR WITHOUT HAVING ANY BRAKES.

SO IF YOU HAVE A TENDENCY TOWARD HAVING HIGHS AND LOWS AND YOU TAKE JUST AN ANTIDEPRESSANT MEDICATION, IT CAN MAKE THE HIGHS AND LOWS BE MORE WELL HIGHER OR LOW AND YOU CAN ALSO HAVE MORE CYCLING WITH THE HIGHS AND LOWS.

SO WHAT WE TRY TO DO IF YOU'RE HAVING DISTINCTIVE MOOD SWINGS IS TO GIVE YOU A MOOD STABILIZING MEDICATION THAT KIND OF ACTS AS A CRUISE CONTROL IN THE MOOD WE'LL USE MEDICATIONS LIKE LITHIUM BEEN AROUND SINCE THE 1940S LITHIUM'S ASSAULT AND IT HAS THIS REMARKABLE A.N.

INFLAMMATORY EFFECT ON THE BRAIN AND IN DOING SO CAN STABILIZE THE MOOD WE TEND DOUCETT IT ON THE LOW SIDE JUST SO YOU DON'T HAVE SIDE EFFECTS SUCH AS DIARRHEA OR TREMULOUSNESS OR NAUSEA OR HEADACHES.

IF YOU GET TOO MUCH LITHIUM YOU CAN USE ANTIEPILEPTIC OR ANTI SEIZURE MEDICATIONS.

THEY'VE BEEN AROUND FOR A LONG TIME NOT ONLY FOR SEIZURES BUT WE USE THEM FOR MOOD STABILIZERS AND NOWADAYS YOU CAN USE MEDICATIONS LIKE TEGRETOL, DEPAKOTE, LAMICTAL, TRILEPTAL OFTEN GETTING USED NOWADAYS SOMETIMES NEURONTIN OR GABAPENTIN BUT THOSE CAN ALL KIND OF STEADY THE MOOD AND LEVEL IT OUT SOME AND SOMETIMES THEY WORK BETTER FOR THE HIGHS OR THE LOWS DEPENDING ON WHICH ONE YOU CHOOSE.

AND THEN WE'LL USE THE SO-CALLED SECOND GENERATION ANTIPSYCHOTIC MEDICATIONS.

THE ANTIPSYCHOTIC MEDICATIONS AREN'T JUST FOR SCHIZOPHRENIA OR PSYCHOSIS.

MANY OF THEM ALSO WORK AS MOOD STABILIZERS AND THERE'S MANY OF THEM.

SO WE'LL USE MEDICATIONS LIKE SARFARAZ RISPERDAL, ZYPREXA SERIK WELL JUST TO NAME A FEW OF THEM AND THESE ARE MEDICATIONS THAT CAN STABILIZE THE MOOD.

AND WHEN YOU LOOK AT MOOD STABILIZERS, YOU LOOK AT THE CLASSES OF MOOD STABILIZERS SO YOU MIGHT HAVE SOMEBODY ON LITHIUM AND ANTIEPILEPTIC MEDICATION LIKE LAMICTAL AND THEN MOOD STABILIZING ANTIPSYCHOTIC MEDICATION LIKE LATTITUDE.

SO THESE ARE THREE DIFFERENT CLASSES OF MEDICATION THAT ALL WORK IN DIFFERENT WAYS AND PEOPLE SOMETIMES WONDER WELL GEE, WHY ARE USED IN TWO OR THREE DIFFERENT MEDICATIONS FOR ONE CONDITION IT'S NOT UNLIKE WHAT WE SEE WITH DIABETES WITH ASTHMA TREATMENT, WITH HEART CONDITIONS.

MANY TIMES CLINICIANS WILL USE DIFFERENT CLASSES OF MEDICATIONS TO TRY TO CONTROL CERTAIN CONDITIONS BASED ON THEIR DIFFERENCES IN MECHANISMS OF ACTION.

SO WE WILL OFTEN USE MEDICATIONS WORK DIFFERENTLY FOR THE PURPOSE OF STABILIZING THE MOOD.

THANK YOU FOR YOUR EMAIL QUESTION.

LET'S GO TO OUR NEXT CALLER.

HELLO SHIRLEY.

WELCOME TO MATTERS OF MIND.

HI.

HELLO.

HI DR. NICE NICE TALKING WITH YOU.

LIKEWISE.

I I HAVE A QUESTION ABOUT MY GRANDSON.

HE'S SEVENTEEN AND HE COUPLE OF YEARS AGO HE STARTED HAVING TROUBLE WITH MOTION SICKNESS IN THE CARS OR THE SCHOOL BUS.

HE HAS ASPERGERS AND IT HASN'T GOTTEN ANY BETTER.

I WAS HOPING HE'D OUTGROW IT BY NOW OR SOMETHING.

IS THERE SOMETHING YOU CAN PUT HIM ON?

RECOMMEND SOMETHING THAT WOULD HELP HIM?

YEAH, SURELY AS YOU'RE AWARE, ASPERGER'S IS A VARIANT OF OF AUTISM SPECTRUM DISORDER.

IT'S BASICALLY A CONDITION WHERE PEOPLE HAVE AUTISM BUT THEIR HIGHER FUNCTIONING TYPICALLY THEY SOCIALIZE MORE SO THAN OTHER PEOPLE.

I WOULD CERTAINLY TALK TO HIS PRIMARY CARE CLINICIAN FOR STARTERS TO SEE IF A MEDICATION CAN BE GIVEN FOR MOTION SICKNESS SUCH AS WLEZIEN, WHICH IS A MEDICATION HAS BEEN USED FOR A LONG TIME FOR REMOTE MOTION SICKNESS FOR A LOT OF PEOPLE MAGAZINE IS SOMETHING THAT'S AN ANTIHISTAMINE MEDICATION BUT SOMETIMES WILL BE USED FOR MOTION SICKNESS AND THAT'S SOMETHING THAT POSSIBLY CAN SEND HELP OUT WITH THAT.

BUT WHEN YOU MENTIONED AUTISM SPECTRUM DISORDER, THE FIRST THING I OFTEN THINK ABOUT SHIRLEY IS WHERE HE'S HAVING DIFFICULTY WITH STIMULI.

PEOPLE WITH AUTISM SPECTRUM DISORDER OR ASPERGER'S DISORDER WILL OFTEN HAVE DIFFICULTY WITH CHANGES AND SEEING LIGHTS AND SOUNDS AND MOVEMENT FOR THAT MATTER AND THE REASON THEY WILL HAVE STRUGGLES WITH THAT IS BECAUSE THEY DON'T DO WELL WITH CHANGE.

THEY DON'T DO WELL WITH ADAPTATION.

NOW DO WE USE MEDICATIONS IN THAT CASE SOMETIMES LOW DOSES OF ABILIFY SOMETIMES HAS BEEN USED LOW DOSES OF RISPERDAL OR RISPERIDONE AND VEIGA IS A MEDICATION THAT'S BEEN USED FOR STRESS INTOLERANCE RELATED TO AUTISM SPECTRUM DISORDER WE'VE USED OVER THE COURSE OF TIME LAMOTRIGINE OR LAMICTAL AS AN ANTIEPILEPTIC MEDICATION IN SOME CASES I'VE SEEN VARYING REPORTS ON THE SO-CALLED SEROTONIN MEDICATIONS LIKE ZOLOFT OR PROZAC OR LEXAPRO.

I'VE SEEN SOME REPORTS SAYING THEY MAKE THE CONDITION WORSE.

OTHER REPORTS SAY THEY MIGHT BE HELPFUL BUT WITH MEDICATION IT HELPS SO MUCH WHAT WE OFTEN FIND WORKS BEST FOR PEOPLE WITH AUTISM OR ASPERGERS DISORDER FOR THAT MATTER SURELY WILL BE TALK THERAPY OR COUNSELING AND WITH MOTION SICKNESS IS A PHYSIOLOGICAL CONDITION WHERE YOUR EIGHTEEN YEAR OLD GRANDSON IS HAVING DIFFICULTY EAR PROBLEMS.

MAYBE THAT'S SOMETHING THAT CAN BE ADDRESSED WITH SOMETHING LIKE MECHANIZING BUT IF IT HAS TO DO WITH STRESS AND TOLERANCE AND START OUT WITH SOME AUTISM CLINICIANS THAT MIGHT BE HELPFUL IN BEING ABLE TO TALK HIM THROUGH THOSE KIND OF THINGS BUT ALSO THE AUTISM CLINICIANS CAN ALSO RECOMMEND IF HE'S A GOOD CANDIDATE FOR ANY MEDICATION TREATMENT.

THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT CALLER.

HELLO ROSSEL WALK IN THE MATTERS OF THE MIND.

YEAH, I WAS JUST DIAGNOSED LAST SCRATCHES ON THE BRAIN AND IT'S CLEARLY HAVE MIGRAINES REAL THAT TWITCH THEY SAID THE SCOTTISH REFERENDUM NEUSE WHAT COULD BE DONE ABOUT THAT STUFF?

ROSSEL I'M SURE YOU'VE CONSULTED WITH A NEUROLOGIST AND I'M A PSYCHIATRIST.

SO FROM A PSYCHIATRIC STANDPOINT WHEN YOU HEAR ABOUT SCAR TISSUE ON THE BRAIN CAUSING MIGRAINE HEADACHES, WE OFTEN THINK ABOUT A PARTICULAR CLASS OF MEDICATIONS CALLED THE ANTIEPILEPTIC MEDICATIONS ALSO KNOWN AS THE ANTICONVULSANTS.

AND THERE'S TWO REASONS FOR THAT.

NUMBER ONE, THE ANTIEPILEPTIC MEDICATIONS OFTEN DO A PARTICULARLY GOOD JOB FOR HELPING WITH IRRITABILITY, MOODINESS AND EVEN MIGRAINES FOR THAT MATTER.

AND WE'LL USE THOSE MEDICATIONS PREFERENTIALLY FOR A LOT OF PEOPLE WHO HAVE SOME KIND OF BRAIN INJURY WITH SCAR TISSUE OR MAYBE A CONCUSSION OR TRAUMATIC BRAIN INJURY AND THEY DO PARTICULARLY WELL WITH THAT.

SO WE USE ANTIEPILEPTIC MEDICATIONS SOMETIMES DEPAKOTE WILL BE USED LAMICTAL, TRILEPTAL, TEGRETOL GABAPENTIN OR NEURONTIN TOPAMAX SOMETIMES IS USED FOR PEOPLE WHO HAVE REALLY BAD MIGRAINE HEADACHES.

THAT'LL BE A POSSIBILITY.

ANOTHER MEDICATION WILL OFTEN USE WILL BE MEDICATION CALLED L'OCCITANE OR CYMBALTA.

IT'S AN OLD ANTIDEPRESSANT MEDICATION OLD BEING AROUND FOR TWENTY YEARS NOW.

SO IT IS GENERIC AND IT'S SOMETHING THAT'S USED FOR PAIN AND HEADACHES ASSOCIATED WITH THAT KIND OF CONDITION WHERE PEOPLE ARE HAVING TROUBLE WITH WITH HEADACHES AND THEY MIGHT HAVE SOME MOODINESS AND IRRITABILITY RELATED TO SCAR TISSUE ON HEAD INJURY ITSELF.

SO THERE ARE MEDICATIONS THAT CAN BE USED BUT I'D CERTAINLY SUGGEST ROSSEL THAT YOU CHECK IT OUT WITH YOUR NEUROLOGIST TO SEE WHAT PARTICULAR KIND OF THINGS CAN BE DONE FROM THEIR PERSPECTIVE IF YOU'RE HAVING SEIZURES, FOR INSTANCE.

YEAH, YOU DEFINITELY WOULD WANT TO BE ON ANTIEPILEPTIC MEDICATION THAT CAN REALLY CONTROL THE SEIZURES THEMSELVES.

BUT SCAR TISSUE ON THE BRAIN NOT UNCOMMONLY WILL GIVE PEOPLE DIFFICULTY WITH IRRITABILITY OR MOODINESS BASED ON WHERE THE SCAR TISSUE MAY BE.

FOR INSTANCE, IF IT'S ON THE FRONT PART OF THE BRAIN YOU MIGHT HAVE MORE DIFFICULTY WITH IMPULSE CONTROL IF IT'S ON THE SIDE PART OF YOUR BRAIN, YOU MIGHT HAVE MORE TROUBLE WITH DEPRESSION AND ANXIETY AND EVEN ANGER FOR THAT MATTER.

SO WE'LL OFTEN TALK ABOUT THAT WITH PEOPLE IN TERMS OF HOW THEY CAN GET TREATMENT BASED ON WHERE THE SCAR TISSUE MIGHT BE .

ROSSEL, THANKS FOR YOUR CALL.

LET'S GO NEXT CALLER.

HELLO JEANNINE.

WELCOME TO MATTERS OF THE MIND.

HELLO.

I WANTED YOUR INPUT ON CONVERSION DISORDERS IN GENERAL AND MORE SPECIFICALLY THE PERSON I'M THINKING ABOUT WHO THIS HAS BEEN ASSOCIATED WITH IS DEALING WITH HAS DEALT WITH SICK LIKE VOMITING FOR A LONG PERIOD OF TIME IMAGINING A CONVERSION DISORDER IS ALSO KNOWN AS FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER AND FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER IS WHERE YOU WILL HAVE SYMPTOMS OFTEN OF A NEUROLOGICAL NATURE SUCH AS SEIZURES OR TWITCHING OR PARALYSIS WHEN YOU BECOME STRESSED OUT AND SOMETIMES ASSOCIATED WITH PEOPLE WHO HAVE HAD A PAST HISTORY OF ABUSE, PEOPLE WHO HAVE HAD DIFFICULTY WITH ONE WAY OR ANOTHER PUTTING UP WITH STRESS.

SO IF YOU THINK ABOUT IT JENENE CONVERSION DISORDER OR A FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER WILL BE A CONDITION WHERE PEOPLE WILL BE IN A SETTING WHERE THEY WITHDRAWAL FROM THE STRESS THAT'S OCCURRING BY KIND OF TUNING OUT WITH THEIR BODY.

SO IT'S KIND OF LIKE THEIR BRAIN SHORT-CIRCUITING AND CAUSING YOU TO HAVE MOVEMENTS THAT ARE CONSISTENT WITH LOOKING LIKE A SEIZURE EVEN THOUGH IT'S NOT AN ELECTRICAL SEIZURE.

PEOPLE WILL SOMETIMES LOSE THE ABILITY TO LOSE ONE PART OF THEIR BODY OR ANOTHER.

NOW WHAT YOU'RE DESCRIBING WITH CYCLICAL VOMITING IS SOMETHING THAT OCCURS IN ABOUT IT 10 PERCENT OF PEOPLE THAT HAVE MIGRAINE HEADACHES WILL HAVE CYCLIC VOMITING AS A SYMPTOM OF THE MIGRAINES THEMSELVES.

SO SOMETIMES PEOPLE TALK TALK ABOUT THAT AS BEING A MIGRAINE OF THE ABDOMINAL AREA AND YOU TREAT IT WITH MIGRAINE MEDICATIONS.

SO CYCLICAL VOMITING ASSOCIATED WITH MIGRAINES CAN KIND OF GO HAND IN HAND.

SO SOMETIMES THEY'LL TREAT THAT AS A NEUROLOGICAL CONDITION.

I DON'T THINK THAT YOU WOULD REALLY CALL CYCLICAL VOMITING A CONVERSION DISORDER IN ITSELF.

THERE IS A TYPE OF CONDITION WHERE YOU CAN HAVE PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL CONDITION AND THAT'S WHERE YOU'LL HAVE DIFFICULTY WITH VOMITING WHEN YOU'RE UNDER STRESS.

BUT IF YOU VOMIT UNDER STRESS THAT WOULDN'T BE NECESSARILY CONSIDERED TO BE A CONVERSION DISORDER.

CONVERSION DISORDER QUITE FRANKLY IS TREATED WITH PSYCHOTHERAPY TALK THERAPY AND YOU TRY TO IDENTIFY THE SITUATIONS THAT ARE CAUSING YOU TO HAVE THE SO-CALLED PSEUDO SEIZURES THAT ARE ELECTRICAL IN NATURE THE PARALYSIS THE MIGHT OCCUR BUT WITH CYCLICAL VOMITING THAT'S USUALLY A STRESS RELATED FACTOR WHERE YOU'RE EITHER HAVING MIGRAINE OF THE ABDOMINAL AREA, ABDOMINAL MIGRAINES OR YOU'RE HAVING STRESS RELATED VOMITING AND THAT'S SOMETHING THAT CAN BE TREATED WITH CERTAIN MEDICATIONS THAT ARE USED TO DECREASE THE LIKELIHOOD OF VOMITING.

WHEN YOU'RE UNDER STRESS YOU CAN BE PRESCRIBED MEDICATIONS THAT DECREASE ANXIETY AND DECREASE IN ANXIETY AND THEREBY DECREASE THE VOMITING ITSELF.

SO OTHER WAYS OF TRYING TO TREAT THAT.

SO THE MAIN ISSUE IS CYCLICAL VOMITING IS TO IDENTIFY WHAT'S CAUSING IT AND TRY TO IDENTIFY WHAT THEN WHAT YOU CAN DO ABOUT IT.

LET'S GO TO OUR NEXT CALLER.

HELLO RODNEY.

WELCOME TO MATTERS OF MIND.

DIFFERENT QUESTIONS WHEN I FALL ASLEEP IT SEEMS LIKE I FIRST FALL ASLEEP AT NIGHT.

I CAN GET LIKE A SHOCK FEELING AND I KIND OF.

YEAH, THEN AND ALSO MY HEART BEATS REAL FAST AT TIMES IN MY LEFT HAND FEELS LIKE IT GETS REAL TIGHT AND BURNING LIKE A STIFFNESS I DON'T KNOW CHANGE MY TICKET.

IT'S I'M NOT SURE REALLY WHAT'S GOING ON I GUESS SOMETIMES I GET LIKE A BURNING IN MY FACE OR BREAK OUT INTO YEAH AS A PSYCHIATRIST I WOULDN'T BE ONE TO REALLY COMMENT ON THE ACTUAL UNDERLYING REASONS BEHIND ALL OF THOSE CONDITIONS.

BUT I CAN TELL YOU THAT WHEN PEOPLE GO TO SLEEP AT NIGHT AND THERE'S PARTICULARLY TIRE THEY CAN HAVE WHAT'S CALLED MYOCLONIC AND A MYOCLONIC IS WHERE YOU'LL HAVE HE'S MOVEMENTS AND THAT'S NOT DANGEROUS.

IT'S JUST MEANS TYPICALLY YOU'RE REALLY, REALLY TIRED.

YOU'RE GOING INTO DEEP SLEEP REALLY, REALLY FAST AND YOU'LL HAVE THOSE KIND OF SO IT'S NOT TYPICALLY A PROBLEM FOR A LOT OF PEOPLE.

SO A MYOCLONIC IS NOT REALLY PROBLEMATIC FOR A LOT OF PEOPLE GETTING HOT, GETTING IN, HAVING FLUSHING AND AND GOING INTO COLD SWEATS SOMETIMES CAN BE RELATED TO ANXIETY.

THAT'S SOMETHING YOU CAN ALWAYS TO DISCUSS WITH YOUR PRESCRIBING CLINICIAN WHO CAN LOOK AT DIFFERENT POSSIBILITIES FOR WHAT KIND OF MEDICATION CAN BE USED, WHAT KIND OF COUNSELING COULD BE USED FOR YOU AND WE'LL USE MEDICATIONS THAT BLOCK ADRENALINE.

THEY'RE CALLED BETA BLOCKERS AND THEY CAN SOMETIMES BE HELPFUL FOR PEOPLE WHO JUST KIND OF SPONTE THE SWEAT ESPECIALLY WHEN THEY'RE GETTING INTO SOCIAL SITUATIONS AND THEY HAVE SWEATING OUTBURSTS.

THEY GET WARM ALL OVER AND THEY GET KIND OF TINGLY ALL OVER.

BUT AGAIN, THAT'S SOMETHING THAT AS A PSYCHIATRIST I WOULDN'T BE NECESSARILY TREATING DIRECTLY.

I'D ALWAYS WANT TO MAKE SURE YOU GO THROUGH YOUR PRIMARY CARE CLINICIAN TO MAKE SURE THAT YOU GET YOUR VITAMIN B 12 LEVEL CHECK, WHICH IS A COMMON REASON WHY PEOPLE WILL HAVE NUMBNESS AND TINGLING IN THE HANDS AND FEET AND MAKE SURE YOU GET A THYROID CHECK AS WELL BECAUSE THYROID CONDITIONS CAN CAUSE SIMILAR TYPE OF SYMPTOMS LIKE THAT.

RODNEY, LET ME GO BACK YOU HAVE ANOTHER QUESTION, RODNEY.

YES.

IT ALSO CAUSED INCREASED HEART RATE WHEN YOU'RE DOING PHYSICAL ACTIVITIES LIKE PRETTY AGORAPHOBIC AND LIKE SOMEONE ELSE MENTIONED THE OH I SEE LIKE AN AIRPLANE OR HIGHTS OR SOMETHING ON STATE TV FOR INSTANCE.

AND IT KIND OF MAKES ME NAUSEOUS.

I DON'T KNOW.

YEAH, YOU'RE DESCRIBING AGORAPHOBIA AND YEAH, BETA BLOCKERS CAN SOMETIMES HELP WITH THAT AND SLOWING DOWN THE HEART RATE ITSELF AND HAVING TALK THERAPY TO TRY TO DESENSITIZE YOURSELF FROM FOR INSTANCE ONE OF THE TREATMENTS FOR PEOPLE HAVING A FEAR OF HEIGHTS AND FEAR OF LOOKING AT JUST LOOKING AT AN AIRPLANE AND GETTING KIND OF ANXIOUS ABOUT IT WILL BE TO HAVING MORE EXPOSURE TO THAT TYPE OF OF EXPERIENCE.

ONE OF THE BEST WAYS TO GET OVER A FEAR OF FLYING IS TO ACTUALLY GET GET A TICKET FOR A PLANE AND BE ABLE TO FLY AND THE MORE TIMES YOU FLY FREQUENTLY THE LESS ANXIOUS YOU GET ABOUT IT.

SOME OF THE WORST THINGS WE CAN DO FOR ANY KIND OF ANXIETY OR FEAR IS RODNEY WILL BE TO AVOID THOSE SITUATIONS AND IT'S A NATURAL INCLINATION PEOPLE WILL OFTEN WANT TO AVOID DIFFERENT SITUATIONS THAT CAUSE THEM TO BE FEARFUL BUT WITHIN A REASONABLE LEVEL OF SAFETY IT'S IMPORTANT THAT YOU CONFRONT THOSE FEARS AND TRY TO GET YOURSELF EXPOSED TO THEM AND GRADUALLY DESENSITIZE YOURSELF FROM THEM OVERALL.

RODNEY, THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT CALLER.

HELLO DEBORAH.

WELCOME TO THE MIND.

HI.

I HAVE A QUESTION.

WHEN I WAS IN MY 20S I WENT THROUGH A DIVORCE AND THEN MY EX-HUSBAND WAS KILLED.

I STARTED HAVING SEIZURES AND WAS TOLD THAT IT WAS STRESS INDUCED EPILEPSY.

IS THAT VERY COMMON?

I DON'T HAVE THEM ANYMORE.

GOOD.

THAT'S FANTASTIC.

THERE'S TWO TYPES OF WHAT WOULD BE CALLED STRESS INDUCED EPILEPSY.

THERE'S EPILEPSY WHERE YOU HAVE AN EEG AND THEY IDENTIFY THE ELECTRICAL CHANGES THAT ARE CONSISTENT WITH ABNORMALITIES WITH WITH BRAINWAVES THAT THEY IDENTIFY THAT YOU HAD AN ABNORMAL EEG BY CHANCE DEBORAH.

YES, THEY DID.

IN THAT CASE YOU TRULY DID HAVE EPILEPSY.

NOW HOW CAN YOU HAVE STRESS INDUCED EPILEPSY?

WELL, WHAT OFTEN HAPPENS IN THAT CASE IS IT'S QUITE RARE OVERALL BUT STRESS INDUCED EPILEPSY IS WHERE YOU'RE UNDER TREMENDOUS STRESS AND OFTEN YOU'RE NOT SLEEPING VERY WELL PUT ON TOP OF THAT SOMETIMES A GENETIC PREDISPOSITION, SOMETIMES A HEAD INJURY.

SOMETIMES PEOPLE CAN BE ON CERTAIN MEDICATIONS THAT CAN MAKE THEM MORE PRONE TO HAVING SEIZURES.

YOU PUT ALL THAT TOGETHER PERHAPS YOU MIGHT HAVE BEEN DRINKING TOO MANY FLUIDS IN YOUR SODIUM LEVEL DROP DURING THAT TIME YOU PUT ALL THESE DIFFERENT FACTORS TOGETHER AND YOU CAN HAVE A TRUE ELECTRICAL SEIZURE IN THE BRAIN.

SOMETIMES PEOPLE WILL HAVE AN ELECTRICAL SEIZURE IN YOUR BRAIN WHEN THEY'RE UNDER A LOT OF STRESS BECAUSE WHILE THEY'RE UNDER A LOT OF STRESS THEY'RE TAKING MEDICATIONS CALLED BENZODIAZEPINES OR MAYBE THEY'RE DRINKING ALCOHOL.

WELL, THAT CAN BE A MEDICATION EFFECT WHERE STARTING AND STOPPING THOSE KIND OF MEDICATIONS ARE STARTING AND STOPPING DRINKING ALCOHOL CAN CAUSE YOU TO HAVE AN ELECTRICAL SEIZURE OF THE BRAIN.

THE GOOD NEWS ABOUT THAT, DEBORAH, IS AS YOU GET THE MEDICAL CONDITIONS CORRECTED, WELL OFTEN THEY DON'T HAVE THE UNDERLYING FACTORS THAT WILL CAUSE YOU TO HAVE THE ELECTRICAL ACTIVITY OF THE BRAIN THAT WOULD GIVE YOU THE SEIZURES.

THAT'S A GOOD THING THAT YOU NO LONGER HAVE THEM.

BUT IF THEY IDENTIFIED YOU TRULY HAD ELECTRICAL SEIZURES IN THE BRAIN, YEAH, THAT CAN CERTAINLY HAPPEN.

AND OFTEN WHEN PEOPLE UNDER STRESS THEY LOSE SLEEP, WHICH IS A BIG FACTOR FOR SOME PEOPLE IN TERMS OF HAVING A SEIZURE.

IF YOU PUT THESE OTHER FACTORS ON TOP OF IT.

SO IT'S GOOD THAT YOU DON'T HAVE ANY MORE.

DEBORAH, THANKS FOR YOUR CALL.

LET'S GO TO NEXT CALLER.

WE'VE GOT A COUPLE OF MINUTES HERE.

HELLO, JENNIFER.

WELCOME TO MATTERS OF MIND.

HI, DR. FARMER.

HOW WOULD YOU EXPLAIN TO YOUR CHILD AGES NINE TO 12 WHAT BIPOLAR DISORDER IS BIPOLAR DISORDER FOR THAT CHILD OR FOR MAYBE A PARENT OR AN ADULT WHO HAS A CHILD?

IF THE CHILD HAS MOODINESS AS A GRADE SCHOOLER A NINE OR TEN YEARS OF AGE, WE'D CALL THAT DISRUPTIVE MOOD DYSREGULATION DISORDER.

DMD IS THE LETTER WILL BE THE LETTERS WE USE BUT DISRUPTIVE MOOD DYSREGULATION DISORDER WILL BE WHERE A CHILD HAS MORE THAN MORE THAN YOU WOULD EXPECT MOODINESS RELATED TO DIFFERENT ENVIRONMENTAL SITUATIONS AND WE'RE GETTING AWAY FROM USING THE TERM BIPOLAR DISORDER FOR CHILDREN UNLESS THERE'S A CLEAR CUT BIPOLAR DISORDER IN THE FAMILY OR UNLESS THERE'S A CLEAR CUT MOODINESS THAT OCCURS SPONTANEOUSLY WITHOUT ANY PARTICULAR STIMULI.

DISRUPTIVE MOOD DYSREGULATION DISORDER IS WHERE A CHILD GOES OFF AND GETS UPSET AND GETS ANGRY AND HAS DECREASED NEED FOR SLEEP BECOMES MORE IMPULSIVE.

IT'S A VERY DISTINCTIVE PHENOMENON.

IT'S QUITE DIFFICULT TO DIAGNOSE IN A YOUNGER CHILD BUT DISRUPTIVE MOOD DYSREGULATION DISORDER IS MORE COMMON FOR A LOT OF CHILDREN AND THE BEST WAY TO EXPLAIN THAT TO THEM WILL BE WITH THE CLINICIAN WHO'S TREATING THEM TO DESCRIBE BASICALLY THE NEED TO LEVEL OUT THE MOOD AND TO KEEP THEM FROM UNNATURALLY GOING TOO HIGH OR TOO LOW.

THANKS FOR YOUR CALL AND FOR I'M OUT OF TIME FOR THIS EVENING.

I'M PSYCHIATRIST JAY FOVEA AND YOU'VE BEEN WATCHING MATTERS OF THE MIND ON PBS FORT WAYNE IF YOU HAVE ANY QUESTIONS OR COMMENTS THAT YOU'D LIKE TO SEND ME VIA THE INTERNET, YOU MAY WRITE VIA THE INTERNET AT MATTERS OF THE MIND AT WFB ORG GOD WILLING AND PBS WILLING.

I'LL BE BACK AGAIN NEXT WEEK.

HAVE A GOOD EVENING.

GOOD NIGHT