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>> Good evening.

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

Welcome to Matters of the Mind now that's 24th year Matters of 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 here at PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if calling anywhere else coast to coast you may dial toll free at 866- (969) 27 two zero.

>> Now on a fairly regular basis where our broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus and if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA dot org.

>> That's matters of the mind at way dog and I start tonight's program with our first question the first question from the emailer age dear to the father what medication or treatment is recommended for an 89 year old with short term memory loss and anxiety?

>> Well, if I heard about it eighty nine year old person with short term memory loss and anxiety I'm going to do a bit of an evaluation first and foremost when you're eighty nine oh you have things going wrong with you across the body so I want to make sure your heart's OK. >> Lungs are OK. >> The kidneys are OK because if you have problems any other areas of the body that can give you short term memory loss and anxiety medications sometimes can give you anxiety so we'd want to do a thorough assessment of different types of medications somebody can be on.

For instance, if you're on a medication that blocks acetylcholine like some of the older antidepressants like amitriptyline imipramine, those kind of medications, they can sometimes give you a memory loss inappropriately.

So we want to look at your medications.

>> Secondly third thing I'm going to probably assess for an 80, 80, 80 plus year old with anxiety will be taking a look at sleep apnea.

>> We will probably do at least in at home and possibly an in office a sleep study where you would be assessed to see how your breathing is doing while you're asleep and that can be done at home with a so-called home poly sonogram where we're looking at how well you're breathing at night.

>> Do you pause in your breathing?

Is your oxygen level dropping at night because as we get older sometimes we'll have a greater likelihood of having sleep apnea and sometimes that's not only from fat in your throat but also the way your throat is constructed constructed in such a way that your airway can be somewhat obstructed as we get older we're more prone to getting diabetes.

>> Diabetes can give you anxiety and short term memory loss.

We want to see those those blood sugars to see if they're elevated and iron levels and be 12.

Those are something that will often examine low iron and low B twelve vitamin B 12 can be a factor.

So once all that's done we've had that assessed number.

The next question I'm going to have is first what medications have you tried before for anxiety or memory loss?

>> Have you already been on medications previously?

>> Secondly, what if your family members taken do you have any brothers sisters who have taken medications for anxiety or memory loss and how have they done with those type of things?

>> I'm going to look at your use of alcohol if any if you drink alcohol to an excessive amount as you get older.

Yeah, it's more likely to affect your anxiety, your memory difficulties if you've been on long term Xanax or Klonopin or Valium or out of the so-called benzodiazepine medications, they will certainly in the long run make the anxiety worse and they can profoundly affect your memory overall.

>> So if we've got all those type of things cleared up for short term memory loss number one we'd always want to consider if you have depression that will affect your memory itself.

So if we need to treat the depression first and foremost, yeah, there are medications like mirtazapine or Raemer on Mirtazapine or Emran as an added antidepressants has been around for about 20 years now.

>> Twenty five years and it's a medication it has five different mechanisms of action .

It will enhance serotonin and norepinephrine but it will also affect specific receptors and allow you to sleep better and it helps with anxiety, sleep, decreased appetite, depression a lot of these problems that older people will have and at low doses it could be profoundly effective for a lot of people for depression, anxiety, sleep disturbances and those can all go hand in hand with memory disturbances overall.

Otherwise we'd want to look at other options that are available for you.

Sure, we'll use Wellbutrin or Trend Telex.

These are medications that have an activating energizing effect.

They can help with memory and concentration and and of course there's some specific memory enhancing medications that are used if you do have Alzheimer's dementia such as Aricept, Exelon resodding these are medications that are used for the purpose of enhancing specifically acetylcholine and in doing so try to help with memory overall.

>> But when you're in your 80s and you have an anxiety and memory disturbances, you want to get a good workup.

>> You don't want to see a clinician who's just going to haphazardly give you a medication to give you a symptomatic relief.

>> You really need a thorough overview to see what might be going on.

>> Thanks for email.

Let's go to our first caller.

Hello Janet.

Welcome to Matters of Mind all Janet Janet, you want to know what does the supplement and in help or does the supplement in in help with anxiety?

>> Janet I have no idea what that supplement is in erm in so let me give you some ideas about a supplement for a longevity.

>> Number one I'm a psychiatrist so you remember I'm not an internist I'm not going to be a person who's going to talk a lot about longevity but I can tell you within my field staying within my lane what I can tell you about supplements for longevity that I find interesting with medications that we use in psychiatry No one low doses of lithium tend to lengthen what's called telomeres.

>> Telomeres are the little caps on the ends of your chromosomes.

>> It as we naturally age the caps on our chromosomes get shorter and shorter and shorter and the caps are called telomeres.

>> Lithium is a medication that we use for bipolar disorder.

We use lithium to decrease suicidal thinking for some people and we use lithium sometimes to enhance the mood and decrease suicidal thinking.

>> Lithium is a salt.

It's a remarkable means of helping people with a lot of different symptoms.

>> But it just so happens that lithium does tend to help extend telomeres now I don't take lithium myself and I'm always very open with people on what supplements I take and what I'd recommend personally lithium I'm not sure what dosage would be best is one hundred fifty milligrams is it minuscule amounts?

>> There's so-called homeopathic amounts on medications that are so small of a dosage of medication they're not thought to be pharmacologically really active so homoeopathic amounts when you hear about those amounts they're exceptionally small micro doses for for instance and there's always controversy of whether homeopathic those are doing anything for you or not.

But with lithium the question is hundred and fifty milligrams is a dosage we commonly used for mood disturbances tiny tiny doses for bipolar disorder you use twelve hundred maybe eight hundred milligrams of lithium a day but for for the purpose of helping longevity I don't know what your lithium dosage would be.

>> So that's something that might come out over the course of time.

Other types of things that might help with longevity will be simply giving up alcohol and the more we study it and the more decades of of use that we see with the marijuana use, it might appear that marijuana decreases longevity by shrinking those telomeres.

>> I'm not sure.

But what we know about marijuana specifically is does decrease the brain growth and especially with people under 24 years of age it suppresses brain growth and it's thought that maybe marijuana might make those telomeres shorter and thereby decrease longevity.

>> Hard to say.

We do know that smoking tobacco cigarets will decrease longevity by shrinking the telomeres.

>> So there are certain things that we can do to shrink telomeres.

We don't want to keep doing that uncontrol stress, depression, anxiety if it's going on ongoing and is causing new so-called functional impairment that might shrink the telomeres as well.

>> So if we want to lengthen the telomeres exercise, try to eat a healthy diet, socialize, do all the things we're supposed to be doing but from a medicinal standpoint I wouldn't necessarily recommend any supplement for increasing longevity just yet because it's difficult to really study supplements to give you a definitive type of responses to really get an idea of if this supplement or supplement increases longevity, you'd have to look at a group of people for several decades who's taken the supplements another group of people for decades with similar health and behaviors who don't take the supplement and figure out OK, did the supplement make a difference one way or another?

So it's difficult to treat those to really assess that longevity in that matter just by studying people.

But you can assess longevity by looking at the telomeres with chromosomal analyzes and I'm excited because I'm thinking in the years to come we're going to be actually looking at chromosomes, looking at those caps on the chromosomes, the telomeres and determine hopefully within a year or two if we're going the right direction and our treatment approaches to really improve longevity is in general because the older we get the more those telomeres shrink and if we maintain their length or even lengthen a more that's always going to be on our best advantage.

>> Thanks for your call.

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

Our next e-mail reads Dear Dr. Fauver, can Gabapentin and on be taken together?

I got this question right at the end of my program.

I think last Gabapentin is a medication.

>> It was originally used for seizures.

It came out in the nineteen eighties and it's a medication that goes by the trade name Neurontin and it's a medication that's a so-called calcium channel stabilizer.

>> So it's thought that when people have pain or if they have excessive anxiety or if they have seizure disorders for that matter they have an itchy trigger finger on their calcium channel.

>> In other words their calcium channel is letting in too much calcium.

What gabapentin will do is stabilize the calcium channel to try to allow the proper amount of calcium to come in and that way it stabilizes the down.

>> Number one, you decrease pain.

Number two , you decrease seizures.

Number three can decrease anxiety that way.

So in psychiatry nowadays we use gabapentin for a lot of different things that helps with tight jaws.

If you have bruxism at nighttime it'll loosen your jaw up a nighttime.

It helps with restless legs for people have restless legs in the evening.

But in psychiatry we use a lot for sleep disturbances and for anxiety in general and we're using more of that more so than the so-called benzodiazepines such as Xanax, Ativan, Klonopin and and Valium.

The benzodiazepines can double the concentration and memory over the course of time with long term use and many people need to take higher and higher doses the longer they take them and that's why they're controlled the benzodiazepines do quadruple the impact of opiates on the IMU receptor in such a way that if you take 30 milligrams of an opiate it can make the opiate on you receptor feel like it's a hundred twenty milligrams so it can amplify the effect on opiate receptors and unfortunately give you some bad effects from that.

>> Gabapentin can do that to some degree but it's not thought to be quite as bad.

>> In other words with Gabapentin a study done and done in New Jersey completive years ago looked at people who were taking gabapentin and determined who just took more and more and who abused it in less than 10 percent of people actually abused it.

>> It was thought to be I believe three percent or so people actually abuse gabapentin or they took higher doses inappropriately and for those people obviously they shouldn't take it.

>> But many people will take gabapentin for anxiety by itself.

So can you take gabapentin with Raymarine?

Amron is also known as Mirtazapine.

I just mentioned that one in regards of in regards of using with older folks it has five mechanisms of action but its mechanism of action will not overlap with gabapentin.

So we use gabapentin for anxiety, pain, sleep for that matter but we can also use mirtazapine a night nighttime for the purpose of helping with anxiety, depression, sleep and even nausea for that matter.

The five mechanisms of action that are possessed by mirtazapine include a mechanism of action will decrease stomach acidity and that decreases nausea as blocks of serotonin type three receptor and it's also a medication that can increase the firing of norepinephrine and dopamine.

>> It doesn't block the vacuuming of norepinephrine and dopamine, norepinephrine and serotonin back into the neurons .

>> It increase the firing of serotonin and norepinephrine in such a way that you can actually add mirtazapine to other various antidepressant medications I mentioned Wellbutrin bupropion is a medication increases norepinephrine and dopamine in a different way.

>> The so-called serotonin medications can be used with mirtazapine such as Zoloft, Paxil, Lexapro, Celexa.

So we'll use mirtazapine with other medications because Mirtazapine has fairly unique mechanisms of action.

We don't use mirtazapine with a medication like Zofran.

Zofran is also known as Dance Itron on Dance A Time will block serotonin three receptors so you don't want to use it with on dance Itron because it has the same effect so we don't use that kind of case but with most medication we can use mirtazapine and the combination of the two .

>> Thanks for your email.

Let's go to our next caller.

Hello Bridget.

Welcome to Matters of Mind.

Bridget, you want to know can you go into inpatient treatment even if you're not actively suicidal but worried for your mental health ?

>> You're already in counseling, Bridget in twenty twenty two most people don't go to inpatient treatment unless they're impaired to the degree that they have trouble functioning as an outpatient.

Now impairment can be suicidal thinking or or if you want to hurt somebody else and that's a reason why some people go in the hospital.

But other reasons why people will go in the hospital, Bridget will be if they're functionally incapable of taking care of themselves.

>> In other words, you're having so much difficulty with eating.

You're having trouble with sleeping to the point where it's starting to affect your day to day functioning and you don't have any debate but really take care of you.

>> You have to have a significant degree of functional impairment to be hospita.

Now when people think about inpatient treatment Bridgid, many people think of a resort where they go for two or three months.

They play volleyball, they do yoga, they go for long walks and they have several hours of counseling every day on the inpatient setting and some of these so-called long term residential counseling centers they might have that but those are far and few between we had those kind of counseling or those kind of inpatient centers probably 20, 30 years ago.

But nowadays in an inpatient psychiatric hospital you typically will go for no more than an average of six days or so as like real common length of stay sometimes less than that, rarely more than that.

But inpatient hospitalizations are not the kind of resort settings they used to be decades ago where you went there to rest.

I sometimes hear people say, Bridgette, that they just want to go get away from everything and go rest.

>> Well, if that's the case, yeah, a mental health setting would be nice if you could have that.

But the best scenario would be for you to go to a really a true resort and then have outpatient treatment on top of that.

>> And if you're having trouble with sleep appetite, mood or anxiety disturbances, often we will use medication as a means of trying to stabilize that.

Yeah, it's dead on an inpatient setting but more often than not we do that as an outpatient nowadays.

I remember when I came to town back back in nineteen eighty eight long time ago it was real common for people to be hospitalized for one month and that was standard treatment.

>> You'd be hospitalized for one month back in nineteen eighty eight and that was if even if you had relatively mild depression because that was the expectation you'd come into the hospital for a month you'd get started on medication, the medication would be monitored over the course of time and then you'd be released after that time.

>> Well the issue with that is number one, did people really have that much better outcomes in the long run because that's that was the challenge.

Did people really get significant benefit from doing that or by starting on the medications as an outpatient still going to work, still being around their families and still doing their day to completing their day to day obligations so if you're taken away from your family, if you're taken away from your work for extended periods of time that can have detrimental outcomes in itself.

>> So the challenge always was well gee, where do we balance that out?

We need to get people seen for treatment.

We need to get them started on medication in some cases.

But many times they need to get involved in intense treatment and we have what's called intensive outpatient treatment now in some areas as what's called partial hospitalization where you come in four times a week and you come for extended periods of time.

So there's intensive outpatient treatments and partial hospitalization where you're not staying in the hospital day and night and that's the difference that we see now compared to a couple of decades ago where people would stay in the hospital day and night for the purpose of initiating treatment.

So I wouldn't recommend going into a hospital oh just to get away from it all or basically to get your initial mental health symptoms addressed.

>> They will screen you to see to what degree of functional impairment you have and then determine can your needs be met from a treatment perspective as an outpatient.

The challenge we have in 2022, Bridget, are just having enough providers providers being doctors and nurse practitioners to be able to see people with mental health issues and that's why you're seeing on the outpatient side there's fewer and fewer psychiatrists available nowadays.

So if you're seen as an outpatient and 2022 for medication, you're often more often than not going to be seen by a nurse practitioner.

Now nurse practitioners have oversight by psychiatrists and many organizations will have very collaborative type of arrangements where the psychiatrist work very closely with nurse practitioners and we're all on the same page and you can have treatment algorithms as a means of keeping you on the same page so you can still get good psychopharmacological treatment or medication treatment as an outpatient.

>> But you can also have intensive outpatient treatment where you can be seen on a regular basis as well while still going home at night.

>> But as you'd mentioned, you can get hospitalized if you are suicidal and the whole idea there is if you're left at home to your own devices you might take your life and of course if you take your life there's no turning back from there.

>> So we want to get you in the hospital if you're getting to the point where you're thinking about suicide at least getting symptoms settled down while you're in the hospital now what do they do for you in the hospital over the course of a few days if you're suicidal?

>> Number one, they want to make sure your sleep if you don't sleep very well, that's going to affect your judgment.

Lack of sleep will affect your frontal lobe functioning up here and the frontal lobe is your impulse control center.

That's the part of your brain that will allow you to make good decisions and think about the future.

>> And when people get suicidal the front part of their brain is not working adequately and what we're trying to do in the hospital setting is No one try to get a person sleeping better because if you sleep better the front part of your brain is going to work better and you're gonna have better judgment and you might see some reasons to not take your life .

>> Secondly, if you're in the hospital, not only are you going to try to sleep better, they're going to try to decrease your anxiety and they'll do that with different medications.

But they'll also try to give you some coping strategies with some group therapies and some help in that way.

And thirdly, in the hospital setting they're always trying to look at your social situation, talking to your family, your friends, see if they can help you out socially.

Many people when they get stressed out and they're getting depressed and anxious, they'll use drugs of abuse so they use an opiate.

>> So using alcohol so the hospital setting there's a means of detoxing somebody from narcotics or opiates as well as alcohol and then over the course of four to six days once that detox for detoxification is done, they will then be transitioned to another level of care typically as an outpatient as a means of trying to keep somebody away from the use of opiates and alcohol.

>> Phrygia, thanks for your call.

Let's go to our next email question.

Our next e-mail question reads Dear dear father, what are some early signs of schizophrenia?

At what age do these signs start to show?

>> Oh, there's something called pre morbid symptoms.

Pre morbid symptoms occur before twenty four years of age and you can pick up some signs and symptoms of schizophrenia as early as twelve or thirteen years of age and the pre morbid symptoms involve symptoms of a lot of social anxiety having strange perceptual abilities in the background.

>> Other words you can hear some things that are kind of unusual.

You can see some things that are kind of unusual.

You see shadows and you see lights that other people don't notice and you see people in different background scenarios.

>> Pretty morbid symptoms also include having difficulty with sleeping, feeling a little bit more fearful and paranoid of other people and reading into their intentions.

>> You're not floridly psychotic but you're an adolescent.

You're just having a hard time getting along with other people.

Your grades might decline in high school and you start taking really poor care of yourself.

Adolescents who have a pretty morbid predisposition will often state of the rooms even more.

Now I don't want to scare and think if your teenagers stand in their room that means they're developing schizophrenia but when they develop schizophrenia they're doing this more often than not and they're stand more and more to themselves.

They will sometimes have some difficulty expressing themselves.

There's some autistic features that we might pick up as adolescents autistic features mean that they have difficulty connecting with other people on a social basis.

They will talk and talk and talk and talk and they won't make a lot of sense and what they're saying they'll have difficulty with the give and take in a conversation not uncommonly with pre morbid symptoms of schizophrenia.

>> And when I hear about those symptoms of schizophrenia, the pre morbid symptoms as an adolescent or young adult before the age of twenty four years of age, I will tell people never ever ever use marijuana before the age of 24 years old because marijuana use will increase the likelihood of going from pre morbid symptoms of schizophrenia to full blown schizophrenia by two hundred times.

>> So if there is one trigger event out there that can increase your likelihood of schizophrenia emerging, it's the use of marijuana before the age of twenty four years old.

>> Now I say that especially if you have a family history of schizophrenia especially a brother, sister, son or daughter or mother or father if you have a family history of schizophrenia you certainly don't want to use marijuana even into your 30s for that matter I would think.

But if you have a mother or father, brother or sister with schizophrenia and here you are under twenty four years of age you don't want to use marijuana because that can significantly trigger the symptoms of schizophrenia that might not have been triggered otherwise.

Now if you have all these so-called pre morbid symptoms of schizophrenia as an adolescent and you're perceived as being kind of odd, socially awkward, a little bit paranoid, having a hard time with a lot of social anxiety well about there's about a twenty five percent chance you won't develop schizophrenia still even if you have all those different symptoms so not everybody automatically will go from the pre morbid symptoms of schizophrenia to full-blown schizophrenia with their first psychotic episode.

But on the average boys develop schizophrenia and have their first psychotic episode at 16 years of Girls because it's thought of their estrogen.

>> Their estrogen protects them a bit but girls would have their first onset of schizophrenia symptoms until the age of twenty four so boys will have an earlier onset than girls.

But in either case marijuana can trigger alcohol not recommended but it's not so likely to trigger schizophrenia.

There's something about the THC that can trigger schizophrenia .

It's sad because you wonder would those people develop schizophrenia had they not used marijuana?

So that's that's a trigger in itself.

Stress can be a factor obviously where you have a significant change in your life .

So when somebody goes from high school to college sometimes as a trigger so we have to take that into account.

But the family histories of schizophrenia will be a big predictor on who might develop schizophrenia and who might not .

Thank you for your email question.

Unfortunately I'm out of time for this evening if you have any questions that I can answer on the air concerning mental health issues, you may write me a via the Internet at matters of the mind all one word W8 dot org.

I'm psychiatrist Jeff Oliver and you've been watching matters of the mind on PBS Fort Wayne God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Have a good evening.

>> Good night