.

GOOD EVENING.

I'M PSYCHIATRIST JEFF OFER LIVE FROM FORT WAYNE, INDIANA.

WELCOME TO MATTERS OF THE MIND NOW IN ITS TWENTY SECOND 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.

PB'S FORT WAYNE BY DIALING IN THE FORT WAYNE AREA NINE SIX NINE TWO SEVEN TO ZERO OR IF YOU'RE CALLING ANY PLACE COAST TO COAST YOU MAY DIAL TOLL FREE AT EIGHT SIX SIX NINE SIX NINE TWO SEVEN TWO ZERO 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 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 A VIA THE INTERNET AT MATTERS OF THE MIND ALL ONE WORD AT A DOT ORG THAT'S MATTERS OF THE MIND AT WFYI AGAIN AND I'LL START TONIGHT'S PROGRAM WITH A QUESTION I RECENTLY RECEIVED.

IT READS DEAR DR. FARBER, WHAT ARE SOME TIPS FOR GETTING BACK INTO THE ROUTINE OF THINGS NOW THAT COVID RESTRICTIONS ARE STARTING TO BECOME MORE FLEXIBLE?

WELL, MANY PEOPLE HAVE NOTICED THAT THEY'RE STARTING TO GET BACK IN THE ROUTINE OF THINGS ON THEIR OWN.

BUT THE FIRST THING YOU NEED TO DETERMINE IS WHAT YOU'VE GIVEN UP, WHAT YOU DIDN'T DO TO TAKE OVER THE RESTRICTIONS.

NOW MANY PEOPLE WERE ENCOURAGED DURING THE COVID LOCKDOWNS AND DURING THE RESTRICTIONS TO TRY TO STAY PHYSICALLY ACTIVE, GO TO PARKS, WALK, GET OUT AND ABOUT AND MANY PEOPLE ARE NOTICING THAT THEY CAN DO MORE THINGS SOCIALLY NOW.

SO THE FIRST THING YOU OUGHT TO DO IS WITHIN THE RESTRICTIONS OF YOUR STATE IS BE ABLE TO GET OUT AND BE AROUND PEOPLE AGAIN BECAUSE I THINK THAT'S SOMETHING THAT REALLY HAS HINDERED US OVER THE PAST YEAR.

WE'VE BECOME MORE SOCIALLY ISOLATED AT THE ENCOURAGEMENT OF THE CENTERS FOR DISEASE CONTROL IN OUR STATE AND FEDERAL GOVERNMENTS.

SO WITH THAT IN MIND, YEAH, I TRY TO GET OUT AND BE AROUND PEOPLE MORE AND MORE START TO HAVE MORE PEOPLE OVER, START TO HAVE SMALL GROUPS AND START GETTING ENGAGED AGAIN WITH INTERACTIONS LIKE THAT.

ONE OF THE KEY FACTORS FOR EXACERBATING DEPRESSION AND ANXIETY WILL BE SOCIAL ISOLATION AND WE'RE ALWAYS TELLING PEOPLE WHEN YOU'RE DEPRESSED, WHEN YOU'RE ANXIOUS, TRY TO STAY SOCIALLY ACTIVE, TRY TO BE AROUND PEOPLE AND KEEP YOURSELF DOING THINGS AND THAT'S THE BIGGEST IMPACT THAT I THINK THE COVERED RESTRICTIONS HAD ON PEOPLE ISOLATED US AS INDIVIDUALS AND KEPT US FROM SOCIALIZING IN SUCH A WAY THAT I THINK IT HAD A BIG IMPACT ON THE MENTAL HEALTH AND WE'RE STARTING TO SEE SOME OF THAT NOW WE'RE SEEING THE AFTER EFFECT ALMOST A TSUNAMI OF MENTAL HEALTH ISSUES RIGHT NOW FOR PEOPLE WHO WERE SOCIALLY ISOLATED.

THEY DIDN'T OR THEY COULDN'T SEEK TREATMENT DURING THE COVERED RESTRICTIONS AND NOW THEY ARE.

SO WE'RE FINDING THAT WE'RE ABLE TO REACH OUT TO A LOT OF PEOPLE AND YOU KNOW, ONE OF THE NICE CONSEQUENCES IF THERE WAS A NICE CONSEQUENCES WITH THE COVER RESTRICTIONS IS IT DID LOOSEN UP THE REGULATIONS ON HOW WE AS PHYSICIANS INTERACT WITH PEOPLE.

SO AS PHYSICIANS, AS MENTAL HEALTH CLINICIANS WE CAN ACTUALLY INTERACT WITH PEOPLE NOW BY VIDEO AND BEFORE THE COVID RESTRICTIONS WE REALLY COULDN'T DO THAT VERY CONVENIENTLY.

SO WE'RE STARTING TO HAVE REGULAR INTERACTIONS WITH PEOPLE BY VIDEO.

THE VIDEO PLATFORMS ARE EXTREMELY EFFICIENT.

THEY'RE CONFIDENTIAL AND WE'RE FINDING THAT WE'RE ABLE TO DO A LOT MORE THINGS NOW THAN WE DID JUST A YEAR AGO.

SO THE TREATMENT I THINK IS A LOT MORE IMPACTFUL FOR WHAT WE CAN DO NOW COMPARED TO COVID.

THANK YOU FOR YOUR QUESTION.

LET'S GO TO OUR FIRST CALLER.

HELLO WALTER.

WELCOME TO MASTERMIND WALTER.

YOU HAD WONDERED HOW OFTEN DO THEY FIND PSYCHOLOGICAL ISSUES COMING FROM SIDE EFFECTS FROM NON MENTAL HEALTH RELATED MEDICATIONS?

I THINK YOU'RE ALLUDING TO OR THE POSSIBILITY OF MEDICATIONS THAT CAN SOMETIMES MAKE PEOPLE KIND OF TIRED OCCASIONALLY WE'LL HEAR ABOUT STEROID MEDICATIONS.

I'VE HEARD ABOUT THAT A FEW TIMES OVER THE PAST COUPLE OF WEEKS ESPECIALLY PEOPLE WERE TREATED DURING THERE IN COVID INFECTIONS WITH STEROIDS.

NOW STEROIDS CAN BE LIFESAVING FOR ASTHMA, FOR INFLAMMATORY CONDITIONS IN SOME CASES EVEN FOR COVID INFECTION.

BUT SOMETIMES STEROIDS WILL GIVE YOU DIFFICULTY WITH FEELING MANIC AND NOT BEING ABLE TO SLEEP, BEING MORE IMPULSIVE, HAVING RACING THOUGHTS AND SOMETIMES EVEN LOSING CONTACT WITH REALITY.

NOW GRANTED, IF YOU NEED THE STEROID YOU NEED TO STEROID AND WE NEED TO WORK AROUND THOSE KIND OF SIDE EFFECTS FOR THE RARE INSTANCES WHERE PEOPLE WILL HAVE THOSE KIND OF EFFECTS .

WE WE'VE HEARD OVER THE COURSE OF TIME WITH SOME PEOPLE AND I EMPHASIZE SOME PEOPLE WHO ARE TAKING VARIOUS LIPID LOWERING MEDICATIONS SUCH AS CRESTOR OR MEVACOR THOSE TYPE OF MEDICATIONS OCCASIONALLY CAN CAUSE A CHANGE IN THE LIPID LEVELS IN THE BRAIN AND POTENTIALLY CAUSE PEOPLE TO HAVE DIFFICULTY WITH MEMORY IMPAIRMENT PROCESSING INFORMATION AND SOMETIMES EVEN DEPRESSION.

SO THESE ARE THE KIND OF LIPID LOWERING AGENTS THAT ARE ACTUALLY CROSSING OVER INTO THE BRAIN, SOME CROSSOVER INTO THE BRAIN, SOME DON'T.

BUT THE ONES THAT CROSS OVER THE BRAIN POTENTIALLY CAN GIVE YOU MORE DIFFICULTIES.

AND CRESTOR OR MEVACOR THERE'S A COUPLE OPTIONS THAT CAN SOMETIMES DO THAT WE'LL HEAR OCCASIONALLY ABOUT MEDICATIONS ,THEIR SO-CALLED BETA BLOCKERS THAT MAKE PEOPLE A LITTLE BIT TIRED.

BUT NOW WITH THE NEWER MORE SPECIFIC BETA BLOCKERS, THE ONES THAT WILL LOWER BLOOD PRESSURE, THEY LOWER THE HEART RATE THEY'RE NOT AS LIKELY TO DO THAT.

BUT SOME OF THE OLDER ONES LIKE PROPRANOLOL FOR INSTANCE, ALSO KNOWN AS INDERAL HAD BEEN KNOWN FOR YEARS TO MAYBE MAKE PEOPLE A LITTLE BIT TIRED.

SOME OF THAT COULD HAVE BEEN BECAUSE THEIR BLOOD PRESSURE WAS BEING LOWERED OR THEIR HEART RATE WAS BEING LOWER.

BUT SOMETIMES IT'S BECAUSE IT DOES GET INTO THE BRAIN AND CAN HAVE SOME DIRECT EFFECTS LIKE THAT.

WE CERTAINLY WILL LOOK AT DRUG INTERACTIONS FOR A LOT OF PEOPLE IF YOU'RE ON CERTAIN MEDICATIONS IT MIGHT INTERACT WITH OTHER MEDICATIONS AND THAT CAN CAUSE THE OTHER MEDICATIONS TO EITHER HAVE HIGHER OR LOWER BLOOD LEVELS AND THAT CAN GIVE YOU KIND OF INDIRECT EFFECTS IN DRUG METABOLISM AND GIVE YOU SIDE EFFECTS FROM THOSE OTHER MEDICATIONS YOU MIGHT NOT HAVE OTHERWISE EXPERIENCED.

SO YOU HAVE TO LOOK AT THE WHOLE PICTURE ALL THE MORE COMMONLY HERE ABOUT MEDICAL CONDITIONS CAUSING PEOPLE TO HAVE MENTAL HEALTH PROBLEMS SUCH AS HEART DISEASE, LUNG DISEASE.

KIDNEY PROBLEMS WILL OFTEN GIVE PEOPLE TROUBLE WITH MENTAL HEALTH CONDITIONS.

WE ALWAYS CONSIDER THE EFFECT OF LOW THYROID DIABETES WILL BE A FACTOR.

THESE ARE OTHER MEDICAL CONDITIONS THAT WILL OFTEN IMPACT THE MENTAL HEALTH OF SOMEBODY FOR FOR THE THE LIKELIHOOD OF GIVING SOMEBODY DEPRESSION OR ANXIETY.

SO MEDICATIONS AND VARIOUS MEDICAL CONDITIONS CAN IMPACT A PERSON'S MENTAL HEALTH.

THAT'S WHY WE TEND TO TAKE A CLOSE LOOK AT ALL THE MEDICATIONS SOMEBODY MIGHT BE TAKING AS WELL AS WHAT OTHER KIND OF MEDICAL CONDITIONS SOMEBODY MIGHT BE EXPERIENCING.

I JUST SAW A PERSON THIS AFTERNOON WHO EXHIBITED A LOT OF SYMPTOMS OF TIREDNESS, POOR CONCENTRATION, DIFFICULTY WITH SNORING AT NIGHT AND ACTUALLY PAUSING IN HIS BREATHING IN NIGHTTIME IT WAS DETERMINED THAT HE HAD SLEEP APNEA.

SO IF YOU TREAT SLEEP APNEA, IT'S MUCH LESS LIKELY YOU HAVE THOSE SYMPTOMS.

BUT MANY PEOPLE WHO HAVE SLEEP APNEA SYMPTOMS WILL HAVE TIREDNESS AND DEPRESSION AND THEY CAN'T CONCENTRATE AND THEY MIGHT INADVERTENTLY BE THOUGHT JUST TO HAVE CLINICAL DEPRESSION WHEN IN IN ACTUALITY IF YOU TREAT THE SLEEP APNEA THEY CAN DO MUCH BETTER.

THANKS FOR YOUR CALL.

LET'S GO OUR NEXT CALLER.

HELLO JOHN.

WELCOME TO MARS THE MIND.

JOHN, YOU WANT TO KNOW WHAT'S THE DIFFERENCE BETWEEN AD AND ADHD?

IT IS THE AGE JOHN AND THE H STANDS FOR HYPERACTIVITY OR IMPULSIVE WHEN USED IN THAT TERM OFTEN REFERS TO ATTENTION DEFICIT DISORDER PRIMARILY THE INATTENTIVE TYPE AND THE INATTENTIVE TYPE IS WHERE YOU HAVE DIFFICULTY WITH FOCUS, CONCENTRATE SHOULD YOU HAVE TROUBLE PAYING ATTENTION TO THINGS FOR LONG PERIODS OF TIME ESPECIALLY IF THEY ARE NOT INTERESTING, EXCITING OR CHALLENGING PEOPLE WITH AIDS WILL STILL TYPICALLY HAVE DIFFICULTY WITH WANTING TO THINK THREE STEPS AHEAD OF EVERYBODY ELSE AND THEY'LL STILL HAVE A LOT OF THOUGHTS BOUNCING AROUND IN THEIR HEAD.

PEOPLE WITH ATTENTION DEFICIT DISORDER WILL OFTEN DESCRIBE DIFFICULTY WITH FEELING LIKE THEIR HEAD HAS A TELEVISION REMOTE CONTROL ON IT AND IT'S GOING FROM ONE STATION TO ANOTHER TO ANOTHER SO PEOPLE WITH INATTENTIVE TYPE BEING PREDOMINANT WILL OFTEN HAVE TROUBLE WITH INATTENTION AND THAT'S DUE TO THE DIFFICULTY WITH THE FRONT PART OF THE BRAIN UP HERE BEING A BIT UNDERACTIVE WHEN THAT FRONT PART OF THE BRAIN IS A LITTLE BIT UNDERACTIVE THAT WILL GIVE YOU DIFFICULTY.

THE ATTENTION SPAN EIGHTY-EIGHT HD REFERS TO INATTENTIVENESS BUT ALSO QUITE COMMONLY THE HYPERACTIVE IMPULSE IMPULSIVITY AND THIS IS AFFECTING THE MIDDLE PART OF THE BRAIN IN HERE.

IT'S CALLED THE STRIATUM AND WITH A STRIATUM DISTURBANCE YOU CAN HAVE DIFFICULTY WITH FEELING FIDGETY, FEELING LIKE YOU'RE ON THE GO, BEING MORE IMPULSIVE WHERE YOU WON'T THINK BEFORE YOU ACTUALLY DO SOMETHING SO YOU TEND TO SAY THINGS AND DO THINGS THAT YOU LATER REGRET AND A LOT OF TIMES THAT IMPULSIVE THAT HYPERACTIVITY IS MISDIAGNOSED AS BIPOLAR DISORDER NOW BIPOLAR MANIA WILL BE EPISODIC.

THE SYMPTOMS WILL COME AND GO WITH ADHD.

THE SYMPTOMS ARE THERE EVERY DAY.

SO I OFTEN COMPARE ADHD TO BEING KIND OF LIKE NEAR-SIGHTEDNESS WITH NEAR-SIGHTEDNESS.

YOU DON'T HAVE GOOD DAYS WITH YOUR VISION AND BAD DAYS WITH YOUR VISION.

EVERY DAY IS THE PRETTY MUCH THE SAME WITH YOUR VISION.

THE SAME IS TRUE WITH ADHD EVERY DAY YOU'LL HAVE TROUBLE WITH ATTENTION SPAN IF YOU HAVE ADHD YOU CAN HAVE DIFFICULTY IMPULSIVITY, FIDGETING, RESTLESSNESS, FEELING DRIVEN LIKE A MOTOR EVERY DAY IS LIKE THAT NOW WITH BIPOLAR DISORDER ESPECIALLY BIPOLAR MANIA YOU'LL HAVE THESE MANIC SYMPTOMS WHERE YOU DON'T NEED TO SLEEP.

YOU GET BY ON THREE OR FOUR HOURS OF SLEEP FOR TWO, THREE, FOUR NIGHTS AT A TIME AND DURING THOSE SPECIFIC TIMES YOU'LL HAVE RACING THOUGHTS, YOU'LL HAVE IMPULSIVITY AND YOU MIGHT HAVE TROUBLE WITH CONCENTRATION.

AND IF YOU JUST GO IN AND TELL YOUR CLINICIAN THAT YOU'RE HAVING RACING THOUGHTS, YOU'RE HAVING IMPULSIVITY AND YOU'RE HAVING TROUBLE SLEEPING, THE CLINICIAN MIGHT AUTOMATICALLY THINK YOU HAVE BIPOLAR DISORDER BUT YOU HAVE TO LOOK AT THE UNDERLYING SYMPTOMS AND HOW LONG THEY'VE BEEN THERE AND THE DAY TO DAY COURSE OF THE EFFECTS OF THESE SYMPTOMS.

IF YOU'VE HAD ADHD OR ADHD, THE SYMPTOMS OF TYPICALLY BEEN THERE SINCE CHILDHOOD AND THE RULE OF THUMB IS ABOUT TWELVE YEARS OF AGE IF YOU'VE HAD THE SYMPTOMS PRIOR TO TWELVE YEARS OF AGE AND THEY'RE THERE MORE DAYS THAN NOT THAT'S PROBABLY MORE LIKELY TO BE ADHD IF THE SYMPTOMS ARE VERY EPISODIC AND THEY STARTED MAYBE IN YOUR ADOLESCENCE OR MAYBE EARLY TWENTIES THAT'S MORE BIPOLAR DISORDER IS A HUGE DIFFERENCE IN THE DIAGNOSES EVEN THOUGH THEY DO HAVE SOME OVERLAPPING SYMPTOMS WITH ADHD WE ACTUALLY MIGHT TREAT PEOPLE WITH STIMULANTS OR MORE ACTIVITY MEDICATIONS THAT FIRE UP THIS FRONT PART OF THE BRAIN WITH BIPOLAR DISORDER.

WE'RE GIVING PEOPLE MOOD STABILIZERS THAT ACT AS CRUISE CONTROLS ON THE MOOD WHERE WE'RE TRYING TO LEVEL OUT THE MOOD SO PEOPLE DON'T GO TOO HIGH BUT THEN THEY DON'T GO TOO LOW.

WE WANT PEOPLE TO HAVE NORMAL VICISSITUDES OF THE MOOD VICISSITUDE REFERS TO THE NORMAL EBBS AND FLOWS OF THE MOOD.

IN OTHER WORDS, WHEN SOMETHING GOOD HAPPENS YOU SHOULD FEEL HAPPY WITH SOMETHING SAD HAPPENED IF YOU SHOULD FEEL SAD, IF SOMETHING MAKES YOU ANNOYED YOU SHOULD FEEL ANGRY.

THOSE ARE NORMAL MOODS AND YOU SHOULD EXPERIENCE MOOD BASED ON THE CONSEQUENCES OF WHAT'S HAPPENING AROUND YOU.

PEOPLE WITH ADHD WILL OFTEN OVERREACT.

THEY'LL OFTEN LOSE TACT.

THEY'RE OFTEN DESCRIBED AS BEING IMPATIENT AND THEY CAN GET KIND OF IRRITABLE SOMETIMES IF THEY HAVE PREDOMINANT IMPULSIVITY AND HYPERACTIVITY.

PEOPLE WITH BIPOLAR MANIA CAN HAVE THOSE SAME KIND OF SYMPTOMS BUT IT'S VERY EPISODIC.

IT COMES AND GOES AND DURING THE MANIC EPISODES PEOPLE WITH BIPOLAR MANIA WILL SOMETIMES BE EXPLOSIVE.

THEY'LL HAVE RAGE, THEY'LL HAVE IRRITABILITY BUT THEN AFTER A FEW DAYS NOT UNCOMMONLY THEY CRASH AND WITH BIPOLAR DISORDER PEOPLE WILL CRASH WHERE THEY WANT TO SLEEP ALL THE TIME.

THEY LACK MOTIVATION.

THEY HAVE DIFFICULTY CONCENTRATING THEN THEY HAVE DIFFICULTY.

THE SPEED OF PROCESSING WITH THEIR BRAINS AND PEOPLE WITH DEPRESSION WILL HAVE TROUBLE ENJOYING THINGS THEY DON'T WANT TO BE AROUND PEOPLE AND THEY BECOME MORE RECLUSIVE AND THAT HIGH AND LOW TYPE OF PHENOMENON WITH BIPOLAR DISORDER IS VERY CHARACTERISTIC OF THAT CONDITION WHEREAS ADHD THE SYMPTOMS ARE PRETTY MUCH THE SAME DAY BY DAY BY DAY.

I REMEMBER HAVING A PERSON TELL ME YEARS AGO THAT THEY FELT LIKE THEY WERE MANIC EVERY DAY.

WELL IT'S NOT LIKELY YOU'RE GOING TO BE MANIC EVERY DAY.

BIPOLAR DISORDER DOESN'T WORK LIKE THAT WITH MANIA EVENTUALLY THE BRAIN KIND OF OUT OF NEUROTRANSMITTERS AND YOU JUST CRASH AND WITH ADHD THE SYMPTOMS ARE THERE DAY BY DAY BY DAY.

NOW A LOT OF PEOPLE WITH ADHD WILL HAVE HIGHER THAN NORMAL IQ WHO'S AND THEY ARE OFTEN THE IDEAS PEOPLE THE ENTREPRENEURS FOR GETTING THINGS DONE.

THEY GET THINGS INITIATED BUT THEY NEED PEOPLE AROUND THEM TO ACTUALLY COMPLETE THE PROJECT SO PEOPLE WITH ADHD WILL OFTEN START PROJECTS, THEY'LL START BUSINESSES FOR THAT MATTER BUT THEY NEED A LOT OF PEOPLE AROUND HIM TO BE ABLE TO GET THE DETAILS OF THE BUSINESSES COMPLETED.

THEY'LL HAVE THE IDEAS AND THEY'LL HAVE THE VISION AND THEY'LL BE THINKING THREE STEPS AHEAD OF EVERYBODY ELSE IN TERMS OF WHAT NEEDS TO BE DONE.

BUT SOMETIMES THEY NEED TO REEL IT IN A LITTLE BIT TO BE ABLE TO ALLOW OTHER PEOPLE TO CATCH UP WITH THEM AND THAT'S WHERE OTHER PEOPLE ARE TRYING TO GET THE DETAILED WORK DONE WITH ADHD OFTEN DESPISE PAPERWORK DURING THE TAX SEASON.

IT'S MISERABLE FOR HIM BECAUSE HE GOT TO GET ALL THE PAPERWORK TOGETHER AND ALL THE DETAILS TOGETHER IF IT'S NOT CHALLENGING, INTERESTING OR EXCITING PEOPLE WITH ADHD JUST DON'T WANT TO GET THE THE WORK DONE A LOT OF TIMES AND IN ADHD AS MANY TIMES USED INTERCHANGEABLY WITH ADHD, WITH THE ADHD THAT'S WHERE PEOPLE ARE HAVING THE THE FIDGETING, THE HYPERACTIVITY AND THE DIFFICULTY WITH DISTRACTIBILITY IN PARTICULAR.

NOW IT HAS BEEN BELIEVED THAT BOYS WILL ARE GOING TO BE MORE LIKELY TO HAVE ADHD THAN GIRLS.

SO THE YOUNG BOYS WHO ARE UNDER TWELVE ARE MORE LIKELY TO HAVE THE HYPERACTIVITY AND IMPULSIVITY COMPARED TO THE GIRLS THE GIRLS AND HAVE ADHD WHERE THEY ARE VERY QUIET.

THEY'RE FAIRLY SOCIALLY INEPT IN SOME IN SOME CASES THEY HAVE DIFFICULTY CONCENTRATING IN CLASS.

THEY HAVE TROUBLE DIFFICULTY READING, THEY HAVE TROUBLE FOLLOWING THINGS BUT THEY'RE NOT GETTING INTO TROUBLE BECAUSE THEY'RE NOT MAKING ANY TROUBLE.

THE BOYS WITH ADHD ON THE OTHER HAND ARE THE ONES WHO ARE GETTING INTO TROUBLE.

THE REPORT CARDS IN THE SECOND AND THIRD AND FOURTH GRADE WILL BE THAT THEY HAVE DIFFICULTY PAYING ATTENTION IN CLASSROOM BUT THEY'RE ALSO VERY HYPERACTIVE BOYS WITH ADHD ARE VERY LIKELY TO BE KINESTHETIC LEARNERS WHERE THEY LIKE TO BE MOVING AROUND AS THEY ARE LEARNING MATERIAL.

THEY LIKE TO FOR INSTANCE, SHOOT BASKETS.

THEY OFTEN WILL SIGN UP FOR THE CROSS-COUNTRY TEAM AND A LOT OF CROSS-COUNTRY TEAM MEMBERS WILL HAVE ADHD BECAUSE THEY CAN BE DISCIPLINED AND IF ARE PHYSICALLY ACTIVE THEY'RE WELL WORKING AWFUL LOT OF EXCESSIVE ENERGY BUT THEY CAN ALSO CONCENTRATE BETTER IF THEY'RE PHYSICALLY ACTIVE AND THAT'S CALLED KINESTHETIC LEARNING WHERE YOU'RE ABLE TO FOCUS ESPECIALLY ON BORING TOPICS IF YOU WERE PHYSICALLY ACTIVE.

SO FOR A LOT OF PEOPLE WE TRY TO DETERMINE ARE THEY MORE VISUAL LEARNERS OR THEY'RE AUDITORY LEARNERS?

ARE THEY KINESTHETIC LEARNERS?

VISUAL LEARNERS NEED TO SEE THE MATERIAL IN FRONT OF THEM.

THE AUDITORY LEARNERS NEED TO HEAR IT AND THE KINESTHETIC LEARNERS ARE THE ONES WHO LIKE TO BE MOVING AROUND AS THEY'RE LEARNING.

THESE ARE PEOPLE WHO ACTUALLY LEARN BEST IF THEY'RE ON A TREADMILL OR IF THEY'RE ON A STATIONARY BICYCLE AND THEY'RE LEARNING MATERIAL AS THEY'RE IN THOSE KIND OF ACTIVITIES BECAUSE PHYSICAL ACTIVITY WILL ACTUALLY HELP THEM FOCUS THEIR BRAIN IN SUCH A WAY THAT THEY CAN DOWNLOAD INFORMATION MUCH BETTER.

WE HEAR THAT A LOT WITH PEOPLE WITH ADHD SO IT KIND OF MAKES US RETHINK HOW WE SHOULD EDUCATE A LOT OF KIDS IN SCHOOL.

WE KNOW THAT PHYSICAL ACTIVITY IS VERY, VERY HELPFUL FOR A LOT OF PEOPLE.

ADHD OR AIDS OR NOT PHYSICAL ACTIVITY CAN BE VERY HELPFUL IN FIRING UP THE BRAIN.

THEY DID A STUDY IN IN AN APP IN ILLINOIS YEARS AGO AND IN THIS PARTICULAR HIGH SCHOOL THEY HAD THE HIGH SCHOOL KIDS COME OUT AND RUN PRIOR TO THEIR STARTING THEIR MORNING CLASSES EVERY DAY.

SO THEY HAD HEART RATE MONITORS ON AND THEY ARE EXPECTED TO RUN NOT TO COMPETE AGAINST EACH OTHER BUT RUN TO COMPETE AGAINST THEMSELVES AND TRY TO GET BETTER TIME IN THE HALF MILE TIMES IN THE MILE TIMES AND JUST GET OUT AND EXERCISE FIRST THING EVERY MORNING.

AND WHAT THEY FOUND IS THAT THESE HIGH SCHOOL YOUNG ADULTS AND ADOLESCENTS WHEN THEY EXERCISED IN THE MORNING THEY HAD BETTER ATTENTION SPAN IN THE MORNING CLASSES AND THEY WERE ABLE TO GET BETTER GRADES AND THEY ACTUALLY DID MUCH BETTER IN TERMS OF MATH AND SCIENCE COMPARED TO THE REST OF THE COUNTRY FOR THAT MATTER.

SO NOW IT'S BELIEVED THAT IF YOU CAN EXERCISE FIRST THING IN THE MORNING, WHETHER YOU'RE IN HIGH SCHOOL OR WHETHER YOU'RE AN ADULT AND YOU'VE GOT BIG MEETINGS COMING UP IF YOU CAN EXERCISE FOR JUST 30 MINUTES, IT ACTUALLY NOT ONLY HELPS WITH THE HEART RATE AND HELPS YOU WITH PHYSICAL HEALTH BUT ACTUALLY WILL TEND TO HELP WITH THE COGNITIVE ABILITY, THE ABILITY FOR THE BRAIN TO PROCESS AND RETAIN INFORMATION AND TO BE MORE CREATIVE FOR THAT MATTER.

SO IF YOU HAVE A BIG MEETING COMING UP LATER IN THE MORNING, IT'S NICE TO BE ABLE TO GET INTO THE GYM, GET SOME EXERCISE OUTSIDE, GO FOR A BRISK WALK, GET SOME KIND OF EXERCISE THAT MORNING FOR ABOUT 30 MINUTES BECAUSE THEY'VE BEEN VERY, VERY HELPFUL WITH FOCUS AND CONCENTRATION AND THAT'S NOT ONLY WITH ADHD OR ADD BUT IT'S ALSO WITH WITH PRETTY MUCH ANYBODY FOR THAT MATTER WHEN WE WHEN WE TREAT ADHD.

I USE THE EYEGLASSES ANALOGY EARLIER ABOUT NEAR-SIGHTEDNESS WHEN YOU HAVE NEARSIGHTEDNESS AS THE DAY TO DAY PHENOMENON AND WITH NEARSIGHTEDNESS YOU ALWAYS WANT TO GET A PARTICULAR STRENGTH TO BE ABLE TO FOCUS THE VISION.

THE SAME IS TRUE WITH ADHD.

SOME PEOPLE DO GREAT WITH STIMULANT MEDICATIONS.

SOME PEOPLE NEED HIGHER DOSES.

SOME PEOPLE NEED LOWER DOSES.

IT DOESN'T MATTER WHAT YOUR AGE IS OR BODY WEIGHT IS, YOU FIND THE DOSAGE THAT WORKS FOR YOU.

SO GOING HIGHER AND HIGHER ON A STIMULANT WOULDN'T NECESSARILY HELP WITH ADHD ANY MORE THAN GETTING THICKER AND THICKER EYEGLASSES WOULD HELP SOMEBODY NEARSIGHTEDNESS.

SO WHAT WE'RE TRYING TO DO WITH ADHD IS FIND THE MEDICATION DOSAGE THAT WORKS THE BEST BUT ALSO THE RIGHT TYPE OF MEDICATION.

SOME PEOPLE DO BETTER WITH STIMULANTS BUT ABOUT ONE OUT OF FOUR PEOPLE DO BETTER WITH NON MEDICATIONS.

THESE ONE OUT OF FOUR PEOPLE TEND TO HAVE A GENETIC PROFILE ON THIS ONE ENZYME CALLED CMT C OMT HAS A GENOTYPE OF VALUE OF MET MET WERE THESE PEOPLE JUST DON'T DO REALLY WELL WITH STIMULANTS.

SO IF YOU HAVE A GENOTYPE C-130 YOU TEND NOT TO DO SO WELL WITH A STIMULANT ABOUT ONE FOURTH OF THE POPULATION HAS THAT PARTICULAR GENOTYPE FOR CMT.

SO THAT'S SOMETHING WE'RE STARTING TO REALIZE NOW THAT WE'VE BEEN STUDYING GENES AND GENETIC GENETIC TREATMENT.

THANKS FOR YOUR QUESTION.

LET'S GO TO NEXT CALLER.

HELLO SANDY.

WELCOME TO MATTERS OF MIND.

OH, SANDY, YOU HAD MENTIONED THAT ADHD ARE REALLY A RELATIVELY NEW OCCURRENCE WITH KIDS IN THE PAST TWENTY YEARS.

STUDENTS SEEM TO BE IN MUCH OF AN ISSUE IN THE 1960S AND 1970S.

YOU ARE ABSOLUTELY RIGHT, SANDY.

ABOUT THE YEAR 2000 IS WHEN I STARTED HEARING A LOT ABOUT ADHD WITH ADULTS AND THAT WAS BECAUSE IN THE YEAR 2000 THEY STARTED TO RELEASE ALL THESE DIFFERENT STUDIES ON MRI OF THE BRAIN LOOKING AT MRI'S AND THEY CALLED FUNCTIONAL MRI IS LOOKING AT THE ACTIVITY OF THE BRAIN WHEN PEOPLE CONCENTRATE, WAITED AND TRIED TO FOCUS ON DIFFERENT TOPICS AND THE PRIOR TO THE YEAR 2000 SANDY IT WAS THOUGHT THAT ADHD DID NOT OCCUR WITH ADULTS.

IT WAS THOUGHT TO BE ONLY BE A CHILDHOOD CONDITION.

I DID MUCH OF MY RESIDENCY TRAINING IN PSYCHIATRY IN MEDICAL SCHOOL TRAINING BACK IN THE 1980S AND AT THAT TIME IT WAS THOUGHT THAT ADHD WAS A PHENOMENON THAT PARTICULARLY HAD THE HYPERACTIVITY AND IT OCCURRED UP UNTIL ABOUT 18 OR 19 YEARS OF AGE AFTER 18 OR 19 YEARS OF AGE YOU JUST DIDN'T HAVE ADHD OCCURRING.

WELL IN THE YEAR 2000 IT WAS REALIZED THAT ADHD DID AND DID OCCUR WITH INDIVIDUALS OVER EIGHTEEN AND NOW THAT WE'VE STUDIED IT FURTHER, ABOUT 40 PERCENT OF PEOPLE WILL CARRY ADHD INTO THEIR ADULT YEARS.

HOW DOES IT AFFECT THEM AS ADULTS?

WELL, THEY ARE NO LONGER IN SCHOOL IN MANY CASES BUT THEY'LL STILL HAVE TROUBLE SITTING STILL IN MEETINGS.

THEY'LL STILL BLURT OUT THINGS THEY'RE THINKING THREE STEPS AHEAD OF EVERYBODY ELSE.

THEY COULD BE IMPATIENT, THEY CAN BE IRRITATING, THEY CAN BE ANNOYING.

AND PRIOR TO 2000 THESE ADULTS WOULD HAVE BEEN DIAGNOSED WITH BIPOLAR DISORDER AS I WAS MENTIONING FOR BIPOLAR DISORDER IS AN EPISODIC PHENOMENON WHERE PEOPLE CAN BE IMPULSIVE AND IRRITABLE AND THEY HAVE DIFFICULTY WITH SLEEP.

ADHD IS A DAY TO DAY PHENOMENON BUT NOW WE REALIZE THESE PEOPLE WHO PREVIOUSLY WERE PROBABLY DIAGNOSED WITH BIPOLAR DISORDER BACK IN THE 1980S 1990S LIKE THEY HAD ADHD.

SO AGAIN IT'S VERY, VERY IMPORTANT TO DISTINGUISH THE TWO WITH BIPOLAR DISORDER.

WE'RE GOING TO GIVE MOOD STABILIZERS WITH ADHD.

WE'RE GOING TO GIVE THEM MEDICATIONS, FIRE UP THE FRONTAL LOBE OF THE BRAIN AND THE TREATMENT IS ENTIRELY DIFFERENT IF YOU TREAT BIPOLAR BIPOLAR DISORDER WITH STIMULANTS YOU'LL OFTEN MAKE THE MOOD DISTURBANCES MUCH WORSE IF YOU TREAT ADHD WITH MOOD STABILIZERS YOU OFTEN MAKE PEOPLE MORE TIRED.

THEY CAN'T THINK SO IT'S VERY IMPORTANT WE DIFFERENTIATE THE TWO CONDITIONS.

THANKS FOR YOUR CALL.

LET'S GO TO OUR NEXT CALLER.

HELLO BASS.

WELCOME TO THE LINE.

HELLO.

HELLO BASS.

YOU'RE ON THE AIR.

MY NAME IS PAT.

HELLO PAT.

YOU DON'T SOUND LIKE BASS.

WELCOME TO MATTERS OF THE MIND MY QUESTION REVOLVES AROUND MEDICATION.

A YOUNG MAN WHO'S LATE 20S NOW AND HAS GONE THROUGH SOME ADDICTIONS IN ADDITION TO ADHD CONDITION THAT WAS DIAGNOSED WHEN HE WAS FOUR IS TWENTY NINE NOW WHAT KIND OF ADHD MEDICATION COULD HE USE WITH THIS ADDICTION ISSUE?

AND FROM WHAT I HEARD ON THE PROGRAM BECAUSE AUDITORILY BELIEVES THAT HIS METHODS BUT HE'S ALSO EXTREMELY ACTIVE ALWAYS PATH THAT'S A QUESTION THAT I WAS DISCUSSING WITH SOME OF MY NURSE PRACTITIONERS WITH WHOM I WORK JUST TODAY.

WHAT DO YOU DO FOR SOMEBODY WHO HAS ADHD AND THEY'VE HAD ADHD SINCE ALL FOUR YEARS OF AGE AS YOU HAD MENTIONED AND THEY GET INTO TROUBLE WITH ADDICTIONS BECAUSE PEOPLE WITH ADHD GET THEMSELVES INTO TROUBLE.

IT'S THOUGHT THAT HALF OF THE INDIVIDUALS IN THE CRIMINAL AND THE CRIMINAL JUSTICE SYSTEM RIGHT NOW THEY'RE IN PRISONS.

HALF OF THEM HAVE ADHD.

ADHD MAKES IMPULSIVITY SHOULD NOT BE ABLE TO ACHIEVE THE KIND OF THINGS YOU'D LIKE TO ACHIEVE IN LIFE.

IT MAKES YOU NOT THINK THROUGH THE CONSEQUENCES OF YOUR BEHAVIORS.

PEOPLE WITH ADHD GET IN TROUBLE WITH DRUGS OF ABUSE BECAUSE THEY HAVE ANXIETY SO THEY DRINK ALCOHOL TO CALM DOWN THE ANXIETY, THE ANXIETIES BECAUSE THEY ARE ALWAYS PROCRASTINATING, THEY'RE ALWAYS RUNNING BEHIND.

THEY'RE ALWAYS HAVING TROUBLE GETTING THINGS DONE.

THEY HAVE DIFFICULTY WITH FOCUS AND CONCENTRATION.

SO YEAH, THEY'LL GRAVITATE TOWARD NICOTINE NOT UNCOMMONLY BUT THEN THEY MIGHT USE COCAINE OR METHAMPHETAMINE OR VARIOUS OTHER DRUGS OF ABUSE.

ANXIETY AND DEPRESSION SOMETIMES WILL LEAD TO LEAD TO THEY'RE USING NARCOTICS OR OPIATES BECAUSE NO NARCOTICS OR OPIATES WILL GIVE YOU A SENSE OF BLISS FULLNESS AND THAT'S WHY PEOPLE LIKE THE EFFECT OF NARCOTICS AND THEY START TO ABUSE THEM.

YOU COULD NOT UNCOMMONLY GET IN TROUBLE FOR MARIJUANA WHEN YOU HAVE ADHD DIFFICULTIES BECAUSE AGAIN MARIJUANA MAKES YOU NOT CARE AND IF YOU HAVE ADHD YOU'RE ALWAYS ANXIOUS ABOUT THINGS THAT YOU'RE NOT GETTING DONE.

SO IF YOU USE MARIJUANA YOU JUST DON'T CARE IF YOU'RE NOT GETTING THEM DONE.

SO THE QUESTION WILL BE, PAT, FOR THOSE INDIVIDUALS EXCUSE ME WHO ARE STRUGGLING WITH ADDICTIONS, DO YOU TREAT THEM WITH STIMULANTS?

WELL, I'LL GIVE YOU A DEFINITE MAYBE ON THAT ONE.

WHAT WE NEED TO DO IS ASSESS HOW LONG THEY'VE BEEN CLEAN AND WE WANT TO BE CAREFUL IF THEY DO USE A MEDICATION THAT'S A STIMULANT THAT THEY DON'T HAVE A PROVOCATION OF THEIR RELAPSE FOR ADDICTION.

SO WE ALWAYS TRY TO LOOK BACK AND SORT OUT WHAT GOT THEM IN TROUBLE WITH ALL THESE SUBSTANCES OF ABUSE BACK IN THEIR EARLIER YEARS WERE THEY TRYING TO TREAT AND SELF MEDICATE ADHD OR ITS CONSEQUENCES SUCH AS ANXIETY OR DEPRESSION WHERE THEY JUST RECREATIONALLY USING THOSE DRUGS OF ABUSE AND THEY GOT INTO TROUBLE WITH THEM ONE WAY OR ANOTHER?

WE'RE TRYING TO FIGURE OUT HOW LONG HAVE THEY BEEN CLEAN AND WHAT CAN WE DO TO TRY TO MAKE SURE THEY CONTINUE THAT THERE ARE NON STIMULANT MEDICATIONS FOR ADHD CONFESSING IS IN THE LONG ACTING FORM FORM CALLED INTUITIVE WE NOT AND COMMONLY USE THAT STRATTERA IS A MEDICATION.

IT PRIMARILY INCREASES NOREPINEPHRINE RATHER THAN DOPAMINE AND THAT HELPS WITH ADHD.

WE USE VARIOUS MEDICATIONS FOR DEPRESSION FOR ADHD SUCH AS WELLBUTRIN, TRENTS, CYMBALTA.

THEY'RE ALL USED IN WHAT IN WHAT'S CALLED AN OFF LABEL MANNER.

THEY WERE NEVER STUDIED NECESSARILY FOR ADHD OR FOR PROOF FOR ADHD BUT THEY DO FIND THEY ARE HELPFUL FOR PEOPLE WHO HAVE TROUBLE WITH ADDICTIONS AND THEY'RE LESS PRONE TO MAKE YOU WANT TO CRAVE THOSE KIND OF MEDICATIONS WHICH ARE DRUGS OF ABUSE.

SO THERE'S WAYS TO GET AROUND THE ADHD SYMPTOMS WITHOUT GIVING SOMETHING SOMEBODY NECESSARILY A STIMULANT.

BUT IF THEY HAVE BEEN CLEAN FROM THE DRUGS OF ABUSE FOR A LONG TIME AND IT'S ALWAYS A JUDGMENT CALL YOU CAN SOMETIMES CAREFULLY AND I EMPHASIZE CAREFULLY GIVE PEOPLE STIMULANT IN THOSE CASES.

PAT, THANKS FOR YOUR CALL.

LET'S GO TO ONE LAST CALLER HERE.

HELLO BAIS.

WELCOME TO MATTERS OF MIND BECAUSE YOU'D ASKED IF YOU HAVE A STROKE ON THE RIGHT SIDE OF YOUR BRAIN, WHY DOES IT AFFECT THE LEFT SIDE OF THE BODY?

REAL SIMPLE BAY BAIS AFTER THE LITTLE NERVE FIBERS CROSS THE NECK IN THE SPINAL CORD THERE THEY GO TO THE OTHER SIDE OF THE BODY SO EVERYTHING CROSSES RIGHT THERE IN THE PONDS WHICH IS KIND OF AT THE TOP OF THE NECK.

THAT'S WHERE ALL THE LITTLE NERVE FIBERS CROSS OVER TO THE OTHER SIDE BASE.

THANKS FOR YOUR CALL.

UNFORTUNATELY I'M OUT OF TIME FOR THIS EVENING.

IF YOU HAVE A QUESTION THAT I CAN ANSWER ON THE AIR, YOU CAN WRITE ME VIA THE INTERNET AT MATTERS OF THE MIND MWF A DOT ORG I'M PSYCHIATRIST JEFF OFFERING YOU'VE BEEN WATCHING MATTERS THE MIND ON PBS'S FORT WAYNE GOD WILLING AND PBSC WILLING.

I'LL BE BACK AGAIN NEXT WEEK.

THANKS FOR WATCHING.

GOODNIGHT