.

>> Good evening.

I'm psychiatrist Fauver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now as twenty third year are 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.

>> PBS Fort Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero.

Now on a fairly regular basis we are broadcast 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, you may write me via the Internet at matters of the mind all one word at a dog that's matters of the mind at a dog.

>> And I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver, how much of mental illness is genetic?

>> I have a family member with schizophrenia and want to know my chances of mental illness in general has some genetic propensities but to different degrees.

>> For instance, attention deficit hyperactivity Disorder or ADHD is almost as genetic as height.

>> There's only one medical condition it's more genetic than ADHD and that's psoriasis.

>> So ADHD is highly genetic bipolar disorders as about sixty three sixty four percent genetic so manic depressive disorder bipolar disorder has that degree of genetic likelihood.

Major depression is about thirty three percent genetic.

>> The rest is has environmental and then you get the schizophrenia with schizophrenia about one percent of all of us have a chance of getting schizophrenia about one out of 100 chance.

>> But if you have a first degree relative such as a mother or father, you have about a 12 percent chance of developing schizophrenia if you have a brother with schizophrenia, your chance drops down to about eight percent a brother or sister with schizophrenia.

So with that being said, what can you do about it?

The good news is if you have a brother or sister with schizophrenia you have a ninety two percent chance of not getting it.

So the idea is to do all the things you could in the early childhood development years to prevent yourself from having schizophrenia within your ability to do so.

Part of the risk factors for schizophrenia in early childhood development while no one at the very, very very top of the list is using marijuana.

>> People who use marijuana before the age of twenty four years of age if they have a genetic likelihood for developing schizophrenia, marijuana is considered to be 200 times more likely to cause these people to develop schizophrenia compared with if they did not develop if they did not use marijuana.

>> So marijuana is a significant risk factor itself for for schizophrenia.

Secondly, difficulty with social development and difficulty with social skills will be a factor in the likelihood of somebody developing schizophrenia, untreated anxiety and severe depression at an early age can be a factor as well as can be a childhood emotional neglect and childhood abuse for that matter that those type of things as a child you can't prevent if you're a child.

So there are risk factors that we're trying to identify in early childhood development to try to offset that.

But the good news is there are things that you can do to prevent the likelihood of developing schizophrenia, try to maintain socialization, definitely stay with marijuana up until the age of twenty four years of age after twenty four years of age is debatable what it's going to do to the brain but definitely up to twenty four years of age it's the use of marijuana that is the big big trigger for schizophrenia now that marijuana is becoming recreationally legalized and thereby considered to be OK by a lot of people in the general public and in several states we've seen a mental health crisis occur in those states especially with the younger adults.

Colorado was the first to recreationally legalize marijuana about nine years ago and since that time they've had a critical difficulty with the children and adolescents and young adults with anxiety, depression and increases in psychotic disorders that have been identified.

So the people that work out in those states are noticing that type of thing and I think we should all pay attention in those states where marijuana is not yet legally recreationally legalized because I think that the states where it's not considered to be recreationally legalized just yet are hopefully going to be able to keep that and keep that in a measured response so that we don't hear about that the mental health crisis when that young age group but up until the age of twenty four years of age or front part of your brain is still growing.

So as the front part of the brain is still growing, it's very critical to not suppress that growth and what marijuana does specifically it will decrease the white matter growth of the brain white matter growth of the brain is considered the insulation of the brain and allows the individual neurons one hundred billion of them but allows them to communicate with each other better.

And if you suppress that growth of the white matter, you decrease the ability for the individual neurons to adequately communicate.

You'll have difficulty with a lower IQ than would be expected and difficulty with being able to maintain a sense of reality.

And that's why there's an increased risk of schizophrenia with young adults that use marijuana.

Thanks for your call.

Let's or our next caller hello Lewis.

>> Welcome to Matters of Mind.

Lewis, you had wondered about my thoughts about the use of I think you're talking about P six P in acetyl and Wanga for anxiety.

It's difficult to say Lewis.

I wouldn't recommend them for myself or any of my family members or friends any time you're using supplemental products it's kind the type of thing where you wonder are you at the right dosage and what are the long term effects?

I remember twenty five years ago that ginkgo biloba was highly, highly popular and it was thought that everybody should take ginkgo biloba because potentially it could help with concentration decrease the risk of dementia and there's a lot of excitement and enthusiasm about that and you'll hear about that in various trends people using this or that or so.

I can't recommend it as a psychiatry.

I treat people who have functional impairment.

They're having significant difficulty with depression and anxiety, difficulty with concentration.

So I'm going to take those conditions very seriously.

So I guess the question is will you use supplemental products and herbal products for that matter if he had a heart condition, if you had diabetes, if you had asthma typically if you have those kind of conditions you want to treat them very seriously.

That's the way I treat anxiety.

I'm going to treat anxiety with a medication that is going to have proven efficacy and the herbs can help with some people if I'm going to use or recommend anything for herbs, I'm going to typically recommend healthy and eating healthy eating is the active ingredient in green tea and you can use several thousand milligrams of it with significant safety but people will get a bit of a calming effect with the use of Althea's need to get an adequate dosage from green tea you'd have to drink about twenty cups a day so it does come in a capsule form but it does help with some people and it tends to be fairly well tolerated.

So for those people who are having difficulty with anxiety, yeah, we have a lot of proprietary or prescription products that are available.

Antihistamines do help some but they have a lot of side effects with difficulty, concentration and trouble with sedation and then you get the herbal products.

The main issue I have with herbal products as well will be any difficulty with drug interactions because a lot of the herbal products do have drug interactions.

So if you happen to be on medication for your heart or your lungs, your kidneys or your for your blood pressure, you can have a lot of drug interactions by using herbal products like that.

So you'd want to be very careful.

So talk it over with your primary care clinician.

Lewis, thanks for your call as your next caller.

>> Hello Julie.

Welcome to Matters of the Mind.

Hi.

Hi Julie.

I've had a rough night, a rough life but the last three it's been really bad and I am focused on my brother who we last two and a half years ago.

So my mom I mean she's like falling apart.

She's she's having seizures with her arm and you know, her hip and stuff and I'm just so concerned about her I don't know how to help her.

I just wanna get it right.

>> Thank you.

Yeah.

Yeah.

Julie, you mentioned your mother is having seizures in her arm and her hip as she's in a neurologist a doctor who specializes in seizures.

>> No she does have an appointment for an EEG and let's have the one the EMG no signs like going take the I don't remember the name of that.

I'm sorry.

Okay.

Well I just thought something because I live on the north side of town from her and I'm thankful I have a niece over there to help her but I just have to I mean she's more than I can get there and try and I'm trying but my cousin is there to help her homeless.

>> Well, it's good that you do have some family members, family members to help Julie seizures or movement disturbances like that should be evaluated by a neurologist who specializes in seizures and an EEG is an electroencephalogram that looks for abnormal electrical activity in the brain and an EMG which I mentioned is electro myelogram.

>> Well, that looks for actual nerve contraction.

The electrical activity behind nerve contractions itself.

There's something called an MRI, a magnetic resonance imaging of the brain.

That's where you get a really nice picture of the brain and see if there's anything going on there and sometimes usually they'll do blood tests for the purpose of trying to determine ,you know, are there any electrolyte disturbances, any kidney problems that could be causing these kind of movements.

>> So it's like with any condition, Julian, you're so concerned about your mother and it's good that you have some extended family members to help her out.

But the first thing you need to do with any condition like that is to identify what's causing it and then once you identify the cause you can treated accordingly if it is indeed a seizure disorder.

Yeah, there are anti seizure medications that can relieve her discomfort hopefully with very little sedation or any side effects.

So there are ways to give a better quality of life and hopefully totally eliminate these kind of symptoms that she's having at this point if it's not a seizure disorder, if it's due to a kidney problem or some kind of disturbance with electrolytes for that matter again that can be treated and needs to be corrected.

So it's good that she does have an appointment and it's like any kind of medical condition.

Julie, a lot of us will certainly worry about our loved ones but at the same time we do need to take action and it sounds like you've done so with getting her appointment and getting her evaluated with some neurological testing to determine what the cause might be.

Julie, thank you so much for calling in.

I wish you the best.

Have a good evening.

Let's go to our next e-mail.

Our next e-mail reads Your daughter Fauver How much of a psychiatric medication is too much?

I've always I'm always discussing with my doctor how much of a dose I should take and I don't know when to stop.

>> Well, psychiatric medication dosing is very similar to the Lenn strength or the thickness of eyeglasses.

>> So if you think about it eyeglasses or something not everybody should wear if you don't have impaired vision you shouldn't wear eyeglasses.

Well same with psychiatric medication.

We use psychiatric medication for the purpose of correcting any biological disturbances in the brain to try to normalize the brain chemistry and you're going to use certain doses of the psychiatric medication for the purpose of giving you the greatest benefit for the symptoms that you are treating and giving you the best possible means of functional improvement which means you're able to do stuff again so you're able to go to work, socialize, be around people, get along with your loved ones and so forth.

That's called functional improvement and there's going to be that tipping point when you get too much of a dosage you're going to have more side effects.

It's not unlike if you're wearing eyeglasses and you get thicker and thicker lenses you don't see better and better and better.

You get to a point where you think gee, I can't see it all now.

>> So if you think about dosing of Sikandar medication, if you go too high you can have difficulty with actually having more difficulty with more anxiety, more depression and rather than saying that medication didn't work for me, you might want to simply back off on the dosage and it's not uncommon that we'll deal with that with our patients as a psychiatrist I'm always asking people OK, if you've taken this or that medication, how do they do for you and did you feel better or worse when you increase the dosage because the last thing we want to do is go higher and higher and higher and unfortunately some people will have the perception that if they go higher and higher on the medication they'll feel better and better and that's not always the way it happens again, think about the eyeglass analogy getting thicker and thicker lenses won't help you see better and you won't have superhuman eyesight just by getting thicker and thicker lenses so with that being said, it's important that we try to find just the right dosage for people with medications now a challenge in psychiatry is there aren't any blood tests to identify just how much of the dosage you need.

We really have to listen to our patients and hear what they have to say in terms of how they're doing.

We have the next best thing the blood test and that will be questionnaires we can use questionnaires for depression, anxiety, sleep concentration overall functioning.

We use all these these these questionnaires as a means of trying to understand numerically how a person is doing because you can get the good scores on your depression, anxiety, sleep and all these different things that we will examine with each individual appointment and then we compare how those questionnaire scores are doing based on medication changes and doses that are might have been used and you try to find that sweet spot where you find just the right dosage of a specific medication with a purpose of finding where you had the the best outcomes overall.

So what we're always trying to do is find the dosage that works just just right for you without causing you to have more side effects.

>> Thanks.

You're thanks for your email.

Let's go next caller.

Hello Robert.

Welcome to Matters of Mind.

Robert, you had mentioned you have a friend with schizophrenia has injections and when he does he functions well then he goes periods with without the injections and when he goes without the injections he behaves and speaks oddly recently had gone eight months without the shot and four months later he began acting oddly.

He got his most recent shot two months ago.

Is there an oral supplement to help with Enviga Sestina at that time to go along with it in Vegas Sestina is basically in Veiga in a long acting form so the long acting formulation of Enviga typically lasts over the course of a month.

There are medications in development that that are going to be lasting for longer than that.

There's a medication called Abilify Terenzio that actually lasts for three months and other medications are lasting longer than that.

Now if you go off medication for a long period of time a couple of things are happening.

Number one, the more times you have a psychotic episode, the more difficult sometimes it is to come out of that.

So that's why we're always emphasize the need for people to stay on their medication and not have another psychotic episode.

>> It's not unlike epilepsy with epilepsy.

The more seizures you endure, the more likely you're going to have more seizures and the more seizures you have, the more treatment refractory you become, the more likely going you need more medications and a combination of anti seizure medications to give you relief.

In the case of schizophrenia with more psychotic episodes there's probably subtle brain damage that occurs because of an excessive amount of glutamate that's released glutamates and excitatory chemical.

But if you get too much of it, it can kind of fry different areas of the brain and that's actually one of the things that happens with dementia, with dementia that's thought there's thought to be an excessive amount of glutamate in certain areas of the brain and it can actually be toxic to to the brain.

That's what's happening with schizophrenia.

That's why email trapline over one hundred years ago called schizophrenia dementia praecox because it looked like dementia when they did autopsies on these people's brains, the brains were shrunken down so people with long term chronic what we now know as schizophrenia had shrunken brains just like people with dementia did.

>> Well, the same phenomenon is probably occurring only in the case of schizophrenia.

The more psychotic episodes people are having, the more toxic effects are occurring to the brain and the brain is literally shrinking down and when the brain shrinks down more sometimes it will cause people to have a longer period of time to be able to come out of it and be able to recover adequately.

>> So with that being said, somebody might have recovered very quickly the first one or two or three episodes of psychosis they endure.

But if he's having more and more episodes of psychosis it's more likely that he's going to have problems with recovering as quickly as he did before in Vegas instead he usually does not need augmentation or addition of anti antipsychotics to it.

>> Abilify can require some oral supplementation early on but Enviga doesn't usually need it if you get the right dosage.

But sometimes people do need a little bit of a help with additional medication on top of the Enviga especially if you've had repeated episodes over the course of time you would have had a follow up question about Abilify wondering about the switch from a bill from Enviga to Abilify to have the longer effect in allowing him to possibly mix these medications.

There's potential for that sometimes Abilify is added to other antipsychotic medications.

Usually you don't add a couple of antipsychotic medications together unless somebody is very treatment refractory.

But Abilify actually has very good studies with Clozaril showing that Abilify inclose role can be beneficial for some people who are highly Traymore refractory.

But Abilify has a bit of a different mechanism of action compared to a lot of the other traditional antipsychotic medication.

So sometimes Abilify is added something with something to with in Vegas Istana.

You want to certainly talk that over with your treating clinicians and try to sort out what might be the best fit.

I think the day may come where long acting injectables will be lasting longer and longer and the advantage with that with schizophrenia is that with schizophrenia people don't recognize and they don't have an awareness that they have an illness because as part of the brain called the insula which is right deep inside the brain there that's a part of the brain that is it's underactive with schizophrenia and that's a part of the brain where people truly have a lack of self awareness and with lack of self awareness you don't realize you have a problem.

>> So we're treating a condition where people cannot reasonably understand they have a problem.

So that's something I learned way back in medical school.

I tried to reason with these people with psychosis thinking well gee, if you just logically talk to them and make them recognize that what they're saying can't possibly be true because they're having delusional thought content, they're having obviously fixed false beliefs.

They can't be they can't be true and you just have to reason them through it.

It doesn't work that way.

These people truly believe that what is occurring is is occurring and it's very much like having a waking nightmare when you're experiencing a nightmare, things around you are very scary and they don't make a lot of sense.

That's what's happening with schizophrenia because when people are experiencing a psychotic episode this left front part of the brain is significantly impaired in its functioning and that in itself is causing people to have difficulty with being able to process information and that's the part of the brain that shuts down when people are having intense dreams and nightmares.

And for that reason, yeah, you lack logical thought during that time.

>> Thank you for your call.

Let's go our next email question our next e-mail question reads Fauver What's the difference between ego dystonic and ego?

>> CENTONZE Delusions Well, it looks like somebody is probably taking a psychology class.

Delusions as I mentioned before are fixed false beliefs.

They're fixed because you can't talk somebody out of them and their false beliefs egocentric are delusions that go along with the mood.

All right.

So if you're depressed you're having very depressive delusions, you're having very depressive bad thoughts.

>> Ego dystonic delusions are the type of delusions that don't match your mood.

In other words, you might be really depressed.

You're having these delusions where you feel like you're somebody really, really special and that you have a lot of administer of authority over your community where you really don't and they don't match the overall mood so egocentric Esswein means with egocentric means it goes along with the mood distorting dystonic means away from means that the mood doesn't match the actual delusions themselves.

>> Thanks for your email and do I have another email?

>> I'm going to take that as a no next year.

It is what Sammy Dauphin that's an interesting email.

What is Sammy Dauphin I've heard of it preventing weight gain.

How does it work and are there any bad effects?

>> Sammy Dauphin it is a medication was recently approved by the Food and Drug Administration as as an add on to olanzapine also known as Zyprexa.

>> Sammy Dauphin is a opiate receptor blocker.

OK, it's not going to give somebody an opiate high blocking opiate receptors and there's four types of opiate receptors.

>> There's opiate like receptor one.

I guess they just couldn't think of a name so they called it opiate like receptor number one.

That's one opiate receptors but the main ones are Mu Kappa and Delta.

The receptors are water stimulated when somebody takes a narcotic and they get a high and they feel good and if they get too much stimulation the receptor it shuts down their breathing and they can get addicted to it and more receptors if they're blocked on the other hand can prevent that kind of response.

So naloxone can be used to prevent and reverse opiate overdose.

Naltrexone is what's in Suboxone and that offsets the likelihood of somebody being able to get it addicted to be profaning and be pure Fernan which is in Suboxone and you have Sampdoria in which is five times stronger than Naltrexone and and when you have a medication it's five times stronger on the receptor also have a more bioavailability in the entire body you're going to get a longer and more potent systemic overall effect.

So the idea of blocking your receptors in preventing weight gain can be due to well if you get a lot of enjoyment and pleasure and you get kind of a high out of overeating blocking opiate receptors, the receptors specifically can decrease some of that craving like that.

So it was added on to olanzapine.

So you'll hear about a medication over the next few months that's been added to an antipsychotic or a mood stabilizer like olanzapine or Zyprexa decrease in the likelihood of its weight gain.

That's because what it's doing is blocking your receptors and they're very potent manner.

>> So the warning you'd have with that would be that if you need a narcotic for pain relief, let's say you have a compound fracture or in an auto X and you broke a bone where you might need a special narcotic like fentanyl which is a very strong and extremely potent narcotic.

The traditional narcotics like morphine Demerol might not help you that much if you're also taking this medication called Sam Dauphine.

So those are the type of things we'd have to work around otherwise Sam Dauphine tends to only have the side effect of sedation so it can make people calm but typically it's not a problem.

>> Thanks for your email.

I'll take another call here.

Jerry walking is mind.

>> We have about 30 seconds left.

You have a question?

Yes.

And a question about students other medications I'm on I seem to get like really stiff answered part of it with your questionnaire about weight gain and stuff in the last phone call I didn't know I have trouble like when I get down on the ground or try doing something that feels like I'm really different and tighten up.

I don't know if these anxiety medications did that or not.

>> Thanks for your call, Jerry.

Yeah, Allatoona can make it a little bit stiff and that is a side effect of it.

It's related to the dosage.

It's called extra Bramall symptoms and dystonia when it gets really bad.

But that's something talk your clinician about possibly decreasing the dosage could help you with that.

Jerry, thanks for your call.

Unfortunate amount of time for the V this evening.

If you have any questions concerning mental health issues that I can answer on the air you may write me via the Internet at Matters of the mind at a big thanks for watching.

>> Have a good evening.

Good night