>> Good evening.

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

Welcome to Matters of Mind now and it's twenty third 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.

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 broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie in the Purdue Fort Wayne Campus Shadows.

>> And if you'd like to contact me with 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 WFYI dot org that's matters of the mind at WFYI Dog and I'll start tonight's program with a question I recently received.

>> It reads Dear Dr. Fauver, I've always heard people casually say that they have OCD.

>> What are the actual symptoms and treatments for OCD obsessive compulsive disorder?

>> Many people confuse obsessive compulsive disorder with obsessive compulsive personality disorder which sounds very similar.

But obsessive compulsive disorder will be a condition where somebody will have repetitive thoughts they can't get off their minds.

>> These thoughts don't make any sense to them.

They're just there and they're just they're over and over and over again.

It's like a loop where it's like the old record player where the needle gets stuck and you can't get off that thought.

>> Now some people will have that thought progressed to compulsions and that will be repetitive behaviors that don't make any sense and you keep doing them even though you want to stop doing them.

>> But every time you stop doing the compulsions you get more anxious.

So it's an anxiety disorder that's reflective of a disturbance in the front part of the brain here there's the front part of the brain looking at you I took the brain apart and there's a circuitry in here that just kind of goes around and around and around and it gets stuck with OCD.

So how do we treat OCD?

Well, there's a simple psychotherapy treatment.

It's almost too simple but it's where you simply say stop and you say it out loud if you're by yourself perhaps but you say stop and the idea there is to jolt the front part ah the reasoning part of the brain into stopping those those obsessions that are going around and around and around.

>> Well pretty simple sometimes people do need medication.

If you knew if you use medications you're often going to use medications that enhance serotonin and the ones that we most likely are going to be using will be Luvox or Flu Voxer mean and then we might use Zoloft or sertraline Prozac or Fluoxetine can be used Luvox or Fluevog Tammin does have a special component where it's going to affect these Little Sigma one receptors.

>> In doing so it's thought that they might have a special effect for OCD.

We'll occasionally use an old so called tricyclic antidepressants called Clow MIFUMI and it's also known as a national there's an old antidepressant called Topher Anneal or Imipramine.

It's been around since the 1950s or 60s but not for a long time and all anaphora now is it's Tofino with little chloride wing on it and it was so effective for OCD when it was originally utilized that it was the people going across the border to Canada to get it because Canada F.T.

Canada approved its use before the United States did so back in the early 1990s when the United States was first studying clomp remainer national for the purpose of OCD people were going cross the border to Canada to get it and we still use an acronym Coloma for me it's fairly sedative.

>> It will increase norepinephrine and serotonin and fairly equal components.

It's very calming and we do use a national not uncommon to suppress dreams and help with nightmares because it's mechanism of action is such that it can suppress dreams and nightmares so it can be used other conditions other than OCD from a psychotherapy standpoint people with OCD will find benefits in terms of trying to redirect their thoughts.

The technique where you just say stop to yourself I can help some people but many people just need to have a timer on how long they're washing their hands, how many times are allowed to lock the door again and again and again, how many times are allowed to check the lights and then step away from it.

And if you can step away from it even though you'll initially get anxious, the idea there is you want to rewire the brain circuitry by convincing your brain that stepping away from those kind of compulsions are not hazardous and they're not detrimental and eventually the anxiety can be extinguished.

OCD is somewhat genetic, does run in family sometimes but if you've had strep throat as a young child sometimes that and predispose you to OCD later on because strep throat does the bacteria themselves can release a protein that your body will attack in the front part of the brain and in doing so the brain inadvertently attacked itself and that can throw off some of that circuitry.

So we will not uncommonly ask people if they have OCD if they experienced a strep throat as a young child for those people I might preferentially also use an old anti seizure medication called Lamictal or Lamotrigine.

>> It's stabilizing glutamate and it's thought that if you've had any damage to the front part of the brain either from strep throat or from a seizure or from a head injury, stabilizing glutamate in that front part of the brain can be helpful and that is what Lamotrigine Lamictal does.

>> Thanks for your question.

Let's go to our first caller.

Hello Heather.

Welcome to Matters of the Mind.

>> Hi, Heather.

You're on the air.

Hi there.

I'm Heather.

As I said and I have a question about memory a while back I was in a facility due to severe memory issues about five years ago I had a ruptured brain aneurysm and it just seems like over the past few years I've had an increase in memory loss and I was wondering if there is anything that can reverse that.

Can you have that corrected with medication?

What exactly is there anything that can be done to that?

>> Heather, did the aneurysm come first and then it was followed by the memory problems?

>> Oh yes.

Yes.

And actually after the brain aneurysm I had no no repercussions.

I had no physical or mental issues from it at all.

But it just seems like, you know, over the past, you know, four or five years my memory has gotten worse and worse and I know sometimes that's just age but I've had, you know, psychiatrists and other people tell me that there's really nothing you can do to reverse the memory issues and you've seen neurologists well, yes, yes, yes.

>> The doctor that performed my I had a metallic calling OK after the brain aneurysm have you had neuropsychological testing where they've actually tried to assess the type of memory disturbance you've been experiencing?

>> Heather, I am waiting to get to get in.

There's a there's a long wait and I can't get in until January 2022.

>> OK, that could be somewhat revealing so I'd be interested to see how that comes out.

Heather, the question would be with the aneurysm, did you have what we'd consider to be a traumatic brain injury, traumatic brain injuries are often associated with head injuries and where people get hit in the head but something internal such as an aneurysm, intra cerebral bleed, a stroke all those can give you symptoms of a traumatic brain injury which include memory problems as well.

>> Sometimes personality changes difficulty with impulsivity can sometimes be evident depending on where the actual injury occurred.

I mentioned a medication by the name of Lamotrigine in a moment ago that stabilizes glutamate thought when people have head injuries there's a release excessively of this very excitatory chemical called glutamate and glutamates great if it's in the proper quantities in the brain but when it's excessive you can have difficulty with irritability, memory problems and seizures and it's a stabilization of glutamate that's the mechanism of action of an Alzheimer's medication that's not uncommon.

Not uncommon.

We use called Namenda Namenda is a medication and basically will indirectly stabilize glutamate by blocking these particular receptors called NMDA receptors.

And if you block NMDA receptors, the glutamate goes around the NMDA receptors goes to the AMPA receptors and the bottom line is your memory can improve because your neurons thereby get more fluffy.

It's the same mechanism by which we will use when we're treating people with acetaminophen bravado for depression.

So there are treat months for people who have had head injuries, traumatic brain injury, aneurysms, stroke you name them when they are having memory disturbances.

Now once in a while Heather based on their psychological testing sometimes not only Namenda might be recommended but maybe Aricept rhapsodizing excellent, these are all medication that can be helpful in terms of giving you mood stabilizers and helping with concentration and memory and they can sometimes be used.

What they're doing basically is increasing the transmission of acetylcholine.

So acetylcholine is a chemical that does help with memory and it's thought that people with Alzheimer's dementia have a drop of acetylcholine and they're thereby they have trouble with memory.

>> And recent recall if you've had a head injury that can sometimes be the case as well.

>> But I've seen people not get the same kind of effects if they've had hej head injuries, if they take those acetylcholine medications compared to if they do have Alzheimer's dementia itself.

So we kind of put those on the back burner.

But the most luck I've seen with people have had head injuries either due to trauma to the head a stroke or an aneurysm.

The best luck I've seen will be the medications that stabilize the glutamate chemical and that would be medications like LaMotte's or Gene Namenda and we're not using it we're not using bravado or as ketamine so much right now for people who have actually had memory problems.

We do use ketamine or bravado for people who have depression so it'll be a different phenomenon.

>> So I doubt they use bravado whereas ketamine for that purpose.

But I think the first thing to do, Heather, is determine the kind of memory problems you're having.

Secondly, that will guide them toward what kind of occupational therapy you might need.

We can all benefit from physical activity or exercise within your physical capacity because exercise, no matter what your age can help your memory, your attention span and help your focus.

So exercising 30 minutes a day can help any of us with concentration and focus.

>> Secondly, and what where does your diet play a role with memory and concentration?

That's always debatable.

We know that eating more omega three fatty acids can be helpful and you can get that in a supplement form as long as you don't have any bleeding difficulties as a repercussion of the aneurysm itself knowing that fish oil or omega three fatty acids in high amounts can sometimes make you more prone to having bleeding.

So you'd want to get the OK to take fish oil as a supplement from your clinicians before initiating that.

But that sometimes will be a dietary change as recommended green leafy vegetables sometimes can be helpful.

We'll do genetic testing for a lot of people who have had strokes or aneurysms to see if they need a particular supplement called methyl folate.

Folic acid is vitamin B nine .

We have twelve B vitamins and vitamin B nine is folic acid and about one out of five of us just don't break down folic acid adequately so they have a so-called deficiency in the final breakdown product of folic acid called L methyl folate and the enzyme that breaks it down is methylene tetra folate ductus and methylene titta folate reductio F.R.

is an enzyme that helps break it down and some people just don't break it down adequately.

>> So if you have that particular deficiency and we recommend a special form of the end product of folic acid called Elmsford folate typically 10 or 15 milligrams a day and that could be helpful if you have that particular deficiency, if you have the GFR deficiency and that's what we'll use sometimes to help people get better concentration and focus and sometimes it even helps with her mood overall.

>> So we'll look at different parameters like that Heather.

And obviously my goodness, we don't want to overlook the obvious if you have diabetes, if you have if I were disturbances and most importantly we want to make sure you don't have sleep apnea even women with skinny necks for instance, we'll assess them for sleep apnea sometimes when they're having difficulty with memory disturbances and we find that they have sleep apnea.

It's pretty simple to treat but it's highly effective to treat that kind of medical condition when somebody is having difficulties or memory later in life .

So we will often assess for thyroid disturbances, diabetes and sleep apnea as medical conditions that are very, very treatable in terms of reversing memory problems and as we get older just one last thing, Heather.

>> I'm going to mention as we had older our little bus that carries vitamin B 12 from the stomach to the small intestine, the little bus is called intrinsic factor.

>> It comes from parietal cells in the stomach and as we get older the parietal cells kind of dementia no well or little busses the intrinsic factor diminishes well so we don't get the bus right of vitamin B 12 from the stomach into the small intestine and when that happens you get a B twelve deficiency that will also give you difficulty with memory problems.

Some people think they have dementia when all they have is really vitamin B deficiency.

So that's something that's very important to check, check, check out.

So there are a lot of different things that can be done be assessed for the memory problems you're having in relationship to the cerebral aneurysm.

You had Heather, Heather, thanks for your call.

>> Let's go to next caller.

Hello Keri.

Welcome to Matters of Mind.

Hello Carrie.

I've got a question.

What's the difference between schizophrenia and schizoaffective disorder?

I keep getting confused on that because I keep hearing different scenarios about don't let yourself get in.

>> Some say it is.

Yeah.

Don't let yourself get to confused about it, Carrie because it's fairly distinctive.

Both of them have schizophrenia symptoms.

All right.

So schizophrenia, schizoaffective disorder both have these symptoms where you can have difficulty with hearing voices or having delusions which are fixed false beliefs.

>> You can have difficulty processing information and communicate in such a way that doesn't make a lot of sense to other people.

You might go from one topic to another and go off on a tangent as we often say, people with schizophrenia or schizoaffective disorder again will have similar symptoms in the sense that they can both have difficulty with their emotional expression so they have trouble with being able to interact with other people and pick it up on social cues from others in such a way that they are often are perceived to have autistic symptoms.

>> So with that in mind, both schizophrenia and affective disorder have those type of symptoms.

Here's what's different schizoaffective disorder, affective refers to mood carry so schizoaffective disorder refers to these people with schizophrenia also having highs and lows or just big lows so they can have a prominent component of their condition being manifested by big highs where they every now and then they get really manic and they can get manic where they don't need to sleep talk even faster than they ordinarily would talk.

They have racing thoughts during that time and they're highly impulsive and that can go on for a week or so.

They may or may not crash into depressions if they do, that's called schizoaffective disorder bipolar type if they just go into depression itself and they don't have the manic highs is called schizoaffective disorder depressive type.

Now the key will be to have schizoaffective disorder.

You have to have a condition where for two weeks or more you have just the schizophrenia symptoms without mood disturbances.

In other words, schizoaffective disorder is where people have schizophrenia symptoms all the time but every now and then they have highs and lows that schizoaffective disorder bipolar type or they get really bad lows periodically and that's called schizoaffective disorder depressive type.

>> Now there's a third condition we always have to differentiate their carry and that'll be bipolar disorder.

>> Bipolar disorder will be where people have big highs, big lows but they're perfectly normal at other times and they don't have the schizophrenia symptoms in between the big highs and big lows.

So schizophrenia and schizoaffective disorder have overlapping symptoms.

It just it's because affective disorder has a the mood component on top of schizophrenia whereas bipolar disorder previously known as manic depressive disorder will be where people have a mood disturbance where they have highs or lows but they don't have necessarily the difficulty with processing information.

They don't have the difficulty with socialization as much as people with schizophrenia might have, especially when their moods are more level.

>> Carrie, thanks for your call.

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

I think our next emails sitting there there it is.

Dear Dr. Fauver, is Turits considered a mental health issue?

How is it treated often psychiatrist will end up indirectly or even directly treating Tourette syndrome because it's highly associated with attention deficit hyperactivity disorder and obsessive compulsive disorder.

Those are two conditions in which will often see Tourette's.

>> So we often try to knock down two birds with one stone if we can in our treatment threats I believe is more of a neurological condition basically and it does affect the so-called basal ganglia in the middle part of the brain here that controls our movements and does affect the front part of the brain, the core to the frontal cortex and it's thought to be a disturbance in the areas of your brain that control movements of Tourette's will be where people have grunts and tics and sometimes they'll inadvertently use profanity, profanity and that's called coprolalia.

>> And for those people what we're going to try to use will be medications that will also treat their underlying comorbid so to speak, psychiatric decisions.

So for instance, if they have OCD and Tourette's, we're going to often treat them with a medication.

It's going to increase serotonin and sometimes are going to give a low dosage of a medication that blocks dopamine because it's thought that Tourette's is related to a disturbance in excessive dopamine and disturbances serotonin as well.

So they might get a low dosage of an antipsychotic medication if they have ADHD and Tourette's will often preferentially use these medications.

It used to be used for blood pressure called Alpha two agonists and want phosphenes one of them Clonidine another one and these are all blood pressure medications.

But it's thought if you specifically affect these two receptors that also affect norepinephrine indirectly you can get some relief with the tics and twitches and the kind of grunting sounds that people might have with Tourette's syndrome.

But Tourette's is indeed a neurological condition that just happens to go hand in hand with a lot of psychiatric conditions.

It does have a genetic component to it.

>> The men with Tourette's are more likely to have the tics and twitches whereas women with Tourette's are more likely to have OCD, they tend to have more of the anxiety disturbances themselves but there is a bit of a genetic component going along with it.

Psychotherapy does help with Tourette's as well.

>> Thanks for your email.

Let's go to another email that I believe we have and it reads Your daughter Fauver How do I know if I am on too many medications?

I take six medications for my nerves and I don't know if I'm any better.

>> Well, that's a good question, you know, and I always wonder if I have a family member or a good friend with a mental health condition am I going to want them to be on six medications?

>> You're only gonna want to be on six medications if they're all working independently in positive ways.

>> In other words, if you're treating somebody with asthma or diabetes or or hypertension for that matter, sometimes people do need two or three different medications that have different mechanisms of action to get the ideal effects.

>> We've seen this for years with various medical conditions where you give people a so-called cocktail of different medications that work differently and with each medication it's added they get better and better and better and with other areas of medication of medicine you can actually measure the improvement.

>> For instance, you can measure blood sugars.

You can measure somebody's pulmonary functioning if they're having difficulty with breathing, you can measure their blood pressure to see if they're doing better.

How about in psychiatry?

I think in psychiatry we should be measuring somebody's symptom improvement and there's a lot of ways we can do that.

You can measure somebody's depression with a so called patient health questionnaire questionnaire.

It's nine questions you can measure their anxiety with so called seven looking at seven questions associate with anxiety we look at their insomnia with the insomnia severity index.

There's all these different scales and there questionnaires but they give you a numerical value and you can follow the numerical value with the change in the medications and it's very important that we pair that numerical value with a change in medications side by side because a temptation with a lot of psychiatric clinicians will be to keep adding on and adding on and adding on medication without taking any away and before we add on a medication to something else, we always need to ask did that something else the stuff that you're originally taken that it help you and I'm always looking for that magic 50 percent or more improvement if somebody is telling me their medication helps them by more than 50, I might leave it stay put.

And what we're doing for is at 80 or 90 percent or even 100 percent improvement.

But if somebody tells me the medication didn't really help them are only helping them like maybe 10 percent, why are you leaving them on it?

I mean take them off of it and go another direction.

So that will be something that needs to be determined if you're on six different psychiatric medications, you need to look back on your history or have your clinician do so and just try to determine did this help?

>> Did this help?

Did this help?

What were the doses that gave you the most benefits?

Some people do better on lower doses of some medications.

Some people do better on higher doses and you have to determine did that higher dosage or a lower dosage give you greater benefit and you have to kind of do a psychiatric medication autopsy that way and really examine piece by piece all the different type of medications you've taken, how long you took them and what the doses might have been.

And you just have to systematically look at that.

It's very important that you will look at your family history medication responses.

That will be a tremendous clue if you're on psychiatric medication.

I'm going to have a guess that you have one or two or three family members who have also taken psychiatric medications over the course of time.

And if your family members have taken certain psychiatric medication based on their responses, good or bad, that can be a clue on how you might respond to those medications, especially if that family member is a mother, father, brother, sister or son and daughter for that matter.

>> And we often get those kind of clues when we treat people with ADHD Attention Deficit Hyperactivity Disorder we look at what the family members did well on and then we might use that as a clue for them seeing with depression many people with depression will have family members who have taken medication for depression and good or bad will use those as clues.

>> Another type of dimension of assessment will consider will be genetic testing.

>> We had genetic testing.

We've had genetic testing available for about oh ten years now and with using genetic testing you can get an idea on what kind of mechanism of action might be suggestive for somebody improvement and also what kind of doses they might need of medications high or low based on how their genetics look that they might break down medications so we will use genetic testing as another means of determining what kind of medication somebody needs.

>> But there's no magic number on how many medications will be good or bad for somebody.

I think it's just so important that we measure outcomes for people and medication by medication.

My medication we dissect what were the best doses, which ones work the best are they all given your benefit and they are great unfortunately individuals who are on a sedating medication and they're on inactivating medication and you look at their combinations of medication and you can just kind of tell that they're fighting against each other and we don't want to see that in psychiatry.

We want each medication to individually give people more and more benefits and talk it over with your clinician and really take a good look at your past history of psychiatric medication treatment and if you can get out your own records, it's always nice when you go see your clinician if you know what medications you've taken and the doses are great.

If you don't know that's fine because nowadays with electronic medical records we can actually go back into our computer system and look at what you might have taken for the past several years and we have ways we can pull that up very, very quickly.

If you've been treated in the same health care system, we have lots of records for people that way and sometimes we just have to sort out what medication might work, what work the best and sometimes more will be better for some people and we'll not uncommonly have people taper down the medication.

But you don't want to go to the extent where you're starting to get into trouble and you're feeling worse because you've gone off of too many medications.

I wish you the best.

Thanks for your email.

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

>> I'm psychiatrist J and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBS will be back again next week.

Thanks for watching.

Goodnight