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

Welcome to Matters of the Mind now in its third year matters 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 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 a dot org that's matters of the mind at a dot org.

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

>> It reads Dear Dr. Fauver, what are some signs and symptoms of attention deficit hyperactivity disorder in adults and at what point should an adult get themselves evaluated for ADHD?

>> And I can answer the second part of that question first because you should be evaluated for any kind of mental health condition when you find that that mental health condition is causing you difficulty getting stuff done on a day to day basis, being able to socialize, being able to go to work, being able to get your daily activities completed and if you find that there's an obstacle in getting those kinds of things done and it's got to be due to a problem with your mood anxiety or difficulty with thinking that's where you get yourself evaluated and I often compare ADHD being a condition where it's not unlike nearsightedness if somebody has difficulty seeing objects at a distance well they were eyeglasses to correct their vision and they can see a lot more clearly and the same is true for ADHD because ADHD is a condition where you can have trouble with attention span distractibility, focus, procrastination and it creates this sense of anxiety because you're always running behind on things.

>> You're always misplacing things.

You're always running late because you get distracted as you're starting to walk out the door.

People with ADHD have difficulty setting priorities so they have problems with figuring out what is the most important thing to do now as opposed to doing the second most important thing or the third most important thing and getting distracted doing these other types of things.

Many people with ADHD have a lot of difficulty doing simple chores like getting their housework completed.

>> They'll put a load of laundry and next thing you know two days later they realize that they put a little lottery on so they overlook basic simple tasks like that but it can create a lot of angst and a lot of worry for a lot of people.

>> So it's not uncommon that we'll see patients with ADHD who have what are called comorbidities.

They have depression because they've always felt as if they're in under achiever.

They feel sad and demoralized about their life circumstances not knowing why but they have difficulty getting through school sometimes.

>> But even if they get through school on many people with ADHD can be very good students because they typically are very they have very, very high IQ.

>> They can get through school but they get to a point in their career development where they just kind of get stuck because they have so much stimuli bombarding their brains because they get up to a certain level of achievement and that's where they start to have trouble and that's where they'll often come in to see me as a psychiatrist.

So with ADHD yeah, it'll cause you difficulty the attention span focus getting things done.

But many people with ADHD can also have distractibility and impulsivity and hyperactivity.

>> That's where the ADHD part comes in.

Hyperactivity means they have a hard time fit with sitting still they might want to fidget.

They're often very kinesthetic learners and what that means is they learn best if they're moving around.

So these are the grade school and middle school and high school kids.

It will do best if they go out and shoot a few baskets while they're trying to do their studies and they're trying to remember things.

So allowing them to move around is really OK because some people do best if they learn things visually.

Some people do best if they learn things from an auditory standpoint.

But many people are kinesthetic learners and they just do best if they're moving around as they're as they're learning.

So you don't want to discount that when people want or need to move around as they're learning so that often goes along with ADHD.

It was a shame when I heard years ago that they are starting to do away with recess and a lot of schools because it was the recess that allowed these ADHD kids to kind of burn off some extra energy and allow themselves to be slowed down because with ADHD especially if children can exercise early in the day, they'll particularly have a better likelihood of doing well in the early morning classes and this goes for children of all ages.

They actually studied this over twenty years ago up in Naperville High School up in the Chicago area where they had a large group of high school and middle school children exercise and run first thing in the morning before their classes and they elected to do that and when they did so they did better in the early morning classes especially with English and mathematics.

So it actually showed that they were able to get a better performance if they exercised first thing in the morning.

Now you might think well gee, that's awfully difficult for a lot of children to do.

>> It's a matter of making time for that.

Adolescents and young adults especially, they tend to want to sleep in in the morning but they want to go to bed later on a night that's not being a so-called lazy teenager.

That's just the way the brain develops as your growth hormone is going higher and higher, you typically want to stay up late at night and then you want to get up later in the morning and it's called delayed circadian rhythm disturbance where by nature you just want to go to bed later.

So a lot of the high school kids and the early and the young adults will actually do very well as they get out of the workplace on second shift jobs because with the second shift job you can go to bed when you want.

You get up pretty much when you want as long as you show up for your work between 3:00 p.m. and 11:00 p.m. give or take a couple hours there.

>> But the same is true for the ADHD.

A lot of people with ADHD will have a hard time turning their brains off at night and they actually will do best in the quiet of the evening when they are alone with their thoughts and they don't have all the outside distractions I often recommend with late adolescents and young adults with ADHD that they not watch television into the late evening because they will get very invested in a particular program and people with ADHD can hyper focus and they will hyper focus in such a way that they will hone in on topics that are interesting, challenging or exciting for them but they don't do so well and things that are more mundane that we all have to try to to learn to find to be adaptive.

>> So people with ADHD will hyper focus on things that are particularly challenging and interesting and novel and exciting and that's why people with ADHD can often be entrepreneurs.

>> They'll they'll need outside individuals to help them get the details of their work done.

>> The people with ADHD are often the ones that will start new businesses and start a new project and they'll have a lot of ideas, a lot of famous inventors Thomas Edison being one example Haddadi PhD based on their biographies and you look at their symptoms and you look at their patterns of workflow and you often find that they did indeed have ADHD.

So ADHD can occur with adults and basically ADHD is a phenomenon where the left front part of the brain especially up here is underactive and this is the part of the brain that you use for paying attention to topics that aren't that interesting and you have to pay attention.

But that left the front part of the brain is the part of the brain that allows you to focus, focus, focus even though it might not be too interesting and it might be a very subtle decrease in activity as little as five percent.

>> But this little bit of a decrease in activity in the left front part of the brain can cause a difficult attention span and focus.

>> Then you got the middle part the brain that will help you decrease the distractibility.

>> So as you look at the front part of the brain here in the middle part of the brain, you have this section of the brain that will allow you to decrease the distractible of things around you because a lot of people with ADHD will have will struggle with all this outside noise and all these outside different distractions and we have to be able to block those out to be able to concentrate and think think about what we're doing and it's this middle part of the brain that will help them be able to get that in check and that's what we're often trying to treat from a medicinal standpoint with ADHD.

We're trying to fire up the front part of the brain and dampen down the difficulty that they're having with distractibility and we'll use medications that increase particularly dopamine and norepinephrine.

There are some medications people will take for anxiety and depression for that matter that increased serotonin like Zoloft, Prozac, Lexapro, Celexa, Paxil, these medication can help with the symptomatic secondary anxiety people with ADHD might experience.

But unfortunately by increasing serotonin you can indirectly decrease dopamine transmission when you decrease dopamine transmission that actually makes the ADHD worse.

So sometimes as a psychiatrist I'll see people come to my office who are on a very popular antidepressant or an anxiety medication like Lexapro and they'll say they're less anxious but they have more difficulty with focus and concentration and as we get to the core symptoms that they might be experiencing, we find that they have ADHD and because of the ADHD they have this secondary anxiety and again they have the secondary anxiety because they're always worried about what they forgot, what they misplaced, what they didn't do, what they overlooked, how they might have offended somebody because people with ADHD will have trouble and social environments because they often lack tact so they'll blurt out things without really thinking about so much.

>> And I'm always advising people with ADHD try to think a couple of seconds before blurt out something and if you're in a meeting make sure you have something to drink nearby.

>> Take a sip before you say something because you want to give your brain a few milliseconds before blurting something out because your brain might be three steps ahead of everybody else.

You're like a chess player when you have ADHD.

A good chess player is always going to be about three moves ahead of his or her opponent and with ADHD yeah you'll often be two or three steps ahead of the conversation and you kind of know what everybody's going to say at least you think you do and you wanted to say for them so many people with ADHD will finish the sentences of other people because you're thinking ahead of what they're actually discussing and it comes across as being fairly rude and that's where you can have difficulty in social environments, especially if you guess wrong on what they're saying and you make the wrong assumptions and finish your sentences in appropriately.

So with that being said, if you're having trouble with focusing and concentrating at your workplace, if you're having difficulty getting through school because the concentration and focus difficulties and if you're having trouble in social environments and that's causing anxiety depression to the point beyond what you would expect now anxiety, depression, apathy ,anger, apathy those are all normal emotions.

>> We should all have those emotions as a situation calls for it.

>> We call it the normal vicissitudes of the range of emotions.

That just means that's the normal range of emotions.

Otherwise we're robots.

We want to have emotions.

So emotions are good.

It's just that when you're overreacting and the emotions are exaggerated or inappropriate to the extent that they cause you difficulty with your life circumstances, that's where you want to do it in a little bit and try to get to the underlying problems that might be going on there so a medication treatment can medicinally, you know, help change the chemistry of the brain and help your brain work better in that regard.

But talk therapy and coaching can be helpful as well.

For instance, with ADHD coaching will often advise you to use your smartphone not to be distracted by all the different apps on there but use your smartphone as a way of giving yourself reminders on what needs to be done next.

So you got to do certain things in priority and with prioritization so you got to have your first priority, your second priority, your third party and you want to get them done before going to the second or third thing because you'll be very prone to being distracted and going off in a whole different tangent when you have ADHD and that's what you always want to remind yourself to do.

You want to maintain a regular sleep schedule.

You don't want to get interested in reading a long book in the late evening hours.

Be careful using your smartphone the late evening because you can go down a rabbit hole really fast with your smartphone and that's how a lot of apps are designed.

They can they have algorithmic values where they can actually track what you're interested in watching and they actually feed you more information to try to keep you on that app longer and longer and longer.

Facebook was brilliant in how they how they developed all that.

So there's a lot of social media apps out there that will try to keep you engaged by trying to understand your interests and keeping you on the site for longer and longer periods of time.

People with ADHD have a lot of difficulty with that because they have a hard time turning off the smartphone and turning off those apps late into the evening and they're prone to stand awake later anyway so they can lose a lot of sleep that way and have difficulty.

>> Thanks for your question.

Let's go to our first caller.

Hello Thomas.

Welcome to Matters of Mind.

>> Well, Thomas, you had mentioned that your brother had received a antipsychotic restart injection a week or so ago for schizophrenia after missing his monthly shots for about six months.

At this point he's talking to himself exhibiting paranoia how long this short for the shots level out again so he can return to functioning?

There are certain medications where you need to give oral medication with it Abilify Mantan and be in one of them.

Abilify Mentana is given roughly once a month for people but for two or three weeks often they need to be given oral Abilify with it because Abilify slowly gets in the system lasts a long time once it gets there but it slows it slowly gets in the system.

There's another long active medication very commonly used it's called in Vegas, Istana and Vegas.

Esten is typically given about once a month as well and that's a medication where you don't typically have to give oral medication with it but sometimes until the medication kicks in you have to get the medications kind of balanced out and you initiate them with oral medications.

Initially Zyprexa comes in a long acting formulation called prev and Zyprexa well previs something that is commonly used for the purpose of allowing somebody to have long acting Zyprexa.

People will take that typically every two to three weeks in a lot of cases with Zyprexa real prev you do have to stay in the clinician's office for three hours after receiving the dosage to makes your blood pressure doesn't go down too low so you're are monitored after you get that.

But the nice thing about the day and age in which we live is that we do have long acting injections for these antipsychotics where people don't have to be so reliant on taking oral medications every day and you might think what's the big deal there?

The problem is when you have schizophrenia you can have the classic symptoms of hearing voices.

You can have delusions which are fixed false beliefs where you have paranoid paranoia and you have fears and questions about what's going on around you and with schizophrenia it's truly a condition where you're having a living nightmare.

We've all had dreams and many times you know you have nightmares and with a nightmare you might awaken and your heart's beating in your breathing faster and it's a very scary experience and you awaken from that nightmare and you're very relieved.

Well, imagine having a waking nightmare where you don't wake up from the nightmare and it just keeps going on and on and on and you actually living the nightmare itself.

>> Ron Howard was a director that directed a movie called A Beautiful Mind.

My goodness, that was twenty years ago I believe.

But it was remarkably done because what did drew you in to the experience of somebody with schizophrenia and it actually made you believe what that individual was schizophrenia in the movie was was was seeing around him and it was very well depicted that regard because it was a nightmare in terms of what was going on and that's what people with schizophrenia will experience and you might think well gee, why wouldn't they take your medications?

Who wants to experience that?

Well, here's the other part about schizophrenia people with schizophrenia lack insight, an awareness that they have a problem to them.

Everything that's happening is true.

So they're not going to take a medication because the medication why would you take a medication for a condition you don't believe that you have?

>> So in those cases, Thomas people will often do is give their medication, they'll check it, they'll fake they're taking it and they spit it out.

And part of the problem is because they have a difficulty the little part of the brain over here on the side of the brain called the insula.

The insula is the self awareness part of the brain and it's thought that people with schizophrenia have less activity in the insula so they have less self awareness of what's really happening to their bodies at that time.

They have lack of insight which depicts the difficulty of the front part of the brain up here.

The front part of the brain doesn't work and gives them a lack of insight, poor judgment is often a phenomenon and they have trouble with decreased activity in the left front part of the brain that I mentioned earlier with PhD.

>> That's why many people with schizophrenia will have the perception they truly have ADHD .

>> They probably have a condition that from a neurobiological standpoint mimics ADHD but true ADHD is a condition that cannot be attributed to other conditions like schizophrenia or ADHD starts when you're typically under twelve years of age and it's a day to day to day phenomenon of words consistently giving you difficulty with attention, focus and distractibility on a day to day basis not unlike near-sightedness wherewith near-sightedness the difficulty the vision is there every day it doesn't come and go.

The problem with concentration and focus with schizophrenia typically will come and go with ADHD it does not.

>> Thanks for your call your next caller.

>> Hello Debbie.

Welcome to Matters of Mind.

Uh yes.

Hi.

Hello Debbie.

Hi there.

Yeah I'm wondering about I've heard something about blue light that's emitted from computers and your smartphone if you're looking at it a lot during the day or any time of day if that would affect someone's ability to stay asleep at night, I think it does.

>> Debbie and I always tell people Debbie, talk to your clinician about what he or she does with vitamins supplements or with blue light blockers or whatever.

>> OK, so you're talking to me as a physician.

I were blue light blocking glasses throughout much of the day because the blue light that's emitted from the computer I don't know if they help any or not but they sure don't hurt.

I don't think I do have a blue light blocker on my on my phone app that kicks in about 9:00 p.m. every evening because I don't want the blue light coming from the phone app Blue Light does seem to give your brain an awakening effect and I want to contrast that Debbie.

>> If first thing in the morning if you want to wake up yeah.

You can get on your smartphone early in the morning to wake your brain up because the blue light from the phone can actually wake you up in some ways the blue light coming from a television can give you an awakening effect.

The brightness of the television is the main factor that I believe will keep people awake at night if they're not careful and I always warn people about watching television late into the evening not only are they getting interested in things that can cause them to kind of wake up more and more and more because you know, going to sleep is like catching a bus.

Debbie, when you're trying to go to sleep the night your brain naturally is starting to wind down at a particular time period.

It's usually about a 30 minute forty five minute time block that your brain really wants to go to sleep now if you somehow keep yourself awake past that time period because you're watching a really interesting movie or if you're watching the Sunday Night Football broadcast or something along those lines, next thing you know you're wide awake and it's past your usual bedtime.

So it's like you miss the bus so then you have to wait about another hour and a half to catch the next bus.

It seems like this sleep cycle where you have these opportunities go to sleep will come around about every hour and a half and that's why when people are wide awake at about 2:00 a.m. he has not highly likely you're going to go back to sleep so you might as well go ahead and get up and do something.

>> It's unstimulating.

Be careful about looking at your computer screen at that time unless you do have a blue light blocking app on it and the best thing to do is to have some dim lighting and read a book or something with chapters where at the end of the chapter you can actually put the book down and try to go back to sleep so blue light can keep you awake.

There's been some more research coming out on that over the past few years that I've been taken pretty seriously.

So that's the reason I try to do the best I can personally to try to avoid blue light in the late evening because I do think it can keep you awake.

I've heard some people say that they get headaches from long term computer use throughout the day and that's thought to be possibly related to blue to blue lights.

>> So there are blue light blocking eyeglasses you can use for the computer throughout the day and during the evening.

Debbie, thanks for your call.

Let's go to our next e-mail.

Our next e-mail read Dear Dr. Fauver, is there an average amount of time that someone experiences grief?

Are there different treatments to make this process easier?

>> Grief is a phenomenon that affects people in different ways and I remember when I is in my psych psychiatric residency training way back in the 1980s it was thought that grief had a time frame of six months and something was supposed to magically happen after six months and you were supposed to be grieving any more.

It's different and people grieve in different ways.

Grief has a lot of different facets that will that will vary from individual to individual.

An aspect of grief will be for whom are you grieving is somebody with whom you were very close.

>> Is it somebody who is more distant?

How long had you had to adapt to that grief?

It's devastating when somebody gets that call late at night and a close loved one has died in a automobile accident that's just not expected.

It's it's horrific for people to experience something like that.

If you've had a long, prolonged period of three to five years with somebody the long prolonged illness to try to gradually grieve their eventual passing, that's much let me say easier to be able to recover from that kind of grief when grief starts to affect your sleep, it's affecting your ability to concentrate where it affects your ability to go to work, be around people, do the usual things day to day that you need to do.

That's where it's getting to the point where you probably need to see your clinician for the purpose of considering counseling, grief counseling especially and maybe medications because when you're having difficulty with sleeping it will indeed affect this left front part of the brain and that's the reasoning part of the brain and you're thinking and concentrating part of the brain that's the part of the brain that will be impacted if you lose sleep night after night after night and it's a vicious cycle because when you lose sleep you'll then have difficulty with reasoning and judgment.

So that's why sleep is so important, especially if somebody is grieving and we have a couple of minutes left walking the map of the mind hello and hello.

>> You're on the air and insurance companies don't like to cover men's tropeano without special permission from the doctor.

>> How do you feel about Ben strobing Ben's droppings been around for literally decades and it's used as a medication offset side effects from antipsychotic medication.

It's a medication that will block acetylcholine and when people are taking certain especially older antipsychotic medications they can get stiff and they can have restlessness and they can have trouble with tremulousness.

And Bidstrup is a very good medication also known as Kunjin.

It's a very good medication to offset those kind of side effects.

It can give you a dry mouth, can give you difficulty blurred vision, sometimes constipation and urinary retention where we have our time going to the bathroom and urinating.

Pretty inexpensive now though now days so I would think that if insurance companies are having trouble with it, I'm the last one to try to figure out why insurance companies do what they do and but I wonder if they were looking at the other medication you were taking and questioning if you need to be on Benza BEN strobing at that time.

>> Thanks for your call unforeseen I'm out of time for this evening if you have any questions that I can answer on the air concerning mental health issues, feel free to contact me via the Internet at matters of the mind all one word at WFA a dot org I'm psychiatrist offer and you've been watching Matters of the Mind on PBS Fort Wayne God willing and PBSC willing.

I'll be back again next week.

Thanks for watching.

Good night