.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

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>> Good evening.

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

Welcome to Matters of the Mind pnow and it's twenty six year matters.

The Mind is a live Call-In program where you have the chance to choose this topic for discussions if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) 27 two zero now on a fairly regular basis we are broadcasting live every every Monday night from our spectacular Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus.

>> And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFA EDG that's matters of the mind at WFA Egg and I'll start tonight's program with an email question that I can answer on the air.

The question raised your daughter Fovea.

I am an active 70 year old woman.

I've noticed a slight increase in situational anxiety.

I am highly sensitive to medication.

>> I have tried low doses of Zoloft beuse now Cymbalta but I hate how I feel on them.

>> Is daily medication the best option?

What could help me?

Well you had wondered as well if you could take some medication just as needed and here's how it all works go through the pathway of how I anxiety is affecting people.

Anxiety is a normal emotion.

No one all of us going to have-.

>> All of us should have anxiety that gives us improve with motivation and concentration not uncommonly when you have anxiety the little part of your brain here called the amygdala it's on the temporal lobe brain shaped like a boxing glove on the front of the thumb of the boxing glove is the amygdala.

Miguel is your anxiety and fear and anger volume control when that gets fired up it actually activates the front part of your brain that helps you concentrate, focus and pay attention what you're doing.

>> So when you're on the interstate and heavy traffic could be a little anxious and then will actually help your concentration if you're studying for an examination as a student for instance and you feel anxious about that examination that will actually help your concentration.

>> So anxiety is a normal emotion not unlike happiness, sadness, anger, irritability those are all normal emotions as a situation may call for them, however, anxiety becomes problematic when this little amygdala gets fired up so much it hijacks the front part of the brain and it overwhelms that.

>> And in doing so kind of short circuits your ability to think and focus on thing and it can get to the point where it causes what's called functional impairment where you're not able to socialize, you're unable to work, you're not able to go to school, you're not able to do the stuff you'd ordinarily like to do because you have overwhelming anxiety and then there's a lot of different types of anxiety.

>> There's generalized anxiety where people can have difficulty with worry and they ruminate and ruminate and think about what if and they think about future possible events and so forth.

>> That's called generalized anxiety.

There's social anxiety which can occur in situations where specifically the situation of socializing feels overwhelming for you.

>> There's panic attacks where people will have out of the blue a blast of physical anxiety where they're having a fast heart rate.

>> They have difficulty with feeling lightheaded, dizzy.

They have nausea, they can have diarrhea.

They have shakiness all these awful physical symptoms are going on and they emerge within twenty minutes and they can feel very overwhelming for people.

There's obsessive compulsive disorder OCD where people will have difficulty with thinking about things that they know don't make any sense and then following them through with doing things over and over and over again to try to relieve those thoughts.

>> The thoughts are the obsessions, the behaviors to do things over and over again or the compulsions.

So that's OCD and there's post-traumatic stress disorder where people have a past traumatic event and that's causing them ongoing anxiety sometimes related to different cues that might remind them of those past traumas.

>> So there's a lots of different types of anxiety.

We will treat them entirely differently.

For instance, we might temporarily treat panic disorder with a benzodiazepine like Xanax, like Valium, like atavism but with obsessive compulsive disorder and post-traumatic stress disorder OCD and PTSD benzodiazepines actually make those kind of conditions worse so we try to stay away from them.

The medications like Xanax out of an invalid and Klonopin if somebody has OCD and PTSD now we always want to look at the underlying reasons why people have anxiety.

>> We look back to when the anxiety might have started and not in commonly we'll find some physical problems that can contribute to anxiety.

We'll often hear about somebody having a pulmonary problem if you're having a pulmonary embolism for instance, you'll have tremendous anxiety if you're having an asthmatic attack you'll have a lot of anxiety if you're having pneumonia that will cause you anxiety because you're having trouble with Eriks change and that will cause you to have the sense of feeling like you're suffocating.

So we want to always look for those physical underlying problems that might contributing to the anxiety itself.

A lot of women will have mitral valve prolapse that will contribute to anxiety.

Their heart rate will start beating really fast and some people will have postural orthostatic postural orthostatic tachycardia syndrome also known as Pott's posses a condition that affects women more than men.

But it's where your heart will be really fast and you'll get very light headed to the point where you can pass out and Pott's will often present as anxiety and as a psychiatry.

>> I will sometimes be suspicious of Pott's when somebody has those kind of symptoms.

So as a psychiatrist I'm a medical doctor.

>> I've got to always consider the overall physical condition for somebody and then looking for thes underlying causes for anxiety.

Now we don't like to use long term benzodiazepines like Xanax out of Klonopin, Valium over the course of time it for somebody over 65 years young it can give you difficulty with memory problems where you'll have trouble with the speed of processing in your brain.

In other words, your brain will feel like it's got slow Internet activity.

So you have a slow Internet provider and you have a hard time thinking from one thought to another to another.

Some people have been on benzodiazepines for three decades and then we get off of a very gradually but they'll often say when you're off of it they feel like they have a new brain because they can finally concentrate a lot more clearly.

So it's benzodiazepine.

Benzodiazepines will not only affect your concentration and your speedy processing but benzodiazepines will also affect your mood and you'll feel kind of dull and it's relieving for people when they first have anxiety to have a dampening and a darling of anxiety.

But in the long term it can actually make the anxiety worse because you need a higher and higher amounts of benzodiazepines not uncommonly now I was a pharmacist before I became a physician in a way back in nineteen seventy nine when I was graduating from pharmacy school the number one medication of all medications across the United States was diazepam or Valium.

So more people were taking Valium than any other medication out there in nineteen seventy nine in the nineteen eighty six Bew Spier Antabuse bar came around and was thought to replace medications like Valium and then later on Xanax it never did be Spirent is a good medication for worry and rumination and dwelling on things.

>> It's affecting serotonin very specifically and selectively but it didn't decrease the anxiety in the panic as well as medications like Valium or Xanax or Ativan.

>> So it's used sometimes but bu Spirent is used specifically more selectively for people with generalized anxiety kind of symptoms where they're worrying and they're ruminating about things.

>> So there's a lot in which we can discuss about anxiety when to use a medication.

Well you can use the medication as needed as you had mentioned because you mentioned Zoloft and Cymbalta do Markstein and he didn't like how you felt on those kind of medications.

>> They are affecting serotonin and by increasing serotonin they could dampen down the overall overall activity to different type of responses and make you less ruminative in that matter.

But you felt probably emotionally numb with those medications.

So you probably want a medication did not affect serotonin more specifically and you could take a medication at the age of 70 years of age fairly safely such as gabapentin also known as Neurontin or Pregabalin also known as Lyrica and those are used for seizures.

>> They're used for pain.

They're used for fibromyalgia.

But you could also use them as needed for anxiety under very close watch of your clinician.

So there are medications that can be used just as needed for situational anxiety but I would not recommend benzodiazepines such as Xanax, Ativan, Klonopin, Valium with long term use.

>> Thanks for your email.

Let's go to Barbara.

Hello Barbara.

>> Welcome to Mars The Mind.

Hi.

About ten days ago I was in a store and I tripped on a rug and I fell hitting my knee real hard but I also fell into a window with a side of my forehand the left side and down through the temple and then my cheekbone and I had a big night on my hand and everything and everything and actually there was a nurse there too that started questioning me and she asked me if I was on a blood thinner.

She was concerned because I had hit my head and she told me I needed to get checked out which I did.

I went to the E.R.

and the C.T.

scan didn't show there was a problem and I've noticed since um I've always had a sense of tremors for a while and I've noticed that that seems worse and I was wondering what else can hitting this area on my head what else could that possibly affect?

Barber Are you indeed on a blood thinner?

Yes.

OK, yeah that's it's great that you got assessed for that.

The whole purpose of the CT of the head was to determine if you had any bleeding on the brain.

So that's good that that wasn't an issue and that wasn't identified when people have a concussion that's what we're talking about with a traumatic brain injury you've hit your head your brain basically has a consistency of jello.

So in your in your skull it's just got kind of a mushy yellowy kind of organ up there and then your skull is rock hard.

>> So when you hit your head your mushy brain will hit against the skull and in doing so it can release an excessive amount of this chemical called glutamate.

>> Glutamate is an excitatory chemical consist.

It's a neurotransmitter that's mainly on the outer part of the gray matter of the brain and if you have excessive glutamate you can have difficulty with on the extreme seizures and when people have head injuries and they have seizures, it's a very serious head injury.

But most people don't have seizures when they have a head injury they will notice some trouble with irritability.

They might have some difficulty.

The concentration may have headaches sometimes difficulty asleep.

>> They'll have various symptoms that can persist.

And if you're already had tremors, Barbara, sometimes the excessive amount of glutamate can make those underlying conditions were so you could have worsening tremors.

>> Now the good news is usually head injuries will resolve the effects of head injuries will resolve the core of the course of several weeks if not months and certainly within one year depending on the severity of the head injury.

Now there's different severities of head injury such that some people will have a head injury where they have loss of consciousness.

They might have seizures again that's extreme amounts of glutamate being released in those cases other people will have these other symptoms that they kind of notice but over the course of time they will go away.

It sounds like you might have had a mild head injury fortunately such that the symptoms you're having may resolve on their own over the course of a matter of weeks.

But if you've already had a tremor, you bet Bahbah.

You can indeed have a worsening of the tremor after having a head injury.

The bottom line is keep an eye on that.

Make sure you contact your primary care clinician if you have any worsening of any symptoms at all.

>> Thank goodness that nurse did recommend that you have an evaluation because that is a very serious issue if you have a head injury and you're on a blood thinner, yeah, you can have a severe bleed inside the brain very quickly within a matter of minutes or an hour or so and that's why it was very important for you to get checked out.

So keep in contact with your primary care clinician if you have any worsening symptoms overall Barbie.

>> But Barbara but I'm hopeful that you're going to have improvement with symptoms over the course of the next few days if not next few weeks.

>> Barbara, thanks for your call.

>> Let's go to our next caller.

Hello Deb.

Welcome to Matters of Mind.

>> Deb, you mentioned that you have a friend who has seizures hourly and wears a helmet.

What are the long term effects on the brain of seizures?

I presume you're asking is this something that might recover or will ultimately cause death if you have seizures hourly?

Deb, that is a severe neurological condition.

Again, seizures are related to excessive glutamate release glutamates and excitatory neurotransmitter that is opposed by GABA.

So if you think about driving a car, glutamate is the accelerator.

GABA is a brake and they're always going in tandem when people have seizures and they're out of control they have excessive amounts of glutamate and that's what's always needed to be dampened with somebody with seizures.

>> Seizures can be very toxic to the brain with excessive glutamate activity in the brain with seizures themselves, electrical activity can be damaging to the brain such that people can have worsening worsening difficulty with concentration and focus.

Seizures don't usually kill people from the electrical activity itself.

>> What will kill people with seizures will be when they break bones or when they have difficulty with breathing so seizures themselves don't will be harmful to people not so much from a neurological standpoint but more from the consequences that it can occur from a seizure itself if they're driving a car for instance and if you're having seizures you're not really allowed to drive a car with a year typically.

But if people are having a seizure and they're driving that can cause them to have a motor vehicle accident.

Those are the reasons why people will sometimes die from seizures themselves.

Thanks for your call.

Let's go next caller.

>> Hello John.

Welcome to Matters of Mind.

John, you wanted to know if I ever heard of anyone experiencing anxiety driven hearing loss?

No, I have not, John.

I will.

Here are people who have hearing loss who have anxiety for several reasons number one, tinnitus where people have ringing in the ears sometimes can be very annoying to people and that can cause them to have anxiety and anxiety will make their tinnitus worse.

Some people will have difficulty with anxiety related to hearing loss when they're having difficulty hearing other people and they start to wonder what other people are saying.

They misinterpret the intentions of other people and that will cause anxiety itself.

But myself I've not heard of people having anxiety and as a result of anxiety dampening down the hearing any more than as a result of anxiety, I've heard people going blind if that's the case that's considered to be an entirely different condition.

We used to call those kind of conditions a hearing a conversion disorder where somebody would go blind when they were in a very stressful situation, a conversion disorder is now called functional neurological disorder where somebody will be in a very stressful situation and they'll go blind.

>> They'll have some kind of neurological event that occurs because their brain can't tolerate what it's experiencing around them.

>> But I've not heard that necessarily occurring with hearing John.

> John, thanks for your call.

Let's go our next e-mail.

Our next e-mail reads Dear Dr. Oliver, can a person hide their mental illness from a psychiatrist or a therapist?

>> Are there ways to spot a mental illness even if someone is trying to hide a well a person with a mental illness can put on their best behavior in front of a psychiatrist or a therapit.

>> We are not mind readers.

I am often asking people to complete lots of questionnaires.

>> I want to know as much about a person's recent history with different symptomatology as I can before I see them I want to know about their past history with their treatments.

>> It's best for me to know as much as I can about a person even before I see them and that's what we do so many questionnaires so I want to know in different ways what kind of things have been bothering a person.

So if a person is trying to hide a mental illness they can do it to a degree.

>> But that's why we like to get collateral information from family members, friends, people who have been around that person.

>> If a clinician only assesses a person for maybe five or ten minutes, you know that person can pull it together really, really well.

>> So people who are even floridly psychotic can sometimes pull together for a few minutes.

>> But then as they're observed, for instance in a hospital environment after that clinician leaves, that person can kind of let their guard down and the underlying condition can be problematic for them so a person can hide their mental illness for a few minutes but from a clinician or psychiatrist.

>> But that's not saying much.

I mean there's things we will try to examine and we look at mannerisms and manners of speech for people to try to identify mental illness.

But very importantly we want the person to cooperate with us to help us understand how we can help them.

And we also want to have collateral information from family and friends and what they've observed about the patient as well.

>> Thanks for email.

Let's go to next caller.

Hello Adam.

Welcome to Matters of Mind.

Adam, you had mentioned that you have schizoaffective disorder autism and borderline personality disorder.

Is there one diagnosed that you can use describe all three.

It depends what the symptomatology will be.

Adam's schizoaffective disorder is basically a condition where you have day to day to day symptomatology of schizophrenia and then on top of schizophrenia you'll have mood swings where you have big highs and big lows.

That's the affective part of schizoaffective disorder.

Schizoaffective disorder is where you have symptoms of schizophrenia such as difficulty with processing thoughts you might have some fearfulness about things happening around you.

>> You might have auditory hallucinations where you hear things that other people can't hear.

>> You might have difficulty with expressing your emotions and have a lot of trouble with social anxiety.

Many people with schizoaffective disorder as a component of the schizoaffective disorder will have autistic features where they have difficulty understanding social cues and understanding the intentions others.

>> So with autistic symptoms people will have disturbances in the right front part of the brain.

That's the part of the brain where you have these little neurons called mirror neurons and that's where you mirror your behaviors based on people around you.

So whether you realize it or not, many times when we're around other people as a means of connecting with other people we pick up some of their mannerisms if their arms across our arms or cross if they're open in their posture we will be all open our postures.

>> People with autism lack that ability to really connect with other people to have difficulty with communicating.

So in that sense the autistic features may be part of schizoaffective disorder.

>> Borderline personality disorder is well you'll have moodiness related to interpersonal conflicts or situations.

>> The moodiness is very quick .

>> It's very extreme and you'll often have difficulty with thrust and pervasive anxiety.

Now if you have a diagnosis meeting the criteria for schizoaffective disorder that probably incorporates the borderline personality disorder symptoms and probably incorporates the autism symptoms.

So to answer your question, Adam, is there one diagnosis would fit all of those?

>> Yeah, I think schizoaffective disorder would probably overrule the diagnosis of autism and borderline borderline personality disorder because they are all incorporated within the schizoaffective disorder symptomatology.

>> Now most importantly with any diagnosis it's important we determine our treatment based on the best diagnosis.

>> People sometimes wonder well why do we even make a diagnosis in the mental health field?

It's not unlike other medical conditions if you have a cough we want to know if that cough is due to bronchitis, pneumonia, cancer, gastrointestinal reflux.

>> Is it due to a heart condition where you're getting some back up with the pulmonary backed-up?

>> Is your cough due to having a peanut lodged in your trachea?

I mean what's causing the cough you would treat all those based on your the cause of the cough itself if you're having difficulty anxiety, difficulty with sleep concentration, socializing, we just don't give you a diagnosis of anxiety.

>> We want to know what kind of anxiety you have and what might be causing the anxiety and be able to direct the treatment in that manner if you had autism by itself, we treat that one way if you had borderline personality disorder by itself we treat an entirely different way.

But if you have schizoaffective disorder we will treat that to incorporate the symptoms you might have with autism and borderline personality disorder and will be very precise in our treatment itself.

>> So it's important that we still diagnose people with psychiatric conditions to be able to identify what direction we should go with our treatments.

>> Adam, thanks for your call.

Let's go to next caller.

Hello Seth.

Welcome to Mars.

The mind set.

>> You want to know why does your handwriting change when you're experiencing a migraine?

Oh, do migraines affect the memory?

>> That's very interesting question, Seth.

I'm a psychiatrist but as a psychiatrist I'm often looking for neurological conditions and when people have bipolar disorder which used to be called manic depressive disorder, they're four times more likely to have migraine headaches compared to the rest of the population.

So I hear about migraines all the time.

>> Migraines are where you have excruciating headache pain usually on one side or another upon exposure to bright lights you might have nausea, vomiting and the only thing you can do to relieve the migraines outside of taking medication will be to go sleep it off.

>> So migraines are excruciating.

They're incapacitating and that's what makes them different from tension headaches.

>> Sinus headaches are where you get a little pain over the sinuses when you thump on them and sometimes you'll have fever and congestion with sinus headaches.

There is also cluster headaches where the headaches will cluster around certain times of the day usually causing you to tear up and you have a lot of congestion on one side of your face.

>> People with cluster headaches will often notice that they are more prominent when had any alcohol or people with smoke who are smokers have more cluster headaches.

>> So there's different types of headaches.

>> But you mentioned migraine headaches will sometimes will affect your writing.

Yeah, it's kind of a neurological to experience when you're having a migraine headache.

We treat migraine headaches with anti seizure medicationspns electrical disturbances going on with migraine headaches that can affect your extremities with numbness, tingling.

You can have difficulty with weakness on one side of the body or another with migraine headaches and that might be why ou're noticing r handwriting changing.

Thanks for your call.

>> Let's go next caller.

Hello Janis.

Welcome to Matters of Mind.

Janis, you want to know how often you should follow up with a psychiatrist with your prescriptions?

You know, Janis, if you're doing great and you're on a medication it's not controlled.

You can see a psychiatrist maybe once a year or even your primary care doctor once a year for that medication trying to control medication like a stimulant or maybe a benzodiazepine.

Like I mentioned earlier, you probably want to be seen every three months or so.

Sometimes they stretch it out to every six months with a benzodiazepine medication or medication like Gabapentin or Lyrica also known as Pregabalin.

>> So three to six months of controlled medication if you're just being seen for a medication you're starting a medication.

I like to have everybody come in in about two weeks, two weeks you're going to get a little better idea somebody's doing the first week they're coming off.

The medications are making some changes.

The second week they're starting to feel a little bit better.

You're able to identify in two weeks number one what side effects people are going to have with medication.

>> And number two , if you can get a little bit of an improvement on many medications in two weeks, it's a very good outlook that in six weeks you'll be feeling a lot better.

>> Now after that second week appointment, not uncommonly people will be coming in maybe a month later and then maybe a month after that once you're doing well then the appointments get stretched out to every three months, every six months and ideally every year.

>> But the idea with treatment Janice will be for us to kind of tweak the dose the medication, get the right concoction on board for you so you cannot just feel better but you can actually feel well pand feel like you can do all you can do and be all you can be in your life .

>> Janice, thanks.

Your call we've got about a minute and a half left here.

Hello Paul.

Walk in the back of the mind, Paul.

>> You know why do people experience grief?

>> Why do they have difficulty with eating, sleeping and energy?

That's a bad sign, Paul.

When you cross the border and you have in trouble was eating, sleeping and energy, that's when you're crossing the line and going into major depression when you get to that point it's persisting for at least a week, perhaps two weeks.

Contact your primary care doctor because if you go for a long time with poor energy difficulty with sleeping and poor eating, it's going to affect your emotional and your physical health over the course of time.

So get some help with that.

Paul Paul, thanks for your call.

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 via the Internet at matters of the mind all one word w e dot org.

I'm psychiatrist Jeff Offering.

You've been watching matters of mine on PBS Fort Wayne God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.