.

Cameron Psychiatry.

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

More information available at CameronMCH.com.

Good evening.

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

Welcome to Matters of the Mind now and his twenty sixth 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 at PBS Fort Wayne by dialing in the Fort Wayne area (969) 272 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 the shadows of the Fort Wayne campus.

And if you'd like to contact me with an e-mail question that I can answer on the air, you may write me via the Internet at Matters of the Mind at WFA dot org that's matters of the mind at WFYI Georg and I'll start tonight's program with a call from Tom.

Hello Tom.

Welcome to mastermind Tom.

>> You wondered if adults on autism spectrum disorder can have successful careers.

Actually they can top people with autism spectrum conditions will often have disturbances in the right front part of their brain among other areas and basically this is the part of the brain where people will mirror behaviors of others.

>> In other words, they can pick up social cues and that is the problem.

>> Many people with autism spectrum conditions will will experience will be they have difficulty with social cues so they might not do as well in careers where they need a lot interpersonal interactions such that they'll have difficulty picking up the social cues in those ways but they can be very focused on certain aspects in their environment.

Other people might not notice, for instance in the Israeli Defense Force the Israeli Defense Forces, they will use people in capacities who have autism spectrum conditions to be able to pick up a lot of intelligence that other people would notice.

So for instance, people with autism spectrum conditions will notice different characteristics and photographs that might not be apparent to anybody else.

So they'll be able to do things very, very quickly and very efficiently in such a way that other people's brains just won't work.

>> So autism spectrum conditions can have a lot of advantage.

Many people with autism spectrum conditions will have marvelous mathematic abilities.

It was thought that Albert Einstein had some autism spectrum conditions based on his personality and his interactions with other people.

Some people with autism spectrum conditions and have very successful careers.

>> You just have to put him in the right spot to be able to do it and it's like with all of us all of us aren't really built or designed to be a one size fits all.

>> We all are our tailor made to be able to fit into certain positions in our careers and the same goes for people with autism spectrum conditions.

>> Tom, thanks for your call.

Let's go to our next caller.

Do we have another caller on the line?

>> Ross, can you bring up these displays down here so we can look for our emails?

Our next caller is coming in.

>> It's I'm a Jean.

I'm a Jean.

Want to know what parts of the brain might be responsible when we're using them for singing?

Well, when you're singing you're using this right front part of your brain right up here and when you're singing you're using this part of your brain.

>> When you're talking as I am right now, I'm using the left front part of my brain so that's why when people have strokes and they have a stroke in their left front part the brain, they will have difficult time articulating words.

They'll be able to hear things just fine and they'll be able to understand speech.

But they have a hard time articulating speech because they have trouble using the left front part of the brain.

So so he has a stroke and a left front part of the brain.

They can't necessarily speak but they can sing.

It's an odd phenomenon so they can sing and you can ask them to sing the national anthem or Happy Birthday.

>> They can sing just fine but they can't speak and that's because you sing mainly with the right front part of your brain.

So it's an entirely different part of the brain.

>> And when you think about the theological side of the brain being on the left side and the artistic side be in the right side, it makes sense because the singing part of the brain is on the right side so that that's the part of the brain that you use to sing.

>> So thanks for your call.

Let's go to our next email.

>> We have an email question waiting out there.

Our email question is do not favor how does smoking affect your sleep?

>> I've noticed that my lack of sleep has gotten worse lately.

Will it help if I finally kicked my cigaret habit?

>> Yes.

Nicotine tends to only last in the brain for a few hours and here's what happens when you smoke nicotine you'll have an energizing activating effect is firing up dopamine to some degree norepinephrine and it's a very, very quick type of jolt of dopamine you're getting when you use nicotine the nicotine goes to the nucleus of companies which is in this middle part of the brain here, you know, fire up dopamine, nicotine hits that but it lasts very, very briefly and that's why over the course of time you need more of a nicotine like effect to get the same type of stimulation.

Now that's a very short lived type of stimulation.

So what happens if you smoke over one or even two packs a day?

>> You'll notice you'll have this drop off in the nicotine in the evening it'll actually wake you up.

>> So that's why some people who are extremely heavy cigaret smokers will have to get up in the middle of the night and smoke because their brain is going into withdrawal.

When you're going to withdraw from nicotine you feel very anxious.

You have some irritability and you'll actually have some trouble with twitches in some cases.

So people going through nicotine withdrawal will frequently awaken.

>> So nicotine in the form of either cigaret smoke primarily because cigaret smoke gets very, very quickly absorbed chewing tobacco has nicotine in it obviously and that will also give you that nicotine withdrawal during the nighttime when trying to sleep.

>> That will certainly interrupt your sleep overall.

Thanks for your email.

Let's go to our next caller.

>> Hello Jane.

Welcome to Matters of Mind.

Well, Jane, you want to know is there any antidepressant medication that helps with weight loss?

Well, Jane, that's a double edged sword right there.

So let's talk about depression and weight gain in general when people get depressed, especially women, they tend to eat more men are more prone to eat less when they get depressed.

>> But women especially are more prone, eat more and they do more stress eating in general.

>> So that's a factor we always have to take into consideration .

>> Women will often not uncommonly have low thyroid while they're depressed contributing to their weight gain.

>> So one thing we need to vigilantly watch will be any evidence of low thyroid especially for women.

It happens in men too but especially if you have a maternal family history of low thyroid.

Your mother had low thyroid, your mom's mom had low thyroid.

We need to make sure the thyroid is in good shape so if your thyroid low that contribute to weight gain in general.

So what kind of medications can we use for people who have depression and they're prone to gaining weight will often will use medications such as bupropion or Wellbutrin.

>> That's probably our number one means of appetite suppressant as an antidepressant medication may in fact be appropriate and the trade name there is Wellbutrin Bupropion is in a medication called Contrave which is a combination of bupropion and naltrexone which is a opiate receptor blocker.

So Naltrexone will give you a little bit of decreased appetite bupropion even more so bupropion came out in 1989 and it was thought to be such a good appetite suppressant they actually studied it in women who had eating disorders who had a tendency to overeat and binge eat and make themselves vomit and for these particular women they had a slightly higher likelihood than the rest of the population might be expected to have seizures so they had more seizures when they used bupropion if they were having trouble with vomiting.

So when we prescribe medication like the opprobrium we'll often ask people have you had any seizures in your past or do you have any difficulty with binge eating with vomiting?

So we don't want people to have ongoing difficulties with seizures if they're taken appropriate and we don't want them to have any difficulty with with vomiting because that may be from an electrolyte disturbance somehow some way, said author Seizure Risk of Bupropion is probably the number one antidepressant we use to suppress the appetite.

Fluoxetine, also known as Prozac came out in 1987 and it was thought to be a miracle drug at the time because it didn't work any better for depression than the older medications.

>> But it helped people with more energy and and helped them suppress her appetites a little bit.

>> So bupropion has a particular feature in it where it affects this particular serotonin receptor called serotonin receptor to see now serotonin has around 14 different receptors and C2C is the name of the receptor if you stimulated that can suppress the appetite a little bit.

>> So Prozac or Fluoxetine has been used for binge eating for some people especially at higher doses.

So that's a a possibility for some people for the Occitan or Treinta Alex came out about ten years ago and forty sixteen also how serotonin and dopamine affects we don't use it specifically for people who are binge eaters necessarily for that purpose but will not typically increase the appetite.

And over the past year and a half we've had another medication come out by the name of civilit, combination of bupropion and extra with dextromethorphan which is a cough suppressant.

But at high levels the cough suppressant dextromethorphan can help with depression and helping people put up with things.

But the nice thing about it too will not typically increase the appetite.

So Jane, right now we're trying to look at chicken or the egg is the increase in appetite weight gain due to depression?

In that case if you treat somebody with an antidepressant does not cause weight gain and you treat the depression, you'll often see an improvement with weight over the course of time.

On the other hand, if the depression is being complicated by low thyroid that will often contribute to difficulty with weight gain for a lot of people.

>> Jane, thanks for your call.

Let's go to our next caller.

>> Hello Danny.

Welcome to Matters of Mind.

Oh, Danny, you want to know what mental disorders cluster will pathological lying be somewhat of a symptom pathological lying.

>> I wouldn't say Danny is necessarily a psychiatric disturbance.

>> It's more of a a moral or an ethical type of issue where if you're lying by definition that means you're you knowingly saying things that you know are not true and you're doing it for the purpose of secondary gain.

In other words, you're trying to get something from the lying itself.

It is one of the Ten Commandments and as a Ten Commandment it's more of a moral issue than it is a psychiatric disturbance.

I wouldn't say somebody who lies frequently is psychiatrically disturbed necessarily.

I'd say they're probably morally deficient in a sense that they are lying knowing that if they deceive other people they can get things for their personal gain.

>> That's not a psychiatric illness.

That's more of a moral type of issue, Danny.

So we don't look at pathological lying has been a psychiatric psychiatric disturbance.

>> Danny, thanks for your call.

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

Our next e-mail question reads Dear Dr. Fauver, is it harder to quit smoking if another smoking question there is it harder to quit smoking when you have other health struggles or is it just as well to tackle smoking and whatever else you are challenged to do yet when you're trying to quit smoking we're going back to that dopamine effect again when you're trying to quit smoking No one you can go through some nicotine withdrawal.

Nicotine withdrawal is not pleasant.

That's a key reason why people have a hard time going off smoking.

So again, nicotine will stimulate this middle part of the brain called the nucleus accumbens and to quit smoking you need to dampen that activation down a bit and you can do so with your medication by the name of Chantix.

That's the brand name of it which people typically know Chantix has been around for twenty years now.

>> It will give your nucleus accumbens the feeling that you're kind of smoking but you're really not.

>> It releases about 30 percent of dopamine compared nicotine.

>> So you're getting a little bit of a little bit of output of the of the dopamine but not as much as nicotine would do.

>> And also if you use Chantix and you do smoke cigarets, it'll block the effect of the nicotine at the nucleus accumbens.

So Chantix will give you a little bit of a spray of dopamine upon its use but it also will block the effect of nicotine even if you do smoke, seal smoke a cigaret you'll think wow, that didn't do much for me.

>> So that's a way that Chantix helps people get off cigarets.

We will often combine Chantix with that medication I mentioned before called bupropion.

If you add bupropion to Chantix you'll have twice the likelihood of not smoking in the future.

They do a really nice job in combination now the biggest side effect of nicotine withdrawal will be nightmares when people are going through nicotine withdrawal will often have nightmares.

>> It was originally attributed to Chantix and then they people at the Food and Drug Administration went back and reexamined the research data which was very apparent when you looked at Chantix versus placebo.

>> Both groups had a lot of had a lot of nightmares.

So the nicotine withdrawal is what causes the nightmares.

So not uncommonly as a means of preventing the nightmares related to nicotine withdrawal will give people people a really small dosage of a medication like Dock's Upon Dock's is a medication.

It helps you sleep but it also suppresses dream sleep specifically.

So that can be a way to get around that.

So should somebody try to stop cigaret smoking at the same time getting their psychiatric disturbance treated?

>> Number one, you do need to get the nicotine withdrawal under control during that time with the Chantix bupropion maybe nicotine patches but you can concomitantly give people psychiaric medications for the purposes of treating the underlying conditions that might be contributing to the smoking.

Now smoking itself will cause you to have the nicotine dependance and crime to go off.

Nicotine will be a problem for a lot of people but many people will smoke nicotine as a means of helping with their mood and helping with anxiety because nicotine can help with those kind of conditions.

So if you treat the underlying conditions not only many other substance use conditions such as alcohol use, opiate use, even cocaine dependance for some people if we treat the underlying conditions that are that are promoting those kind of behaviors will often try to get the heart of the problem itself.

So I'm a big fan and helping people get off of nicotine.

It's less prominent now than it was 20 years ago but we have so many medications now that are much better at helping people get off the nicotine compared to 20 years ago overall.

Thanks recall.

>> Let's go our next caller.

Hello Mike.

Welcome to Matters of Mind.

Yeah, I had a question about the pituitary yeah.

It was the brain effect could cause tremors in the arms.

I have these memories that are there all the time.

They're just when I get my arm to a certain position and I just wondered that would have anything to do with that if it's something too long there, Mike, why would you think it's a pituitary gland?

>> Have you identified there's a problem with your pituitary gland or anything like that?

Yes, I had an MRI and they must have saw something there so they're going to do another MRI with contrast within without contrast they about the same something in that I guess because I have a tremor problems and also collected during OK are they identifying the tremors could have been related to the pituitary problem they haven't said yet.

The reason I mentioned that might is because of pituitary gland as you know is right there.

It hangs down in the middle part of the brain and it secretes a lot of different hormones including thyroid related hormones.

It secretes prolactin, all sorts of different hormones.

If you have a secondary problem with those hormones, sometimes it can affect your adrenal lands and that by thereby it can secondarily affect norepinephrine or epinephrine all these different types of neurotransmitters that might contribute to a tremor itself now usually a disturbance of the prime of the pituitary gland by itself wouldn't be a cause for tremors but the secondary downstream effects could be a problem such that if the pituitary gland is causing you high thyroid, the well high thyroid will give you tremors if the pituitary gland is causing you to have excessive adrenal release of adrenaline, epinephrine, norepinephrine those kind of chemicals that can give you tremor so it wouldn't be the pituitary gland itself necessarily causing the tremor.

But if there are some downstream effects from the pituitary land that could be a possibility.

And the bottom line is hey, you just want to get the tremors relief so try to figure out what you can.

I'm glad they were able to identify something on the MRI.

The big issue now is let's get it fixed and go the next step.

>> Mike, thanks for your call.

Let's go to our next caller.

>> Hello Carter.

Welcome to Mars the mind.

Well, Carter, you had mentioned that your son's taking clozapine and is still hearing voices.

Is there any other medication that can be helpful clozapine?

Carter is a medication also known as Clozaril.

>> It's been around since nineteen ninety one, been around for a long time and it's considered still one of the better medications for schizophrenia, especially when people have the ability to hear voices when nobody else is around but they have trouble with maintaining touch with reality clozapine as you are aware it needs to be carefully monitored for any disturbances in white blood cell count.

So that's why you have to get a blood test every week for the first six months, every other week for the next six months and then once a month thereafter watching the white blood cell counts.

Clozapine is a medication as a side effect can give you increased appetite and weight gain and for some people it can give them cardiovascular problems but otherwise it's a very effective medication for schizophrenia symptoms.

So what other medications can be used on the medications that could be used would be one of roughly sixteen different antipsychotic medications that are now available and they all do work in different ways.

>> There's to give you some of the trade name some of the newer ones capped Leida has come out the works entirely differently than clozapine.

We have Alar we have Olanzapine which has a chemical structure Klimek similar to clozapine but olanzapine also can give increased appetite weight gain.

That's why there's another medication has been added to olanzapine by the name of Sammy Dauphine in combination Sammy Dauphiné Olanzapine is Liebovich Liebovich will give you the benefits of olanzapine without the increase in weight.

So that's another option as well.

Sometimes people add different medications to clozapine like Abilify that's actually been studied using with clozapine.

But bottom line is you have to get the ideal dosing or clozapine first and foremost.

And the nice thing about clozapine there are blood levels that can be obtained with clozapine where people can identify just how much exactly they need without getting toxic on it.

But sometimes you have to be kind of creative in terms of adding other medications to clozapine.

But it's still considerd one of the better medications out there for the symptoms of schizophrenia, including hallucinations as well as delusions and difficulty with socializing and being able to maintain contact with reality in general.

>> Carter, thanks for your call.

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

Our next e-mail question reads your daughter Fauver I heard you talk about sleep paralysis a couple of weeks ago.

>> What's a chemical cause of sleep paralysis?

>> Sleep paralysis is basically where you awaken typically after you've been dreaming and all of a sudden you can't move now while you're dreaming you should have sleep paralysis.

>> That's a normal type of phenomenon.

But some people will awaken and their brain will be awake but their brain is still kind of in that dream state where they're still paralyzed now might take a few seconds for them to come out of .

It's kind of scary for some people but it does go away and it resolves within a matter of seconds.

>> The two chemicals primarily the receptors involved in sleep paralysis will be is it's like the nuclear missiles where you need the two keys to actually engage it.

>> That's kind of how sleep paralysis works to go into dream sleep and to have sleep paralysis you need to have stimulation at the glycine receptor and at the gabey receptor so you stimulate both those receptors and you will have sleep paralysis not just glycine, not just Gabb.

>> You got to stimulate both of them.

>> So the reason why people will awaken sometimes with sleep paralysis because they're still dreaming why are they still dreaming and why they awakening at that time?

It's often because they haven't been able to get enough sleep so sleep debt will often cause you to get a little bit more dream than you'd ordinarily experience.

That's what often happens when people have difficulty with the non REM related sleep disturbances where they're sleepwalking whether having night terrors where they are are sometimes very confused in the middle of the night and they might scream out and they don't remember what's been going on.

It's an entirely different phase of sleep compared to dream sleep that's from sleep deprivation.

>> So if you have sleep deprivation and you haven't been getting good sleep and you're trying to make up on your sleep, you'll have sometimes more sleep paralysis.

>> But it's two chemicals involved the glycine stimulation GIGABA stimulation both at the same time giving people difficulty with sleep paralysis and it's something people commonly will not uncommonly will experience if they've had sleep deprivation rather than treat it with any particular medications we prefer just to take a look at a person's hygiene and see if we can do anything we can to get them to go to bed the same time every night get the same time every day, try to get back on that good sleep wake cycle so they're not having difficulty sleep paralysis.

Now there is a phenomenon where people can have a bit of sleep paralysis when they're having a narcolepsy event.

That's another reason why people can have sleep paralysis.

Narcolepsy is where your brain in the middle of the day just goes in a dream sleep when your brain goes in a dream sleep right in the middle of the day.

You can briefly forget what you've been saying for a few seconds but your knees will buckle on you when you're when your knees buckle on you.

That just means your brain, your body starting to go in paralysis.

So it's very quick.

It's very brief but that's called narcolepsy and that is happening because your brain's going into REM or REM cycle even though you should be wide awake and there's medications that are given to people who have narcolepsy to keep their brain more awake during the day so they don't go into the dream sleep like that during the daytime.

>> Thanks for your call.

Let's go to our next caller.

Hello, John.

Welcome to Mars the mind.

>> John, you had mentioned oh hello John.

There you are.

>> Yeah, I'm addicted to milk.

Is there any I mean two gallons a day at least just like alcoholics addicted to liquor cigarets or whatever.

>> Is there anything I can take ?

>> John, what do you like about milk?

It soothes my stomach and I mean I'm just addicted to it.

I can't catch all kind of black from my girlfriend because I have sugar and I just can't get off of it.

>> I was wondering if with if the milk if it was chocolate milk flavored milk I'd be more concerned.

But you've got some of the carbohydrate effect of milk that you're enjoying.

You've got some protein in the milk which is actually a good thing.

>> You're enjoying that you take some calcium milk.

It's not the worst thing to be using excessively but you're you're not likely addicted to it, John, unless I know you're drinking a lot but you're not likely addicted to it unless you're drinking more and more and more of it and it feels out of control where other people are saying is causing you problems with being able to do things in your day to day life .

>> So when we talk about the term addiction, it means you keep doing something even though it's causing you problems at work in your day to day lifestyle.

Also when people are addicted to something they continue to exhibit the behavior and do it while hiding it from others.

So if you're hiding milk in various parts of your house and a refrigerator in different place, your house princes as a means of hiding it from others that would be an addiction itself.

But you're saying that you like milk because you like how it feels in your stomach.

I think you're basically self medicating a little bit of gastritis there.

That's not all bad, John.

If it helps milk helps you feel good as long as the milk is not causing you social difficulties getting to work or having other problems in your life .

John, thanks for calling for us today.

We're out of time for this evening.

If you have any questions that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFB EDG I'm psychiatrist Fovea and you've been watching Matters of the Mind on PBS Fort Wayne now available on YouTube God willing PBS willing.

>> I'll be back again next week.

Thanks for watching tonight Cameron Psychiatry.

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

More information available at CameronMCH.com.