good evening, I'm psychiatrist Jay Fawver live from the Bruce Studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th 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 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 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 I can answer that.

I can answer the area.

You may write me via the Internet at matters of the mind all one word at WFYI Dog that's matters of the mind at WFYI ECG and I'll start tonight's program with an email I recently received.

>> It reads Dorna to favor My Daughter uses bupropion also known as Wellbutrin to treat minor depression.

She's an athlete or high school.

She really recently suffered an injury and can't really participate for another six weeks.

Her games and practices are a big part of her mental health .

Do you have any advice for getting her through as you bet remind her that being an athlete is an important part of her life .

>> The current time but it doesn't define her as a person in other words is not her entire identity.

>> Get her focused on things outside of her athletic endeavors during this time and sometimes it can be quite an awakening when a stellar athlete for that matter gets sidelined for a few weeks because it kind of wakes awakens that stellar athlete to other attributes they may have.

So during this time she can still work out and exercise in ways that will not aggravate the injury perhaps so she can still do that.

>> But this could be a good time to help open up her eyes to other possibilities and the other attributes she might be able to experience.

So get her involved in academics, other hobbies and kind of open her eyes in these other areas.

>> Sometimes it takes an injury to help at a high school athlete to really wake up to other aspects of their identity and that can be the case for your daughter at this point.

>> Thanks for your email.

Let's go to our first caller.

Hello Carl.

Welcome mastermind.

>> Carl, you'd mentioned you've seen a lot of television commercials on dyskinesia.

>> What is it and why does it what is some mental health medication of the medication that will cause tardive dyskinesia?

Carl will be medications a blocked dopamine receptors used to be called antipsychotic medications.

Now we call them dopamine receptor blocking agents.

Derbez and these are medications that will treat schizophrenia bipolar disorder and they can sometimes be added on for mood disturbances like depression in general.

>> Now if you have a mood disturbance and you use these dopamine receptor blockers, unfortunately you can be at a higher risk for tardive dyskinesia compared to if you have schizophrenia for various reasons.

>> So the reason we're hearing a lot about tardive dyskinesia now is because a lot of people are using these dopamine receptor blocking agents for mood disturbances.

So with that being said, what has tardive dyskinesia?

It's where you block dopamine for an extended period of time and due to your blocking dopamine over the course of time you can out just like little buds on a plan but out more dopamine receptors so you become more sensitive to dopamine when you are more sensitive to dope.

I mean you can have facial movements with twitches and tics in your eyes and your mouth can can right around you can have tongue movements that are all moving around.

Some people will have shoulder shrugs and trunk movements.

>> So tardive dyskinesia is where you have tics and twitches that affects the that will affect the face, the shoulders and the trunk and will occur gradually over refers to being delayed.

>> It takes some time for that dopamine blockade to occur and dyskinesia means bad movements.

So it's it's delayed bad movements now what's a predictor for tardive dyskinesia as I mentioned using the dopamine receptor blocking agent for mood disturbances but also as we get older we're more sensitive to it as well as if you have early evidence of what's called extra pyramidal symptoms due to the dopamine receptor blocking agent itself.

So if you take a medication it's blocking dopamine and Araf about it cause you'd have tremors shuffling if you have difficulty with slobbering or a Parkinsonian symptoms symptoms that look like Parkinson's disease, if you have those symptoms early on your three times more likely to have tardive dyskinesia later on.

So we do have predictors there is a dopamine to gene that we can examine and if you have a particular parameter of a genetic makeup for that particular gene, we can kind of predict that that will be more likely to give you difficulty dyskinesia later on.

It also seems that having diabetes type two diabetes will give you a higher risk for tardive dyskinesia.

>> So there are risk factors for tardive dyskinesia.

We do have medications that can treat it Austereo as well as in Griesa and they can treat tardive dyskinesia and that's great.

It's better what we had in the past in the past what we had to do is try to decrease and even eliminate the medication is causing the problem to begin with.

>> But it's nice to not cause the problem as opposed to treating it later on.

>> But if we need to treat it now we do have medications we can treat those kind of movements.

>> Thanks for your call.

Let's go to the next caller.

Hello Jack.

Welcome to Matters of Mind.

>> Jackie had mentioned anxiety medication called XOX XOX.

>> I forget the generic name on that starts with Hox but is that old benzodiazepine medication short acting medication that has been around for oxazepam?

That's it.

It's been around for a long time and is a better than Obama.

Yeah but Obama is a medication that was around in the 60s and 70s way way back when I was a pharmacist we had Obama around .

Obama used more as a muscle relaxant is better than Obama.

I don't like either one of them, Jack, because they both can be very seductive.

They can give you difficulty with trouble with concentration in focus.

They both can give you somewhat of a tolerance and both of them can cause you to stop your breathing if you take a little bit too much of them.

>> So if you're treating anxiety in general, Jack, I'd recommend you use a whole different type of medication than Sarah or Obama.

But you know, they both have their pros and cons one way or another.

Sarah being a benzodiazepine, Metrobus might be more of a muscle relaxant type of medication.

Jack, thanks for your call.

>> Let's go to our next caller.

Hello, Sarah.

Welcome to Mars.

The mind set you want to know is there a correlation between attention span and age as we get older?

>> It's interesting, Sarah, because it will take an older person longer to come up with an answer but they'll often be able to come up with it as long as they don't have the early stages of dementia.

>> So the drawback of a lot of memory tests for older people we don't give them enough time with an older person is just sometimes takes a little bit more time to generate that thought.

>> And is that a disturbance of attention span and maybe maybe not.

I mean there are a whole lot of reasons there for an older person having attention span difficulties and we'll all want to examine those sleep apnea, low thyroid, low ion diabetes, all these different medical reasons.

Sometimes depression can affect a person's attention span as it's getting as they're getting older.

So we want to take those all into consideration.

But yeah, your memory and your attention will change somewhat as you get older.

But that doesn't mean it's pathological.

It just means that just takes a little bit different time period to fire off those synapses as we get older.

>> Thanks for your call, Sarah.

Let's go to our next caller.

Hello, Bethany.

Welcome to Mars the mind.

Bethany, you want to know how you can manage your stress and anxiety as your family stretches out your money for the holidays?

That's a really general question, Bethany, but I'll do the best I can to try to answer that because everybody has individual concerns.

Number one, my question would be why are you spending or stretching out your money or potentially overspending in a manner that you might find stressful for you?

>> So if you're spending money and as you had mentioned stretching out your money where it's causing stress and anxiety, why are you doing that?

I mean what what's the whole purpose behind that?

And I think for many of us we need to reconsider our goals during the holidays as opposed to trying to outdo the previous year or outdo each other.

So I think it all comes down to your whole perspective on the holidays themselves and if you're feeling yourself getting stressed and spending excessively the first thing to do is step back and ask why and potentially not spend so much does that's a good start and I don't think you need a psychiatrist to be able to tell you that.

>> Thanks for your call.

Let's go to next e-mail question.

Our next e-mail question reads Dear Dr.

Farber in the scene from the Waterboy the medulla oblongata was cited as a reason why alligators are aggressive.

>> Is there any truth to this in the waterboy?

>> And yes, that is one of my favorite movies because I used to play football and you have to generate that rage like the Waterboy did.

But unfortunately that scene in the biology classroom is entirely wrong.

>> The scene in the biology classroom the professor who did look like Colonel Sanders I mean the professor claimed that the alligators had larger than normal medulla oblongata and that's why they were aggressive.

>> That is entirely wrong.

The the medulla oblongata is located in the middle part of the brain right at the base of the brain is like the bottom part of the brain and it connects the brain to the spinal cord.

So it's very important for vital signs breathing heart rate.

It's important for swallowing but it connects the brain to the spinal cord and different movements and it really doesn't have a lot to do with rage.

The part of the brain that has a lot to do with rage is up here in the amygdala.

It's the almond shaped body.

Amygdala in Latin means almond shaped almond shaped body in the front of the thumb part of the brain which is the temporal lobe and that part of the brain gets fired up when you're experiencing rage, anxiety, anger, irritability and guilt for that matter.

So this is the part of the brain that really gets fired up when you are really emotional and the problem is let's get away from the waterboy and the alligators.

But the problem will be that when you have a lot of rage and anger it can sometimes hijack your thinking part of your brain.

You're thinking of the brain is the front part of the brain.

>> So the front part of the brain is the part of the brain where you use rational thoughts.

You decide is should I do this or should I not do this?

What are the social consequences if I act out in a certain way that's the front part of your brain doing the work there and if you have an overactive amygdala and it's really getting fired up, it can hijack the thinking part of your brain and in doing so you can basically act based on your emotions and that's never a good place to be.

>> The problem with alcohol for instance is alcohol and that's the that's the front part of the brain.

>> So why do people do stupid things when they're drinking is because they're front part of their brain is anesthetize their emotional part of the brain will take over and in doing so they act based on their emotions.

So the rage, the anger, the irritability comes from the amygdala, not the the medulla oblongata.

I think they just like using that term in the waterboy.

It was a funny scene but totally biologically inaccurate.

>> Thanks for your call.

Let's go to our next caller.

Hello Cole.

Walking America Blind Cole, you want to know is depression common in seniors?

>> How can they fight the feelings of isolation?

>> Depression can be predicted Cole by isolation.

So the more seniors and we're talking by definition a senior somebody over 65 years of age, some people even say over fifty five years of age but it's people who are semi retired, the retired they have family and friends moving away.

>> They might have a death of loved ones and it can be a very isolating time for them and a big, big predictor for depression for older adults will be isolation, social isolation.

So you bet what comes first the chicken or the egg?

>> Well, if you're socially isolated you're more likely to get depressed and then you get depressed where you start losing motivation to do things you don't have goals you don't find in things enjoyable.

You don't have the passion for the day to day activities you might have earlier that will cause to thereby be more isolated.

>> So it kind of is a is a vicious cycle where you get depressed, you get more isolated, you get more isolated, you get depressed so it goes hand in hand.

So we're always trying to get older adults to No one maintain some kind of schedule and have things to do on day to day basis.

>> Remember to try to be around people somehow, someway try to be around people even if it's very informal casual type of interaction.

But you got to be around people as you get older to try to decrease that social isolation overall.

>> Thanks for your call.

Let's go our next caller hello's welcome to Matters of Mind.

Say you want to know what's it mean if you have a recurring dream?

Hard to say because it's difficult to study recurring dreams from a neurobiological standpoint.

>> So the best we could do is kind of fall back on the analytic type of perspectives of it.

>> If you have recurring dream it's that dream is symbolically and I emphasize symbolically very abstractly giving you some kind of means by which you can try to resolve conflicts that are occurring on a day to day basis.

It's not that dreams represent things that are on your mind for the past 24 to 48 hours.

So abstract very symbolically your dreams are a way of trying to help you sort out stuff that's going on in your head.

So if you have different things going on in your life you might have dreams that symbolize different things going on if you have a recurring dream is probably the very current theme of something that you're still trying to resolve.

So back in the old days when there was a lot of psychoanalysis being done where you would lay down the couch and predominantly talk about things that are just coming to your head, a lot of times people would talk about their dreams.

When I was in my training back in the early 1980s I had psychoanalysis on my done on myself by a psycho, a psychoanalyst and I'd go in and first thing in the morning on a Tuesday and Friday morning and I'd lay down on the couch and I'd just basically talk about my dreams because I just awakened and my dreams are very, very prominently still in my mind.

>> Dreams are kind of like a whiteboard however because if you don't think very in a focused manner concerning your dreams very quickly after you get up you don't try to think I'm through it's like a whiteboard where your dreams will be erased within a matter of minutes.

So if you try to think about what you had dreamt about at three o'clock, four o'clock in the afternoon and you try to think about your previous night's sleep often you won't remember your dreams but if you awaken and immediately start thinking about your dreams often you can remember what they are and I'm presuming you are remembering your dreams zei because you're thinking about them when you first awaken and you're noticing these ongoing themes.

>> But if you're having ongoing themes, ongoing dreams that are recurrent, it's probably because of something happening in your life that you're trying to work out and at nighttime the thinking part of your brain, the part of the brain that I mentioned previously, the front part of the brain gets a good rest and when you recharge your brain at night, which is very important to do, you are recharging the front part of your brain.

So that's left dorsolateral prefrontal cortex right here the part of the brain that you use for focus attention, reason, reality when you are shutting that down.

Right.

That's why your dreams are very abstract because your front part of your brain is very quiet at nighttime.

So when that part of the brain is resting that helps you think more clearly the next day because it's been allowed to rest.

And when you're dreaming this part of the brain is very much at rest.

>> Some people will have nightmares because other parts of the brain are firing off because they have unresolved conflicts.

For instance, it's not diagnostic but many people with post-traumatic stress disorder who have had experiences with trauma in the past will have bad dreams because different parts of their brains are firing off inappropriately at nighttime and giving them difficulty with dreams.

>> So we have to take that in consideration.

>> Thanks for your call.

Let's go to our next caller.

Hello Annie.

Welcome to Matters of Mind and do you want to know about the essential tremors?

Basically essential tremors are neurological disturbances and I'm going to stay in my lane here.

I'm a psychiatrist but we get some training in neurology and psychiatrists and neurologists are medically boarded by the American Board of Psychiatry and Neurology.

>> So central tremors basically are tremors without any known reason.

They don't have a specific disease state associated with them.

They are indeed hereditary in the brain.

It's thought that there's a dopamine disturbance and that dopamine disturbance is occurring in the middle part of the brain that regulates smooth movements.

An essential tremor will be worse under stress.

Sometimes caffeine can make it worse although I have heard some people say caffeine will make a little bit better because caffeine indirectly can increase dopamine.

That's what we're often going to do with essential tremors is treated with a medication like propranolol propranolol, the so-called beta blocker.

It blocks norepinephrine but indirectly it can increase transmission of dopamine.

>> So increasing dopamine transmission is the most common way that we'll try to address essential tremors.

But you know, being aware of the effect of caffeine on this central tremors fatigue being in anxious situations can make the tremors worse.

But essential tremors are often seen when people are trying to right and especially if they're getting anxious when they're writing.

So we'll try to do things about that again, propranolol mean based medication will be the way that will often treat that.

>> Andy, Andy, thanks your thanks for your call.

>> Let's go next caller.

Hello Jessica.

Welcome to the mind.

Jesse Yono when having a codependent relationship when is it unhealthy codependency alludes to Jessica having a reliance on your partner and whether it be your spouse, your boyfriend, your girlfriend and having this tight relationship where you're your feelings and your actions will be heavily influenced by theirs.

>> To put it simply when that kind of relationship unhealthy well and on a loving relationship we should care about our loved ones around us.

>> Is that codependent?

It becomes codependent basically when it starts to be functionally impairing.

So in other words we often hear about the codependency in somebody who's drinking alcohol for instance.

>> So with your loved one drinking alcohol you do things to indirectly support.

They're continuing to use alcohol and they're using alcohol starts to affect you and detrimental way.

So it's basically a pathological relationship where your actions and behaviors will be influenced by your loved one in such a way that it won't be healthy for either of you at that time.

>> Thanks for your call.

Let's go our next e-mail question our next e-mail question reads Dear Dr.

Fauver ,I was taking some cold and flu medication the other day and I noticed there's Tylenol acetaminophen in all the medications in my cupboard.

I also commonly used Tylenol to treat common aches and pains.

>> Do I need to be careful about the amount of talent I take while the general rule of thumb for Tylenol acetaminophen will be about 4000 milligrams a day that sounds like a lot better about twelve and twenty five milligram tablets or so so three and twenty five thousand twenty five milligram tablets or capsules what you'll often hear about and 4000 milligrams a day is considered to be the safe dosage if you keep it underneath of that how what do you do if you take too much Tylenol or acetaminophen if you feel like you're getting nauseated, you're getting blood in your urine especially if you're having problems.

It could be indicative of liver problems from the excessive acetaminophen use and in doing so by all means contact your primary care clinician to get some treatment for them if you're taking more Tylenol than you usually would be, you're keeping it well under four thousand milligrams a day if you wish to protect your liver you can do this with your primary care clinicians oversight but simply take a supplement called Acetylcysteine in AC is the common term for that.

Six hundred milligrams twice a day can be safely used for a lot of people as long you don't have a sulfa allergy in acetylcysteine and contains acetylcysteine and acetylcysteine is a sulfur derivative and if you have a sulfur allergy you can't take that.

But in AC six hundred milligrams twice a day can be protective for the liver and you can use that whether or not you take an acetaminophen or not.

>> But if you're taking more acetaminophen than you might usually take because you have muscle aches and you're now having cold symptoms and you're having a fever and you're thinking I'm taking more acetaminophen than usual by all means take in AC sixty six hundred milligrams twice a day with your primary care clinicians oversight and it's something that can be safely used in acetylcysteine as a supplement.

It's over the counter you can get it very easily without a prescription and if you take too much in AC you can get some nausea and diarrhea from that so you don't wanna take too much AC but 600 milligrams of NMC twice a day can be somewhat protective for the liver.

>> Thanks for your call.

Let's go.

Our next caller Scott Walker to of mind.

>> Hey doc take you for taking my call.

Sure.

Yeah but I had a question I am so I don't sleep well.

My mother never did and I personally I think it is kind of a genetic thing, you know the DNA component because they have always asked so how much caffeine do you take and in all this and I don't even drink coffee but I just have that ruminating pain.

Doc Yep.

And they have been has worked so well for me but recently my VA doctor took me off and put me on something called Seroquel and it really doesn't work.

So I was just wondering what is wrong with the Ambien being on that for a long period of time ?

>> Yeah the problem Scott with Ambien zolpidem is the generic name on as you're aware being around for a long bit of time.

>> It's sometimes just doesn't work that well.

A long long term Ambien in the immediate release formulation as you may have experienced will really knock you out.

I mean you hit the you hit the pillow, you're out.

The problem is that good effect can fade over the course of time.

So many people will find that they need more and more Ambien over the course the years my goodness got when Ambien first came out a couple of decades ago we used it all the time and we thought it was a really nice medication because it knocked people out but it wore off so quickly.

The immediate release formulation wears off in about four hours for a lot of people.

Then they came up with a Ambien ,a controlled release which is basically the immediate release with another layer that releases four hours later to try to give you the eight hours.

It doesn't give you as good of a quality of sleep and I think that's my biggest concern when you sleep you should be able to get a good quality of sleep where you have dream sleep you have deep sleep and allows your brain to be recharged allowing you to feel mentally and physically better the next day.

Ambien doesn't do such a good job for that.

So that's the biggest issue there.

It doesn't give you as good of a quality of sleep sometimes when people use it for more than a few weeks or a few months for that matter, they need more and more and if they don't have it they have a worsening effect.

If you awaken during the night while you're under the influence of Ambien, especially older adults, they can totally forget what they're doing and you might wander around.

>> We've heard about sleep eating under the influence of Ambien as well as a lot of them.

Thanks.

So you're taking Quartier Pain Seroquel, Seroquel or Quartier Pains?

Main mechanism for sleep will be blocking serotonin 2A receptors which will give you a deeper better quality of sleep.

>> It has a similar effect as does Trazodone but it's stronger than Trazodone on serotonin 2A receptors so that's a safer means of helping you sleep.

Low doses of Seroquel or typing should not put you at risk for tardive dyskinesia because it's not blocking dopamine that much at low dosage we get above a hundred 200 milligrams at bedtime you can start blocking dopamine but at the doses that used for sleep with Kittie opiners Seroquel we're talking 25, 50, maybe 100 milligrams at bedtime and you're primarily affecting serotonin 2A receptors with a little bit of an antihistamine effect.

So it is a safer means it's not addictive and it's something and give you a better odiously for dream sleep and deep sleep which we call non REM sleep.

>> Thanks for your call.

We'll go to our next caller.

Hello Robert.

Welcome to Matters of Mind Robert you'd asked when I was showing the brain and pointed out the medulla oblongata what was the other yellow piece outside the brain?

>> Oh, I think you're talking about this.

It's called the amygdala.

I was referring to the amygdala.

This yellow area here is called the temporal lobe.

Your brain is kind of shaped like a boxing glove and the thumb part of the boxing glove is the temporal lobe.

>> The amygdala is in the front of the temporal lobe.

That's the part in which I was referring.

>> Thanks for your call.

Unfortunate I'm 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 the Mind at WFYI Dog I'm Psychiatrist Ja'far and you've been watching Matters Mine on PBS Fort Wayne now available on YouTube God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

Goodnight