.

>> Good evening.

I'm psychiatrist Forfar live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 10th year matters.

Mine 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 the PBS Fort Wayne studios by dialing in the Fort Wayne area (969) 27 two zero or if you're going anywhere else coast to coast you may dial toll free at 866 (969) 27 two zero now on a fairly regular basis we are broadcating every night every Monday night live from our 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 a via the Internet at Matters of the Mind at WFB org that's matters of the mind at WFA and I'll start tonight's program with an email I recently received.

>> It reads Dear Not to Fall Over.

What can you tell me about Korbin Fee could be a capital C on Karpinsky it's a trade name of a new medication is any different than any other medication available for schizophrenia.

Koban Fee was approved by the Food and Drug Administration in about a month ago and it will revolutionize the treatment of schizophrenia either by itself or medications that follow up.

Basically it's not focusing on blocking dopamine when we've talked about schizophrenia for the past 60 years the treatment has always been focused on blocking dopamine right up here in the limbic system.

>> Right.

So you have too much dopamine in the limbic system when you have too much dopamine in the limbic system you will hear voices that other people can't hear and they're distinctive.

They're as distinctive as my voices to you right now.

They're very clear and often very coherent voices talking to you when there's nobody around.

Secondly, you'll have these fixed false beliefs which we know of as delusions fixed false beliefs will be where something can't possibly be true.

But you insist that it's true and you can't talk that person out of a delusion.

>> Many people will have difficulty with concentration focusing they'll have distractibility and many times they'll have overlap of other conditions like attention-defic >> They have trouble relating to other people and that's called the autistic features of schizophrenia or schizophrenia has been a debilitating condition that we've known quite a bit about for the past 60 years.

>> We've known to draw to at least block dopamine but that has only been part of the story.

Medical students are wonderful to with whom to interact because I teach medical students in my free time and they will ask you questions that need to be asked.

>> And one of the questions medical students have been asking me for the past 30 years has been OK, you have too much dopamine schizophrenia.

>> How come?

And my response is characteristically been I don't know we don't know why there was too much dopamine with schizophrenia and that's part of the problem where people have these hallucinations and delusions.

>> But for the past 30 years there's been a a endeavor to try to discover why there's too much dopamine and now we've understood why why there is too much dopamine is because people with schizophrenia have underactive receptors involving the acetylcholine.

OK, the little colony is an important chemical.

>> The brain acetylcholine 30 years ago was thought to be the sole reason for people with Alzheimer's dementia thinking they had too little acetylcholine.

So acetylcholine is an important chemical and acetylcholine will balance out with dopamine.

It's like a teeter totter I've talked about with depression gabb and glutamate being need a balance in the same way acetylcholine needs to be in balance with dopamine.

>> So if you block dopamine you can get too much acetylcholine and have various symptoms such as tremulousness shuffling gait and we call an Parkinsonian symptoms.

So what do you do then you block dopamine to try to bring you block acetylcholine to try to bring this little COLENE balance down to dopamine.

So we've known about blocking dopamine because there is too offsetting the excessiv acetylcholine effect from that by blocking acetylcholine.

>> The bottom line is our outcomes have been OK but not the greatest.

Well now we have an entirely different mechanism with the use of Koban for the benefits of medication.

That's two medications in one the main medication is a medication that will stimulate these receptors that are under stimulated or under under the two little volume one is called muscarinic receptor one and one is called muscarinic receptor type for these are acetylcholine receptors.

They are underdeveloped in people's brains who have schizophrenia probably starting in the.

>> It starts early on and some people have triggers for schizophrenia where the symptoms will evolve but people will have too few muscarinic one and too few muscarinic for receptors and the brain there's five different types of muscarinic receptors type one, two , three and four and five.

OK, these are we're talking about muscarinic receptor one and muscarinic receptor type for muscaria muscarinic receptor type one are located primarily in the gray matter of the brain and they're also located in the salivary glands as well as the gut muscarinic receptors.

Type four are located over here in the hippocampus, the memory part of the brain that's the part of the brain helps you process thoughts and memories and also in the inside part of the brain called the substantial nigra in the middle of the brain.

>> So these parts of the brain will affect a person's ability to to maintain reality.

>> And if you have too few receptors of muscarinic receptor type one are muscarinic receptor type four you're more prone to release more dopamine.

>> So if you don't have enough of the muscarinic one in four receptors you're going to release more dopamine that answers the questions of medical students have been asking me for decades why is there more dopamine now I can ell them it's because pe with schizophrenia have too few of the muscarinic one and four receptors.

>> Now why is that important?

Think of dopamine as an accelerator in a car if the accelerator is is left unchecked with braking and there's nothing there to slow down the accelerator, the car will go too fast and often be out of control.

That's what happens to people's brains when they have psychotic symptoms and they've lost touch with reality.

The brains feel like they're out of control.

They have racing thoughts.

They can't think straight and they have these hallucinations and delusions.

>> The brain's out of control.

It's like a speeding car.

So how do you try to slow down a speeding car one way it can slow it down is by having big semis and big trucks and other cars in front of the speeding car to slow it down and to block its progress.

That's what we've been doing to treat schizophrenia for the past six decades.

We've merely been blocking dopamine receptors and in doing so it's helped but it doesn't get to the underlying problem if you stimulate the receptors that are at lower volume muscarinic one in four receptors, if you stimulate those receptors you're actually getting to the core the core cause of the excessive dopamine stimulating those receptors will decrease the amount of dopamine being released.

>> It's kind of like letting off the accelerator and doing so.

So when you look at the package insert which is basically instruction sheet that the Food and Drug Administration publishes the instruction sheet on Koban three doesn't even mention dopamine.

>> It's a downstream effect.

The main mechanism of action of UNFI is the acetylcholine mechanism.

>> It's a whole different way of attacking this problem which was really getting to the core issue.

So like with any medication you're gonna have side effects if you stimulate muscarinic receptors one and four.

What do you what do you have in terms of side effects you have slobbering we've seen that for years with a medication called clozapine or Clozaril.

A side effect of it is slobbering.

That's because it's a really good muscarinic for animals one receptor stimulant.

>> So if you stimulate those receptors you get slobbering.

>> You can get a slowed down heartbeat, you can get diarrhea ,you can have some uncomfortable physical effects from stimulating those receptors so that's the reason why there's a second medication and Koban fee the second medication is blocking in the periphery not of the brain but blocking the periphery those side effects you can get.

>> So that's why it's weird because people will say gee on the side effect profile of cogency, it's diarrhea and on the other on another side effect is constipation with diarrhea is coming from one medication that is stimulating the muscarinic one receptors and the constipation is where you get too much of the second medication in your system.

It gives you constipation.

So it's important to get that fine balance between those two medications for people.

But it's a medication that I think is going to change our whole thinking about schizophrenia.

>> In the past we've always been all about blocking dopamine and that helps with a psychosis.

My goodness, back in the 1950s when a medication like Thorazine followed by Haldol those medications came out, it literally did significantly empty out a lot of state hospitals where people had been housed for years with schizophrenia.

So they are effective medications in some degree but it's how they are effective.

If you got the speeding car, would you rather block it with semis and keep it from going so fast by putting things in front of it or would you rather go directly to the accelerator and try to let off the accelerator what you are doing with co benefit in the treatment of schizophrenia is not just blocking the dopamine but we're actually decreasing the likelihood that the cause of the increased dopamine is problematic.

So is something are going to be hearing about over the course of time?

I believe that future medications being developed for schizophrenia will all mirror this type of mechanism of action where they're going to be looking at the core reason why there's excessive dopamine and schizophrenia.

>> Thanks for your email question.

Let's go to our first caller.

Hello Samuel.

Welcome to Matters of Mind.

>> Hello Samuel.

Where you wondered if you have severe anxiety is there a chance that your kids will develop anxiety?

>> My face kind of looks like a half moon tonight, doesn't it?

Yes.

The answer there is if your children see that you as a parent have a significant amount of anxiety in life circumstances, they will mirror that kind of behavior.

>> So yes, your children do pay attention to you especially if they're under the age of eight years of age.

>> That's when a lot of their personality development is occurring.

But when you have children mirroring your behavior, if you're anxious in different situations and you're having difficulty with resilience and putting up with stuff, you bet your children are going to notice that.

But there's about a 30 percent biological factor they're going on where you know, there are some genetics involved with anxiety.

But I think for the most part anxiety can be a learned behavior from children watching and mirroring and mimicking their parents responses to stressful situations.

>> Samuel, thanks for your call.

Let's go our next caller.

Hello, Alex.

>> Welcome to Matters of Mind.

>> Alex, you want to know why do you have trouble sleeping without noise?

You can't sleep without music or television playing.

Be careful about television, Alex, because the bright screen of a television screen can keep you awake back in the old days we had the dimmer screens.

Now we have these bright LCD screens that the light itself can keep you awake.

>> Same with computer screens so be careful about the television screen music or television sound in the background can be somewhat calming because it'll keep your mind from having to think about stuff and this is not an uncommon type of tactic people will attempt Alex, where they will notice that if they have music playing in the background music will stimulate this little part of the brain here the auditory cortex and if you're stimulating that part of the brain, you're kind of thinking about listening to music in the background.

It can shut down some of your extraneous thinking.

>> So that's why some people will notice that if they play classical music, music it's kind of in the background but it's not something that's annoying you or causing you to have a lot of thought behind it.

You can actually increase your focus of your brain which is in the front part of the brain.

So if you have noise in the background you're not going to notice gee maybe a limb falling down outside or car noises.

You're not going to notice those extraneous noises outside the house.

You'll hear the you'll hear the soft quiet we call it white noise.

It's in the background.

It's actually a recommendation that many people will receive from us clinicians to have some white noise in the background to be able to sleep better.

>> But you you're you're hearing the White noise and it cuts down.

>> You're able to hear extraneous sounds that might keep you awake otherwise.

>> Alex, thanks for your call.

Let's go our next e-mail question our next e-mail question reads You're not a favor.

Is there any hope for someone who spent most of their 58 years of life feeling unloved and unwanted with a broken spirit?

>> I have no interest in living medication and therapy does not help.

Well, keep in mind no one you need to contact your primary care clinician, your mental health clinician, anybody who you have in mind, anybody who's available, you should contact them.

If you have any thoughts of taking your life with severe depression, you don't want to simply call a television show and talk to some guy on PBS about wanting to kill yourself.

You need to talk to the proper professionals right away and there was a hotline call that's where you dial nine eight eight .

You can always be directed to a mental health clinician that way.

So with that being said, let's talk about depression.

That's just not getting better.

>> OK, you mentioned has been going on for fifty eight years.

There's a lot of different assessments will do for depression off the bat.

We want to make sure that what you're dealing with will be depression itself as a bipolar disorder where you have it highs and lows.

>> Is it simply lows when you say medication hasn't helped?

Keep in mind we have twenty ine different oral antidepressants available for the treatment of depression nowadays I bet you you haven't taken all twenty nine of them.

Secondly, we have some bravado which is a nasal spray affecting glutamate now traditionally for the past six decades the main medications we've had for depression mainly affect norepinephrine, serotonin and dopamine.

If you affect glutamate you can get an entirely different type of an effect compared to the prior medications and it can be a very fast effect.

>> There's also an oral medication it came out two years ago called All Veloute.

It's an oral medication.

It affects glutamate and then we have some so-called off label uses of a medication like ketamine.

>> Ketamine was approved in nineteen seventy four.

>> Anesthesia has been around for a long time and the approved for anesthesia but it can be given IV and some people have even tried to use it under the tongue as a means of helping with depression ketamine use for anesthesia can be a very, very potent and effective medication for depression.

>> So before saying I've tried everything for a medication it hasn't helped often what we do now in the 21st century is we'll start with medication to allow the brain to reason better and allow you to concentrate better than once.

>> The medication is allowing your brain to work better then we get into the behavioral type of aspects of talk therapy.

We talk about diet and exercise, all these things that tend to go downhill when people are severely depressed.

>> So I would certainly talk to your primary care clinician, make sure you don't have any underlying medical issues like diabetes, thyroid disturbances, iron disturbances, sleep apnea.

>> These are all conditions that can cause the person not to respond to various antidepressant medications.

But your primary care clinician might have some other ideas for concerning what else can be done for what we call treatment refractory depression, which is what you're describing at this point.

It's refractory maybe because the medications you've tried they haven't worked because they haven't hit the proper neurotransmitters and it's not just all about neurotransmitters but your brain's got to work properly for you to be able to think clearly and to think clearly.

That gives you rational thoughts and course that allows you to have enjoyment and motivation to be able to have fun in life in general.

>> So I wish you the best but talk to your primary care clinician as soon as possible here.

>> Thanks for your email.

Ask our next caller.

Hello Bonnie.

Welcome to Mars Mind Body.

You want to know what is attention deficit hyperactivity hyperactivity disorder there?

What are the symptoms?

What are the effects?

Is there medication you can take for ADHD body as a condition that starts in childhood?

By definition it's a day to day phenomenon that can be worsened based on different stressful situations or under people with attention deficit hyperactivity disorder as the name implies have difficulty with attention span distractibility and they have a hard time getting things done.

They get started on things but they don't get them done.

They have a hard time focusing on things that aren't very interesting which describes a lot of things we have to endure in life , especially in our school system.

>> So if you're not challenged, if you're not interested, if it's not new and exciting for you, you might not be able to pay attention to it.

But interestingly enough, bonding people with ADHD typically have higher IQs compared to people without ADHD.

So we have to remember that yeah, we call it a developmental disorder because it does affect the front part of the brain front part of the brain appears to be underactive with people with ADHD.

The attention is part of the part of the brain over here on the left side called the dorsolateral prefrontal cortex, the orbital frontal cortex up here in the above the eyeball orbital lateral orbital frontal part of the cortex that's the part of the brain that you use for controlling your impulses.

These are impaired with ADHD.

The middle part of the brain called the cingulate gyrus is impaired.

That's accounting for the distractibility.

>> So it's a biological problem where as you grow older up to the age of twenty four years of age those parts of the brain will grow and grow.

But many people even as adults will still have lingering symptoms of ADHD that may or may not be problematic if they're problematic you certainly would want to for it with ADHD there'snt- different severities of ADHD just like there's different severities of nearsightedness.

When you have nearsightedness some people can wear really thin lenses on their glasses and they do find other people need really thick lenses because they have very severe nearsightedness.

Well that's the way we all consider ADHD.

>> Some people have ADHD where it's not really a problem until they get into graduate school and they're just overwhelmed with keeping up with things before they were able to get all their homework done in high school, maybe in study hall or something like that and they just blew through high school.

No problem at but they got challenged to a certain degree and that's where they're devastated now for other people.

>> They have such severe ADHD they're out of control with impulsivity and decision making even as adolescents they get themselves into trouble and that's why in the prison systems it's thought that half the half the inmates in prison systems have a history of ADHD because it causes them to have difficulty with impulse control and decision making in general.

>> So it's important we identify it.

Does everybody need treatment for it?

Not necessarily if it's not causing you significant impairment, that's not problematic.

Many people with ADHD come across as being very charismatic and they're fun and they're they're a joy to be around because they're going from thought to thought to thought to thought.

But at the same time they'll describe to you having difficulty getting things done.

I saw a woman earlier today who had ADHD and she's in her 30s and she just said she can't get anything done around the house and it takes her three hours to get what should just take her to get done in thirty minutes.

>> So with ADHD it caused you to be very inefficient in doing mundane type of activities.

So something as simple as washing the clothes and getting the laundry done can take days in some cases because you get distracted, you go to something else and you don't get the initial type of project done.

>> So that's one the symptoms of ADHD can cause problems in that way it can cause marital stress in some cases because when a spouse has ADHD he or she comes across as being uncaring and a poor listener to the other spouse because their brains going off in some other direction as their spouse is speaking to them.

So those are the consequences of ADHD, other medication that we can take.

>> There are medicaions that we can take nonstick medications will primarily affect the front part of the brain and fire that up non stimuli medications will help anywhere between 60 to 80 percent of the time.

>> So we have those available now there are still medications that have been around for decades now.

>> There are long acting so you have the Ritalin type products and you have the amphetamine type products.

The long acting ones are the ones we prefer because they're less addictive.

They're giving you a slower release throughout the day.

They're not wearing off and causing you to crash early afternoon.

So we like the medications that are stimulants that will last for eight to ten hours and last out most of the day.

But the non still medications can also work to some degree but not as well as the stimulants will.

>> So there's a lot of different medications that are available for ADHD really for people of all ages.

The similar medications as you might as you might guess can be a little bit more difficult to take for people who have heart problems because they can increase the blood pressure, increase the heart rate in some times cause rhythm disturbances of the heart.

So have to be careful with a lot of older adults if they take stimulant medications because they can have heart issues themselves.

>> Bonnie, thanks for your thanks for your call.

Let's go next email our next e-mail reads during evolve or is it normal to feel depressed when your adult children finally leave home?

>> Well if your children leave home and are living independently and they're having fulfilling lives, give yourself a pat on the back because you succeeded as a parent.

>> That's what's supposed to happen.

>> The birds have left the nest.

That's a good thing.

Is it normal to feel depressed and that of course I mean you miss them but in today's world you can text them, you can email them, you can communicate with them on a regular basis.

So it's not like the old days where we had to write letters and communicate in that matter.

>> Now we can text them, we can face time.

There's a lot of ways to maintain contact but you know, you miss them.

>> It's important as a so-called empty nester to try to fill up that nest with hobbies, with friends, with social activities, lot of other things you could do and the absence of your children.

But give yourself credit if your children have left the home they're getting on with their lives.

>> That's a good thing.

That's what we want.

We don't want our children to be camping out with us as adults.

So thanks for your email.

Let's go next caller.

>> Hello Paula.

Welcome to Mars the mind.

>> Paula, you heard me talking about ADHD is constant daydreaming and forgetfulness a sign of ADHD?

>> Yeah, people with ADHD with women especially you'll hear about daydreaming.

>> They are not really impulsive.

They're not hyperactive.

That's referred to as a predominately inattentive type.

It's where they just kind of daydream and they'll go off in their own worlds and they can't focus and concentrate more commonly seen with women than men.

And that's why young girls and adolescent girls are often not identified having attention deficit disorder because they don't cause any problems.

So they're quietly daydreaming and they're not able to complete their assignments and focus on the work at hand.

So daydreaming is certainly a symptom.

Forgetfulness is a symptom of ADHD because you're not downloading the information in your hippocampus, your hippocampus a hippocampus is the part of your brain that's kind of like the library.

It's the memory center their brain with 8D you're not downloading the information into the hippocampus.

So that is a symptom of attention deficit disorder itself.

>> Thanks for your call.

Let's go next caller.

Hello Charles.

Welcome to Matters of Mind.

>> Charles, you asked why do why does having a photographic memory make stressful to say goodbye to people?

>> I'm not following the gist of your question are Charles having a photographic memory make it stressful to say goodbye to people?

I'm not going to answer.

You might want to call back in and let's get you on the phone so I can talk to you about that because I really don't know where you're going with that question.

>> So let's go to our next e-mail question.

Our next e-mail question says Dear Dr.

Favor, how can I tell if I have chronic stress and are there any lifestyle changes that might help prevent chronic stress, chronic stress basically is not all bad.

I mean a stress basically is where somebody is having changes in their lives now a change in your day to day activity is good for all of us.

It makes us stronger.

>> It makes us more resilient, makes us tougher in the event of other stresses because if you endure past changes you're more confident and you're more able and you develop coping skills to tackle future stresses.

>> So stress is simply a chain that's not a problem when you have problematic stress it's it's incapacitating.

>> It causes you to have difficulty with sleep anxiety feel overwhelmed and you feel anxious and anxiety leads to insomnia, insomnia eventually can lead to depression and then it cascades to all these different things things so chronic unmitigated stress where it's it's it's causing you to have difficulty coping with life circumstances will actually have a physical effect on the brain where your little neurons which are supposed to-be anywhere between twenty thousand to fifty thousand little branches on each individual neuron in your brain while those branches get more shriveled up if you're under chronic unmitigated stress that you're in which you're not dealing with.

So it will have an effect the brain and in doing so you can have difficulty with being able to concentrate being able to feel motivated, having energy and so forth.

>> So if you have unmitigated stress where it's just pounding at you and you can't get over it, yeah, it will have an effect on you.

No one try to identify in your stressful life circumstances what you can and cannot do about those different situations.

No to exercise, exercise, exercise is one of the best ways that you can deal with stress and number three, keep a diary and then take a look at that diary three months for now give yourself some confidence that that stress that felt overwhelming for you now now stuff happened.

You got over it.

Thanks for your call.

Unfortunate amount of time for this evening if you have any questions concerning mental health issues and I can answer on the air you may write me via the Internet at Matters of the Mind at WFYI Dot org God willing and PBS willing.

I'll be back again next week.

Thanks for watching.

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

>> Have a good evening tonight