.

>> Good evening.

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

Welcome to Matters of the Mind now in its tenth 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 here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling coast to coast you may be alcohol free at 866- (969) to seven to zero.

>> Now on a fairly regular basis I am broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which are 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 via via the Internet at matters of the mind all one word at WFB a drug that's that's matters of the mind at WFYI Big and I'll start tonight's program with an email I recently received.

>> It reads not a favor when I go on psychiatric medications I respond much more quickly than expected to the positive effects.

On the other hand, I seem to go backwards after just a couple of week causing the need for frequent medication and dosage changes.

>> Why might this be happening while I'm going to do a lot of speculation here because I'm speculating that perhaps you're having some difficulty with mood disturbances related not to just antidoping Crescent's where you need treatment for depression but you may have a condition called bipolar disorder where you're having highs and lows.

>> And again I'm reading in between the lines there you take psychiatric medications.

I'm going to speculate they might be antidepressant medications and then you feel good if not better than expected briefly because basically when you take an antidepressant medication and you're prone to having highs and lows, you're going to have a little bit of a revved up feeling for a little while on an antidepressant medication.

>> But it can cause you if you have bipolar disorder to have some symptoms where you don't need to sleep as much.

>> Your thoughts might be racing might be a little bit more impulsive and on the high side is kind of like stepping on the gas too much.

>> Then you crash because you run out of gas and that's when you get more depressed.

So many people who are being treated for depression will take antidepressive medications as their psychiatric medication.

But if they have an underlying condition called bipolar disorder, they need a mood stabilizer.

So instead of an antidepressant which acts as an accelerator, you need something more along the lines of a mood stabilizer or a cruise control on the mood that would kind of level you out.

>> I would suspect that you need to have another diagnostic assessment to see what might be going on there to determine what kind of medication you might be needing.

But I'm going to suspect that if you feel good for a while and then you don't feel good thereafter after a couple of weeks, I suspect that you might need more something along the lines of a mood stabilizer.

>> Thanks for your thanks for email.

Let's go to our first caller.

Hello Luanne.

>> Welcome to Matters of Mind.

Luanne, you had mentioned that your son was diagnosed with schizophrenia 14 years ago and was recently evaluated and diagnosed with schizoaffective disorder.

What are the similarities and differences?

Basically affective disorder is a subtype of schizophrenia.

Luanne's or schizophrenia is a condition where it's a neurobiological condition starts in the.

>> Certain things need to trigger it but basically it's a disturbance in the front part of the brain where it's a bit underactive in the side part of the brain is overactive and the side part of the brain is the part of the brain where you try to maintain contact with reality.

That's the perceptual awareness part of the brain where you can have auditory hallucinations, where voices are talking to you and you can have difficulty with delusions where you have fixed false beliefs day by day by day.

People with schizophrenia will have difficulty with processing information or have difficulty with interacting with others and being able to pick up social cues.

They often have difficulty getting the thoughts together and they have trouble functioning on a day to day basis because of the difficulties with processing information and their brains as well as the so-called positive symptoms of hallucinations, delusions, difficulty with the agitation that schizophrenia and that's a day to day phenomenon.

Schizoaffective disorder is where on top of those symptoms day to day periodically you can have highs that are related to mania where you don't need to sleep as much or more impulsive.

You have racing thoughts going from one thing to another and you can't have lows where you have severe depression.

You want to sleep all the time, you're even more withdrawn and sad and lacking enjoyment compared to the rest of the time.

>> So schizoaffective disorder is a mood disturb that's occurring periodically on top of day to day schizophrenia symptoms.

So not uncommonly somebody might have a diagnosis of schizophrenia where they are indeed diagnosed with an antipsychotic medication and thereafter it's noticed that they're having some highs and lows periodically those people might need an antipsychotic medication and an antiepileptic medication on top of it or a medication like lithium which is also a mood stabilizing medication.

So if you have schizoaffective disorder you might need an antipsychotic medication with another mood stabilizing medication on top of that.

>> So that's the difference.

There is an important to sort that out the most important thing to do with either condition, whether it be schizophrenia or schizoaffective disorder is for somebody to take their antisec medication day by day by day and in many cases that's all somebody will need occasionally if somebody has severe depressive episode.

So she was because of affective disorder we might add a bit of an antidepressant medication typically not for a long period of time but they might add a little bit of an antidepressant to try to bring them out of the Lewitinn.

>> You can be encouraged because we now have a entirely new medication called Koban Fee that came out about a month ago.

>> Birleffi is a whole different treatment strategy for the treatment of schizophrenia for the treatment of schizophrenia for the past 60 years we've been focusing on blocking dopamine going all the way back to the days of Thorazine when it was introduced in the nineteen fifties.

>> So we've always been focusing on blocking dopamine and co benefits of first medication.

>> It actually increases acetylcholine so if you increases COLENE in a certain part of the brain it actually indirectly decreases dopamine.

>> So it's a whole different type of treatment so we have a lot of hope that it's going to give us an entirely new spectrum of treatment in the treatment of schizophrenia schizoaffective disorder.

So this is a very exciting time in psychiatry now that we have that as our first of what we expect to be many different medications that will be programed primarily affecting the brain of somebody schizophrenia in a different way than just simply blocking dopamine.

>> Luján thanks for your call.

Let's go to our next caller.

Hello Diane.

>> Welcome to Matters of Mind.

Diane, you want me to explain narcissism?

Are you born with it as a developed over time?

>> How would we treat it and communicate with someone who has it will all start with that latter part of the question first, Diane, because if somebody has narcissism they're not going to be really receptive or open to hearing that they have narcissism.

>> Narcissism is basically where you're only thinking about yourself and you tend to neglect the needs of others.

>> You tend to be very focused on yourself.

You want other people to talk about you so it all comes back to you as a person with narcissism for somebody who has narcissism so you can imagine a person with narcissism doesn't want to hear that they're self-centered and that they tend to turn conversations around to them.

So it's something that's very difficult to explain to somebody unless they are willing to identify that there's a difficulty in their lives with interpersonal relationships.

>> People with narcissism will often have difficulty with socialization and they have problems with interpersonal relationships so they will struggle with that.

>> Are you born with it?

>> We don't think there's a lot of high genetics with narcissism.

I think it's something that people will develop in their early childhood experiences and it comes back to their relationships with their parental figures and often those relationships are developed before the age of eight years old.

>> So you can have difficulty with feeling especially entitled and privileged at a young age and if you continue that through your adolescents and young adult years, it can kind of be a lifelong issue.

But if somebody is interested in wondering why they have difficulty with interpersonal relationships then that's where the possibility of their having narcissistic traits can be reviewed.

>> Diane, thanks for your call.

Let's go our next caller.

Hello Matthew.

Welcome to Mastermind Matthew.

>> Say you'd mentioned that you're having a hard time sleeping a night takes you a long time getting to bed.

How can you treat that, Matthew?

In the 21st century when I hear about people having a hard time getting to bed, getting to sleep, I'm always thinking social media are you by chance looking at social media late at night because there's algorithms and social media that we can't forget that algorithms will keep you engaged.

That's what it's all about.

It's they're watching their tracking what you're viewing on social media and they're feeding you more and more information to keep you engage.

>> It's a brilliant way to keep people online because it's a means of tracking what interests you.

>> So for instance, if you really enjoy looking at football clips, for instance, is going to keep feeding you more football clips.

So in any type of topic that might be interesting to you.

So the first thing I'd recommend, Matthew, is you've got to get away from the social media and try to get away from any digital media within a couple hours of going to bed you're thinking what am I supposed to do?

>> Oh, back in the old days I used to have these things called books and even magazines for that matter.

But you can look at books and try to read one chapter at a time, get yourself not to the point where you want to read the whole book but try to get away from social media and read something that's not going to keep you involved from an algorithmic standpoint to reading and viewing more and more and more things books the words on the page.

>> You actually have to think you have to read what your what's in front of you and it can make you tired in doing so.

So historically we've told people to read chapter books where they read one chapter.

>> They get to a certain point they put the book down, try to get away from the bright television screens and that includes PBS .

>> She shouldn't be watching PBS late at night because these bright screens on televisions now actually biologically keep you awake because what they do is they will affect your pineal and your pineal gland is right smack in the middle of your brain.

>> It secretes melatonin.

When is it secrete melatonin and starts to get dark so it gives our brain a natural signal to go to sleep.

So this front part of the brain over here right smack in the middle of the brain is the pineal gland.

>> It's releasing melatonin and it's known as the vampire hormone because goes up it gets up when it gets dark so melatonin increases when you're ready or not being stimulated with bright light if you stimulate your right now with bright light melatonin is suppressed and it's harder to go to sleep.

>> So that's one thing I'd recommend right off the bat try to get away from any social media, any television late at night if you're having trouble going to sleep now if it's a way you know, social media watching television, if that's a means by which you kind of wind down and you're able to turn your brain off and go to sleep great.

But many people will say they not uncommonly will lose a half hour or one hour or even two hours of sleep just by staying engaged with social media at nighttime because the algorithm kind of draws you in and it's hard to get away from that.

So I'll often recommend people getting away from social media or television and secondly try to exercise some kind of physical activity earlier in the day later the day can actually keep you awake as well but try to get some physical activity earlier in the day what your caffeine content especially late afternoon and thereafter caffeine can obviously keep your brain more awake and have give you difficulty getting to sleep and if you're getting to sleep at a certain time many times people want to sleep in if they haven't gotten to sleep adequately enough we call that delayed circadian rhythm disturbances where they go to bed later than they'd wish but then they sleep in the following morning.

It's important to try to set that alarm and get yourself up a little bit earlier to try to reset that clock if you try to go to bed earlier as well.

>> Thanks for your call.

Let's go to the next caller.

Hello Julie.

Welcome to Mastermind or Julie.

You had mentioned you'd been diagnosed with the cancer seven years ago and now is in remission.

That's fantastic.

How do you stop obsessing with thoughts of returning and dying from cancer?

Move on with your life , Julie.

I mean it's fantastic that you're in remission from cancer and we always want to hear that word recovery but if you're in remission and presumably going in to recover from cancer, you have to trust your clinicians that they have not found any more cancer.

Now you had a life threatening experience when anybody has a life threatening experience, either it be with cancer or a cardiac condition, they will remember that experience and it's called post-traumatic stress where you've had a stressful situation B traumatic to you and it kind of woke you up so it can give you instead of the ongoing sense of an impending catastrophe, think of it as a chance for a new life .

>> You could have died from the cancer perhaps.

OK, now you've you've survived it.

You're a so-called cancer survivor.

>> Talk to other people about your experiences.

Give them encouragement.

Be grateful that you have the oncology support to be able to recover from cancer so as opposed to looking at your life experience as being potentially catastrophic for the possibility of a relapse.

Be grateful for the life that you've been given and move on from that.

So it's a matter of changing your perspective on what could happen.

Julie, you know, from everything we know death is 100 percent certain for those of us mortals.

>> So it's something is going to happen.

You've been given a new lease on life because it sounds like you've so-called cheated death with cancer and nice thing about a lot of cancer treatments nowadays as many of them are very treatable.

It used to be thought that certain cancers were inevitably fatal and now I'm hearing about a lot of these cancers being over ninety six percent or so treatable.

>> So there's a lot of potential treatments out there for cancers that give people long term recovery .

>> Julia, I wish you the best.

Thanks for calling.

Let's go to our next caller.

Hello, Jim.

Welcome to Matters of Mind.

Jim, you'd mentioned you had a mini stroke two months ago and you're cognitively OK. >> You can't remember names.pIsy that's happening?

A mini stroke, Jim, is basically where you had maybe a small blood vessel blockage in a mini stroke is where you didn't have a full fledged stroke that would necessarily be manifested on an MRI or a CT scan of the brain where you'd have notable area of damage of any stroke you might have experienced what's called a transient ischemic attack or TIA where it was just a brief loss of blood flow to a certain part of the brain that can give you memory disturbances when that occurs.

>> It's kind of like having a traumatic brain injury gym where if you have a traumatic brain injury there's a brief excessive release to the point of neurotoxicity of this chemical called glutamate.

Glutamate is the excitatory neurotransmitter of our brain and if you have an excessive amount of glutamate released in mass, you can have neurotoxicity where you have a shriveling up of some of the branches of neurons and in doing so you can have trouble sometimes with mood disturbances but not uncommonly especially in this area down here in the side part of the brain with memory.

>> So the question would be are there any means by which you can have any occupational or even physical therapy for the purpose of recovering maybe what you've lost?

Try to keep yourself cognitively active, keep yourself involved with socialization, learning new activities, memory type of games that you can do try to keep your brain busy and active.

>> That's one of the best ways to get the little branching areas to go on again, I mentioned earlier exercise in the morning is great for sleep but exercise physical exercise actually helps with the brain development especially with the memory center of the brain.

The hippocampus here is a memory center of the brain you can exercise it actually cause the hippocampus to be more fluffy and get more branching of the neurons themselves.

>> Sometimes the neurologist can give you some ideas on what kind of medications you could use specifically for the purpose of trying to rebrand those neurons and make them more fluffy.

But it all comes back to glutamate in general and the key is to try to use your brain as much as possible to try to stimulate that growth because 30 years ago we thought that once you had stroke or once you had damage to the brain it was always irreversible because it was thought 30 years ago that the brain can't regrow back neurons or branching and now we know that's entirely untrue.

We now realize that the brain does grow back in certain areas and thus branching of the neurons can occur within a matter of a day or two if you do certain things and will stimulate certain chemicals.

So talk to your primary care clinician about that.

Talk to your neurologist and kind to see what ideas they might have for you Jim.

>> Jim, thanks for your call.

Let's go to our next email.

We have another email waiting for us.

>> There it is.

It reads Your daughter Fauver my friend gets seasonal depression.

>> What is something I could do to help or activities that we could do to gather to help our seasonal depression is basically where somebody gets depressed in the late fall and it continues over the winter months into around late March or April when it gets bright again there's more seasonal depression at the northern latitudes than there are the southern latitudes.

So for instance somebody in Alaska is more likely to have seasonal depression or winter depression especially compared to somebody in Florida.

So the farther north on latitude you go, the more likely you're going to have depression in the wintertime.

>> Well, I mentioned earlier the pineal gland, the pineal gland that responds to the brightness of the light around us.

>> So as the retina you are getting stimulated stimulated with light the bright light will decrease the melatonin in the pineal gland and thereby you can be more awake and alert and off you go and seasonal depression you have more darkness occurring so you have that pineal gland getting more stimulated, more melatonin is being released and they actually feel tired.

>> You're less prone to socializing.

You want to eat more especially carbohydrates.

In the wintertime many people with seasonal depression will notice that they're more tired, they sleep more and overall they're more socially withdraw.

>> So the best thing you can do for your friend with seasonal depression is try to get your friend out and about more often especially the morning I would suggest if you have a friend or a seasonal depression, best thing you can do is try to take your friend for a walk in the early morning hours around nine 10 a.m. when the sun's coming up peak at above the horizon in the winter time try to get out and go for a walk and get some fresh air.

But most importantly you're getting some exposure to sunlight that way in the early morning hours.

Now there are light boxes that can be used for treatment but you're trying to help your friend as a friend who has seasonal depression so you can also socialize on a regular basis because many people have seasonal depression, don't want to socialize, get them out and doing things and especially exercise.

>> I think that's a third time tonight.

I've mentioned exercising but exercising can do a great job for seasonal depression.

>> Many people that's for many people that's the last thing they want to do.

But hey, if you exercise in the darkness of the wintertime it can really help you out because exercising can help your mood, especially if you have seasonal depression.

>> Thanks for your email.

Let's go to our next caller.

Hello Randall.

Welcome to Mars.

Mind.

Randall, you had mentioned you have a friend who has bipolar manic depression so to be bi polar depression was prescribed.

Allatoona has had a long term psychotic episode.

>> Is that drug at fault?

Usually Randall, if you take a medication like Latouche to which is a dopamine receptor blocker but it has many other features associated with it if it's used for bipolar disorder itself it's used as a mood stabilizer it will treat an underlying psychotic condition.

>> Now a psychotic condition basically is where somebody loses touch with reality.

Lietuva wouldn't be prone to doing that even in the clinical trials for bipolar depression, La Tuta was not associated directly with causing a psychotic episode.

Now could an antidepressant medication do that absolutely positively.

>> So if you have an underlying bipolar depression let's say and you're prone to having highs but more often than not you have lows and because you're having lows somebody gives you an antidepressant medication as a prescription.

>> Yeah, Then you can have a psychotic episode directly related to that antidepressant medication but little to no, not so much.

>> It's more of a mood stabilizer that actually will work as an antipsychotic medication.

I would suggest that your friend might have taken an antidepressant medication Will Stuto and that could have provoked a psychotic episode or I'd suggest maybe that is a natural on the natural course of the illness, the psychosis might have appeared later on which sometimes will do with somebody has bipolar disorder.

>> They're having highs and lows.

They can have a psychotic episode that occurs later on in the natural course of the illness itself.

But I would doubt that the LATU actually provoked that.

>> Randall Randall, thanks for your call.

Let's go our next caller.

Hello Pamela.

Welcome to Matters of Min Pamela.

>> Pamela, you want to know what mental health disorders could possibly mirror attention deficit disorder?

>> People with attention deficit disorder by definition need to have the attention deficit disorder symptoms, the inattentiveness to the-distracte difficulty, the procrastination, the difficulty with perseverance and vigilance in their day to day activities.

>> People with ADHD or attention deficit disorder will have will need to have those kind of symptoms appearing initially as a child or adolescent and they're occurring to some degree day by day by day based on their life circumstance chances.

>> Now you don't all of a sudden develop ADHD when you're an adult.

You might notice that the symptoms are more problematic when you get to a certain level of your academic pursuits or you notice that you're being challenged cognitively in a way that you weren't previously.

>> So it might come out more later on but the symptoms should have always already been there going all the way back all the way back to the young adult years.

>> And the reason for that is your brain in the front here is what's affected predominantly with ADHD.

>> I say ADHD hyperactivity is the part of that with attention deficit hyperactivity disorder you also have impulsivity, you have hyperactivity, you're involved in all these different things and you're not getting anything done with the inattentive type with the attention deficit disorder where you're predominately having trouble paying attention to things.

>> So in either case they're primarily affecting the front part of the brain, the front part of the brain fully developed by the time you're twenty four and it used to be hought that people would grow out of attention deficit disorder by the time they got to be twenty four now to some degree over 90 percent of the people will have some kind residual symptoms even going into the adult years now going into the adult years you're not typically in school anymore.

You're not being challenged day by day to pay attention to things that are very interesting and that's where people with will will suffer.

>> So what kind of other conditions can mimic attention deficit disorder symptoms depression?

>> When you have trouble with depression you'll often have difficulty with speed of processing.

So it's like your brain has slow Internet speed and you have difficulty processing information and there's a phenomenon called pseudo dementia where people have depression in their older years and they think they have dementia but they actually have depression.

You treat the depression the difficulty with memory and speed of processing will improve.

So that's a predominant type of condition that can kind of mirror some of the symptoms of low thyroid very, very common especially with women.

>> We do see it occasionally with men but low thyroid can certainly mimic the symptoms of attention deficit disorder where somebody will say they have trouble processing with information troubled memory attention span menopausal women on average age of menopause is around fifty one so menopausal women can by decreasing estrogen which goes to the hippocampus right there the memory scent of the brain it's studied with little estrogen receptors with estrogen going down during menopause that can give you a lot of trouble with memory and concentration attention span and distractibility diabetes when you people have high blood sugars, if the blood sugars are high and then low and going back and forth, that too can give you a lot of difficulty with aid like symptoms and very prominently a condition where identifying more and more and more will be a condition called sleep apnea where somebody will snore at night they'll have difficulty with exchanging oxygen and carbon dioxide at night so they get less oxygen to the brain.

Less oxygen in the brain at night will give you the next day more difficulty with concentration, focus and memory.

Untreated sleep apnea is very, very commonly associated with add like symptoms.

>> So we have to sort through all that as we're talking to somebody who has difficulty the attention span and distractibility.

>> Thanks for thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues you may write me a via the Internet at Matters of the Mind at Nebula a dot org .

I'm psychiatrist Jeff Allbright.

You've been watching PBS Fort Wayne Matters of the Mind now available on YouTube God willing and PBS willing.

>> I'll be back again next week.

Thanks for watching.

Good night