.

>> Good evening.

I'm psychiatrist Jeff Offer live from the Bruce Haines studio in Fort Wayne , Indiana.

Welcome to Matters of the Mind now and it's twenty seventh year Matters of the Mind is a live 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 calling in the Fort Wayne Area (969) 272 zero or if you're calling outside the Fort Wayne area you may dial coal free at 866- (969) seven two zero now on a fairly regular basis we are broadcasting live everybody night from the spectacular Fort Wayne studios that lie in Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WFB Dog that's matters of the mind at WFYI Dog and I'll start tonight's program with a question I recently received.

>> It reads Do not a Favor.

I have an observation about a couple of loved ones who in the past were part of some self-destructive behavior.

I found that they maintained a much healthier life when they participated in hobbies and social groups.

>> How do I encourage them to return to those activities?

>> You're absolutely right socialization participating in pop and hobbies will be will be a manifestation of improved mental health for many people.

>> How do you encourage them?

I'd say the best thing you can do as a friend and colleague or family member would be to accompany them to these activities and remind them based on your observations when they are participating in hobbies and they are socializing that they seem to have well better have better mental health functioning or sometimes having an outside observer comment on your behavior can help you get a little bit of awareness and insight into how you were functioning during those times.

That's one of the attributes of group therapy having other people comment on how they feel like you've been doing so if you noticed they were functioning at a higher level of mental health functioning when they were involved in hobbies and they're socializing by all means let them know that and accompany them and doing those particular activities.

>> Thanks for your email.

>> Let's go to our first caller.

Hello, Jake.

Welcome to the mind, Jake.

You've mentioned you've been having some trouble sleeping recently because your mind is always active.

Are there any medications I can help but that can help with sleep?

A lot of medications out there, Jake, for sleep.

Firstly I want to know is you turning off a cell phone and you're trying to get off the television within an hour of going to bed.

Many people become very involved in social media right before they go to bed and some people will say, well, it relaxes me.

Be careful with that.

If it's social media, the algorithms within social media are intentionally keeping your brain active and I talked to a man earlier today that said sometimes he'll hear songs on social media inadvertently the songs will be playing and then he can go to sleep because he keeps hearing the song in his head as he's trying to go to sleep.

>> So that last hour before going to sleep and attempting to go to go to sleep at least needs to be a quiet time for your brain where you start shutting down different things and that includes you want to shut down things in terms of reading something that has chapters where you know you can put it down.

You won't be so interested in something it's going to stimulate your brain a biography, something that will be something you can actually put down after a few paragraphs perhaps people sometimes will watch sitcoms at night time that they've watched many times over because that's something that allows them to get their mind off the stresses of the day that can be helpful.

I used to tell people not to watch the newscasts at night time simply because it gets them worked up and gets them upset and yet be careful about that.

So if you're one to watch newscast late in the evening yeah.

Sorry about that newscast but I think in the evening if that gets people worked up they shouldn't be watching you so be careful about that.

That's first thing I'm going to ask other medications.

You bet.

There's a lot of different medications that are non addicting that will have people use something as simple as melatonin can be helpful at low doses of three milligrams or even less in some cases melatonin is kind of like turning off the light switch in your brain.

>> It works.

It's like a puff of smoke as well.

>> It works very quickly.

It lasts for about twenty minutes and it's gone so it gives your brain the chemical signal to go to sleep and melatonin basically is a natural hormone that comes from your pineal gland which is right smack in the middle of your brain.

>> When it gets dark melatonin starts to rise and as part of your circadian rhythms late at night the melatonin will rise and melatonin can be given safely to people at three to five milligrams a bedtime to help them get the chemical signal to go to sleep if you have difficulty staying asleep because you're waking up worrying about things and your you're having early morning awakening for that matter.

We use certain medications like gabapentin also known as Neurontin that gives you a deep good quality of sleep.

>> In other words, it'll help your deep in your sleep so your brain and your body will be more relaxed the next day.

But it also allows you to go a dream sleep.

Many of the antidepressant medication suppressed REM sleep you want to maintain dream sleep and a lot of cases.

>> So Gabapentin is something that increases REM sleep.

It increases non REM sleep which is the deep sleep you want to increase both of those as we get older we tend to lack both of those types of sleep so older people often do really well with something like gabapentin as long as they're not on a narcotic gabapentin will amplify the effect of a narcotic and sometimes make you more sedated and cognitively impaired from that tragedy has been around since the 1980s, were originally studied as an antidepressant medication and we predominantly almost exclusively now use it as a medication to help people sleep.

It's affecting serotonin receptors, works within about twenty minutes last for about eight hours for some people they feel a little bit lightheaded and they have trouble with it the next morning but that's always something where you can adjust the dosage overall the Z drugs, the medications like Ambien, Sonata, Lunesta those medications and we thought we could use them for a long time but unfortunately there's something it should probably be used short term ideally less than two weeks at a time only as needed because if you use those kind of medications that mean you might have some memory impairment especially if you're over fifty five years of age.

So we have to be very careful about those medications as well as the antihistamine medications which have traditionally been used for sleep.

You have to be very careful about diphenhydramine also known as Benadryl.

That's an antihistamine medication that is in various sleep products but be careful about diphenhydramine because it also will impact the impact the memory the next morning even up until noon and you might not even realize it.

>> So diphenhydramine for older adults especially can be something as detrimental for the memory the next morning after you take it.

So if you're going to take an antihistamine medication at bedtime you probably won't take Dock's el-amine.

Doxil I mean is in a medication like UNISOM Philomena's an antihistamine but it doesn't have the memory impairment component that you'll see with something like diphenhydramine .

>> And so you can talk to your primary care clinician about all these different options for sleep.

But the first thing I always want to examine would be your sleep hygiene.

I want to know how that's doing for you and what might be keeping up.

Many people can keep a diary of their anxieties and worries and I'm talking about literally writing down the things that are on your mind and things that are really bothering you.

You can do it day by day, week by week, whatever it takes.

But write down what's worrying you and then take a good look at those worries and figure out what you can do about them and determine what you can't do about them and let that go and try to write out those worries earlier in the evening or you're not taken to bed with you because so many people at nighttime that the lights go out.

They don't have any stimulation to speak of and they just start thinking and it's the first time they've had all day to start thinking.

So for those people I always encourage them to try to think about those different worries early in the day and work them out earlier in the day as opposed to bedtime.

>> Thanks for your call.

Let's go to our next caller.

Hello Dave.

>> Welcome to Matters of Mind.

Hi Dave.

Dave, you want to know what is a personality disorder?

>> A personality disorder is something that your person you personally starts to to develop by the time you're eight years of age.

>> Dave.

>> So in early childhood your personality does start to evolve but there are certain different personality disorders which are traits of how you behave and how you interact with others and they're pervasive in their words their day by day by day.

So we have personality disorders such as paranoid personality disorder where you're kind of suspicious and fearful about the intentions of other people.

They're schizotypal personality disorder where you're kind of had Hobb behaviors and you might come across as being peculiar but on the other hand you're not psychotic so you might appear to be eccentric but you're not psychotic in those cases schizoid personality disorders where you really prefer to be by yourself, you have no interest in being around other people.

>> You have avoidant personality disorder.

Avoidant personality disorder is where you intentionally avoid social interactions with other people.

>> Going alongside with other types of personality disorder are histrionic personalities where somebody is trying to always be the center of attention and they are very flamboyant in many cases borderline personality disorder is the one in which we discuss the most because it's kind of a offshoot of a bipolar spectrum condition.

So it's a type of bipolar condition where you get really moody and perhaps rageful based on interpersonal interactions as well as life circumstances.

So you can very quickly have a mood shift.

It's called borderline personality disorder.

I think it should be part of a bipolar spectrum condition because with borderline personality disorder the issue will be poor stress resilience.

>> In other words, you have a hard time putting up with stuff and you have a lot of moodiness.

>> So we're often going to treat people that have borderline personality disorder with a mood stabilizers, something that can kind of level out the mood and allow them to not have this explosive rage or this moodiness related to challenges with their current life circumstances or interpersonal relationship conflicts.

>> Thanks for your call.

Let's go to next email question.

Our next e-mail question reads Dear Dr.

Fovea is it possible that my mental health concerns could be caused by a physical or neurological condition?

What can I how do I know if I should see a psychiatrist or a neurologist?

>> Usually it's the primary care clinicians who will sort that out for you.

There are specific neurological conditions that neurologists will treat, particularly the headaches, the migraine headaches.

It will be something the neurologist will they'll often look at somebody who's having memory disturbances.

There's a lot of overlap as a matter of fact, the board that will certify a psychiatrist as well as a neurologist is called the American Board of Psychiatry and Neurology.

So when we do our testing to get our licenses as a psychiatrist and get bored of the psychiatrist, we have a component in there about neurology.

>> So there's a lot of overlap between neurology and psychiatry.

Psychiatry deals more with the mood and behavior of a person's medical status whereas a neurologist will look more of the electrical wiring of how the brain's functioning.

So a neurologist is often going to look for stroke abscesses, hemorrhages, things that can influence a person's behavior based on Worthy's where the pathology might be in the brain itself.

And that's why neurologists will do a lot of work with seizures, a lot of overlap.

And what we do the neurologist will be looking for sleep apnea as we psychiatrists should be as well because sleep apnea is where you're not adequately getting enough air flow to your lungs at night thereby not getting enough oxygen to the brain that'll make get tired give you difficulty the concentration the next day it occurs more commonly as we get older but it will affect people psychiatrically because it'll make you more depressed and tired and neurologically it'll make you have more difficulty with concentration and memory.

So a lot of people as they get older, if they have sleep apnea and they're snoring at night or pausing in their breathing night, the sleep apnea they'll often think they have early onset dementia.

So we have to sort out those type of things.

>> But where you start would probably be with a primary care clinician to determine do you have a mood or behavioral disturbance that would warrant more treatment by a psychiatrist or do you have more of a condition such as a seizure disorder, a disorder that's affecting the the actual nerve firing themselves that would be more warranted in treatment with a neurologist.

>> Thanks for your call.

Let's go our next caller.

Hello Louis.

Welcome.

The mastermind Louis, you want to know if you take twenty five milligrams of Zoloft that's also known as virtually how long will it take to kick in and how long will it last?

Zoloft is a medication that very specifically and selectively will increase serotonin and secondarily give you a little bit of an increase in dopamine.

>> They're Eluay and then what?

It was 25 milligrams Zoloft primarily at that dosage is going to help you more for anxiety.

So Zoloft also known as searchingly been around since nineteen ninety two .

It's going to help with conditions like obsessive compulsive disorder at higher doses and low doses it can help with worry also known as generalized anxiety.

It can help with panic attacks .

Sometimes when people are prone to having panic attacks it can help with social anxiety so it can help with various types of anxiety.

I believe the serotonin reuptake inhibitors have like eight different indications for anxiety and they only have the one indication for depression.

So twenty five milligrams probably is going to help that much for depression.

But what it will you'll notice Louis will be twenty five milligrams of Zoloft every day within about a week or two can give you a little bit of a calming effect and allow things to roll off your back a little bit easier takes four to six weeks to get its full effect.

>> But you might notice in a couple of weeks you feel a little bit calmer.

That's a very small dosage.

The typical dosage of Zoloft is between 50 and 200 milligrams a day.

But if we're using it for anxiety, worry and people with social anxiety and panic attacks sometimes a little bit will go a long way.

So twenty five milligrams a good start if you can be patient with the dosing.

>> Louis, thanks for your call.

Let's go our next caller.

Hello, Roger.

Welcome to Matters of Mind.

>> Roger, you want to know what kind of allergy medication can you take that won't raise your anxiety level?

I think the best allergy medication would be one it would be a a non sedating allergy medication and there are many of them out there nowadays over the counter.

You can certainly talk to the pharmacist many times the pharmacy techs know about those non sedating over-the-counter allergy medications, antihistamine medications that do not get across the brain.

For instance, I mentioned diphenhydramine earlier diarrhea minor Hidemi 80 percent of it gets across the brain blood brain barrier.

So it's something that can significantly affect some people with sedation and even even increased anxiety hydroxyl a little bit less so hydroxyl is actually used as an anti anxiety treatment.

>> I don't like to use Hydroxy and it's also known as visceral or attraction.

>> I don't like to use it so much for anxiety because basically it's mechanisms to make you tired so it makes you tired by by blocking histamine histamine keeps you awake and all Hydroxycut is doing and helping with anxiety is making you tired.

So I'd rather go to the source of the anxiety itself work on chemicals like Gabb and even serotonin for that matter histamine if you block that just makes you tired.

>> But that's the mechanism by which some people can feel lousy on antihistamines.

But antihistamines also have this additional ability to block acetylcholine again diphenhydramine is among the most potent in blocking acetylcholine and for many people you block acetylcholine that will make you more anxious .

So those are the type of medications if they're crossing the blood brain barrier they can often make you more anxious.

Look for a non sedating antihistamine medications out there.

Talk to the pharmacist or the pharmacy technician there.

You can get those kind of things over the counter right off right off the shelf.

Thanks for your call.

Let's go our next caller.

Hello Brad.

Welcome to Matters of Mind.

Brad, you want to know what do you do if you have borderline personality disorder?

First off, Brad, recognize how it's affecting your life and then get some treatment for the best treatments for borderline personality disorder will often be psychotherapy treatments where you're trying to help with stress resilience dialectic behavioral therapy is one of those treatments if you have comorbid post-traumatic stress where you've had some really bad experiences occurring in the past that led to you have been traumatized that will often contribute to your having borderline disorder because borderline personality disorder starts with difficulty with attachment as a child prior to the age of eight years old.

So if you had difficulty with attachment with one or both parents at that age that can often be a factor and often going along with that lack of attachment can be traumatic experiences at that young age.

That's a setup for borderline personality disorder which is characterized as I mentioned earlier by difficulty putting up with stuff, having rage, moodiness, irritability, having trouble with trust, pervasive anxiety, having a sense of sadness and a feeling of discouragement there more often and not these people with borderline personality disorder will often cut it themselves.

They might even make suicide attempts.

They feel miserable and it's often a day to day situation where it's provoked by circumstances so people situations can set them off into these moods.

So you treat it well with psychotherapy to help you deal with those kind of situations.

>> Yeah, from a medication standpoint our treatments will primarily be with anti epileptic medications for the purpose of stabilizing the mood very, very cautiously.

We sometimes we use the dopamine receptor blockers like low doses of Abilify Risperdal, Castellitto.

>> There's all sorts of different things we can use at low doses to try to improve mood stabilization depending on the nature of the condition itself because some people with borderline personality disorder get so upset and get so stressed out they get psychotic for a brief bit of time and they'll come into a hospital for instance with psychotic features.

They will they won't understand what's happening around them.

They might be delusional where they have fixed false beliefs and they have misunderstandings of the intentions of other people.

They might even hear voices sometimes and they can unfortunately get misdiagnosed with schizophrenia.

The problem is well, the symptoms will go away within a day or so once the stress is remitted and that doesn't happen typically with schizophrenia.

So we have to sort out is a schizophrenia is a severe borderline personality disorder but either way we might treat them with medications that are used as antipsychotic medications.

>> Thanks for your call.

Let's go our next e-mail question.

Our next e-mail question reads Dr.

Fovea how does peer pressure affect decision making?

>> Is there neurological process in the brain that affects decision making?

>> There are certainly is it when you are trying to make a decision you're taking in input from the outside.

The input gets processed by the middle part of the brain here and a couple of areas of the brain that are very important will be area the brain called the ventral medial prefrontal cortex which is down here and then you have the dorsal medial prefrontal cortex which is up above that's the front of the brain looking at you this the inside of the brain inside the brain you have these couple of areas where information that's coming in will get filtered as it's getting process for you to make a decision.

>> So your decision is making is no one influenced by your own self values and that's influenced by the ventral medial prefrontal cortex.

>> The lower part here, that part of the brain is is filtering this information through your sense of identity, your sense of values, your sense of who you are and what you believe.

>> All right.

That's why for some people they have a very difficult time changing your mind because by golly they know what they know and they know what they believe and despite getting evidence otherwise they have to filter through that part of the brain and sometimes it's difficult to do so now on top of that particular layer of cortex is that dorsal medial prefrontal cortex.

That's the part that's influenced by peer pressure.

So the dorsal medial prefrontal cortex in the middle part of the brain will be influenced by your peers around you.

So if your peers have a certain belief about certain things in life you will often acquire those beliefs because you want to be accepted by your peers.

That's actually a layer in your brain that will influence that.

>> So as information comes through yep.

You're going to try to identify does that information jive with what you believe and what your identity and your values are consistent with being?

>> But also number two , do those thoughts and does that information coming in agree with what your peers believe because you want to stay friends with them, you want to stay connected so your peer pressure can be a big, big influence on how you make decision and how you see the world around you.

And there is that neurological part of the brain that will influence all of that.

Thanks for your call.

Let's go our next caller.

>> Hello John.

Welcome to Mars the mind.

>> John, you want to know what's the what's the explanation for determining one overriding well, let's go to let's go to the question.

Let's go to Grace.

Hello, Grace.

Welcome to Matters of Mind.

>> Grace, you want to know about the term neuro divergent?

What is that?

What are the characteristics and is interrupting part of the whole concept of nerve neuro divergences, neuro divergence.

>> He was first coined the term about thirty years ago and there is a book called Neuro Tribes.

Neuro Tribes was written by a man by the name of Silverman I believe about eight years ago eight , nine years ago.

So Neuro Tribes' is a book that really helped talk about the attributes of behaviors that are consistent with autism, ADHD, Tourette's disorder, dyslexia.

These are all neurological conditions that were thought to be something that well we always need to treat and if you don't you can't fit in with society.

And I remember when I was a kid way back in fifth grade I was a long time ago for me I was on the fifth grade I remember a girl getting punished because she was writing with her left hand.

It used to be thought that if you were left handed that was an anomaly and you need to correct that.

So you need to start using your right hand and throughout history until about 20, 30 years ago left handedness was thought to be a neurological anomaly.

>> It was thought to be harmful if you continue using your left hand left hand now we realize the left handed us is perfectly fine.

>> It's thought the same with conservatives urgency neurodiversity with autism.

People with autism have difficulty understanding the social context of other people's intentions and they sometimes have difficulty with the day to day conversation because they lack that mirroring of other people's behaviors and their social cues.

But people with autism often have extraordinary creativity and they notice things that the rest of us don't see with ADHD.

>> If you had ADHD Attention Deficit Hyperactivity Disorder centuries ago and you're out hunting you would have been the first one to see the bird.

You would have been the first one to see the rabbit because with ADHD your brains all over the place and you know people joke about seeing the squirrels right now but that's what happens.

>> You're you're going to be a really good hunter if you have ADHD.

So rather than then pin somebody with a neurological disorder such as ADHD neuro ADHD, autism, dyslexia, Tourette's we look at how it's affecting their ability to function in society and for instance with ADHD we might not treat it when somebody is an adult we might if it's still affecting them.

You bet if there's some but I'm having difficulty getting their work done on the job because with computers you're getting a lot of stimuli coming all over different directions.

You need to have the treatment for ADHD often as an adult but maybe you don't because you're in a challenging novel, exciting work environment where you don't need treatment you're able to adapt.

>> Same with autism.

The Israeli Defense Forces did a remarkable job creating a particular division of people with autism and they use those people that had autism and their intelligence services for the purpose of identifying very subtle clues that the enemy is is is showing and people that didn't have autism weren't I weren't able to identify those particular clues with Tourette's with dyslexia there might be neurological attributes and those in those areas as well.

So neuro divergences is is a term coined to talk about the possible attributes of these neurological anomalies.

They're different but they're not necessarily disorders.

So we're trying to figure out how we could allow these people to function better in society while treating what would they need to have treated now granted some people with autism will get very snappy.

They get irritable, they get anger outbursts and they need to have that treated but many other areas they don't.

>> So it's not something that always needs to be treated is something where we might need to help people just adapt to their current challenges.

>> Thanks for your call.

Let's I'm 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 WWE Dog.

I'm psychiatrist Jay Farber and you've been watching Matters of the mind on PBS Fort Wayne now available on YouTube.

God willing and PBS willing I'll be back in next week.

Have a good evening.

Good night