.

>> Good evening, I'm psychiatrist Jay Fawver live from 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 a 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 Thirty Nine Studios if you live in the Fort Wayne area by dialing (969) 27 two zero or if you're calling any place else coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie 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 via the Internet at matters of the mind all one word at WSW ECG that's matters of the mind at WSW Edgard I'll start tonight's program with a question I recently received.

>> It reads The Revolver I could probably use a therapist .

>> The thing is I just don't like to talk.

I'm fine expressing my symptoms to my doctor but I'd rather not talk about how I feel.

Do you need do I need to get over this where you might want to start with a therapist start by writing some things down.

>> What kind of things are bothering you?

What kind of things you'd like to address?

We use a lot of questionnaires in my field so prior to a person coming in for the initial evaluation we'll ask him about symptoms of anxiety, symptoms of depression, symptoms of past trauma and we'll ask them if they've had traumatic experiences what kind of treatment they've had in the past hasn't worked.

Has it not worked?

We'll ask about their ability to concentrate what kind of things they'd like to do and very importantly what goals they might want to try to achieve and what kind of side effects from any medication for instance they'd want to avoid.

>> So we try to kind of break the ice with lots and lots of questionnaires so no one you could ask for some questionnaires to address specific symptoms.

>> But on the other hand, if you'd really like to consider just writing down some things and writing down some thoughts that can be an icebreaker between you and the therapist and the therapist is always going to want to know what kind of goals do you want to achieve?

>> You know, what's the whole idea of the treatment?

>> It's not unlike trying to negotiate any other kind of situation where you're trying to achieve what kind of outcome do I want.

>> So identify how you'd like to feel better than you are now.

>> How would you like to achieve things differently?

What kind of things make you afraid?

What kind of things are you apprehensive about?

And then the therapist can always go from there.

So writing some things down and doing some journaling even day by day or week by week can be helpful to get things started.

>> Thanks for your email.

Let's go to our first caller.

Hello Angela.

Welcome to Matters of Mind Angela, you had mentioned that you take flu Fennessy and it's also known as prolixity for schizophrenia.

But sometimes you'll miss the dosage.

>> Is that a big deal?

Should I double your should I double my next dosage flu farnesene is a medication that typically lasts about a day or so.

Some people will notice a difference if they miss a dosage.

However, Angela, it's really between you and your clinician to answer that question whether you should double the dosage the next time if you're at a very low dosage and by missing a dose not highly problematic for your clinician might recommend that you double the dosage next time.

>> But if you're on a higher dosage you might get more of a fluctuation in blood levels.

>> And actually I'd recommend if you're having a hard time missing doses with flu farnesene my goodness since the nineteen seventies it's available in a long acting injection class every alas for two weeks so you take use the injection lasts for a couple of weeks colds, flu, anything to Canongate and it's something where the injection stays in your muscle and slowly reaches out over the course of a couple of weeks.

So especially with that particular medication if you're having a hard time missing doses, I'd certainly recommend that you consider the long acting injectable which is available as it is for many other medications in that class as well.

Now on the other hand, Angela, I'd recommend getting a pill getting a pill tray so you know, at least you took it day by day by day and if you miss a dosage let's say at 9:00 p.m. when you usually take it, take a look at your pill tray if you.

>> It's 10 pm now go out and take it at 10 p.m.

So if it makes you feel drowsy you want to take it more toward the evening but get a pill try to try to remind you to take it day by day and get in a routine of taking it at the same time many people who are very good at taking their medications take it methodically at the same time with the same routine every day it could be right at bedtime.

Flu phenelzine is frequently taken right at bedtime so have it at your nightstand or take it right at that time does not have to be taken with food.

>> So many people will take the flu vaccine not unlike how they'll take a levothyroxine a thyroid supplement.

Thyroid supplements need to be taken on an empty stomach and a lot times people have a hard time remembering to take it an hour before they eat or at least two hours after eat.

>> So they'll just take it at bedtime presumably when they have not eaten for at least a couple hours or they'll take it in the middle of the night so flu venison can be the same type of medication where you have it at your bedside and take it whenever is available for you.

>> Thanks for your call.

Let's go next caller.

Hello Phillip.

Welcome to Matters of Mind.

>> Phillip, you want to know what are the benefits of group therapy for somebody in drug recovery with drug recovery ?

>> Many people feel embarrassed and they feel like they're the only ones who have endured the kind of time of the kind of difficulties they've endured and what you'll find out very readily in group therapy whether to be for drug therapy or drug recovery therapy or whether it be for depression or, you'll find that other people have experienced some similar type of challenges and the idea of group therapy the whole premise is to try to share your experiences, realize you're not alone, get some empathy from the rest of the group and help help them be able to help you and listen to the kind of ideas they might have now a problem that can occur in group therapy of any kind as you start to get some bad ideas from other people.

Now that's the role of the therapist.

The group therapy therapist needs to take control of that and make sure that the bad ideas are not exchanged.

So there is some mediation with that.

But group therapy the whole premise is to share experiences, realize you're not alone and understand other people have gone through some similar type of situations.

>> Philip, thanks for your call.

Let's go to our next e-mail question and think we have another email question available there.

The next email question reads a favor.

I have social anxiety disorder and never went back to the office after covid what slow steps can I take to be social and fight off my loneliness?

>> Yeah, loneliness is a predictor for depression.

>> So when you have difficulty with loneliness in your you're by yourself you're not socializing.

It's actually set you up for having depression where you don't enjoy life in general you start feeling more sad, you lose motivation and lose energy.

So loneliness is something we need to address when some way somehow and what happened during the covid pandemic with the restrictions it was a traves for a lot of mental health conditions because people who are already prone to depression got more depressed because of the loneliness and the social restrictions and the social isolation.

>> Well, what we found in our field is that a lot of people had a hard time getting back out again and we're seeing that even in twenty twenty four we haven't had the restrictions for a couple of years now but we're still hearing about people having difficulty getting back out and they'll say it all happened during the covid restrictions where they did a lot of shelter at home.

They work from home.

They didn't need to socialize.

>> Groceries were delivered to them.

There are some nice things that came out of that.

For instance, in my field we developed telehealth where the government allowed us to start treating patients through telehealth through video visits and we continue to do that now and it's something that's allowing us to reach out to people who wouldn't be able to take off work, get babysitting for the kids they wouldn't be able to come to the office.

We can see them right in their comfort of their home.

So there were some benefits that came out of those restrictions.

>> But one of the one of the travesties with all that was& that some people got so socially anxious when they started to get get out and about and I was mostly concerned about the younger children, the preschoolers, the children who were up to eight , nine years of age when they're trying to develop social skills here, they are expected to stay at home and they I'm I'm concerned even to this day that as they grow up they'll have difficulty a socialization in some cases.

>> So with the with the fear of being around people and having trouble with social anxiety, I would certainly suggest you do at a step at a time as you had suggested slowly going out and trying to socialize.

>> You can start by going to for instance, a health club just being around people in any situation used to be people would go to malls and if you could go to a mall just to be around people, that's the next step and try to establish meaningful connections with other people whether it be in a club, a social environment, athletic events, any type of things you can figure out try to get around people and have some kind of social connection with them but often is a gradual process.

Many people will notice that since the covid pandemic restrictions they couldn't get back out and socialize as they did before.

But it's a matter of getting back out there and trying to do it again.

>> Thanks for your call.

Let's go our next caller.

Hello John.

Welcome to Matters of Mind.

>> Yes.

What might be the main determining factor was when choosing between one's more emotional side of the brain and one's logical side of the brain the the ever ongoing battle between the head and the heart .

>> You bet.

And that's an ongoing challenge that we're always addressing in psychiatry.

John, we talked what we call a top down try and top down decision making the front part of the brain right up here that's the logical part of the brain, especially the thinking part of the brain over here are that's called the dorsolateral prefrontal cortex.

That's the part of the brain where you're thinking, you're concentrating, you're focusing the decision making part of the brain is the front right above the eyeball called the orbital orbital lateral prefrontal cortex and the middle part of the brain here the cingulate gyrus.

>> So you've got these different parts of the brain in the front that are helping you with your logical thinking.

>> Now here's what happens when people get hit in the front of the head sometimes lose logical thinking when people become intoxicated with alcohol it's an sensitizes the front part of the brain.

>> Logical thinking goes out the window.

Well what happens then?

The emotional part of the brain right down here in the amygdala and right beside the memory center the part of the brain but the amygdala takes over the amygdala is the center for anger, fear and anxiety.

So anger, fear and anxiety comes right here from the amygdala.

It gets really fired up when people become very emotional and it can hijack the logical part of the brain has a hijacked logic logical part of the brain if you have that connection and there is a physical connection going back and forth between the logical part of the brain and the anxiety, fear and anger part of the brain, it's going back and forth and it's always connected.

You'll actually physically have a decreased connectivity when people have depression, head injuries, alcohol use disorder, psychosis, various conditions will cut off that connection between the logical part of the brain and the emotional part of the brain and that's when the emotional part of the brain will take over and the most important thing for you to dopin you're getting upset about something OK, am I really logically thinking this through?

>> There's a treatment that's been available for the past 50 years called cognitive behavioral therapy.

That's what it's all about.

Cognitive behavioral therapy is simply a therapy where you're trying to logically think through does this make sense?

Do my are my emotions really validated by what's really happening around me?

So you're always questioning what your emotions might be interpreting how your emotions might be interpreting the environment around you and checking with other people.

I often will tell people who are married check in with your spouse, maintain that good relationship with your spouse.

Often it's your husband or wife who will know if you're doing better one way or another or not because they can actually look from the outside in.

So hopefully you have that loving relationship in a marital relationship where you can check in with the spouse.

>> They will often be able to to validate if you are getting logically upset about different things and if you don't have a spouse, friends, family they can always be helpful.

So maintain connection with other people, ask them what they think about the situation as you may be interpreting it but the whole idea is to keep that logical part of the brain connected to you know, we talk about the heart in the emotions.

Well, from a neurobiological standpoint you're talking about this part of the brain right here over here at the amygdala.

>> Amygdala is an almond shaped body and amygdala in Latin means almond shaped.

That's why it's called the amygdala so that the amygdala is right beside the hippocampus.

Now the hippocampus stores past memories and you can actually distort past memories based on your emotions so you can insist something happened in a highly emotional state where it might not have happened that way.

So your emotions can indeed distort your past memories and that's why you have to be very careful about interpreting or trying to recollect incidences that occurred when you're highly upset because you can insist things happened that really didn't.

>> Thanks for your call.

Let's go next caller.

Hello Connie.

Welcome to Matters of Mind.

Connie, you want to know about Parkinson's disease?

How does that affect the brain?

How long can you live with it and what's the best test for Parkinson's disease, Connie, is a condition where this inner part of the brain right here that affects movements called the substantia nigra.

Here's the front part of the brain.

I opened it up here and you're looking at the inside of it a substantial megraw nigra means dark body and it decreases by about 60 to 70 percent in size when somebody has Parkinson's disease, what's happens then?

Well, basically you have decreased outflow of dopamine and when people have decreased flow of dopamine it can affect their physical movements.

No one such that they can have a little bit of a tremor they don't have much arm swing.

They have a shuffling gait and they're more prone to falling.

They sometimes will have masked faces.

That's a fancy term for not having much expression to their face.

They kind of a stari far off look sometimes I have a little bit of drooling on occasion so they'll be wiping their mouths periodically when they have Parkinson's disease with Parkinson's disease as they walk they will not spin around as many people do.

>> If you have somebody walk to walk five yards away and then try to turn around with Parkinson's disease, they'll have a fascinating gait.

That means that they kind of need several steps to be able to turn around.

They don't spin around when they try to turn around.

They just have they need a few extra steps to turn around.

So it's a movement disturbance now some people Parkinson's disease will also have difficulty with dementia where they're having trouble of memory and focus and concentration.

>> So when we talk about dementia, we're talking about short term memory impairment about 60 percent of dementia is related to Alzheimer's dementia.

About 30 percent is related to Parkinson's disease and then another 10 or 15 percent is due to strokes and vascular dementia.

>> How we what we call we used to call mini strokes but vascular dementia is where you have the little tiny strokes occurring all over the brain.

Lewy body dementia is about maybe five percent.

So you have different conditions that can be responsible for short term memory loss and Parkinson's is one of them.

How do you treat Parkinson's disease?

Basically you give people medications that are going to either enhanced dopamine production or stimulate the actual receptors themselves and make the brain think it has more dopamine than it does.

So there are treatments and it's kind of condition where we are hoping to find more and better treatments over the course of time.

But you'll see people that have that slow so-called fascinating gait where they're kind of shuffling and they don't turn as quickly as they would be expected to and those are often people with Parkinson's disease in the past twenty years there's been a very novel type of treatment for Parkinson's disease and it's where people are doing shadowboxing and they're boxing.

They're boxing not each other but they're they're doing boxing exercises and we're talking about boxing where they're hitting boxing bags and and they're they're doing movements that would mimic that of a boxer and in doing so it actually helps with Parkinson's disease.

So the key is instead of having some of the Parkinson's disease, just stay seated all the time, try to get a moving in a very structured type of environment.

So it's kind of an interesting novel treatment that I've been seeing over the past twenty years.

Thanks for your call.

>> Let's go to our next caller.

Hello Lauren.

Welcome to Matters of Mind.

Lauren, you've mentioned that you've been a widow for a couple of years and you try to stay active but you suffer from loneliness.

>> What can you do, Lauren?

As I had mentioned earlier to a gentleman who was having difficulty with social anxiety and is getting out, sometimes you just have to take it step by step and you're going to be lonely when you lose a spouse.

>> It's not that you ever recover from that.

You're always going to be grieving to some degree.

But the key is to try to overcome the loneliness by just being around people in any kind of setting and you might think well gee I many of my friends were my husband's friends and I don't have any engagement with other people.

>> That's where you have to make a step which might be a little uncomfortable for you but you need to get out outside your usual type of social circle in which you might have previously been involved and try to be around other people and that can start with just going to places where there's other people just interacting with people in a very informal manner.

Many people will get involved in clubs activities, church activities.

They'll get involved.

I mentioned earlier sporting events and quite frankly a lot of people will go to areas where people are exercising and they develop a sense of community there.

So it might be a type of socialization you've not done previously but think of one or two ways in which you can socialize that maybe you have not done so before but the only way you can overcome the loneliness is to actually get out there and be around people maybe not all at once where you're around people very quickly but one once or twice a week and just finding different groups and activities where you can socialize.

Lauren, thanks for your call.

>> Let's go our next caller.

Hello John.

Welcome to Matters of Mind.

John, you had asked does anxiety solely cause balance issues and you want to know about my thoughts on leave?

It's deep brain stimulation for the treatment of depression .

>> Deep brain stimulation is indeed a treatment worthy.

The part of the brain is stimulated picking my brain apart here this left front part of subject annual prefrontal cortex is right up here.

This part of the brain has a decreased activity when people are depressed.

So if you can physically fire up that part of the brain you can potentially relieve somebody of depression.

It is a treatment.

It's not the only treatment.

It can be very effective but it does require a surgical treatment where you actually put an electrode going through the brain into this deep area, the brain it's a it's a gray matter cortex that's just below where the judgment center would be.

But when people have decreased sub general the prefrontal cortex activity, they tend to not enjoy things.

And as time has gone on, John, we've come to realize that when you don't enjoy things that might be a condition that's affected by glutamate glutamate is it excitatory neurotransmitter that's affecting eighty five percent of all electrical activity in the outside part of the brain and when you have a glutamate disturbance you'll have difficulty enjoying things.

And as time goes on, I think we're going to be studying more about the whole concept of resilience.

Resilience is where you have a better ability to put up with stuff when people are depressed they not only don't enjoy things but they just can't put up with stuff.

They can't cope with things and those are two key factors that I think we're going to be examining as time goes on.

>> And that's why deep brain stimulation work can be helpful now does anxiety by itself cause balance issues not typically there might be something else going on there.

So if somebody said they had balance issues I wouldn't say oh you might be anxious.

Let me give you a medication for anxiety medication for anxiety caused balance issues in some cases.

So I wouldn't necessarily go that route in thinking anxiety and is causing the imbalance issues.

But you might want to be assessed for any blood pressure abnormalities if you're having balance issues, look for any medical issues.

People with low thyroid, people with low iron can have balance issues are a lot of medical reasons for having balance issues and if we treat you for anxiety related and we think it's related to difficulty with your balance, it might actually make the balance worse.

>> So talk your clinician about that.

>> Thanks for your call.

Let's go to our next caller.

Hello Barney.

Welcome to Matters of Mind.

>> Bonnie, you've been on a medication my name ACAP Leida for twenty two years.

I don't think Cap Lite has been out that long, Bonnie.

It might be some other kind of medication Cap Light has been out for I'd say about ten years so it came out about two thousand sixteen I'd say SOCAP of the medication is very selective and specific for the serotonin type 2A receptors doesn't affect the dopamine receptors so much so if we're talking about the same medication here Cap Light is a medication that doesn't cause you to have as much extra pyramidal symptoms which means tremendous Parkinson's like symptoms which I described earlier that can occur with some of the bipolar medications that are blocking dopamine receptors capelet it doesn't block dopamine receptors so much it drastically blocked the serotonin receptors.

People like serotonin 2A receptors in the front part of the brain which which is where they're primarily housed .

>> You actually increase dopamine release in the front part of the brain which is good if you have depression or bipolar disorder.

So carolita is a bit different than other medications a blocked dopamine it's considered an antipsychotic medication because it was originally approved for schizophrenia and psychosis.

Now it's been found to be helpful for people who have highs and lows because of its mechanism of action so it doesn't have the safety issues that we've seen with some of the traditional dopamine receptor blockers, many of which that are out there.

>> But it's the cap light is an entirely different medication but you haven't been on it for 22 years because it's only been out for about ten years ten years maybe maybe eight .

>> But it's it's something that is relatively new.

But we've been very happy with it because it doesn't cause weight gain and it doesn't cause the Parkinsonian symptoms if it doesn't cause the Parkinson's symptoms such as tremor stiffness or shakiness the shuffling gait.

>> Fortunately in the long run it's not going to be as likely to cause tardive dyskinesia.

Tardive dyskinesia is where you can have irreversible tics and twitches in the face.

That is a risk factor.

We've taken any strong medication that's blocking dopamine so fortunately we're hoping that as Carolita continues to be studied over the years we're not going to see that occurring as much.

Thanks for your thanks for your call, Bonnie.

Let's go to our last caller here.

Hello, Paula.

Welcome to Matters of Mind, Paula.

>> You mentioned for the past year you've been losing your train of thought and should that should you be concerned what often happens in the middle of the conversations and it's only been for the last year?

>> Well, Paula, I would say that it's not attention deficit disorder.

People sometimes ask that they'll say they're having trouble with their train of thought and they wonder if they have adult onset and that's kind of like an oxymoron .

>> Adult aid is a condition where you've identified as an adult but attention deficit disorder by definition starts when you're a child or at least in the middle school year.

So it's been there day by day, year by year if you have it occur in your adult years and in your case, Paula, let's assume you're an adult and it's only been occurring for the past year.

The very first thing I'd examine would be thyroid.

Secondly, would be make sure your blood sugar is OK.

So ask your clinician to do some blood tests and I'd want to look at thyroid.

I want to look at glucose.

I want to look at ion low iron not commonly will cause people to have a difficulty train of thought a big, big factor we've identified over the past twenty years for a lot people will be sleep apnea.

So if you're snoring or you're having trouble with pausing your breathing at nighttime that is a big factor for causing people to have a pause in their concentration and difficulty at nighttime some people with depression, Paula, will indeed have slowed processing speed where they'll notice they just can't process information as quickly.

So there's a medical factor there.

There's a psychiatric factor.

A lot of different things could be examined.

Talk to your clinician about these cognitive possibilities because I think that you could get some help based on what you describe Paula.

>> Paula, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues, feel free to write me via the Internet at matters of the mind all one word at WFYI dot org.

>> We'll see if we can get you God willing and PBS willing.

I'll be back again next week.

You've been watching matters Mind on PBS Fort Wayne.

>> Have a good evening.

Good night