Psychiatrist Answers Mental Health Questions From Twitter | Tech Support | WIRED

I'm psychiatrist Dr Eric Bender let's answer your questions from the internet this is mental health [Music] support at pink penguin writes someone please educate me what does psychotic mean psychotic means a break from reality you are experiencing things that other people might not be that can include auditory hallucinations hearing things other people might not be hearing visual hallucinations although those are rare you might have delusions fixed false beliefs you believe are true despite other people showing you that those aren't true psychotic does not mean someone is going to commit crimes Andre H Perez how does

depression make you exhausted but then sometimes I'm too sad to even sleep when you're depressed your circadian rhythms are off in fact one of the first things we ask patients about is sleep people don't realize it they have this picture that when you're depressed you might sleep more but in fact it's the opposite you wake up early and people are like why am I waking up at 5:00 in the morning not even setting an alarm it's because your sleep cycle has been phase shifted or phase Advanced you go to bed earlier and you wake up

earlier we think this has to do with a lack of neurotransmitters when you're depressed so there's less serotonin Nur epinephrine and there's less acetylcholine and for some reason this makes us wake up early at Aton Supreme anyone else thinks dress is contagious I'll tell you watching high school students in the Bay Area go through the college application process I can absolutely tell you it is contagious there was a study that looked at an audience watching a speech being given by someone who was very anxious saliva samples were then gathered from the audience as as well

as the presenter the saliva had increased cortisol levels which is that stress hormone not only in the presenter but in the audience so stress is absolutely contagious at say baby is asking can depression be hypnotized out of you no hypnotherapy is very effective for some things it can help people with smoking sensation it can help people decrease their temper sometimes hypnotherapy can also be used to treat Sleep disorders and insomnia it cannot change a level of neurotransmitters in your brain that are correlated with depression some people are more hypnotizable than others when you you look

at this eye roll chart it gives you a sense of a gradient how hypnotizable somebody might be you ask them to look up into their head when they're looking straight ahead that's a zero then one is slightly you start to see a little bit of white then you start to see more white the scale goes all the way down to four being you see mostly white almost Exorcist style there is a correlation between those that show a lot of white when they roll their eyes and being able to be hypnotized easily DJ leapcard asks what's

the difference between a psychologist and a psychiatrist and which one do I need to see well psychiatrist has gone to medical school so they can prescribe medications if you're feeling overwhelmed and need to talk to somebody a therapist would be fine that could be a psychologist or a psychiatrist if there's suspicion that medication is needed then a psychiatrist is the one you'd want to see at Bel Maps wants to know question for psychiatrist counselors how do you not cry well at Bell maps to be honest sometimes I do get tearful with patients we are human

after all even though some people don't think we are at Mets for n 33 do personality disorders work on a spectrum like can you have mild disorder of narcissism absolutely there's a spectrum here you can absolutely have narcissistic traits when it's unhealthy is when you start to think only of yourself fantasies and obsessions over unlimited power or beauty and then the full-blown disorder you could go as far as to be a malignant narcissist you have a lack of empathy and don't really care about other people this is where we find Psychopaths at resilience doc how

do you think the brain gut connection Works preclinical Data meaning data and research from animals not people shows that there's a relationship between the brain the gut and the microbiota or the bacteria that populate your gut what we found was that in some stress induced rodents they ended up having short chain fatty acids and what we find is there's actually less serotonin produced in the stress induced rodents guts now that's not the same serotonin that's in your brain yes it's the same structure but that serotonin in your gut doesn't cross the blood brain barrier however

what we find is that the inflammation that is caused during this stress causes the veg nerve which is involved in depression to not fire the way it's supposed to and so as a result this inflammation might have something to do with a depressive state it suggests that with a healthy gut and healthy microbiome we can actually have improved mood okay next question at dar's nobot wants to know when did Psychiatry start well formal Psychiatry can be traced back to the 19th century we used to have a group of doctors called alienists and their job was

to understand and treat and be with people who had an alienation from the rest of society that was due to mental health issues in 1895 Freud wrote studies in hysteria some consider that the birth of psychoanalysis why does no one talk about how depression and anxiety can cause major memory loss depression really can make us have memory issues what we think that has to do with is a lack of glutamate glutamate is the excitatory neurotransmitter and when there's less of that we find that people don't lay down memory processing speed of somebody with a depressed

mind can be 40% below what it is when they're not depressed there's something called pseudo Dementia in fact this false appearance of dementia but it could in fact be a depression at megie Meg 26 you ever had a random ass thought that just won't leave your head I'm going through it right now first off every human being has a random ass thought if we don't want them they're called intrusive and then they can become obsessive if you can't let go of it and that's when it can start to go into the obsessive compulsive disorder range

so the obsessive thought pathway starts with the connection between the orbito frontal cortex and goes back to these areas here called the basil ganglia when that pathway is activated there's a worry but then the inhibitory pathway goes back to the orbital frontal cortex and actually shuts it down it inhibits it in someone with an obsessive thought disorder where they keep worrying about the same thing there's overactivation of that direct pathway back and underactivation of the inhibitory pathway it's like there's no breaks to stop this worry so we have this cycle that goes on and on

and on and on cognitive behavioral therapy or CBT is used to help somebody with these kind of obsessions you can also do something called exposure and response therapy that's where you make a hierarchy of fears let's say somebody's fearful of spiders first rung on that hierarchy of fears might be all right let's talk about spiders the next thing might be going to the tarantula exhibit then the last thing might be petting spiders and letting them crawl all over you oh not that Mimi is asking why does Tik Tok keep telling me I have ADHD Tik

Tok is going to tell you a lot of things please do not look at Tik Tok as your sole source of information for mental health a study looking at 500 videos on Tik Tok with the hashtags mental health tips and mental health advice showed that about 84% were misleading about 31% had inaccurate information and 14% had information that was damaging only 9% of the people doing the videos even had relevant qualifications to do the videos as a society right now our brains are being trained to be stimulated for only a few seconds and to go

to the next thing and to go to the next thing and to go to the next thing I think people find they have a hard time focusing it's not ADHD maybe it's being on Tik Tok too long at Mindy I wish there was more information available on how shrooms can help manage PTSD anxiety and depression the information's here and More's coming there is a lot of promise that shrooms or mushrooms can actually help with PTSD or with depression what we're talking about when we talk about shrooms is really silos cybin a chemical that binds to

the serotonin receptor particularly in the thalamus so that we have these hallucinations but what's interesting is it's not the hallucinatory experience that necessarily is the treatment there's a case report of a man who did have a siloc cybin guided treatment he didn't have the Psychedelic experience and was actually kind of disappointed he didn't but 40% of his depressive symptoms went away based on his reports and the structured evaluations that he was given there's something about having a guided treatment something about having somebody there with you can be really helpful and really powerful it shows us

that there's really a value to being interconnected with each other at Hex bags am I having a panic attack heart attack heartburn weird chest pain what is it cry Emoji cry Emoji a panic attack is abrupt it comes out of nowhere you can have chest tightness difficulty breathing it can feel like your throat's constricting you might have sweaty hands or sweat all over and maybe some pain so it feels like you're going to have a heart attack that anxiety Peaks after a certain number of minutes and then it comes down but you're so worked up

and so worried that absolutely you feel panicked there's also something called an anxiety attack maybe you're giving a presentation maybe you have to take a test you get more and more anxious and you feel like you can't go on that's an anxiety attack at tune of your death wants to know help I'm having an anxiety attack in the middle of class sad face what do I do help you can do a grounding technique remind yourself where you are and what you're doing I'm here I'm sitting in the room there are people around me some people

go by the rule of 3 three three see three things hear three things and move three parts of your body a common thing people say is just breathe that is not helpful I never find that helpful to say just breathe a good breathing technique is actually inhaling through your nose and exhaling for twice as long so you can inhale for say a count of three and exhale for a count of six it's the exhale that's actually relaxing at Angel disrupted I'll be honest I don't know the difference between serotonin or dopamine or oxytocin or endorphins

and at this point I'm too afraid to ask endorphins are hormones endorphin comes from the name endogenous meaning it's made inside us and morphine which is a painkiller and the endorphins imitate what morphine does that runner's high comes from endorphins serotonin and dopamine are neurotransmitters they transmit messages in the brain serotonin has to do with mood and anxiety and dopamine has to do with joy pleasure and sometimes even motivation or attention serotonin is implicated in depression and anxiety when it's low and dopamine can also be low in depression and an ADHD oxytocin is that loving

or bonding hormone in women when they breastfeed that actually helps form a loving relationship with the child at anxiety aloner says has anyone tried fish oil or Omega-3 supplements for mental health it's meant to be good for anxiety and depression did you notice any difference omega-3 fatty acids increase blood flow in the brain now this doesn't necessarily correlate to improvements in mood but some people do report improvements in mood and that Omega-3s can actually help with depression even with ADHD there's a population that will respond to that and they'll be able to concentrate more you

you can take 1 G or up to 2 G but studies show that going up to four gr doesn't really do anything 1 G is the equivalent of having salmon meals maybe three times a week you could get fish burps though just be aware of that ad Rider Trill writes I would love to know what trigger schizophrenia like actually study that we do know that now there are over 200 genes responsible for schizophrenia and what happens is if you have enough errors in those 200 genes you might develop schizophrenia even in schizophrenia and something we

know has strong genetic component to it it there are environmental factors and we know this from studies of twins if one twin develops schizophrenia there's a one and two chance the other will but it's not 100% suggesting there's something in the environment what might unlock that could be substance use it could be trauma we're still trying to figure out the connections between these what is the Environmental Factor exactly what genes are turned on exactly here's another one how does stress work how do you destroy the freeze response when we face stress there's a section in

the brain called the amydala it's a nuclei a collection of cells that senses a threat and sends a message to the hypothalamus the hypothalamus then gets our body ready to make adrenaline or cortisol which allows us to have that fight ORF flight response are we going to get ready to stand up to this threat or are we going to take off what can also happen is another response called the freeze response the deer in a headlights response your body's been flooded with cortisol it gets you ready to fight or flight but if your body's not

responding then you don't do anything destroying the freeze response would probably involve some cognitive behavioral therapy or other types of therapy where you you talk about what is it that is keeping you Frozen in place at lifting Humanity can depression be beaten or only managed absolutely depression can be beaten I have seen people have depression in what's called remission it's not coming back again what happens in depression is that we have lower levels of Serotonin and when I talk about serotonin I mean between neurons in the synapse that connection between nerve cells there are medications

called selective serotonin reuptake Inhibitors big fancy name ssris that Target serotonin re ctors and block them and then the serotonin sticks around in that synapse with that you get increased dendrites which are the branches of the nerve cells and with that you get an elevation of your mood hopefully medications in this category might include fluoxitine or the brand named proac Cene which is Zoloft esalo pram which is Lexapro what we think these medications do is increase the number of dendrites that's part of the reason it might take 2 to 6 weeks for these medications to

work you're increasing synaptic connections so medication is one way you can beat depression in some studies show therapy and meds together help more than just medication or therapy alone at goldes 27 writes I was telling my therapist about Encanto that was all about generational trauma and she was like uh you sure about that a Disney movie yes I'm sure about that in Kanto was absolutely about what's called transgenerational trauma Abella the grandmother lost her husband Pedro he was killed right in front of her what ends up happening is that that trauma was so disruptive she

wants to keep her children close she wants them to not do anything that will cause her any any kind of worry or pain everyone is trying to protect Abella from experiencing any kind of loss or sadness again and in the case of Bruno who recognizes wait this doesn't feel right he is the one who's Outcast because he's not part of this group of people who are protecting Abella she wants nothing to do with him we don't talk about Bruno well you know you should talk about Bruno because Bruno is actually realizing something's wrong at latrae

asks are mental health issues genetic there's a gene on my mom's side of the family that has me questioning my reactions all the time some mental health conditions do have a very strong genetic components things like bipolar disorder schizophrenia autism even ADHD in fact in ADHD cases sometimes 25 to 50% of the time a parent has ADHD but genetics are not the only part of the picture your environment plays a huge role in whether your genes are expressed so you could have a gene or several genes that contribute to you showing a mental health issue

and if they're not turned on then you're not going to express that that's called epigenetic it means there's something else that turns on this genetic code that unlocks it at metal Guru girl is asking how many of us take a form of anti-depressant medication well the CDC data is actually from 2015 to 2018 they said that during that time frame about 13.2% of the population took an anti-depressant however that was before the pandemic the American Academy of Pediatrics said in their Journal that from 2020 on there was a 64% increase in prescriptions to children and

teens alone in terms of anti-depressants so it's certainly more than 13.2% of the population now at sour kitas asks does ketamine therapy work asking for a friend yes there's a lot of data on ketamine working for depression however it's really important then to know that ketamine therapy is not recreational ketamine there's an amount that you take either by an intravenous infusion there's also a spray esketamine what ketamine does is it blocks the place where glutamate the excitatory neurotransmitter binds by block blocking that the glutamate can increase it allows us to actually feel better but it

only lasts for 2 or 3 days the drug rapamycin is being looked at it's being given with ketamine and what that does is it's actually preventing GLE cells in the brain which chew up neurons from chewing up neurons and the length of ketamine is lasting longer so there's promise here that's being investigated at Yale and we need to still see more results and more data at Ruby Bonia 3 is curious is there a test for psychopathy yes Robert hair a Canadian psychologist came up with a scale called the psychopathy checklist he wrote out a number

of traits that you look at to see how someone fits on a scale of psychopathy those include personality traits and those include criminal behaviors some of the personality traits might be pathologically lying particularly about your own history or you might be glib you might not share much that's real with other people someone goes through each of these 20 items and scores it 0 one or two zero is not present two is very much present maximum score is 40 if someone is 25 in some places particularly for research they meet criteria for psychopath based on this

checklist the closest diagnosis from DSM is antisocial personality disorder that's where you break rules a lot but not everyone with anti-al personality disorder is a psychopath however typically those with psychopathy are in fact having criteria for antisocial personality disorder at Malik Mars wants to know can you develop a personality disorder I think I caught one from somebody you can catch lots of things from people but typically a personality disorder isn't one now that said there are a couple cases where people might show personality traits when that is already in their family for instance histrionic personality

traits being very dramatic about things if someone in a family acts that way you might start to do that too there's something called Folly Ado which is folly for two and that's when a mental health experience is transmitted to somebody else and they have the same experience that often happens when you're living with someone who's psychotic and maybe they have a break from reality in fact the next Joker movie is called fully Adu referring to Harley Quinn and the Joker in their relationship at real jawbreaker wants to know what does the dsm5 say about me

thinking everyone is constantly talking about me behind my back well the dsm5 might actually say you are a paranoid person there is something called paranoid personality disorder where the DSM lists out criteria saying that you might have delusional beliefs the DSM 5 is the diagnostic and statistical Manual of mental illness it's essentially the guidelines with all the criteria that psychiatrists and psychologists use to diagnose people with a mental illness sometimes it's controversial in early DSM volumes being gay was a disorder clearly that has changed over time a new version of the DSM can come out

once every 11 or 12 years or so so I guess I'll have a new one to look forward to in another 5 years or so at X Tadashi wants to know what does the ink blot test even prove the ink blot test also called the roar shock test was developed by Herman rorock he was a psychologist and a psychoanalyst and what happens when you given a roar shock test someone might hold up the card and say tell me what you see Batman some kind of animal something sexual and then there's a scoring system you would

look at what part of the picture did someone focus on and the idea is that it reveals something about their unconscious initially wor shock thought this could be a way to diagnose schizophrenia we know that that's not the case the warshock test is still used in some ways in Psychotherapy particularly with kids you get a sense into how they're thinking what their life is like so there's a way to glean something about something from this test it's just not going to be a way to diagnose schizophrenia at Soul money says what do you think about

integrative Psychiatry which merges traditional medicine with alternative therapies can these things work together I have actually had patients given terminal diagnoses of illnesses they took on conventional treatment and then brought in spiritual healers or guided meditation and what was a terminal diagnosis has turned into this person's tumor shrinking there was a study that looked at around 30,000 outcomes and the outcomes with anxiety were that therapy and medication together did better to me that's an example of how you can combine treatments and do a lot of good so those are all the questions for today thanks

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