This content is a Q&A session with a psychiatrist, Dr. Eric Bender, addressing various common questions about mental health topics, including definitions of psychological terms, the nature of mental illnesses, treatment options, and the history of psychiatry.
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I'm psychiatrist Dr Eric Bender let's
answer your questions from the internet
this is mental health [Music]
[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
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
for watching mental health support [Music]
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