Psychiatry & Psychotherapy Podcast - Sensorium: Medications, Drugs (THC, Alcohol), Medical Issues, Sleep, and Free Will

Episode Date: April 5, 2018

Learn: Why to optimize medical issues like hypertension and diabetes Change psychiatric and non-psychiatric medications to optimize brain function Optimize sleep to obtain rest and increase brain function How drugs influence the brain short and long term to change sensorium How viewing yourself without "free will" influences brain function By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. For PDF with citations and full notes go to: https://psychiatrypodcast.com/resources Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. So welcome back to the podcast. Today we are going to be covering the last part of Sensorium. So in the first episode of Sensorium, I covered what basically Sensorium is, that it's, you're fluctuating total brain capacity. You know, it's sharper in the morning.

Maybe it kind of is a little bit in a lull, you know, two to three in the afternoon. And, you know, that's why a lot of people who are really high functioning people get some good work done in the morning, get their writing done in the morning first thing. And then a lot of cultures take a nap in the afternoon. And then I talked about. about in that first episode on Sensorium, you know, what are some patients that have come in with really low Sensorium? So people teetering on delirium almost. I remember one patient that came in with kidney failure and, you know, her kidney function, her ability to sort of clean her urine, right, or clean her blood, clean the toxins out of her body, clean her toxins out of her body by urinating.

You know, when that goes down, you have a buildup of toxic metabolites and your Sensorium decreases. And that really gives an example of one of the things I'm going to talk about today, which is how to maximize medical treatment for medical issues to optimize Sensorium long term. Another topic I'm going to go into is medications. Which medications are the biggest culprits of Sensorium? Which ones I would definitely want to remove? and which ones maybe don't cause as much sensorium issues.

I'm going to be talking about sleep and how sleep can really optimize sensorium and how, you know, things like obstructive sleep apnea can really cause issues with sensorium long term. And then I'm going to go into some alcohol and some drugs and how those influence the brain for better or worse. And the last thing I'm going to touch on is, is a kind of a prelude to a future episode, which will be going over how the way that we feel like we have the potential to change our environment

and change our situation can actually change our sensorium. So interesting research on how free will and the thought that you have free will can actually change your sensorium. So, you know, why am I interested in this? First of all, once again, I work in a, psychiatric practice, which is both outpatient and, you know, partial hospitalization and intensive outpatient program. So I treat people who are, you know, in between hospitalization and outpatient practice. And, you know, where do you send a patient that's too suicidal to really

treat once a month as a psychiatrist, but, or once a week as a therapist, but not ill enough to be in an inpatient psychiatric hospital? And that's kind of what the partial hospitalization does. that's what the intensive outpatient program does after they graduate from the partial program. And in this program, we treat a unique group of people. We treat people with a range of medical issues and psychiatric issues. And so I am really interested in how to optimize brain function because basically if you have poor sensorium, the psychotherapy is not going to be as effective. okay so the psychotherapy is one way to optimize sensorium actually so just going through the program we have shown to increase IQ in in our adolescent mend program and that's because you know if you

come in and you're super stressed and you have uncontrolled medical issues and then all of those get optimized and you're sort of the chronic stress in the home gets relieved through good family therapy, then your brain is going to work better. Okay. So then I had an episode on diet and sensorium and how, you know, there are certain foods and certain lifestyle choices that long-term can change brain function. And then in a subsequent episode, I went through studies on exercise and how gaining strength and having cardiovascular endurance can sort of promote long-term brain help. Brain health. Brain help, yeah. All those things help promote brain health. Okay. So today I'm going to touch on medical issues, sleep issues, drug and alcohol issues, and here we go. So first of all,

treating medical issues. So for example, diabetes, which is very common in our culture, you know, as people get older, if they have unhealthy lifestyle, they're at an increased risk of diabetes. So if people aren't exercising and eating, you know, the typical Western diet and, you know, they're, you know, more heavy set and struggle with weight, you know, you are at a higher risk of getting diabetes. And when diabetes is not properly treated, you have increased risk of depression. and cognitive issues. So in one study, they show that they have twice the rate of depression if they have diabetes. If they have diabetes, but they're brought under better control through medications,

the depression risk goes down and the cognitive function improves. your working memory improves, the ability to hold things in your memory, you know, hold numbers, hold like, you know, where am I going, what am I doing, I'm walking across the house, and all of a sudden I forget what I'm looking for. Like, that's like the working memory. That improves as diabetes is controlled. And it's interesting some of the myths that people come in to my clinic with, with their diabetes. Like one person believed that they would get obese if they properly controlled their diabetes.

and I said, I have no idea where you got that, but I can tell you that it's going to be a lot harder to treat your depression, and it's going to be a lot harder to treat your anxiety, and it sounds like you binge on food when you're anxious and depressed, and so let's focus on treating your depression, treating your anxiety, getting your glucose under control, and you're going to feel a lot better. So controlling diabetes. The next one would be hypertension. So hypertension patients without vascular complications had deficits in the speed of cognition, episodic and working memory, and executive function. So even the hypertensive patients that didn't have vascular complications,

meaning they didn't have a history of stroke, they didn't have any small strokes in their brain, even these people, when they're uncontrolled, have a higher risk of sensorium issues. and so we want to treat the underlying issues with hypertension when they're present. We want to treat depression and mental health issues if they're there. We want to treat seizure disorders. We want to treat obstructive sleep apnea. So whatever the medical issue, I can almost guarantee you that if it's untreated, you're going to have worse cognitive function.

Okay. The next portion, I'm going to touch on medications. So the first thing I do when I look at someone's medications is, I think, is there any way I can reduce the amount of medications they're on? And specifically, I look at the kind of the more high-risk medications for sensorium issues. So I want to reduce polypharmacy. And one example is if someone is on baclophon and gabapentin, when they're taken together, they cause cognitive effects. When taken alone, they did not in one study. So just by reducing

one of these, you know, they can have reduced cognitive effects. And, you know, it could be sedation. It could be they're just not processing as quickly as they used to. They're not enjoying reading as much as they used to. So reducing polypharmacy. Do they really need to be on every medication that they're on. And one of my goals, by the end of someone getting out of my treatment program, is that I reduce their medications, maybe three to four medications. And if they've really engaged the psychotherapy, I find it a lot easier to take them off of medications. So the big class of medications that I try to reduce, there's two of them, is anticholinergic medications and benzodiazepines. So anticholinergic medications, probably the most commonly understood anticholinergic is Benadryl.

So a lot of people take Benadryl for like allergic outbreaks or to sleep at night. And other medications, though, are anticholinergic. So anticholinergic acetycholine, you know, is something that we want to increase when someone has dementia. Now it doesn't help that much, but just think about it like, so we're, decreasing it with an anticholinergic medication. So on my website, I will put a link to a PDF with the different medications and all of my notes here in citations. But in general, I try to minimize anticholinergic medications. So different ones include amatryptylene, benchtropine, you know, benadryl, diphenhydramine, you know, nortyne, you know, nortyptylene, you know, nortyptylene,

Tritoline, olanzapine, peroxatine, quitoapine. So all of these medications have an anticholinergic burden that's very high. And it also depends on the dose. So sometimes I just try to reduce the dose a little bit. You know, if they're on nortriptylene, nortripylene, actually, like at lower doses, is not very anticholinergic, but then as you get into higher doses, 50, 100, 150, the anticholinergic burden really increases. Paroxetine is probably the most anticholinergic out of all of the antidepressants. And it's good for social anxiety, but I try to get every one of my patients off of it, especially if they're professionals, it's not a good medication to be on.

It can make you feel sedated and tired. and most of my patients who are on it, if you get the history, sometimes they don't even realize it. But when they started taking it, they started gaining some weight and they got more sedated and had a harder time focusing and concentrating. So, anticholinergic medications, you know, a lot of people get put on benstropine if they're on an antipsychotic. And I usually don't do that unless they have severe. severe EPS for that reason. I don't want to, you know, put the burden of having them on a sedating

medication. Now, if someone has to be on the antipsychotic clausoro, can you give it at night, you know, so they're not as sedated during the day. Now, one of my patients, when he takes it at night, he gets really bad gurg, so I have to give it during the day, and he's gotten used to it at this point. So, clausoryal is a great medication for schizophrenia, probably the best. and it doesn't cause any EPS, so I really like it. You know, it's a pain to start someone on because you have to monitor their blood closely, but, you know, it's usually not, that's not the one that I'm taking someone off to optimize their anticholinergics. Okay, so the second class that I really try to get people off of is benzodiazepines.

And I'll have patients come into my office asking for benzodiazepines. You know, the only thing that works is Xanax and Klonopin is what they'll tell me. That's all that works. And, you know, it's possible that they're on it for good reason. As an overenthusiastic resident, I remember taking one patient off of Klonopin. And he came back the next time with severe aceshesia. And he was a patient with schizophrenia. and he was put on this medication likely to treat his aceshesia.

I didn't realize it at the time. But aceshesia is an internal and external restlessness from a dopamine blocker. And so he had developed that and so I put him back on and he felt a lot better. But why do I try to get people off of this? Benzodiazepines can cause issues with psychomotor speed, memory, processing speed, attention, verbal memory, general intelligence, working memory, verbal reasoning, and the mean effect size for those things across all, you know, across multiple studies and across multiple different types of benzodiazepines is 0.74. So negative 0.74 decrease in those abilities. And you can

think about it as like, you know, that's a big change in people's mental functioning. Of note, after tapering people off of chronic benzodiazepine use, there was a significant improvement in Sensorium. However, compared to controls and normative data, there was incomplete restoration at six months. This is something that I tell people when considering starting them on benzodiazepines or when they ask me, you know, Dr. Peter, why aren't you going to prescribe this for me? I say, well, because it's going to lower your intellectual abilities, your sensorium, and if you stay on it for multiple years, when you get off of it, it may take a long time to get back to normal or you may not ever get back to normal. Now, I question what this really means,

because scientifically I look at this and I say, well, compared to normal controls, are these normal controls people who have suffered from a significant psychiatric issue? Because we know that just suffering from, you know, significant psychiatric issue, significant chronic stress can influence and hurt the brain. You know, so I don't know if it's fair to compare them to normal controls. But my case of point is I rarely want to put someone on this during the day, for chronic long-term use. Sometimes, you know, a short-acting to Mazepam or something for sleep seems to be of less

concern, and I'll put up that citation as well. And I would like to continue to investigate this and try to figure out, you know, how much of a dose is too much and, you know, but the people who are on it during the day, every day, and it's usually fairly high doses, those people will have significant cognitive effects. And, you know, so when I have a medical student come in or someone who's high functioning, who's, you know, needing their brain to do what they do, this is not the medication that I think of first and foremost. I'm thinking of other medications that I'll get to to lower their anxiety. Okay. So the next medication is Zolpidem or Lonesta. Now Zolpidem

in specifically is a, is a common sleeping medication. If you take it eight hours, prior to driving or cognitive test, it does not cause impairment. Whereas if taken four hours before it does, at two hours after ingestion, it causes even balance issues. So Zolpidem is one of those medications that, you know, they really need to take it, you know, at 9.30 and then have a good eight hours of sleep after. they can't just take it and then four hours later, you know, show up to a meeting and expect to perform at a high level. The other thing I'll say about Zolpidem is I've had several patients who take it during the day to take a nap. And that's a horrible idea. One guy who came into a chemical dependency program would literally find himself in another city after taking Zolpidem because he would drive there and he wouldn't realize what he was doing.

I have several nightmarish stories about people who have taken Solpedem because they don't quite remember what they're doing while they're doing it so they don't remember it in the morning like they'll wake up and go to the kitchen and the kitchen door will be open and a bunch of food will be eaten and they won't have remembered and that they ate the food. And in this case, I actually believe them that they don't remember. The next medication class is antihistamines. I try to minimize the doses of antihistamines. Antihistamines can be sedating. I try to minimize or take them off of opiates, opiates like Vicodin, oxycodone. In one study, in one animal study,

opiates reduced neurogenesis by 42% in the hippocampal granular cell layer. What this means is that someone with an opiate on board, their brain isn't necessarily going to regenerate, and specifically the part of their brain, the memory areas, will have a lower rate of neurogenesis. One of the big things about opiates is that if someone has severe pain, that is untreated, that can also decrease censorium.

So this is kind of like a difficult place, right? It's like you want the minimum amount of opiates, so you have optimum censorium. And it's best to try to use alternative medications. And actually, I found that psychotherapy can reduce pain significantly. I have people that I've seen come into a chemical detox program who have been on opiates. And there was one guy in particular, I'll change his story like I do all patients that I tell their stories. but, you know, this guy had about 12, 15 back surgeries, and he was on a bunch of opiates.

And he was kind of lying in bed most of his days, watching TV, not really wanting to engage with people. And as soon as we got him off of opiates, we, you know, detoxed him through Suboxone. He felt so much better. He, um, his pain went from like an eight to a six after, after two or three weeks. even being off of opiates. So sometimes chronic opiates, you know,

and people's pain levels are still very high. I'm not convinced that their pain would be that high if they were off opiates because I've seen so many stories of that being the case. So you definitely want to consult a physician, you know, with all of these things, by the way. This is medical information. It doesn't replace a physician.

But one of my general thoughts is how do I reduce opiates? So one of the next big culprits that I have for memory and cognitive issues is topomax. And topiramate topamac is given for migraines. It's given sometimes for mood stabilization. It is a nice medication in that it can lower your weight. It reduces your food cravings. It can be helpful for binge eating.

And at 25, 50 milligrams a day, it usually doesn't cause very many cognitive issues. but it sometimes does. And when people get higher doses up into like the 100, 200, 400, almost always I see cognitive issues, issues with word finding, issues with short-term memory, issues with, you know, doing things that people used to do and using their brain they used to do it. It just doesn't work as well.

And so I try to get people off of Topamax wherever possible. You know, if they have chronic migraines, I try to get them in to see a migraine specialist. You know, can they get Botox for their migraines? Can the psychotherapy help their migraines? Cognitive behavioral therapy has been shown to be helpful for migraines. And my program can really help people decrease the levels of stress that they have and decrease their migraines. So can you treat the underlying issues as much as possible and get them off of this medication? And some people will not have cognitive issues with Tobamac.

So it's like you always really have to, you know, get a close history and talk to them about what their function was like before and after. Another medication that can cause issues is valproic acid, valproate, depakote, depokine, all the same medication. And of note, this medication can cause working memory issues. It can cause decreased brain function. It can cause decreased sensori. and so I don't put patients on this lightly. You know, if they really need to be on it, if it's a medication that really stabilizes,

maybe they have true bipolar, true, you know, seizures, and this is the medication that seems to be the most helpful for them, then, you know, by all means. But, you know, if someone has schizophrenia and they were put on it in an inpatient psychiatric hospitalization to speed up the rate of recovery or for whatever reason, you know, I try to get them off of it slowly. If they're on it just for anger and irritability, you know, I may try other medications. You know, some people are put on it to in a hospital for hyperactive delirium,

which interestingly, we're talking about how it can decrease sensorium, but acutely it seems to decrease aggression in a delirious patient. So this is where like there's a lot of nuance and having a good doctor to kind of navigate these things is important. So other medications that can cause sensorium issues are carbamazepine and zonisomide. I won't go into that very much, but I'll put the citations there if you're curious. Medications that could cause mild sensorium issues include gabapentin. It doesn't seem to cause cognitive changes, but can cause sedation, especially at high doses.

I see a lot of patients who, you know, are on, you know, 600 milligrams, you know, maybe three to four times a day. And, you know, we'll try to reduce some of those daytime doses when they come into my program so they can get the most benefit out of the program. And over time, we may be able to get them on lower doses because their pain is decreased so they don't need to be on this medication as much. You know, gabapentin is usually for, like, neuropathic pain, but it can also be, it's commonly used for anxiety

and others off-label symptoms as well. So mild sensorium issues, oxycarbamazapine, trilopal, this medication can cause some sedation. It can cause some alpha wave slowing on EKGs. it can cause some sedation, but it's usually not very bad. And so this is in my mind a better option than benzodiazepines for reducing anxiety, for treating sort of mood liability.

And another medication, trazodone, it can cause mild issues with short-term memory, verbal learning, body sway, muscle endurance. But usually, I mean, this is like if the person's taking it during the day. So this is where, you know, you give it at night and most of it wears out by the morning. Now, some people, when they take tracadone for sleep, and tracetone in my mind is one of the first medications I give for sleep. You know, so you put them on 50 milligrams and most people do okay and they sleep through the night really well, a lot better.

And, you know, if they're getting more restful sleep, it's easier to treat their depression, their anxiety, their chronic stress issues. So I think it's worth acutely to use medication sometimes to do that. this. And the problem with tracadone is that there's a certain amount of patients where there's like an initial dip that gets them to sleep, but then they kind of wake up two, three in the morning, and then they have another dip of sedation, like right at seven o'clock when they're trying to get up. So with those patients, I tend to either try a lower dose, and if that doesn't work, I'll switch them to a different medication. But tracadone is not a medication you want to give in the morning.

So medications without cognitive side effects. So, lemotrogen is one of those medications. Lamotrogen, limitle, it's used for certain types of seizures. It's used for maybe not like a severe bipolar, but, you know, someone who has mood lability issues, someone who has some sort of high anxiety that needs to. to be treated. Sometimes it treats variants of bipolar. And I think it tends

to be good in people with the history of chronic trauma and it doesn't cause cognitive issues so I don't mind it as much. Now Lomotra gene causes a severe skin rash called Stephen Johnson. And so patients who take it need to start at a low dose like 25

milligrams. I increase it every two weeks. So I go 25 and then 50 and then 100 and then 150 and then 200 and somewhere around 100 to 200 is you know the patient will have benefits where they're having lower anxiety and and less experiences of stress but they are maybe um not experiencing the sedation that they would in other classes and medications so i think lemotrogen is a good medication people need to be warned about the skin rash and be willing to go into an emergency room if they're having the skin rash or at least, you know, have some way of reaching out quickly. But in general, I like the medication. It doesn't cause weight gain and it's good

for anxiety. So another medication, Kepra, although 20% complained of somulence, it doesn't seem to mess with working memory and sensorium issues. Now, I will say, you know, have a concern of Kepra with increasing some psychiatric issues, actually. So this is not a medication I give for psychiatric issues. I don't know any psychiatrists who do, but it's a medication given by neurologists for seizures. And so if you have a patient that you can treat their seizures without causing some soaringum issues, that's a win.

Another medication that doesn't cause cognitive side effects is propanol. Propanololol is a beta blocker. Rarely, I'll have some patients complain of sedation. It's a good medication for test anxiety. It's a good medication to reduce anxiety as an alternative to, you know, benzodiazepines and different medications that lower sensorium. And it can also reduce the occurrence of migraines. So it's kind of prophylactically given for someone with a lot of migraines.

So it's a better option in my mind than like Topamax, which can cause a lot of cognitive issues. Okay, so poor sleep can lead to decreased memory encoding, mood issues, worse concentration, driving accidents, and sleep can counteract the effect of chronic stress and allow the body's immune system to regenerate. So we want to set up patterns of rest which can allow us to have improved cognitive function, Sensorium,

sort of thriving throughout the day. And so I recommend, you know, limiting caffeine later in the day, limiting electronics before bed. In a future episode, I've been looking into the effects of social media. And in this one study, they found that a lot of kids

are accessing social media at night and video games. And it's causing lots of issues with focus and concentration during the day. They probably don't realize how much it's affecting them. If the person has obstructive sleep apnea, this can be a big issue, you know, getting on a CPAP, it's a mask that helps the person keep their airways open can be helpful. You know, obstructive sleep apnea is more common in our culture than we would like due to the obesity epidemic that we're facing. And, you know, you know,

know, people who come in who are obese that don't feel rested, that feel exhausted, that wake up with morning headaches and that snore, and I'll ask them, you know, does your spouse ever comment that you stop breathing a night? Some of them will say no and I'll say, okay, and I'll have their spouse watch them. That's the cheapest way to do a sleep test, and the spouse will note that they stop breathing. So they'll be snoring and they'll go like this, wait 20 seconds, like that and that is obstructive sleep apnea so if they have that um weight loss may not fix it you know some people have obstructive sleep apnea and are in great shape and i know these people um but some people weight loss will help it'll help open up the the airways in the in the in the throat area

and other things that can help are getting on an obstructive sleep apnea machine you know, this is a machine that is cumbersome to use. And if you have, if you're a therapist and you're treating a patient with obstructive sleep apnea and they just will refuse to use their machine, have them come in with it and do some relaxation training with them. I sometimes will do that with patients. And it's something that I'll bring up every time with a patient with obstructive sleep apnea, you know, in my sort of screening for how things are going.

Are they using the breathing machine to help them at night? Are they using it? What percentage of the night are they using it 100%? And do they take naps during the day without it? Because even naps will not be as refreshing if they don't have their airways open. So, sleep issues. I'd like to do a future episode on cognitive behavioral therapy. It's called it like for sleep.

And this is really one of the best ways. of long-term help for sleep. It goes over, you know, bad sleep behaviors, good sleep hygiene, but also has some techniques of, of, you know, slowly decreasing the amount of time in bed, increasing the sleep effectiveness. And, you know, a lot of people have behavioral issues with sleep. Behavioral as in, you know, they'll drink alcohol, they'll stay up later than they should, they'll watch Netflix and they'll watch the most exciting stuff on Netflix. And then they'll wonder why they're tossing and turning and not sleeping well. And after six hours or five hours of sleep, why they don't feel rested.

And it's actually really hard to get people like this to get to bed at night at a reasonable hour to create some restful practices before they go to sleep. You know, journaling, reading, contemplating, contemplative and relaxing, meaningful books, you know, doing things like that. The other thing with sleep that I'll just throw out right now is sleep associations. So some people have really bad sleep associations, meaning what do they fall asleep doing? So if you fall asleep watching TV, when you wake up in the middle of the night and TV isn't on, in the lighter levels of sleep, you may need TV to actually fall asleep.

So I try to get people to create or fall asleep in the same way that they're going to wake up and need to fall asleep in the middle of the night. You know, a good example, this is infants. If they're used to falling asleep on a nipple, then in the middle of the night, they may need in those lighter levels of sleep a nipple to fall asleep again. and so if you can get them to fall asleep on their own, then they can usually transition on their own in the middle of the night. Okay, moving on to drugs and alcohol. So the first drug I'm going to talk about is THC. So persistent cannabis use showed greater IQ decline of six points

and worse neuropsychological tests with greater impairment, with greater impairment of executive functioning and processing speed. So there is a problem with attention, memory, learning, verbal IQ in studies where they look at how chronic THC influences the brain. And it seems to be worse in adolescence. This is a big issue. and, you know, how does marijuana influence the brain in a negative capacity? Well, it does.

And that's going to be, you know, unpopular for some people to hear. But it's what I think is the closest thing to science and what science is saying. So I have to put it out there. I have to speak truth. And a six-point decrease in your IQ is, you know, a mild to moderate level of a decrease. and so, you know, acutely, marijuana can do it, but also chronically, marijuana can have a decreased influence on, on sensorium. You know, acutely, it shouldn't surprise us that it decreases sensorium.

You know, the people who get stoned, their short-term memory is off. And for this reason, when a patient comes into my office and they have memory complaints, but they're a chronic marijuana smoker, until they're willing to get sober, I won't consider even treating them for their ADHD. And I've had several patients get very angry at me for this. Like, oh, why would you not give me a medication for my ADHD, even if I'm smoking other psychiatrists have in the past? And I've told them, like, look, I don't know any psychiatrist at my university that would give

you, you know, riddlin or adderol for your ADHD if you're smoking marijuana. and so you're going to have to get sober. I'm going to have to be able to random urine test you to make sure you remain sober. And if you, you know, break our contract, then I can't prescribe you this controlled substance. And, you know, I've had a couple of patients that just kind of walk out and are angry at me for this. And there's not much I can do, but, you know, point them to what I know science to say, which is, you know, that working, memory, cognitive function, executive functioning, all is impaired by chronic marijuana use. Okay, the next thing is alcohol. Now we know alcohol acutely decreases sensorium. So, you know,

one to two drinks in, you lose the ability to really know how alcohol has influenced your mind. And a lot of people have a little bit of social inhibition in it, and they have a euphoria that comes with that and it's, you know, pleasurable. And, you know, one thing that I'll say, though, is when I was looking at this and trying to just pull out the literature and what the literature says is it said that one to six drinks per week has actually shown to reduce the risk of dementia. And I think this is more red wine than anything else. But it also could be associated with the lifestyle of the people who drink, you know, like half a cup of red wine a night. You know, what, what that kind of lifestyle is is probably someone who's resting more and relaxing more. So who knows how much that has to influence it.

People who drink more than 14 a night had increased risk of developing long-term dementia. And so in this one cohort study, and I'll put the citation in my website so you can take a look at that. And this one cohort study, they had increased risk of developing dementia greater than 14 drinks per week. So, you know, acutely, we know drinking more than four drinks. So that's the 0.08 on the alcohol level. You know, so for every drink of alcohol, it's about 0.02. So 0.08.8.0.8. So for every drink of alcohol, it's about 0.02.0.0.0.0.0.0. is four drinks. With four drinks, you have impaired planning, spatial recognition, memory, attention, and therefore, censorium.

And, you know, most people who do that probably don't care that the sensorium is impaired a little bit. But, you know, I think that's why we have the cutoff of 0.8, or sorry, 0.08 with the legal limit of driving. Okay, now on to my last point, which is on free will. So they've done these really interesting studies on trying to convince, you know, one group of people, so they have two groups of people, one group of people, they'll try to convince them that they don't have free will. So how they do that is they, you know, take this group of people into a room, have them read an article, kind of talking about how really we don't have much control over things,

we're just product of our genes and our environment. And inevitably, we don't have control over many decisions that we make. And so the people read these articles and then they subject them to tests. So they compare this group of people with the other group that reads something just completely boring and random. And what they find is that people who have been primed to think that they don't have free will by primed I mean, they just read this thing. Those people are more likely to cheat. They're more likely to conform to social norms.

They have reduced help. They have reduced helping behavior and increased aggression. And they have this thing where they don't slow down after making an error to reevaluate. And so this is where I'm sort of grabbing onto the sensorium. thing. And I'll go into this in a future episode in more detail. But basically in this one study, they found that with this group of people who read this thing that argued that they didn't have free will, they would have them, you know, click right or click left, depending on the color, depending on, you know, the instructions. And normally people, when they make a mistake,

they'll slow down their speed at which they're responsible. responding to these things. But the people, and this post-air slowing is normal. But the post-air slowing was reduced in the no-free will group. So the group that were primed to think that they didn't have free will, they didn't slow down anymore. Which means after making a mistake, they just kept going at the same speed. They just kept moving forward. Interestingly, this is also seen without the priming in people with schizophrenia and children with ADHD. They don't slow down, right? So that kind of makes me think that there's a frontal lobe thing going on here that normally the frontal lobe kicks in and says, whoa, slow down here. Let's try to figure out

what we did wrong. Let's try to figure out how we can do this better. But that was weakened when the belief in free will, intentional control decreases. So they have found that people who have, who don't have this sort of slowing down process, are more careless and more impulsive and display more antisocial tendencies. So kind of how this links to psychiatry and psychotherapy is, you know, sometimes we, we,

tell our patients, you know, what they're doing is because of their genes, because of their environment, and we may take away some of their responsibility that they may feel. And some people feel too much responsibility. And, but I think there's a balance between, like, that and taking away someone's conception that they can make choices and move forward and overcome obstacles. And so, So one of my thoughts is we have to be mindful of helping people realize that they actually have control and the ability to make decisions, irrespective of their genes and their environment. People can make decisions. So if they, remember, if in the groups that were told that they didn't have that capacity,

they had, you know, increased likelihood to cheat, increased likelihood to conform to social norms and had this increased aggression and this sort of decrease in their evaluative functioning. So that comes to the end of this episode on Sensorium and my little series on Sensorium. Now, these are topics that I'll touch in the future. specifically I'm going to have on in the future some of the therapists from the program talk about

how they help people reduce stress through family therapy and through different means and I'll also in the future be going through different mental health issues and talking about these medications more and talking about you know how it influences the brain but I kind of wanted to go through a couple of these episodes to give an overview of this and hopefully that was helpful for you. If it was helpful, you know, I appreciate good reviews. I'm up to about 50 as of recording this, which is encouraging to me. And I also appreciate people reaching out to me on social media, just saying what's up. And, you know, I post, for every episode, I post a, you know, a picture on Instagram, a post on Twitter. So, you know, throwing up a comment there.

is a way of letting me know that you appreciated this and had some thoughts. And if you have any questions, throwing them up in the comment section, I'll try to answer it. Now, obviously, there's a lot of this that goes beyond the scope of what I can do without knowing someone's full history. And so this is where you might want to consider getting a full assessment by a psychiatrist or a physician who knows about this kind of stuff. All right, I will leave it there for today and have a great day.