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Interviews with Psychiatrist Dr. Jas Sandhu and Vanderbilt Neuroscience major Meeros Khittaie - CART group project
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Interviews with Psychiatrist Dr. Jas Sandhu and Vanderbilt Neuroscience major Meeros Khittaie - CART group project
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Interviews with Psychiatrist Dr. Jas Sandhu and Vanderbilt Neuroscience major Meeros Khittaie - CART group project
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Lauren Shahadi explains what the meninges is, describing the three layers and their functions. She plans to interview a psychiatrist to learn more. The psychiatrist explains his work in treating mentally disordered offenders and the importance of the meninges in protecting the brain. He also discusses the clinical significance of the different layers and the potential for bleeds and infections. Hello, my name is Lauren Shahadi and today I will be explaining what the meninges is. The meninges is a part of the brain that acts as kind of like part of the brain's armor. There's three layers of the meninges. The first layer is the delicate like fragile inner layer and it's called the pia mater. The middle layer of the meninges is the arachnoid and it's called the arachnoid because it's like a web-like structure and it's filled with lots of fluid that cushions the brain. And when a brain is actually dissected you can see from a fixed to unfixed brain when the fluid is there and not there. It's very obvious, it's very like a cushioned type type little layer and with the fluid in it it's it's a little bit thicker not too thick but it's very cushion like and without the fluid it's more drained and kind of like a dried-out sponge. And the tough outer layer is called the duramater and these three parts work together and they're called the meninges. So today I'm going to be getting some inside info from a good friend of my family's. His name is Dr. Sandhu. He is a psychiatrist and I will just be asking him a few questions about the meninges and hopefully we'll be able to get some good insight out of him. So let's hear what he has to say. Yeah so I just wanted to reach out to you because I'm currently taking classes at CART which is the Center for Technology and Research, Advanced Technology and Research. And I'm taking psychology, neuroscience, and English there. And right now in my neuroscience class we are studying and kind of learning the different parts of the brain and what their functions are kind of just the basics right now. We've gone over just like the lobes and stuff like that but right now we're doing a group project that each group in our class has been given like a part of the brain that we just find out as much info as we can. It's kind of there's options. We chose to do a interview with some type someone who worked in the medical field either a neurosurgeon, psychiatrist. So I just was like oh my gosh I know someone. So yeah. So yeah would would you be open to do that right now? Okay sounds good. Okay so the first question is where are you currently located in your job in psychiatry and what do you do in this position? And you mostly answered this question so I think just where do you work and what is your title in your job? Yeah I'm a American Board in Psychiatry ABPN certified psychiatrist. I work in a forensic hospital inpatient. It's an inpatient facility where they admit patients who are civilly committed meaning they are I mean I'm not trying to use as much layman's language as not use big mouth words. I'm going to try. It's okay. No worries. Okay so basically people who are deemed dangerous out in the society that they have committed certain crimes that they are violent, aggressive, they are too reckless doing drugs and whatnot. They murder people, hurt people you know so so so then the way the system works is that they get these kind of patients they have a mental illness they have to have a mental illness and they commit certain kinds of crimes they end up in a prison and then at the time of their release they are forensically evaluated by a forensically trained psychologist and if two out of three evaluations say that the evaluation report is positive meaning these people are risk-ordainable to the society if let go from prison without treatment. So then they are sort of two different penal codes. They through their county court system, DA gets involved, district attorney gets involved and they get civilly committed against their will and wish. They are admitted to we have I think five state hospitals, they are forensic hospitals so I work in one of them. So what my role is that I treat mentally disordered offenders. These are the patients who have mental illness typically a serious mental illness like schizophrenia or bipolar and with antisocial personality disorder most of them some addiction issues as well. So these people they are treated in patient hospital. We prescribe them medications most of them take it voluntarily some we have to go through the court and force medications on them and then they are evaluated every year by an independent report by a forensic psychologist who kind of then makes the determination that with medications with therapy with counseling that they have developed more insight that their symptoms have ameliorated improved and they're willing to take treatment then they are either let go or the civil commitment is extended every year. So they can end up staying there for years or they stay for a year or two and they go out. So I basically evaluate those patients, diagnose those patients and treat them with psychotropic medications. I hope this wasn't too long. No not at all. It's very insightful. It's really good to know kind of all the details and still in a short time which I think I think you did a perfect job at explaining that. Now kind of switch over to the meninges type part of it. What if you could give just a basic definition of what the meninges in our brain are what would your definition be? Meninges basically are the three layers of coverings on our brain. Meninges are three layers on our central nervous system, precisely brain and spinal cord. So they cover the brain under our skull. They kind of help the brain. They are like more a structure that keeps the brain sort of anchored. Otherwise our brain inside our bony skull will be like a rattle. It will shake. So they kind of cover the brain and I think there are three like ionator, electronometer, meter and durometer. So they basically are the three packing layers that cover the brain and kind of anchors the brain which is a soft tissue with the bone which is a hard structure and keeps it anchored there. Perfect. That is perfect. So basically the main layer to protect the brain is spinal cord. Basically that's the main function. Protection. Protection. Okay. Cool. So the meninges are from what I know they're they both or all three have different kind of textures that kind of pull like the protection making it protection like I know one is like kind of a cushion and one is harder and one is softer. How would you describe the like of each layer how would you describe the texture that helps them protect? I mean the meninges basically the one which is I think biometric is really attached to the brain and the kind of like a part of it and I recognize it is kind of the middle one. It's a little bit more thicker and the durometer is just sort of right like kind of attached with the bone, the skull. And the main thing that the main function of the one that's attached with the skull, the durometer, is the subdural space in which the cerebrospinal fluid flows. And that has a lot of functions as a cushion and buffer but the cerebrospinal fluid kind of sort of has the inner circulation system of the brain and the spinal cord. So the dura is the one that's closest to the skull and that one has like further, what do you can say, clinical, what is the word? Like has further clinical importance because you know when especially elderly people or with the trauma you know sometimes badly people they fall you know because they become weak and they have a like they fall backwards on their head. So there could be a bleed under the dura matter between the dura matter and the rectinoid matter which they call it a subdural hematoma and sometimes that hematoma or bleed can really cause problems if it is a major bleed. And sometimes you have to surgically remove it because that can really compress the spinal cord and the brain because everything is so tightly packed because it has to be you know because otherwise everything will just shape and will hold up too much you know. So you know that anatomically that has another role that you look for a bleed you know if somebody has a fall they will typically you know do the, I mean they will typically look for, do a CT scan to kind of rule that out is what I mean. Okay, okay. So Mark can you repeat your question because I think I went on a tangent with that one. So exactly if you don't mind your original question about what was it? Go ahead, sorry. It's okay, like the texture of the meninges and how the texture or I guess density of one, how they're different from each other from the three parts. Yeah, I mean I really will have to open a book of neuroanatomy to really answer that question to be honest but this is what I understand about the structure that pionators are thinnest and deuter is the second one and the bigger one in the middle is the pionator. But major issues are with the two bleeds which is duromere because of the, you know, the sub-spinal fluid that under which, I mean there's no space but a space would be created in terms of if there's a trauma or a bleed. Same thing can happen under the subarachnoid there too. In terms of, I think for you, this is good enough, the durometer is the outermost and closest to the skull, you know, it's attached to the skull and for the arachnoid it's the middle one and the pion is just the innermost and it's sort of almost attached to the brain. You know, it's kind of hugging the brain, it's closest to the brain tissue. So pion, arachnoid and dura, from the brain to the skull. Perfect. That's I think more than enough for, I don't think they would expect more than that to be honest. I mean, I can find a Nivero and Rd book and I can send you some material but I think that would be really beyond your scope. Yeah, I think that what you explained, like just the three parts, where they are, how their functions are, the bleed, I think that's perfect. That's the most relevant clinical issue that they would even need meningitis, other than the meningitis part or maybe the tumor of any of the meningitis, but that is the most important clinical aspect, you know, because it's very common. The subdural hematoma and subarachnoid bleed, they are very common. It's like a medical emergency. Because once their brain stem, because brain stem is like the tail of the brain and it's coming out, so if anything they cause increases the pressure inside the skull, there's not much space there to store anything more than what it is. If any swelling, any bleed is going to cause a bad headache, nausea, vomiting, mental status changes, if it's a really major bleed, the person is going to go into coma and you don't have so much time to sort of wait. So you have to rush the patient to the ER and then look at how extensive the bleed is, the swelling, and even after they remove the blood, the tissue is damaged inside and there will be some swelling there and that swelling can itself paralyze the patient. Because if you look at the brain as our central nervous system, autonomic nervous system, and then through the brain stem all the wires are coming out, all the nerves, all the blood vessels, veins. So that is why the neck or head injury is very dangerous because higher the level of injury, more damage it will cause downstream. Because I saw people, if they have a neck injury and they end up paraplegic, meaning all their four limbs become lame. So yeah, so that's more than enough and I think you got the point about the urinal spaces, which as I explained, and then you can also throw in there that in the epidural space, that's where the paraglossal fluid flows. You know, you heard all about this, you know, epidural, like during pregnancy, most women they choose the epidural, which is basically putting a drip, like we put drip, you know, we give fluids to the people, you know, for our wee, right? When we give somebody dehydrated or sick in the hospital. So they use the epidural space the same way because of the reverse spinal fluid flowing, they can put a direct needle and give pain pills, I mean pain medications. And that's what they call it, you know, the spinal anesthesia, you know, so that's another use of that. I mean, they won't do it high up where the meninges are, obviously, you know, they do it in the vertebral column, in the lumbar region, lower down at the back, you know, epidural short. And then they also test sometimes, like you mentioned, you studied meningitis. So you must have studied somewhere there that they test the cerebrospinal fluid, you know, by doing the spinal tap is what they call it, by doing the lumbar puncture, basically taking the needle from the back, you know, and inserting that needle and then taking a sample of that fluid. Because if the meninges are infected up there in the brain, that infection can spread to the brain and can kill the person. So the fluid will tell the story, what sort of infection is it, is it bacterial, is it viral, is it fungal, you know. Because knowing that information, we can target with our medications, because you can't fix a viral infection with antibiotics or a fungal infection without giving antifungal medications. So that's why it's important that you want to know the type of infection. So that's where, you know, value of, you can tie it up with the spaces in the meninges that through the epidural space, you can do lumbar puncture or spinal tap. Okay, that, thank you so much for doing this interview with me. I think you have just done such a phenomenal job of describing not only like meninges, but more information exploring different ways that can, like sick or illnesses, I guess, considered. I'm glad, you know, and if you think of any questions later, you can just shoot me a text or anything. Okay. Or if you want to do this one more time or something else comes up, you know, so, you know, let me know. I think it's brain and spinal cord and psychiatry and neurology and neurosurgery, they are very fascinating fields. And if you are aspiring to go to medical school, I would say you can't go wrong with either of them. Yeah, I find it just absolutely so fascinating. And I'm really happy I got to take this class. Yeah, so feel free to call, you know. Okay. Anytime for questions or anything. Yeah. Good luck with the project. Thank you so much. I really appreciate your time. You're welcome. Anytime. Thank you. Thank you. All right. Well, I hope you have a nice rest of your day. Tell the family that came to me. I said, Hello. Sure. I will. Yeah. And I met your mom today. My God, I don't know where she has all this energy. I was amazed to see. I mean, kids are kids, you know, they are out there, but I can hear mom. She is amazing. I don't know how she balances all these things. And it's amazing. Yeah. You do her hard work. Yeah, she's, she's great. The big ball of sun or energy or Yeah, she is. Yeah. All right. All right. Okay. Take care. You too. Have a nice weekend. You too. See you later. Okay. All right. Bye bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. 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