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INVISIBLE DISABILITIES & THE NEED FOR CENTERs OF EXCELLENCE IN DIAGNOSTICS & TREATMENT

12/18/2024

Val's Take/Conjecture

In the Middle Ages, they may have thought that someone with a psychiatric disorder was possessed by a demon.
Further, the person themselves may have thought that

We haven't thought that for awhile -- but Anti-Social Personality Disorder is a pretty close second.

The science is exploding and we're not on top of that the way we need to be.

We need to be funding Centers of Excellence in teaching hospitals around the country that can keep up with the science.

Further, we need robust Professional and Public Education Campaigns that can address new or modified paradigms.

It's a Wonderful Life

I think this is a brilliant scene by Frank Capra --- and Capra turns our hero George Bailey into a Bully --- I think that was genius.

We do understand the fear and frustration --- even as "shaking Uncle Billy" isn't going to solve the problem.

Ingmar Bergman
The Seventh Seal

The young woman is believed to be in communication with the devil, and she believes that too.

The knight believed it as well, and after a conversation with the young woman doubted any communication with the devil and struggled to address her burning at the stake.

He and his squire determining that the young woman was almost dead anyway.

youtube

Additionally, many people in the Criminal Justice System have a "NEURO-DEVELOPMENTAL DISORDER" which is part of the Neuro-Developmental/Psychiatric Continuum.

There is no reason why we can't have HUMANE. THERAPEUTIC, CUSTODIAL CARE if needed.

Further, we're on the verge of biomarkers and treatments involving microglia and other aspects of the IMMUNE SYSTEM --- that were not on the radar screen 20 years ago.

JUSTICE IN AN AGE OF CHANGING SCIENCE --- The blessings and challenges of "consensus"

12/16/2024

Val's Take/Conjecture

A little over a decade ago. then National Institute of Mental Health Director Thomas Insel:
- advised the DSM 5 "lacked validity"
- mental health professionals often based their treatments more on "religion" than "science"
- and Insel asked for ATONEMENT.

Atonement (October 8, 2014): In his blog for Mental Illness Awareness Week, Dr. Insel talks about the complexity of mental disorders and the need for scientists, clinicians, patients, and families to work together in searching for better treatment.

I think for some of us it was clear Mental Health had some real problems. For me, I saw that in the context of Criminal Justice and Homelessness.

At that time what I understood was on a logical and systemic level --- I would have been hard pressed to flesh out too many specifics.

Image Credit: Grace Point

Now ---- what's going on with Neuro-Developmental & Psychiatric Disorders is much more clear, and there does seem to be a CONSENSUS in the Research Community even if that is only beginning to get to the professionals on the ground.

As for a Political Consensus, I think most people are much more concerned with PLACEMENTS, TREATMENTS, and SAFETY.

Mental Health Professionals who may be on the fringes of Neuro-Diversity themselves ---- can provide the individualized assessment and treatment necessary.

The Need for more professional & Public education on the role ofMicroglia in Psychiatric disorders

11/27/2024

One of the big psychological challenges in Modern Times is Illness that is not completely understood now, and yet the expectation is that treatments or cures will be available in the future.

For People with Neuro-Developmental / Psychiatric Disorders and an IQ over 70 --- outdated conceptualizations put many at risk of homelessness and/or incarceration.

Further, the needs and types of support needed are often different than what is being provided.

Updated paradigms have the real possibility of directly addressing underlying Developmental processes and subsequent inflammatory exposures that may be magnified by dysregulated microglia, etc.

CME

January 12, 2021 Psychiatric Times

Microglial Involvement With Psychiatric Diseases

Author(s):
Haley Alleson Vecchiarelli, PhD,
Eva Simoncicova
+1 More

This CME article briefly outlines the role that microglia play in neuropsychiatric disorders.

Burden of Proof

Neuro-Developmental & Psychiatric Disorders as multi-System Disorders

11/25/2024

Val's Take/Conjecture

One of the big discoveries of the 21st Century is that NEURO-DEVELOPMENTAL & PSYCHIATRIC DISORDERS involve MULTIPLE SYSTEMS OF THE BODY.
That does include the Brain and the Central Nervous System (CNS).
It also includes the Immune System, the Microbiome and the Endocrine System.

Role of the immune-kynurenine pathway in treatment-resistant schizophrenia. (2024)

Is depression the missing link between inflammatory mediators and cancer? (2022)

Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely.

Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowle …

Transgenerational Epigenetic Inheritance was discovered by Alexander Brink in 1956 as it relates to maize.
Since then Epigenetics has been identified as a Key Component of our most difficult chronic diseases, including:
- Autoimmune Diseases
- Cancer
- Type 2 Diabetes
- Neuro-Developmental Disorders, and
- Psychiatric Disorders

Val's Take/Conjecture

One of the big discoveries of the 21st Century is that NEURO-DEVELOPMENTAL & PSYCHIATRIC DISORDERS involve MULTIPLE SYSTEMS OF THE BODY.
That does include the Brain and the Central Nervous System (CNS).
It also includes the Immune System, the Microbiome and the Endocrine System.

Maternal immune activation and role of placenta in the prenatal programming of neurodevelopmental disorders (2023)

How Inflammation Affects the Brain in Depression (2021)

While it is unclear how the inflammatory response affects brain networks involved in the psychopathology of depression, it has been suggested that proinflammatory cytokines and several metabolites from inflammatory processes in the central nervous system (CNS) exert direct neurotoxic effects on the brain.

These effects may lead to dysfunction of the neural circuits involved in emotion regulation and reward or cognitive processing, which is associated with overwhelming low mood, failure of...

Society of Biological Psychiatry

Dysfunction of Kynurenic Acid in Major Psychiatric Diseases

This will focus largely on the contexts of:

Maternal Immune Activation
and Exposure to Endocrine-Disrupting Chemicals

2nd Draft: More References with regard to Endocrine Disruptors and Neuro-Developmental & Psychiatric Disorders.

Microglia Protection, Repair & Replacement & Microbiome Re-Colonization

10/19/2024

A public Health Approach to Criminal Justice

Val's Take/Conjecture

People with Neuro-Developmental Disorders and an IQ over 70 make up a large contingent of the Justice-Involved population.
Further, it is not just not just ADHD and Autism. Schizophrenia and Bipolar Disorder are also considered Developmental Disorders and others may be as well.

As we're slowly moving from the SYMPTOM-CLUSTERS of the DSM to BIOMARKERS we're finding a COMPLEX ENVIRONMENT in which multiple systems of the body appear impacted in highly idiosyncratic ways by Maternal Immune Activation IN UTERO.

The truth is some current medications can be protective of the microglia --- for some people.
We're starting to understand the complexity of what is going on --- in a way we haven't in the past.

First Gut Microbiome Map for Personalized Food Responses
(Yale, 2024)

Key Facts:

Gut bacteria respond differently to the same food molecules in different people.
The study mapped 150 food compounds’ effects on gut microbiomes.
This research could lead to personalized dietary recommendations for better health.

Tuning neural circuits and behaviors by microglia in the adult brain. (2024)

Microglia are the primary immune cells of the CNS, contributing to both inflammatory damage and tissue repair in neurological disorder. ...We discuss current studies utilizing microglial optogenetic and chemogenetic approaches to modulate adult neural circuits. Thes …

Maternal immune activation and neuroinflammation in human neurodevelopmental disorders (2021)

Evidence from human and animal studies indicates that maternal immune activation programmes the fetal brain and immune system through inflammatory and epigenetic mechanisms during key periods of CNS, microglial and immune system development, and colonization of gut.

Conclusion

Researchers are providing a much more comprehensive narrative and understanding of Neuro-Developmental and Psychiatric Disorders.
These new understandings are also relevant for:
- Autoimmune Disorders
- Cancer
- Dementia, and
- Neuro-Degenerative Disorders
With respect to Neuro-Developmental/Psychiatric Continuum:
- A focus on improving Microglial health as well as
- Re-colonization of the gut could go a long way to addressing the effects of Maternal Immune Activation.

Thoughts on the King Soopers' Verdict

9/29/2024

Val's Take/Conjecture

As long as people believe insanity or some Public Health Explanation for Bad/Horrific Behavior is a "COP OUT" --- they are not going to go for it.
According to media reports, one of the challenges for the Defense was --- there were NO EXPERTS to support the claim of "INSANITY" under Colorado Statute; although there were experts to testify with regard to Schizophrenia.
One of the reasons why I spend so much time on the Science --- there is a gulf between the Researchers and the Clinicians ---- and most attorneys are going to be looking to Clinicians as their experts.
Most people with Neuro-Developmental Disorders, Psychiatric Disorders and Brain Injury are not in the Criminal Justice System.
But the majority of those in the Criminal Justice System are contending with some form or combination of Neuro-Developmental Disorders, Psychiatric Disorders, or Brain Injury.

Why are biomarkers so important

Insanity

Ultimately, what everyone wants is PREVENTION.

The walk away from the adversary system to a more collaborative approach

9/12/2024

Val's Take:   We're slowly moving away from the Adversary System to a more Collaborative Approach --- a more Problem-Solving Approach.

Given modern science on AGGRESSION --- one of the problems with the Adversary System --- it tends to make everyone in it --- MORE AGGRESSIVE in relative terms.

The Legal System was really designed in the beginning to be an ALTERNATIVE to the BLOOD FEUD.   And from that vantage point, the Adversary Legal System was a big step up.

Historically, there actually have been numerous reform efforts over hundreds of years. It seems like we're getting the medical understanding of the biological basis of behavior. It's more complicated than we thought and not always what we thought historically, most notably the immune system and the immune system in the brain seem very important.

The more we can de-personalize illness or dysregulation ---- the more we can get on the same page. In many cases, people themselves will be advocating for the healthcare they need.

The Today Show
Sing Sing Files

PBS
Insanity

Aggression: Humanity's Ultimate Double-Edged Sword

Aggression

9/11/2024

Val's Take/Conjecture

Especially in conceptualizing "Acts of Aggression," we're often conceptualizing these acts as acts of "Specific Intent."
Further, because these acts are acts of "Specific Intent" we're assuming the person is exercising "CONTROL" over these behaviors.
I don't necessarily think that is "WRONG" but I do think it is partial, and there are many other biological links in the chain prior to seeing the "Specific Intent."
Further, these BIOLOGICAL LINKS are often "But for" links --- without these biological links --- you wouldn't see the specific intent or the act.

but-for test

The but-for test is a test commonly used in both tort law and criminal law to determine actual causation.

Scape·goat
/ˈskāpˌɡōt/noun
1. a person who is blamed for the wrongdoings, mistakes, or faults of others, especially for reasons of expediency.

When we start talking about "AGGRESSION" in human society ---- it is extremely complicated, not least of which because human beings are AGGRESSIVE and we're "TOP PREDATOR."

I don't perceive "AGGRESSION" or "BULLYING" to be particularly rare among CHILDREN, ADOLESCENTS or ADULTS.

BUT there can be extreme differences in the level and intensity of that.
Further, most of us are trying to MASK our "AGGRESSION" --- some more successfully than others --- But usually at some point the MASK comes off.
As that MASKING has its limits, we try to TRANSFORM that AGGRESSION.

Further, if we weren't "AGGRESSIVE" to some extent --- we wouldn't be able to survive.

There are a lot of ways we try to deal with that "AGGRESSION" on a micro and macro level.

By and large --- we're often focused on "Who's to blame?"

That is not only what the LAW is focused on but it is also how we're pretty hard-wired to understand things.
We do need to understand "SPECIFIC" situations and "SPECIFIC" People>
Once you get enough EXAMPLES, I think we start seeing "PATTERNS"
BUT --- those patterns are generally IMPERFECT PATTERNS that need to be subject to REVISION and MODIFICATION for good cause.

I think the DSM 5 is an imperfect collection of "SYMPTOM CLUSTERS," and biological research and researchers are pushing the need to reform these CATEGORIES.

As CU Researchers have advised, let's get to something that is more grounded in individualized, precision medicine and "A LITTLE LESS BY THE BOOK [meaning the DSM 5]."

The UBIQUITOUS nature of:

Neuro-Developmental Disorders
Psychiatric Disorders,
Metabolic Problems and
Chronic Disease in the Society
- is pushing new understandings.

Are "lifestyle choices" irrelevant --- no, BUT this is starting to look more complicated and in many cases DEVELOPMENTAL ISSUES and EPIGENETICS appear to be playing LARGE ROLES.

Further, maybe we knew that the IMMUNE SYSTEM was involved with Multiple Sclerosis and Cancer ---

How many of us knew the immune system was involved with Metabolism (this is a lot more than how much people weigh),
Further, researchers are using METABOLOMIC BIOMARKERS to identify people with psychiatric disorders.
Maternal Immune Activation is greatly associated with neuro-developmental and psychiatric disorders.

University of Tsukuba, Japan

Associations of the immune system in aggression traits and the role of microglia as mediators (2024)

Future anger management strategies and clinical control of excessive aggression and violent behavior may be realized by developing a therapeutic strategy that adjusts glial activity in the cerebellum.

Plasma and cerebrospinal fluid inflammatory markers and human aggression (2023)

A growing body of work suggests that individuals with aggressive behavior and/or aggressive tendencies have evidence of chronic, low level, inflammation as manifested by elevated circulating levels of acute phase reactant proteins and pro-inflammatory cytokines …

Aggression: Humanity's Ultimate Double-Edged Sword

One of the things that happened with the "ENLIGHTENMENT" and "WOKENESS" for that matter is people who really want to change things --- see them as SYSTEMIC.

The "Enlightenment" wasn't just a Political Enlightenment it was also a Scientific Enlightenment.

Stephen Hawking saw AGGRESSION as the primary problem facing Humanity --- and he absolutely understood that it had led to our SURVIVAL.

When we start thinking about things Systemically ---

We start identifying more Stakeholders
Often Complicated Challenges
The need to engage in INTEGRATIVE THINKING
And more often than not the need to come up with THIRD ALTERNATIVES.

Additionally, the more we start to look at this --- the more LATERAL THINKING may be possible.

What is Lateral Thinking?

"Lateral thinking (horizontal thinking) is a form of ideation where designers approach problems by using reasoning that is disruptive or not immediately obvious.

"They use indirect and creative methods to think outside the box and see problems from radically new angles, gaining insights to help find innovative solutions."

Neurodiversity and Homelessness

8/17/2024

The UK's No. 1 government & public sector news alerting service.

What can you do?

Take some time this week to reflect on how your service can further support those who are neurodiverse.

It is important that we take a person-centred approach, as every neurodivergent person has a unique pattern of strengths and challenges.

Please see a number of resources in the Neurodiversity section in our Knowledge Hub here.

It includes excellent resources to help your services to become more inclusive to those who are neurodiverse and experiencing homelessness, such as a learning disabilities and homelessness toolkit, resources from our dementia training project and an autism and homelessness toolkit.

The need to address ADHD and Criminal Justice

8/17/2024

ADHD in the criminal justice system: a case for change – with Takeda

A special podcast from Spotlight, the New Statesman’s policy supplement.
(July 2024)

Excerpt from The New Statesman in the United Kingdom:

Attention deficit hyperactivity disorder (ADHD) affects millions worldwide, yet its presence within the criminal justice system is often misunderstood or overlooked.

In this podcast we navigate the complex landscape where ADHD and the criminal justice system intercept; shedding light on the unique challenges and misconceptions faced by people with ADHD in prisons and the opportunities for improved care and support.

From late diagnosis to repeated prison sentences, the impact of ADHD can shape outcomes in profound and often unrecognised ways.

Host Emma Haslett is joined by Dr Tony Lloyd, the CEO of the ADHD Foundation; Sir Robert Buckland, the former Secretary of State for Justice and MP; Daley Jones, trustee at ADHD Liberty; and Sarah Templeton, an ADHD author and therapist, to explore the stories of those living at this intersection.

Val's Take/Conjecture

The Scandinavian Countries have recognized for awhile that there appeared to be a number of people with ADHD in their criminal justice systems.
- Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study (2024)
Great Britain is issuing papers about Neuro-Diversity in the Criminal Justice System.
- Attention Deficit Hyperactivity Disorder (ADHD) in the Prison System (2019)
- (UK Criminal Justice Joint Inspection) Neurodiversity in criminal justice system - more effective support needed, say inspectorates (2021).
Further, various members of British law enforcement are "coming out" as Neuro-Diverse --- with ADHD or Autism. [See Police Neurodiversity Forum] That shouldn't be that surprising.
Additionally, certainly in Colorado, Law Enforcement and 1st Responders are advocating for resources to address their own mental health needs.
Clinicians, including some in Colorado, have recognized that there were a number of men with ADHD in Criminal Justice.
The US response is slowly starting to get more formalized. See the University of Michigan Policing A Neurodiverse World (2024).

More recently, new paradigms are viewing Neuro-Developmental and Psychiatric Disorders as "Brain Energy" issues implicating mitochondrial dysfunction.

Buena Vista Correctional Complex

Warning: The "R" word is used below.

If He Outgrew it --
What is he doing In My Prison

T. Dwaine McCallon, M.D.
Medical Director, Buena Vista Correctional Facility,
Asst. Chief Medical Officer, Colorado Dept. of Corrections (1998)

If your ADHD is so disabling that you have found yourself living in a remote walled prison of over 1,000 men, then it is unlikely that you will progress toward rehabilitation without the aid of medication.

Stimulant medicine can greatly enhance the ability to learn how to develop caution and judgment, and to learn a job skill.

. . . Over half of these recall being told they would not need treatment beyond the teens as they would outgrow their ADD.

None whom we have worked with were treated into their twenties.18% had discovered that crystal meth on the street would give them focus and a sense of calmness.

20% found solace from the feeling of “being a meathead”, “still being the retard kid” by seeking oblivion with marijuana and heroin."

The quote above came from an article on Canadian Adult ADHD Coach Pete Quily's website.

[Medication is controversial. More and more genetic testing for psychiatric medication may be available --- people can have the same diagnosis and not be able to take the same medication.]

People with Neurodevelopmental Disorders and an IQ over 70 have traditionally gotten little support.

Generally, because people thought and the person themselves may have thought --- they didn't need help.

And they often don't need help "intellectually."

Further, it has been relatively recently that we've started to hone in on "Executive Functioning" challenges as a legitimate challenge and worthy of accommodation.

We do important work when we don't understand the issue or how to address it.

How to better understand issues and how to address them we learn through engaging with those issues.

Significant new paradigms are already here, we are also identifying biomarkers regarding ADHD and other neuro-developmental and psychiatric disorders.

Some researchers are already proposing new treatments based on new paradigms.

We need to consider the UK's policy recommendations with regard to neuro-diversity in the criminal justice system and come up with some policy recommendations of our own.

<<Previous

Transitional/ Translational Justice Monday

INVISIBLE DISABILITIES & THE NEED FOR CENTERs OF EXCELLENCE IN DIAGNOSTICS & TREATMENT

JUSTICE IN AN AGE OF CHANGING SCIENCE --- The blessings and challenges of "consensus"

The Need for more professional & Public education on the role ofMicroglia in Psychiatric disorders

Neuro-Developmental & Psychiatric Disorders as multi-System Disorders

Microglia Protection, Repair & Replacement & Microbiome Re-Colonization

A public Health Approach to Criminal Justice

Thoughts on the King Soopers' Verdict

The walk away from the adversary system to a more collaborative approach

Aggression

Neurodiversity and Homelessness

The need to address ADHD and Criminal Justice

If He Outgrew it --
What is he doing In My Prison

T. Dwaine McCallon, M.D.
Medical Director, Buena Vista Correctional Facility,
Asst. Chief Medical Officer, Colorado Dept. of Corrections (1998)

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Transitional/ Translational Justice Monday

If He Outgrew it --What is he doing In My PrisonT. Dwaine McCallon, M.D. Medical Director, Buena Vista Correctional Facility,Asst. Chief Medical Officer, Colorado Dept. of Corrections (1998)

Archives

Categories

If He Outgrew it --
What is he doing In My Prison

T. Dwaine McCallon, M.D.
Medical Director, Buena Vista Correctional Facility,
Asst. Chief Medical Officer, Colorado Dept. of Corrections (1998)