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Translational Medicine Friday

Immuno-psychiatry Leader Dr. Christopher Bartley:  Autoantibodies in neuro-psychiatric Disorders and Autoimmune psychosis

7/5/2025

 
Dr. Christopher Bartley, M.D., Ph.D
Currently Chief of the National Institute of Mental Health's Translational Immunopsychiatry Unit
Autoantibody Discovery in Neuropsychiatric Syndromes  (2023)
​The Evolving Concept of Autoimmune Psychosis: From the Clinic to the Laboratory  (2024)

WE're Here!  The Cellular and Molecular levels of neuro-Developmental & Psychiatric Disorders

7/5/2025

 
Val's Take/Conjecture
  • With regard to the Nature vs. Nurture argument --- The National Institute of Mental Health and others have said for awhile --- "IT"S BOTH."
  • When we've thought about "NATURE" --- it was generally cast in terms of GENETICS --- but Neuro-Developmental and Psychiatric Disorders were not completely genetic.
It certainly seems today that a big part of the "NATURE" is MATERNAL IMMUNE ACTIVATION and wide-ranging effects from DEVELOPMENTAL INFLAMMATION.
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​Trepanation
​Further, how were we really going to know what was going on without opening up someone's skull.

One of the reasons Psychiatry is so far behind other areas of medicine --- they didn't have BIOMARKERS and it wasn't clear how they were ever going to get them.
Well, as it turns out Neuro-Developmental & Psychiatric Disorders are not just brain disorders, and if we know what we're looking for:
  • We can get those biomarkers
  • Without opening up someone's skull
  • Metabolomic biomarkers can be obtained with a  blood draw.
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​Metabolomic Biomarker Signatures for Bipolar and Unipolar Depression  (2024)
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​
​Maternal immune activation imprints translational dysregulation and differential MAP2 phosphorylation in descendant neural stem cells (2025)
​Abstract

Alterations induced by maternal immune activation (MIA) during gestation impact the subsequent neurodevelopment of progeny, a process that in humans, has been linked to the development of several neuropsychiatric conditions.

To undertake a comprehensive examination of the molecular mechanisms governing MIA, we have devised an in vitro model based on neural stem cells (NSCs) sourced from fetuses carried by animals subjected to Poly I:C treatment.

​These neural progenitors demonstrate proliferative capacity and can be effectively differentiated into both neurons and glial cells.

Transcriptomic, proteomic, and phosphoproteomic analyses conducted on these cellular models, in conjunction with counterparts from control treatments, revealed discernible shifts in the expression levels of a specific subset of proteins implicated in neuronal function.

​Furthermore, the phosphoproteomic data highlighted a discernible discrepancy in the basal phosphorylation of proteins between differentiated cells from both experimental groups, particularly within proteins associated with cytoskeletal architecture and synaptic functionality, notably those belonging to the MAP family.

Observed alterations in MAP phosphorylation were found to potentially have functional consequences as they correlate with changes in neuronal plasticity and the establishment of neuronal synapses.

Our data agrees with previous published observations and further underscore the importance of MAP2 phosphorylation state on its function and the impact that this protein has in neuronal structure and function.
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THE IMPORTANCE OF INTEGRATING dEVELOPMENTAL, pHYSICAL & mENTAL hEALTH

7/3/2025

 

[developmental origins of health and disease (DOHaD)]

Val's Take/Conjecture
  • The move to integrate physical and mental health has been around since the mid-1980s ---
    • ​and a lot of progress has been made in Medicaid and in Health Care generally in  the last 10 to 20 years.
​Especially, with regard to Mental Health and the Immune System ---- that has EXPLODED with many Neuro-Developmental & Psychiatric Disorders conceptualized as Neuro-Immune Disorders.
  • ​as well as autoimmune disease, cancer, etc. recognized as often containing a "psychiatric" component.
We've also generally been aware of "genetic risks" and those exist --- 
  • BUT the risk of DEVELOPMENTAL INFLAMMATION is critically significant and it may also "turn on" certain genes that are "pro-inflammatory"
    • I think this also goes to why our "Diet & Exercise" prescriptions are much more successful for some than others.
​Maternal Immune Activation has been greatly associated with Neuro-Developmental and Psychiatric Disorders.

At least Google AI recognizes the possibility that Maternal Immune Activation could be associated with neurosarcoidosis.
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​Influence of Immune System Abnormalities Caused by Maternal Immune Activation in the Postnatal Period (2023)

*Japanese Researchers
​Abstract

The developmental origins of health and disease (DOHaD) indicate that fetal tissues and organs in critical and sensitive periods of development are susceptible to structural and functional changes due to the adverse environment in utero.

Maternal immune activation (MIA) is one of the phenomena in DOHaD.

Exposure to maternal immune activation is a risk factor for neurodevelopmental disorders, psychosis, cardiovascular diseases, metabolic diseases, and human immune disorders.

It has been associated with increased levels of proinflammatory cytokines transferred from mother to fetus in the prenatal period.

Abnormal immunity induced by MIA includes immune overreaction or immune response failure in offspring. Immune overreaction is a hypersensitivity response of the immune system to pathogens or allergic factor.

Immune response failure could not properly fight off various pathogens.

The clinical features in offspring depend on:
​ the gestation period, inflammatory magnitude, inflammatory type of MIA in the prenatal period, and exposure to prenatal inflammatory stimulation, which might induce epigenetic modifications in the immune system.


​An analysis of epigenetic modifications caused by adverse intrauterine environments might allow clinicians to predict the onset of diseases and disorders before or after birth
​Val's Note:  There's also Paternal Immune Activation.
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Neuropsychiatric manifestations of sarcoidosis (2025)
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Neurosarcoidosis and Maternal Immune Activation
​ What is neurosarcoidosis?
 (Cedars Sinai)
It is a long-term (chronic) disease of the central nervous system, which encompasses the brain, spinal cord and optic nerve, and is characterized by inflammation within one or more of those areas.

This inflammation can cause the destruction of the coating (myelin) that surrounds and protects nerve fibers (axons).

As a result, the damage disrupts the normal flow of messages (nerve impulses) from the central nervous system, causing a reduction or loss of body function.
WHAT'S THE LARGER POINT?

  • I've written a lot about why we have such a hard time recognizing "DEVELOPMENTAL ISSUES" in Health Care.​
  • ​​And there are seemingly "sympathetic" reasons for that.
    • We want to be EMPOWERING.
    • We don't want to be Nazis or Eugenicists
  • The problem is the flip side of that coin can be just as damaging and disconnected from "REALITY" and that disconnect means it is often NOT EMPOWERING.
  • It is with Neuro-Developmental and Psychiatric Disorders that we are recognizing the importance of  "MATERNAL IMMUNE ACTIVATION." ​
    • ​I would be surprised if the significance of MATERNAL IMMUNE ACTIVATION was limited to "Neuro-Developmental" and "Psychiatric Disorders."

DeMYelination and Neuro-Immunology in neuro-developmental & Psychiatric Disorders

7/2/2025

 
​Val's Take/Conjecture
  • ​If we do think of "DEMYELINATION" ---- we might most often think of MULTIPLE SCLEROSIS -- an AUTO-IMMUNE DISEASE.  ​​ ​
  • Part of the last 10 to 15 years, has been appreciating how IMPORTANT the IMMUNE SYSTEM is to:
    • Neuro-Developmental,
    • Psychiatric
    • and even Substance Use Issues.
  • Further, DEMYELINATION is a significant consequence of Brain Injury.
Cognitive Disability and Mobility
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Demyelination in psychiatric and neurological disorders: Mechanisms, clinical impact, and novel therapeutic strategies  (2025)

*Japanese Researchers including those at Chiba University Center for Forensic Mental Health
Highlights

  • Demyelination plays a key role in major psychiatric and neurological disorders.

  • Genetic, environmental, and immune factors drive myelin loss.

  •  Arketamine has potential for promoting myelin restoration through TGF-β1 activation.

  • Therapies targeting the gut-brain axis through the vagus nerve may support myelin repair.
​"Demyelination, defined as the loss of myelin sheaths around neuronal axons, is increasingly recognized as a key factor in a broad range of psychiatric and neurological disorders, including:
  • schizophrenia,
  • major depressive disorder,
  • bipolar disorder,
  • post-traumatic stress disorder,
  • autism spectrum disorder,
  • substance use disorders,
  • Alzheimer's disease,
  • Parkinson's disease, and
  • multiple sclerosis."
​
[bullets added]

Mast cell activation Syndrome & Psychiatric disorders

7/2/2025

 

​Understanding the ramifications of Psychiatric Disorders as Neuro-immune Disorders​

Val's Take/Conjecture​
  • Preventing unnecessary institutionalization of people with Neuro-Developmental and Psychiatric Disorders will be more successful with better IMMUNE ASSESSMENTS.
  • Serious Mental Illness (SMI) --- is  SERIOUS -- but it is made  much more SERIOUS because our PARADIGMS and DIAGNOSTIC CATEGORIES are not tracking REALITY.
    • ​It's a DANGEROUS SITUATION that puts people AT RISK.
​
  • It is NO ACCIDENT that there are associations among Serious Mental Illness and ----
    • Auto-Immune Disease
    • Certain kinds of Cancer
    • Neuro-Degenerative Disease
    • Etc.
​It is a MAJOR CHANGE to go from BRAIN DISORDER to DEVELOPMENTAL NEURO-IMMUNE DISORDER affecting MULTIPLE SYSTEMS of the Body.

That doesn't mean that everyone with a PSYCH DIAGNOSIS has every immune disorder ---- BUT there's much more of a CUMULATIVE EFFECT of Multiple Factors that individually might not be a big deal --- but taken together are overwhelming the body.
​WHAT ARE MAST CELLS?
​Mast cells are a part of your immune system.

  • They’re made in your bone marrow, then move through your bloodstream into your tissues.

    The mature mast cells live in tissues throughout your body to help protect you from hazards around you.

    They can help fight infections and regulate your organs.


    When your mast cells are overprotective, you may react to harmless things in your environment. This happens in people with seasonal allergies or allergic asthma.

    Mast cell activation can sometimes cause anaphylaxis, a serious allergic reaction.
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PHYSIOLOGICAL CORRELATIONS WITH GIFTEDNESS -- Gro-gifted.org
​Mast cell diseases–especially MCAS–are involved with many of the immune issues associated with RCCX/CAPS disorders.

Because mast cells are involved with every system in the body, MCAS symptoms can vary widely as can the severity of the syndrome.

Although many physicians were trained to find systemic mastocytosis, which is the most severe form of mast cell disease, they were not trained to find less severe forms of mast cell disease.

Symptoms of mast cell disease can be wide-ranging. For that reason, physicians and patients are often unable to pin down what caused a particular symptom.

Additionally, tests traditionally used for some of the symptoms of mast cell disease do not test for mast cell disease itself, but rather test for other causes of those symptoms.

. . . Because it appears that mast cell activation problems exist in the gifted population in greater frequency than in the general population, we urge those in the gifted populations with health issues not solved by drugs in those categories to discuss the possibility of mast cell activation problems with their doctors. . . ​
Giftedness, Neuro-Diversity, Bipolar Disorder and Inflammation
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​Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series  (2023)
Abstract

​Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%.


Mast cell chemical mediators lead to heterogeneous multisystemic inflammatory and allergic manifestations.

This syndrome is associated with various neurologic and psychiatric disorders, including headache, dysautonomia, depression, generalized anxiety disorder, and many others.

Although MCAS is common, it is rarely recognized, and thus, patients can suffer for decades.

The syndrome is caused by aberrant mast cell reactivity due to the mutation of the controller gene.

A case series is presented herein including eight patients with significant neuropsychiatric disorders that were often refractory to standard medical therapeutics.

Five patients had depression, five had generalized anxiety disorder, and four had panic disorder.

Other psychiatric disorders included attention-deficit hyperactivity disorder, obsessive compulsive disorder, phobias, and bipolar disorder.

All eight patients were subsequently diagnosed with mast cell activation syndrome; six had comorbid autonomic disorders, the most common being postural orthostatic tachycardia syndrome; and four had hypermobile Ehlers-Danlos syndrome.

All patients experienced significant improvements regarding neuropsychiatric and multisystemic symptoms after mast-cell-directed therapy.

In neuropsychiatric patients who have systemic symptoms and syndromes, it is important to consider the presence of an underlying or comorbid MCAS.

Multi-Factoral Disease & Disorders and Epstein-barr Virus

6/26/2025

 
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​Predisposing and Precipitating Factors in Epstein-Barr Virus-Caused Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (2025)
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​
​Does Epstein-Barr virus and intracellular Toll-like receptors affect the course of Hashimoto disease? Findings from studies on newly-diagnosed patients
 (2025)
​"Epstein-Barr virus (EBV) reactivation is increasingly recognized as a potential exacerbator of autoimmune diseases, including Hashimoto thyroiditis (HT)."
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​Epstein-Barr Virus BARF1 Is Expressed in Lung Cancer and Is Associated with Cancer Progression (2024)
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​​Elevated Epstein-Barr Virus Antibody Level is Associated with Cognitive Decline in the Korean Elderly (2017)
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​Schizophrenia is Associated With an Aberrant Immune Response to Epstein-Barr Virus (2019)
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​Microglia as potential key regulators in viral-induced neuroinflammation (2024)

[What gets dysregulated in Maternal Immune Activation ---- MICROGLIA]
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​Unraveling the links between neurodegeneration and Epstein-Barr virus-mediated cell cycle dysregulation  (2022)
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​Study identifies how Epstein-Barr virus triggers multiple sclerosis  (updated 2025)
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​Epstein-Barr virus infection increases the risk of depression: A cross-sectional study and Mendelian randomization analysis (2025)
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Shared interactions of six neurotropic viruses with 38 human proteins: a computational and literature-based exploration of viral interactions and hijacking of human proteins in neuropsychiatric disorders (2025)
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​New insights on the link between Epstein‑Barr virus infection and cognitive decline in neurodegenerative diseases (Review) (2024)
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​Awakening the sleeping giant: Epstein–Barr virus reactivation by biological agents (2024)

Chronic Fatigue Syndrome

6/25/2025

 
Val's Take:  It is more and more obvious that many Neuro-Developmental and Psychiatric Disorders are BLURRED and not distinct.

It is becoming more and more obvious that physical health issues are BLURRING with Neuro-Developmental and Psychiatric Disorders.

Three of the most obvious are Thyroid Disorders, Chronic Fatigue Syndrome and Long Covid.

Probably patients with Chronic Fatigue Syndrome more than any other have fought a "PSYCHIATRIC LABEL"  ---
  • "I've got a REAL ILLNESS --- not a Mental Illness"

Patients with Chronic Fatigue Syndrome do have REAL PHYSICAL FATIGUE and they often do have cognitive or psychiatric symptoms.

People with "MENTAL ILLNESS" often do have REAL PHYSICAL FATIGUE (not always to the extent of CFS -- but enough to greatly affect their quality of life).

AND that FATIGUE is complicated.  
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​Childhood neurodivergent traits, inflammation and chronic disabling fatigue in adolescence: a longitudinal case-control study (2025)
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​
​The impact of autoimmune thyroid disease on cognitive and psychiatric disorders: focus on clinical, pre-clinical and molecular studies
 (2025)
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Unravelling the Connection Between Energy Metabolism and Immune Senescence/Exhaustion in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (2025)
​Dr. Sanil Rege
Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME)
​"Correction: 14:19 Graded Exercise Therapy NOT Graded Exposure Therapy. Graded exercise therapy is a term used in varying ways by different services supporting people with ME/CFS. (NICE).

"In this guideline, graded exercise therapy is defined as first establishing an individual's baseline of achievable exercise or physical activity, then making fixed incremental increases in the time spent being physically active.

"This definition of graded exercise therapy reflects the descriptions given in the evidence that was reviewed, and it is this approach that the guideline says should not be undertaken.

"Correction: 
14:25 Graded Exercise Therapy NOT Graded Exposure Therapy"
Medical Secrets
Dr. Anthony Kaveh
Chronic Fatigue Syndrome
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​Association of preexisting psychiatric disorders with post-COVID-19 prevalence: a cross-sectional study (2023)

Paradigm Shift:  Cytokine Therapeutics In Mental Health

6/24/2025

 
Val's Take/Conjecture
  • The most striking thing about conceptualizing Neuro-Developmental and Psychiatric Disorders as Neuro-Immune Disorders affecting Multiple Systems of the Body ----
    • It's illuminating not only Neuro-Developmental and Psychiatric Disorders but also many other diseases and disorders as well.
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Google AI Overview

What Medical Disciplines Generally Target Cytokines?


Multiple medical disciplines focus on or utilize cytokines due to their crucial role as signaling molecules in the immune system and their involvement in various disease processes.

Cytokines regulate inflammation, cell growth and differentiation, and immune responses. 
Here are some of the key disciplines:
  • Immunology: Cytokines are fundamental to understanding immune responses, and immunologists investigate their function in both healthy and diseased states.
  • Rheumatology: Cytokines are central to the pathogenesis of rheumatoid arthritis and other inflammatory diseases, with therapies targeting cytokines like TNF-α and IL-6 having revolutionized treatment.
  • Oncology (Cancer Treatment): Cytokine therapy, including the use of interferons and interleukins like IL-2, is used to boost the immune system's ability to fight cancer cells.
  • Dermatology: Cytokine-based treatments are employed for various skin conditions, including melanoma, psoriasis, and vitiligo.
  • Gastroenterology: Cytokine-targeted therapies are transforming the management of inflammatory bowel diseases (IBD) like Crohn's disease.
  • Infectious Disease: Cytokines play a critical role in the inflammatory response to infections, and cytokine-based therapies can be used to manage infectious diseases, such as Kaposi's sarcoma associated with HHV-8 virus.
  • Psychiatry: Evidence suggests that cytokines may be involved in certain psychiatric conditions, and research is ongoing in this area. ​
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Causal relationship between psoriasis and psychiatric disorders with the potential mediating factors: a two-step Mendelian Randomization study (2025)

*Chinese researchers

Background:  Psoriasis (PsO) is a chronic, recurrent inflammatory skin disorder, with a high prevalence of psychiatric comorbidities.

Although various studies explore the association between the two diseases, the causal relationship and underlying mechanisms remain poorly understood.

PsO may be linked to the aberrant secretion of circulating cytokines, and disturbances in peripheral inflammatory factors are considered substantial contributors to central pathophysiological abnormalities.

Thus circulating inflammatory cytokines may serve as potential mediators in the association of PsO and psychiatric comorbidities.
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​Targeting Cytokine-Mediated Inflammation in Brain Disorders: Developing New Treatment Strategies (2025)

*Researchers from Finland, India, Sweden, Bangladesh, Texas, Mexico and Norway
​Abstract

Cytokine-mediated inflammation is increasingly recognized for playing a vital role in the pathophysiology of a wide range of brain disorders, including neurodegenerative, psychiatric, and neurodevelopmental problems.
Pro-inflammatory cytokines such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) cause neuroinflammation, alter brain function, and accelerate disease development.

Despite progress in understanding these pathways, effective medicines targeting brain inflammation are still limited.

Traditional anti-inflammatory and immunomodulatory drugs are effective in peripheral inflammatory illnesses.

​Still, they face substantial hurdles when applied to the central nervous system (CNS), such as the blood-brain barrier (BBB) and unwanted systemic effects.

This review highlights the developing treatment techniques for modifying cytokine-driven neuroinflammation, focusing on advances that selectively target critical cytokines involved in brain pathology.
​Novel approaches, including cytokine-specific inhibitors, antibody-based therapeutics, gene- and RNA-based interventions, and sophisticated drug delivery systems like nanoparticles, show promise with respect to lowering neuroinflammation with greater specificity and safety.

Furthermore, developments in biomarker discoveries and neuroimaging techniques are improving our ability to monitor inflammatory responses, allowing for more accurate and personalized treatment regimens.
​Preclinical and clinical trial data demonstrate the therapeutic potential of these tailored techniques.

However, significant challenges remain, such as improving delivery across the BBB and reducing off-target effects.

As research advances, the creation of personalized, cytokine-centered therapeutics has the potential to alter the therapy landscape for brain illnesses, giving patients hope for better results and a higher quality of life.
***Physical Health Issues, the Immune System and Mental Health

Multiple Sclerosis and Mood Disorders

6/23/2025

 
Val's Take

One of the big discoveries of the last decade or so is that many Neuro-Developmental and Psychiatric Disorders are blurred --- not distinct.


Further, that among other things is driving the need for PRECISION MEDICINE.

Additionally. many other chronic illnesses have psychiatric symptoms.


Integrating Physical and Mental Health Care has already begun --- and there is more to do.
​National MS Society
Mood Changes in MS

Clinical Immunology is slowly But Surely Stepping Up

6/21/2025

 
​Val's Take/Conjecture
  • Over 100 years ago medical researchers began speculating about a role for the Immune System in psychiatric disorders.
  • Now with better technology those suppositions are proving to be true.
  • Especially in the last 10 to 15 years--- the research linking neuro-developmental and psychiatric disorders to the Immune System has exploded.
  • When we talk about integrating Physical and Mental Health
    • ​What does that Care Team look like?​
  • We're talking about idiosyncratic Neuro-Immune Disorders that impact multiple systems of the body.
​
  • What are the ramifications of these new understandings for people who are Homeless and/or Justice-Involved?
​​THE HISTORY OF LINKING THE IMMUNE SYSTEM TO PSYCHIATRIC DISORDERS
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​The immune system and psychiatric disease: a basic science perspective (2019)
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​Editorial: Peripheral Markers of Immune Response in Major Psychiatric Disorders: Where Are We Now and Where Do We Want to Be? (2019)
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​Conventional and new immunotherapies for immune system dysregulation in postpartum mood disorders: comparisons to immune system dysregulations in bipolar disorder, major depression, and postpartum autoimmune thyroid disease.  (2025)
​Abstract

Introduction: Postpartum mood disorders are heterogenous disorders and comprise postpartum psychosis and postpartum depression.

Evidence is accumulating that systemic monocyte/macrophage activation, low-grade inflammation and (premature senescence related) T cell defects increase the risk for mood disorders outside pregnancy by affecting the function of microglia and T cells in the emotional brain (the cortico-limbic system) leading to inadequate mood regulation upon stress.

​Areas covered: The evidence in the literature that similar immune dysregulations are present in postpartum mood disorders.

Results: The physiological postpartum period is characterized by a rapid T cell surge and a mild activation of the monocyte/macrophage system.

Postpartum mood disorder patients show a diminished T cell surge (including that of T regulatory cells) and an increase in low grade inflammation, that is, an increased inflammatory state of monocytes/macrophages and higher levels of serum pro-inflammatory cytokines.

Expert opinion: Anti-inflammatory agents (e.g. COX-2 inhibitors) and T cell boosting agents (e.g. low-dose IL-2 therapy) should be further investigated as treatment.

​The hypothesis should be investigated that postpartum mood disorders are active episodes (triggered by changes in the postpartum immuno-endocrine milieu) in ongoing, dynamically fluctuating aberrant neuro-immune-endocrine trajectories leading to mood disorders in women (inheritably) vulnerable to these disorders.
<<Previous

    Translational Medicine Friday

    We're riffing off NPR's Science Friday to create Translational Medicine Friday.

    We'll be collecting Research Article recommendations for Clinicians with regard to Cognitive Disability.

    ​There is much in the RESEARCH JOURNALS and we'll just be SKIMMING THE SURFACE.

    The POINT is to INCREASE FUNDING for TRANSLATIONAL RESEARCH at the Federal Level for the National Institutes of Health, the Centers for Disease Control, the Nation's Research & Teaching Hospitals and possible collaborations with Medicare and Medicaid providers.

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    • About Orchid >
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    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
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      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
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  • " 'Defund the Police" Means 'Invest in the Resources Our Communities Need' " or Don't Cost Shift to the Police
  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
  • Updating & Reforming our Understanding & Treatment of "Anti-Social Personality Disorder" Blog
  • Reform of " Anti-Social Personality Disorder" in Criminal Justice
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  • Microglia and the Brain's Immune System
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