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    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
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      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
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​                  NEURODiversity          Wednesday

Maternal Immune Activation and Pre-Mature Aging

8/7/2023

 
Conjecture
  • So as Neuro-Diverse Folks --- we were often BORN with
    • Developmental Systemic Inflammation, and
    • Sometimes Subtle Dysregulations of:
      • the Central Nervous System
      • the Immune System
      • the Endocrine System
      • the Metabolism and
      • the Microbiome
  • Further, these DYSREGULATIONS along with having a "HYPER-CONNECTED BRAIN" are NOT ALL BAD ---

BUT

there are some pretty WICKED TRADE-OFFS:
  • More susectibility to Stroke
  • More Susceptibility to Cancer
  • A "Continuum" of Neuro-Developmental and Psychiatric Disorders, and
  • "Excitable" neurons that are involved with a greater pace of AGING.

This is requiring "INTEGRATIVE THINKING" to solve WICKED PROBLEMS.

Rotman Program of Integrative Thinking at the University of Toronto
How to Solve Wicked Problems Using Integrative Thinking

The ISOLATION of "SENSING," "PERCEIVING," "KNOWING" MORE* than Most of the People Around You

5/22/2023

 
And having Intense Emotions and Executive Functioning Challenges

*MORE --- Not Everything

Conjecture

The approach to the right is a very different approach than --- "Let me help you to change or get better coping mechanisms" ----
  • for an ENVIRONMENT that may be BLISSFULLY IGNORANT that it is DESTROYING YOU.

On the other hand, we're often ignorant of how our Intense Emotions and Executive Functioning Challenges affect OTHERS ---
  • even as we're very aware of how the CHALLENGES OF OTHERS AFFECT US.

Ultimately, this isn't about Neuro-Typical vs. Neuro-Diverse ---
  • As the psychologist recognizes in the video above --- Most people are OUTLIERS in some respect.

Further, the Standards of Danger to Self, Others or Gravely Disabled are probably pretty good  ----
  • our ability to keep people out of those danger zones has not been that great.
  • more UNDERSTANDING regarding managing INTENSE EMOTIONS and EXECUTIVE FUNCTIONING could HELP.

[As an Aside: 

On a Macro Level it's not letting people with PARKINSON'S engage in INTERNATIONAL ACTS OF AGGRESSION.]

The Counselling Channel (UK)
What is Neurodiversity?

Paraphrasing at 11:48 : 

The Temptation of the Therapist if THEY WEREN'T ALIVE TO THIS could be to say there is nothing wrong with you.

Obviously, there is a problem with saying there is something wrong with someone and I'm not saying there is something wrong --


What I'm saying is you have significant differences from other people that can make life more difficult than it is for most people.


WHAT ARE WE GOING TO DO ABOUT IT?

Public Health, Time & Executive Functioning

5/9/2023

 
Conjecture

Challenges in TIME MANAGEMENT and other Executive Functioning Issues for People with an IQ over 70 are often not perceived as "REASONABLE."

Further, those TIME MANAGMENT ISSUES are often related to GREATER NOT LESS SENSORY and EMOTIONAL PROCESSING.


There are absolutely GIFTS that come with these Differences --- but some of it can be quite difficult to manage and we need better STRATEGIES & TREATMENTS.

Additionally, a lot of the HELPERS have their own LIMITS --- and our DYSFUNCTIONAL SYSTEMS have a habit of exposing those LIMITS.

Picture
I'm highlighting this British Medical Journal Cover for its Observation that we need a NEW DEAL on Disease Definition.

Our current categories are breaking down and nowhere is that more evident than in the outdated DSM 5.

We are needing to integrate Physical, Neuro-Developmental & Mental Health --- just so we can understand what is going on.

Picture
'I can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19 (2022)
Affiliations
  • 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • 3 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Picture
Associations between executive function impairment and biochemical abnormalities in depressed adolescents with non-suicidal self-injury. (2022)
Affiliations
  • 1 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
  • 2 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; The Department of Child and Adolescent Psychology Xiamen Xianyue hospital, Fujian 361012, China.
  • 3 Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
  • 4 School of Management, Jinan University, Guangzhou 510316, China.
  • 5 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China. Electronic address: [email protected].
  • 6 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Conclusions:   Depressed adolescents with NSSI may have executive dysfunction and NAA and Cho metabolism abnormalities in the thalamus. And the NAA/Cr ratios of the right LN could distinguish NSSI from depressed adolescents. Further, the executive dysfunction may be associated with the abnormal NAA metabolism in the left thalamus and ACC.
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Executive Functions, Time Organization and Quality of Life among Adults with Learning Disabilities

Affiliation
  • The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, Haifa University, Haifa, Israel.
Conclusions:   Deficits in initiation and emotional executive functions as well as organization in time abilities and emotional responses to impairments in organizing time affect the QoL of adults with LD and thus should be considered in further research as well as in clinical applications.
20/20
Carly Fleischmann

Most people are NOT experiencing exactly what Carly Fleischmann is --- BUT many of us are getting various levels of sensory and emotional input that are difficult to manage.

Understood
ADHD & Dyslexia --- Working Smarter Not Harder

Click to set custom HTML

ADHD, Conduct Disorder and Anti-Social Personality Disorder  ---- What Might Be Going On?

5/7/2023

 
Picture
Does ADHD Cause Antisocial Personality Disorder?
Can You Have ADHD and ASPD?

Studies suggest that as many as 90% of adults with ADHD have other mental health disorders.

ASPD [Anti-Social Personality Disorder] is one of the most common mental disorders that happens with ADHD.

One study showed that men with ADHD were more likely to have antisocial personality disorder than women with ADHD.

Other common mental conditions you can have with ADHD are:

  • Anxiety disorders
  • Mood disorders
  • Substance use disorders
  • Behavior disorders
  • Learning disabilities
  • Language disorders
[These Disorders are BLURRED --- Colorado Researchers are finding that as well as researchers around the world.  See Shared Genes & Psychiatric Disorders.]
Academic Proposal that Anti-Social Personality Disorder is a Neuro-Developmental Disorder
I think in many cases the BOTTOM LINE is that some Neuro-Diverse person has limits that are NOT FALLING WITHIN Neuro-Typical Ranges ---
  • and we've decided that is NOT REASONABLE ---
  • and we won't take "NO" for an answer.

AND  we're often making a DIFFICULT SITUATION --- MUCH WORSE.

For many Neuro-Diverse people --- we may have been on BOTH SIDES OF THIS --- and be painfully aware both of how we wished we were treated and how we wished we would have treated others.

Conjecture

The "BLINDERS" of US vs. Them Thinking.
  • The time it takes to bring things into "CONSCIOUS AWARENESS" to reach a "CRITICAL MASS"

"HIERARCHY" has really "MANAGED" a lot of disordered human behavior ---
  • That is becoming less and less true.

One way of looking at this is to say ---
  • We need more fair systems --- we need to PUNISH MORE PEOPLE.

I am definitely not saying anyone, including the Society at large, should IGNORE --- human behavior that is:
  • a danger to others
  • a danger to self or
  • gravely disabled

BUT we really have to UNDERSTAND that BEHAVIOR on a much DEEPER and CELLULAR LEVEL than we have.

If all you have is "Conduct Disorder" or "Anti-Social Personality Disorder" ---
  • Maybe you do go with that --
  • BUT at some point it's becoming painfully obvious MORE IS GOING ON

Many of the people we're most concerned about --- are very open to "TREATMENT":
  • We just need to know more about what we're doing ---
  • And ethically address those situations -- where we don't have the best answers.
    • Further, if we don't have great treatments don't expect people to want sucky treatments.

To me this is very much about MATERNAL IMMUNE ACTIVATION and HYPER-CONNECTED BRAINS:
  • that often have SOME STRENGTHS, but
  • come with weaknesses in TRADITIONAL EXECUTIVE FUNCTIONING.

When we think about "NEURO-PLASTICITY" --- we often think of it as something that somehow hasn't already been going on.
  • I think that is a CRITICAL MISTAKE.

Not that NEURO-PLASTICITY can't maybe help in some cases ---
  • BUT for many people with NEURO-DEVELOPMENTAL DIFFERENCES --- it's more about DISCOVERING what NEURO-PLASTICITY has already done.
    • AND Work within those Limits.

It's fine to try and extend those LIMITS ---
  • But at least some people are already MAXXED OUT using TRADITIONAL MEANS.
  • If we're going to EXTEND THOSE LIMITS IN EXECUTIVE FUNCTIONING:
    • We're going to need PRECISION MEDICINE, and
    • In the meantime, we need a lot more PUBLIC EDUCATION about ACCOMMODATIONS & WORK AROUNDS for EXECUTIVE FUNCTIONING CHALLENGES

Neuro-Diversity --- Super powers, Disability, both or a matter of perspective

5/5/2023

 
Picture
“ADHD Superpowers:”

Toxic Positivity vs. Celebration of Strengths
(2023)


When we refer to ADHD superpowers, are we dismantling ADHD myths or perpetuating toxic positivity? Could it be both? . . . ADDitude readers reflect on their ADHD traits and how they view them.
Autism from the Inside
Am I Disabled?

The Counselling Channel (UK)
What is Neurodiversity?

Belief, Sensory Processing and Overload

4/20/2023

 
Conjecture
  • Fuentes says --- Hey --- why are we so complicated --- it's not that --- we had to be --- THAT'S NOT THE WAY EVOLUTION WORKS.
  • Well --- Yes and No.
 
  • On the one hand --- we're taking in an enormous amount of information ---
    • On the other hand, we don't have an INFINITE CAPACITY TO TAKE IN INFORMATION
    • and WE DON'T HAVE AN INFINITE CAPACITY TO PROCESS IT.
 
  • I think one of the things that makes Human Beings very anxious is having a NARRATIVE that doesn't hang together ---
    • Especially, if it is about themselves.
 
  • Many of the great theologians and philosophers associated with various religious and spiritual traditions said ---- HEY, THIS IS BEYOND HUMAN UNDERSTANDING.
 
  • I don't think most issues are PERMANENTLY BEYOND HUMAN UNDERSTANDING.
    • But there are some very real TIME AND PRACTICAL CHALLENGES
    • and Neuro-Diverse People are often on the FRONTLINES OF THOSE PRACTICAL CHALLENGES.
Big Think
Agustin Fuentes
Why Sex, Food & Shelter Aren't Enough for Homo Sapiens
For some NEURO-DIVERSE PEOPLE in our societies --- we are pushing maturity not just to 25 but to 30 and maybe beyond.
For many Neuro-Diverse People our societies are SO ADMINISTRATIVELY COMPLEX
  • They are having a hard time FUNCTIONING.
  • EXECUTIVE FUNCTIONING CHALLENGES for People with Giant Brains ---
    • Is not what we were EXPECTING.

Executive FunctionING, Neuro-Diversity and the NeeDS to Both Learn & TEACH

4/1/2023

 
Picture
This can be very hard for Neuro-Diverse People --- because we often don't understand our differences and neither does anybody else.

That is starting to CHANGE.

Understanding Our Own "Unreasonable" Limits & That of Others

& NOT Ignoring Them

Executive Functioning is pretty boring in a lot of ways and I think that is why we are just now getting to it.

BUT . . .  It has a BIG IMPACT.

  • Short Term Memory
  • Organization
  • Planning
  • Emotional Regulation
  • etc.
 
  • If YOU don't know and the people around you, including professionals, don't know or don't understand that YOU have EXECUTIVE FUNCTIONING DIFFERENCES
    • And you are unknowingly MASKING in a Neuro-Typical World
      • You could be headed for BURNOUTS or EVEN BREAK-DOWNS
 
  • For a lot of people PSYCHIATRIC LABELS can be a BIG IRRITANT --- and I don't think they are accurate ---
    • I think that is a big reason why we are MISSING SO MANY PEOPLE ---
      • UNTIL THE CRISIS.

On the other hand, a lot of LATE DIAGNOSIS Neuro-Diverse people are quite GRATEFUL for that "DIAGNOSIS"  ---
  • Even if we may have gone through HELL to get it.
  • I would knowingly and personally say that a DANGEROUS PSYCHOTIC EPISODE is HELL.

How we get out of this is GETTING TO THE UNDERLYING BIOLOGY and moving beyond VAGUE and OFTEN MISLEADING SYMPTOM CLUSTERS.
Strength-Based Approach
Employment Index
Picture
AAAS = American Academy of Arts & Sciences
The integrated stress response:
From mechanism to disease
(2020)

Affiliations
  • 1 Department of Neuroscience, Memory and Brain Research Center, Baylor College of Medicine, Houston, TX, USA.
  • 2 Howard Hughes Medical Institute and Department of Biochemistry and Biophysics, University of California at San Francisco, San Francisco, CA, USA
Abstract

Protein quality control is essential for the proper function of cells and the organisms that they make up.

The resulting loss of proteostasis, the processes by which the health of the cell's proteins is monitored and maintained at homeostasis, is associated with a wide range of age-related human diseases.

Here, we highlight how the integrated stress response (ISR), a central signaling network that responds to proteostasis defects by tuning protein synthesis rates, impedes the formation of long-term memory.

In addition, we address how dysregulated ISR [Integrated Stress Response] signaling contributes to the pathogenesis of complex diseases, including cognitive disorders, neurodegeneration, cancer, diabetes, and metabolic disorders.

The development of tools through which the ISR can be modulated promises to uncover new avenues to diminish pathologies resulting from it for clinical benefit.

I think the confusing thing about STRESS and Neuro-Developmental & Psychiatric Disorders:
  • the Stress is often going to one or more aspects of Executive Functioning ---
  • NOT TO SUBSTANTIVE KNOWLEDGE which may be quite high
    • I think the Sensory Processing Load is sometimes to often driving both:
      • EXECUTIVE FUNCTIONING CHALLENGES, and
      • HIGH SUBSTANTIVE KNOWLEDGE in one or more areas
[See also Why Orchid?]
So I think people need to work at WHATEVER LEVEL THEY ARE AT for THEIR OWN MENTAL HEALTH --- and that level may be quite high.

The ACCOMMODATIONS or WORK-AROUNDS often need to go to one or more aspects of EXECUTIVE FUNCTIONING.

Why "People of the Book"* are MISSING SO MANY PEOPLE

2/15/2023

 
*The Book is the Outdated DSM that we're still using
At the end of the day, Neuro-Diversity is not so much about "SYMPTOM CLUSTERS" as it is SHARED GENES & DEVELOPMENTAL INFLAMMATION

And that Developmental and After-Acquired Inflammation can be quite IDIOSYNCRATIC.

Picture
The University of Colorado Boulder leads research linking psychiatric disorders, genetic makeup (2022)
“So what this is doing — is it’s starting to kind of shed light on the specific biological pathways that might be shared across these disorders; namely, these specific neurons that are sort of critical and just brain signaling pathways,” Grotzinger said.

With these findings, Grotzinger hopes to be able to identify what the specific genetic risk pathways are so an individual can be diagnosed and treated more efficiently.

The goal is to be able to give an individual one diagnosis and treatment for the disorders they have instead of multiple, if possible.

Currently, an individual cannot be diagnosed with bipolar and schizophrenia disorder.

However, these two disorders have an overlap in their genetic makeup — meaning that an individual can experience symptoms from both disorders.

Grotzinger hopes in the future diagnoses can be made “a little less sort of by the book.”

In addition, there also may be a possibility of treating certain diagnoses with psychotherapy versus prescription medicines.

The research team only analyzed the genetic variation that showed up in at least 1% of the population“

That really rare stuff might be really important.

And it’s something that we’re just now getting to the point that we can start to look at,”  Grotzinger said
.
Picture
The hidden links between mental disorders (2020)

[Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help.]
Researchers are also drastically rethinking theories of how our brains go wrong.

The idea that mental illness can be classified into distinct, discrete categories such as ‘anxiety’ or ‘psychosis’ has been disproved to a large extent
*.

Instead, disorders shade into each other, and there are no hard dividing lines — as Plana-Ripoll’s study so clearly demonstrated.
Picture
Psychiatric Diagnostic Uncertainty: Challenges to Patient-Centered Care (2016)
[*Has this message gotten to Mental Health Professionals TESTIFYING in Court --- often not.

That IGNORANCE is not their fault --- but we need POLICY-MAKERS to address this.]

The Need for a New Integrated DSM

More on Neuro-Diversity, Gender & Sexuality Getting Beyond the "Culture Wars" in 2023

2/9/2023

 
Val's Take & Conjecture
  • Sarah Huckabee Sander's response to Biden's State of the Union was TELLING in more ways than one.
  • As a Society in 2023, I think we're pretty CONFUSED as to whether LGBTQ+ is a LIFESTYLE CHOICE or a BIOLOGICAL REALITY.
    • And beyond that ---- what is the STATE OF THE SCIENCE?
 
  • I think we are NEEDING TO ASK SOME QUESTIONS both of the LGBTQ+ COMMUNITY & ALLIES and of the PERSECUTORS.
 
  • I think there is a HUGE NEED to get out of US vs. THEM THINKING and parse some of these issues --- because both sides can sometimes take ILLOGICAL POSITIONS.
 
  • So on the one hand --- if you're really for FREEDOM ---
    • This should be easy
    • People should be able to CHOOSE their partners
 
  • The problem in 2023 is this doesn't seem like such a "LIFESTYLE CHOICE" as COMPLICATED BIOLOGICAL REALITIES.
 
  • Further LGBTQ+ does seems to me to be "A PART" of the NEURO-DIVERSE COMMUNITY which includes HETEROSEXUAL people as well. 
Arkansas Governor Sarah Huckabee Sanders
  • To me NEURO-DIVERSITY is very much about:
    • Shared Genes and
    • Maternal Immune Activation
 
  • It "appears" that the COMBINATION of SHARED GENES AND MATERNAL IMMUNE ACTIVATION is "DYSREGULATING" MULTIPLE SYSTEMS OF THE BODY in IDIOSYNCRATIC WAYS.
 
  • I think the IRONY for some TRANS people --- they really are trying to get to a more "NORMATIVE" and TRADITIONALLY REGULATED EXPERIENCE ---
    • It is not clear to me the SCIENCE can always provide that.

  If we want a PRO-LIFE CULTURE we have to INCREASE OUR UNDERSTANDING OF THE BIOLOGY OF LIFE.
Neuro-Diversity, Gender & Sexuality
Lateral Thinking & Conspiracy Theories

The Quest for an Accurate Narrative of Neuro-Diversity

2/3/2023

 
"Research from the field of narrative psychology shows a link between narratives and well-being.  Exploring personal stories, reflecting on them, changing these narratives, and sharing them might make us vulnerable, but also helps us heal and grow."

How Storytelling Is Good for Your Mental Health

Val's Take
  • So much of Neuro-Diversity seems CONTRADICTORY
    • Big Strengths and Big Weaknesses
    • Logic Skills and Meltdowns
    • Seemingly opposite Diagnostic Categories (notably ADHD & AUTISM) that are not distinct but blurred
 
  • To me, the DSM cannot provide a COHERENT NARRATIVE of NEURO-DIVERSITY
    • and the DSM 5 is in fact PART OF THE PROBLEM
 
 
Picture
I don't think you push for the "UNDERLYING BIOLOGY" --- unless you have to ---
  • We've had to --
  • The recent new discoveries and conceptualizations of the last 10 years by Researchers around the world ----
    • Mean a lot of the money we're spending in Mental Health has not been well-targeted --- EVEN if it has been well meaning.
SUSTAINABILITY for Neuro-Diverse People --- looks different ---
  • than what sustainability looks like for people who are NOT contending with:
  • Sensory Overload
  • Hyper-Connected Brains, and
  • Developmental Inflammation that is often impacting multiple systems of the body ---
    • the Central Nervous System -- yes, but also
    • the Immune System
    • the Endocrine System
    • the Metabolism, and
    • the Microbiome.
<<Previous
Forward>>

    Neuro-Diversity
    Wednesday

    (with variable spellings of Neurodiversity)


    NEURODIVERSITY  is BLURRED. 

    What people are keying off of is:  EXECUTIVE FUNCTIONING DIFFERENCES or DEFICITS --- and saying "Hey, that's me."

    BUT they are also saying:  "Hey, I've got some BIG TIME STRENGTHS and I need those recognized too." 

    ​
     

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    • ***Physical Health Issues, the Immune System & Mental Health Index
  • University of Chicago: Institute of Translational Medicine
  • Hot Topics
    • 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
    • Executive Functioning & "Prison Brain" >
      • 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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  • Colorado Abuse & Neglect Scandals Involving People with Disabilities
  • Mental Health By The Numbers
  • New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW
  • Olmstead & Homelessness
  • Double V
  • " '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
  • CO HB22-1278
  • New Understandings Matter
  • Mental Health, Ethics & Law
  • CO Olmstead Disability Homeless Law & Policy Project
  • Inflammation, the Immune System, Neuro-Developmental Disorders, Psychiatric Disorders, Substance Use Issues & Chronic Disease
  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System