Blog Posts

Do we have the right profession to address the "Neuro-developmental continuum"---?

1/16/2022

Genetic research supports the hypothesis that ID (Intellectual Disability), ASD (Autism Spectrum Disorder), ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum

There's a lot of "INTEGRATIVE COMPLEXITY" in the statement above from Dialogues in Clinical Neuroscience, and I suspect we will be UN-PACKING IT for the next century if not far beyond.

Much of how we REASON is to take the CAUSAL LINK we've come upon in the MOMENT and try to make sense of it and create a STORY and a NARRATIVE until we can't anymore --- the ANOMALIES have built up to such a degree that we know this STORY --- can't be "RIGHT."

The STORY the MENTAL HEALTH PROFESSION is telling themselves and others regarding PSYCHIATRIC DISORDERS is "NOT RIGHT" in FUNDAMENTAL WAYS that are preventing us from MORE EFFECTIVELY addressing the MENTAL HEALTH CRISIS that we see in most DEVELOPED COUNTRIES and DEVELOPING COUNTRIES.

Is the STORY "WRONG" --- well, it is MISSING KEY ELEMENTS that would DRAMATICALLY CHANGE TREATMENT STRATEGIES in MANY CASES.

On the other hand --- DON'T THROW THE BABY OUT WITH THE BATH WATER --- it is not as if there is nothing of value in our current approaches to treating "PSYCHIATRIC DISORDERS."

Further, many of our current approaches have SAVED LIVES --- even as those approaches are NOT SUFFICIENT to address the CRISIS we're currently facing.

WORK has to be a TWO-WAY STREET and it may be most easily seen in the "EXTREME" of people with NEURO-DEVELOPMENTAL DIFFERENCES and SERVICE PROVIDERS.

You can't just RAM Neuro-Diverse people into any old WORK Environment and think it is going to "work out"
- they often have BIG STRENGTHS that aren't getting SUFFICIENTLY CHALLENGED, and
- EXECUTIVE FUNCTIONING Differences or Deficits that are not receiving SUFFICIENT SUPPORT.

"My New Job Isn't What I Signed Up For" --- Inc.com

It has been HARD to understand how the Profession could:

Blow off the significance of a scientifically invalid DSM, and
Compelling Research of the last 5 to 10 years regarding the relationship between Neuro-Developmental & Psychiatric DIsorders BUT
This isn't necessarily APPEALING to the people who are currently in the Profession.

You can't just add FUNDAMENTAL ELEMENTS to the JOB Description of treating PSYCHIATRIC DISORDERS --- and think everyone who is currently working under the title MENTAL HEALTH PROVIDER --- wants to do or is even well-suited to incorporate those FUNDAMENTAL NEW ELEMENTS.

Are neurodevelopmental disorders discrete conditions? (2018)

There is abundant evidence to indicate that neurodevelopmental disorders tend to co-occur, rather than existing as individual conditions.

Could this ‘comorbidity’ reflect an overall atypical course of neural development, which manifests in various ways?

The NEW PARADIGMS from the RESEARCH view:

Neuro-Developmental Disorders as BLURRED
Psychiatric Disorders as BLURRED, and
Psychiatric Disorders as DISORDERS of the NEURO-DEVELOPMENTAL CONTINUUM

That's a far cry from the DSM and goes a long way to explaining why we are having such a hard time addressing our MENTAL HEALTH CRISIS ---

We've got a bigger problem than we realize, and
Our Systems are not set up to deal with it.
Further, a lot of people who went into Mental Health wanted to do "Mental Health Therapy" --- NOT work with people with DEVELOPMENTAL DISORDERS --- but that is their primary population
- THIS IS A PROBLEM.
- There is a role for therapy, but much of what is needed is DIFFERENT than what is being offered.
- Now, a lot of Mental Health Professionals if they had the TRAINING would be interested in working with people with DEVELOPMENTAL DISORDERS involving EXECUTIVE FUNCTIONING.
- Further, it is not as if Mental Health Professionals don't have some general knowledge, but by and large they are NOT the EXPERTS we need them to be, even if there are EXPERTS within their ranks, not surprisingly in EDUCATIONAL PSYCHOLOGY --- which is focused on more DEVELOPMENTAL ISSUES.

One of the points we've tried to make on this website is that CRIMINAL JUSTICE REFORM often FAILS because what's needed is so UNDER-ESTIMATED.

At least in part, that can be traced to Medical and Educational Under-Estimations of what it actually takes to address DIFFERENCES or DEFICITS in EXECUTIVE FUNCTIONING.

To say this is DISASTROUS sounds like hyperbole --- UNTIL you realize:

Most people with psychiatric disorders started out as people with neuro-developmental disorders involving EXECUTIVE FUNCTIONING, and
Graduated to people with psychiatric disorders and HYPER-CONNECTED BRAINS at least in part I would submit trying to manage those EXECUTIVE FUNCTIONING DIFFERENCES in a largely clueless if not PUNISHING SOCIAL ENVIRONMENT.

Those super sensitive / reactive people are becoming more sensitive and more reactive in attempts to address EXECUTIVE FUNCTIONING and that is DYSREGULATING SYSTEMS of the BODY even more.
Finding BALANCE and SUSTAINABILITY is a much more CHALLENGING PROPOSITION than we've been willing to recognize as a society ---- the more ASYNCHRONOUS the PERSON --- the more of a challenge that can be.

We somehow have this IDEA that DEVELOPMENTAL DIFFERENCE doesn't have any consequences if one has an AVERAGE or ABOVE-AVERAGE IQ.

Of course, our MENTAL HEALTH CRISIS and who it is affecting is telling quite a different story.
Further, that population of NEURO-DIVERSE people is steadily increasing as inflammation in the society and MATERNAL IMMUNE ACTIVATION increase.

It is not fair to say that the SOCIETY is causing ALL the CHALLENGES --- but it is FAIR to say the SOCIETY is EXACERBATING the CHALLENGES by FAILING TO ADEQUATELY APPRECIATE THEM.

Image Credit: VIA Institute on Character

Those NEURO-DIVERSE STRENGTHS that are a NATURAL ATTEMPT to BALANCE what may be MULTIPLE DYREGULATIONS of BODILY SYSTEMS by conventional standards --- may prove INSUFFICIENT ---

but those NEURO-DIVERSE STRENGTHS are still an IMPORTANT COMPONENT to MENTAL & PHYSICAL WELL BEING.

Maternal Immune Activation, DYSREGULATION INCLUDING Metabolic Dysregulation & the Tree of Knowledge

1/14/2022

Psychiatric Disorders appear to be in some to many cases a progression of Neuro-Developmental Disorders.

Further, those Neuro-Developmental disorders often bring with them DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY.

Such DYSREGULATIONS "appear" to be IDIOSYNCRATIC and can tend toward one extreme or another.

Metabolic Dysregulations from Maternal Immune Activation are associated with Neuro-Developmental and Psychiatric Disorders.

This is above and beyond Professor Graham Rook's concerns of the lack of diversity in the HUMAN MICROBIOME that is causing the IMMUNE SYSTEM to be TOO SENSITIVE which might be considered a SOFTWARE CONCERN.

The issues with MATERNAL IMMUNE ACTIVATION --- appear to go to HARDWARE and perhaps more difficult to address.

Do these METABOLIC ABNORMALITES / DYSREGULATIONS represent another type of EXECUTIVE or UNCONSCIOUS FUNCTIONING that now has to be managed more CONSCIOUSLY with ADDITIONAL CHALLENGES?

Interestingly, "BIPOLAR DISORDER":

Bipolar Disorder is being conceptualized by the University of Michigan as a DEVELOPMENTAL DISORDER that includes
Cells that are MORE REACTIIVE
Further, Bipolar Disorder appears to involve DSYREGULATIONS of MULTIPLE SYSTEMS OF THE BODY
And those INTER-CONNECTED DYSREGULATIONS have a LIFE OF THEIR OWN

Tree of Knowledge --- The Art of DionJa'Y

Metabolic Disorders May Contribute to Anorexia
(2019)

Researchers say these metabolic abnormalities may not be symptoms of the eating disorder. They may be part of the cause.

Metabolic abnormalities associated with obesity in children and adolescents in Jordan (2011)

"Obesity was significantly associated with increased odds of individual metabolic abnormalities and their clustering."

Metabolic and behavioral features of acute hyperpurinergia and the maternal immune activation mouse model of autism spectrum disorder (2021)

Tree of Knowledge by Lucas Cranach the Elder

BUT all of those DYSREGULATIONS MAY FORCE a certain partaking of the TREE of KNOWLEDGE --- because you can't rely to the same EXTENT on AUTOMATIC FUNCTIONING.

So you MAY have to develop other skills including LOGIC SKILLS and other ABILILITIES much more than someone else -----

and what you're finding is what a lot of theologians and philosophers and artists found before you ---- YOU DON'T HAVE AN UNLIMITED ABILITY TO DO THAT.
The HYPER-CONNECTED BRAINS and DYSREGULATED SYSTEMS associated with NEURO-DEVELOPMENTAL and PSYCHIATRIC DISODERS are a kind of FORENSIC EVIDENCE that are telling a COMPLICATED TALE --- full of INTEGRATIVE COMPLEXITY.
- Just the kind of Tale that someone who was into the HUMANITIES would understand.

Addressing the failure of SYSTEMS to care for those with the greatest needs

1/4/2022

This person who is "GRAVELY DISABLED" has REFUSED MEDICATION & TALK THERAPY

there are no MENTAL HEALTH BEDS

WHATEVER SHALL WE DO?How does the person feel about:

Hotel Vouchers
Assisted Living
Nursing Homes
- Often Disfavored as Institutions
- Often a Step-Down from the Mental Health Institutions
- Nursing Homes COULD BE a great place to do DISCHARGE Planning for 30 to 90 days--
- BUT it is a TRAP if there is NOWHERE TO GO.

Medication

Is the person open to genetic testing as a way to get quicker and better insight into some Medication selections?
Medication is a complicated issue in Mental Health as it is in Cancer and other major illnesses.
Further, many people with High IQ Neuro-Developmental Differences involving Executive Functioning and/or Psychiatric Disorders:
- Have IDIOSYNCRATIC SYSTEMS --- and if they are on the Street or the Jail, etc. --- they may be OUTLIERS in an OUTLIER POPULATION.

For most people with PSYCHIATRIC DISORDERS it has been an ALICE IN WONDERLAND experience of YEARS of TRIAL & ERROR --- that maybe turned up something that "worked and was better than nothing" and maybe didn't.

Our Society needs the ability to deal with that COMPLEXITY both CONCEPTUALLY & PRACTICALLY.

Marshall Fire --- Photo Credit: AXIOS

The Researchers have been RINGING THE ALARM BELLS for the need for BETTER TREATMENTS for AWHILE --- and it is in their INTERESTS to do so.

In this year's PBS Program on Mental Health funded by the AMERICAN PSYCHIATRIC ASSOCIATION FOUNDATION --- that need for BETTER TREATMENTS was acknowledged.
BUT how many people in the SOCIETY understand the need for BETTER TREATMENTS as opposed to just the need to FORCE SOMETHING DOWN some RECALITRANT PATIENT'S THROAT?

MORE CONJECTURE --- EPIGENETICS

It seems that we should be talking about Neuro-Developmental Disorders such as ADHD and AUTISM with PSYCHIATRIC DISORDERS --- and a lot of the research does that.
What Neuro-Developmental and Psychiatric Disorders often have in common is EXECUTIVE FUNCTONING CHALLENGES.

MORE CONJECTURE: The Epigenetics of the IMMUNE SYSTEM are SENSITIVE because they need to be for our SURVIVAL.

BUT many factors are pushing our IMMUNE SYSTEMS TO THE LIMIT and we need better and more complete understandings of what's going on.
We've tended to fill in the gaps with PRO SOCIAL COMPETENCY RELIGION for people "we judge harshly"
- That "we judge harshly" comes from Stanford Neuro-Biologist Robert Sapolsky and his ADMONITION to be very careful in judging a behavior --- "ESPECIALLY IF IT IS A BEHAVIOR YOU JUDGE HARSHLY."

Doing Therapies

Music Therapy & Something like Britain's Key Changes which provides opportunities for patients to perform and record musical tracks.
Art Therapy
Animal Therapy (Dog, Equine)

Supported Employment

One of the insights of the Dartmouth Supported Employment Model was that if done in an INDIVIDUALIZED manner --- it could often improve Mental Health.
BUT Employment is tricky for people with Psychiatric Disorders or High IQ Neuro-Developmental Difference involving Executive Functioning
- People need to be challenged in their STRENGTHS (which can be HIGHER than EXPECTED), and
- SUPPORTED in areas of Executive Functioning such as Planning, Organization, Emotional Regulation and Short-Term Memory.

The truth is most people want HELP --- BUT the options are meager, especially when what we're doing is in some cases not working and hospital beds haven't gotten any cheaper.

SAMHSA.GOV

The National Registry of Evidence-Based Programs and Practices (NREPP) has been indefinitely suspended by federal health officials.

Since 1997, NREPP has listed effective, science-based interventions for behavioral health issues, including the prevention and treatment of mental illness and substance use disorders (SUD).

Programs included in NREPP were independently audited and regularly updated.

The registry included proven interventions as well as programs to avoid because they had not been shown to work sufficiently.

The White House froze the public database in September 2017 and months later pulled federal funding for NREPP, which was a project of The Substance Abuse and Mental Health Services Administration (SAMHSA).

This defunding of NREPP is more COMPLICATED than it looks --- mainly because CMS, SAMHSA and the STATES have largely failed to address the needs of people with the most serious mental health needs.

So when the conservative organizations like the Mental Illness Policy Organization and the Treatment Advocacy Center saw things like NREPP --- it made their BLOOD BOIL -- these governmental subdivisions had so FAILED at what should be their primary mission --- serving those with the greatest needs.

So we absolutely have to hold CMS, SAMHSA and the STATES' FEET TO THE FIRE on providing for those with the GREATEST NEEDS -- which isn't being done --- and it is INFURIATING.

On the other hand, this is a CONTINUUM and we do need the National Registry of Evidenced-Based Practices and Programs.]

The CATCH-22 for HIGH IQ DEVELOPMENTAL DIFFERENCE --- nobody is expecting or prepared to deal with the need for EXECUTIVE FUNCTIONING SUPPORT.

CONJECTURE: The FAILURE to address EXECUTIVE FUNCTIONING with REASONABLE ACCOMMODATIONS and WORKAROUNDS -- and even just some KNOWLEDGE -- is resulting in an EPIGENETIC CASCADE.

So the person's IMMUNE SYSTEM and SENSORY PROCESSING is RAMPING UP to find PATTERNS to address this CHALLENGE
BUT there are LIMITS which our SOCIETY and our MENTAL HEALTH Profession largely think NEURO-PLASTICITY or COGNITIVE BEHAVIORAL THERAPY ARE going to solve.
What's Happening --- you have a person with a NEURO-DEVELOPMENTAL DISORDER that now has a PSYCHIATRIC DISORDER and an even more HYPER-CONNECTED BRAIN.
- and a Mental Health Profession that is by and large CLUELESS those people with DEVELOPMENTAL DISABILITIES that they didn't want to treat are their PRIMARY POPULATION --- but with HIGHER IQs.

MANY JOB DESCRIPTIONS today read like "NO BLACKS, ASIANS, HISPANICS, LGBTQ NEED APPLY" for people who may have those EXECUTIVE FUNCTIONING CHALLENGES.

Because the knowledge doesn't appear to be there to deal with that on the part of anybody --- certainly the ADULT MENTAL HEALTH SYSTEM.
There are a HANDFUL of EDUCATIONAL PSYCHOLOGISTS and OCCUPATIONAL THERAPISTS who could add a lot to the discussion --- BUT we normally don't think of them for ADULTS.

If we can't discriminate against people because of their skin color or their sexual orientation or preference --

that ODDBALL in the corner who seems so EMOTIONAL or SPEAKING OUT of TURN, has BORING "SPECIAL INTERESTS," or is DISORGANIZED --- surely we can DISCRIMINATE AGAINST them --- that's OBJECTIVE CRITERIA, isn't it?

Waitlists, Evolving Treatments & Olmstead

12/25/2021

The "process" as laid out by the Olmstead Decision to get to Olmstead Compliance is "WAITLISTS MOVING AT A REASONABLE PACE."

The Olmstead Decision doesn't talk about "WAITLISTS" in terms of SPECIFIC HOUSING, PLACEMENTS, SERVICES or EMPLOYMENT.

Those kinds of things change over time with better and more effective TREATMENTS and MODELS.

What the Olmstead Decision talks about are WAITLISTS of PEOPLE who could move into the COMMUNITY or I would say a less restrictive or less harmful setting with known treatments or modalities such as SUPPORTIVE HOUSING ---

But that SUPPORTIVE HOUSING or other Known Evidenced-Based Treatment or Modality isn't available.

So that includes Assertive Community Treatment, Models of Supported Employment, and Strength-Based Approaches.

I do think there is a HARM REDUCTION COMPONENT to OLMSTEAD. So a therapeutic placement could be a LESS RESTRICTIVE ENVIRONMENT than a Jail or Prison and may be desired by the person.

HOMELESSNESS does theoretically offer "MORE FREEDOM" but what some people find is that it comes at a HIGH COST to their PERSONAL SAFETY and WELL BEING.

Most people would be more interested in SUPPORTED HOUSING.

One of the ways to get there would be to RAMP UP INVESTMENT in HOTEL VOUCHERS.

But if the CHOICE at the MOMENT is a THERAPEUTIC PLACEMENT over HOMELESSNESS (such as an Assisted Living, Nursing Home, Group Home or some New Model)--- some people (not all) would choose a THERAPEUTIC PLACEMENT.

See HORROR STORY -- It Doesn't Have To BE THIS WAY.

So far this has sounded a lot more like Translational Justice than Translational Medicine.

BUT the TREATMENTS and MODALITIES we need are NOT those of 1999 (when the US Supreme Court decided Olmstead) they are the EVIDENCED-BASED TREATMENTS and MODALITIES of 2021 and the PRESENT DAY going forward.

Before you can IDENTIFY who could successfully live in the community with KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES --- you IDENTIFY those KNOWN, EVIDENCED-BASED TREATMENTS and MODALITIES.

Further, that requires CONSTANT REVISION and UPDATING --- because those TREATMENTS and MODALITIES are CONSTANTLY EVOLVING.

So ideally this is done at the FEDERAL LEVEL and in fact it is being done at the FEDERAL LEVEL at SAMHSA.

BUT the efforts of SAMHSA and CMS need to be more INTEGRATED generally, but especially for people needing LONG TERM CARE.

States need SAMHSA/CMS/HUD/DEPT. of LABOR to provide updated MODIFIABLE TEMPLATES for the STATES for people with COGNITIVE DISABILITY NEEDING LONG TERM CARE incorporating KNOWN EVIDENCED-BASED TREATMENTS and MODALITIES and EMPLOYMENT for PEOPLE with COGNITIVE DISABILITY.

States need to provide AGGREGATE WAITLIST DATA to the FEDS, their STATE LEGISLATURES, and the GENERAL PUBLIC.

That AGGREGATE DATA should show not only how many people could transition SUCCESSFULLY to the Community from the Institute, the Nursing Home or the Jail or Prison with Proper Supports.

It should show in the AGGREGATE what SPECIFIC TREATMENTS, HOUSING, PLACEMENTS and MODALITIES are needed and not currently available.

The Americans with Disabilities Act and the Olmstead Decision are all about "REASONABLENESS."

We can't make REASONABLE DECISIONS if we are AFRAID OF THE DATA.

D.J. Jaffe was what I consider to be a "CONSERVATIVE" Mental Health Advocate --- although I don't think he saw himself that way.

There were a lot of things I didn't agree with regarding Jaffe's policy prescriptions -- although he did become an advocate for SUPPORTIVE HOUSING.

But Jaffe was far ahead of most Mental Health Advocates in understanding the "INSANE CONSEQUENCES" of failing to provide for people with the most serious mental illness who are often Homeless or Incarcerated.

Internationally recognized Mental Health Advocate --- Colorado's own Amy Smith -- is about 25 years ahead of the curve in her thinking on Mental Health Policy, Peer Services and Peer Respite.

There's a CRYING NEED to INTEGRATE the INSIGHTS of the Jaffes and Amy Smiths of the Mental Health Policy World.

A BIG CAVEAT: Brain Injury may be more common in Criminal Justice than some Traditional Notion of Schizophrenia or Bipolar Disorder.

But Brain Injury and Mental Health Issues often go together.

Further the Developmental Issues coming from Maternal Immune Activation and broadly understood in OVERLAPPING CATEGORIES of ADHD and AUTISM --- are OVERWHELMING in Criminal Justice.

One of the PRIMARY INSIGHTS of ORCHID is ---- it is NOT just our traditional distinct boxes of MENTAL HEALTH DISORDERS in the DSM --- it is INDIVIDUAL combinations of Cognitive Disability and often more than one CATEGORY of COGNITIVE DISABILITY --- especially in Criminal Justice.

The Mental Health Crisis and Incorporating New Understandings

12/19/2021

It's hard to see how we get out of our current mental health crisis without incorporating the new understandings of "Immuno-Neuro-Psychiatry."

Further, researchers haven't quite settled on a TERM for this new Age in Psychiatry. Contenders:

Immunoneuropsychiatry
Immunopsychiatry
Psychoneuroendocrin-ology
Psychoneuroimmunology
etc.

But these NEW UNDERSTANDINGS are GAME CHANGERS.

Under the current regime of Translational Research and Medicine in the US: Clinicians will be on top of these new understandings in 10 to 20 years.

But the US has Hundreds of Thousands of People who are Incarcerated and Homeless and/or Punished in Other Ways for Neuro-Developmental and Psychiatric Disorders.

We need to continue our move to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE while maintaining safety.

Further, we need greater investments in Translational Research and Medicine for the benefit of Clinicians, Patients and Policy Makers.

Immunoneuropsychiatry -
novel perspectives on brain disorders (2019)

Affiliations
1Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
2Inserm, U955, Institut Mondor de la Recherche Biomédicale, Créteil, France.
3Fondation FondaMental, Créteil, France.
4AP-HP, Department of Psychiatry of Mondor University Hospital, DHU PePsy, University of Paris-Est-Créteil, Créteil, France.
5Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. [email protected].

Abstract
Immune processes have a vital role in CNS homeostasis, resilience and brain reserve. Our cognitive and social abilities rely on a highly sensitive and fine-tuned equilibrium of immune responses that involve both innate and adaptive immunity.

Autoimmunity, chronic inflammation, infection and psychosocial stress can tip the scales towards disruption of higher-order networks.

However, not only classical neuroinflammatory diseases, such as multiple sclerosis and autoimmune encephalitis, are caused by immune dysregulation that affects CNS function.

Recent insight indicates that similar processes are involved in psychiatric diseases such as schizophrenia, autism spectrum disorder, bipolar disorder and depression.

Pathways that are common to these disorders include microglial activation, pro-inflammatory cytokines, molecular mimicry, anti-neuronal autoantibodies, self-reactive T cells and disturbance of the blood-brain barrier.

These discoveries challenge our traditional classification of neurological and psychiatric diseases. New clinical paths are required to identify subgroups of neuropsychiatric disorders that are phenotypically distinct but pathogenically related and to pave the way for mechanism-based immune treatments.

Combined expertise from neurologists and psychiatrists will foster translation of these paths into clinical practice.

The aim of this Review is to highlight outstanding findings that have transformed our understanding of neuropsychiatric diseases and to suggest new diagnostic and therapeutic criteria for the emerging field of immunoneuropsychiatry.

Neuro-Developmental and Psychiatric Disorders ----- Improving Systems of Translational Medicine

12/16/2021

Cancer Medicine is probably providing the GOLD STANDARD today in Translational Medicine -- bringing research to the clinician and the patient --- But efforts on the mental health front are increasing.

Division of Translational Research (DTR)

Utah

$90 million approved for first-of-its-kind translational research building for mental health (Sept. 2021)

Developing mental health policy in Sweden:

a policy analysis exploring how a complex societal challenge was consigned to individual citizens to solve (April 2021)

Colorado Clinical and Translational Sciences Institute (CCTSI)

part of the UK's National Institute of Health Research

"QUESTIONING" in a COMPLEX SOCIETY

12/2/2021

Battle of the psychiatric experts has been a tradition in American Criminal Justice at least since Ake v. Oklahoma (1986)

the US Supreme Court held that the Due Process Clause of the Fourteenth Amendment required the state to provide a psychiatric evaluation to be used on behalf of an indigent criminal defendant if he needed it.

In 2021, I would say that most criminal defendants have some form of brain injury, substance use, developmental difference / disability, psychiatric disorder --- and many of them "intended" the crime.

Problem-Solving Courts have emerged as a MIDDLE WAY to deal with some of these COMPLEX PROBLEMS.

BUT for this to work, PROBLEM-SOLVING COURTS need access to the FULL RANGE of the CONTINUUM of CARE --- which Colorado and most states are struggling to provide.

The BOTTOM LINE: The better the "TREATMENTS" --- the more "successful" this is going to be. There's a BIG INCENTIVE to invest in TRANSLATIONAL RESEARCH and MEDICINE.

IN THE MEANTIME: Building on Strengths and Providing Work-Arounds for Executive Functioning Differences / Deficits is CRITICAL to enable a growing percentage of the population with NEURO-DEVELOPMENTAL INFLAMMATION ---- TO THRIVE.

Problem-Solving Courts

At least one paper has identified SUPPORTIVE HOUSING and SUPPORTIVE EMPLOYMENT as potential important tools of PROBLEM-SOLVING COURTS.

Mental Health Courts: Pro & Con

Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

(Jan. 2021)

Neuroendocrine and immune pathways from pre- and perinatal stress to substance abuse

(2018)

Executive Functioning in--Neuro-Developmental and Psychiatric Disorders

11/22/2021

Conjecture

I think that some of the BIG TALENTS one sees in NEURO-DIVERSITY may be the result of:

Differences in Information and Sensory Processing AS WELL AS
The need to OVERCOME EXECUTIVE FUNCTIONING DIFFERENCES, CHALLENGES or DEFICITS.

Further, this is on a CONTINUUM and most people probably are dealing with SOME LEVEL of EXECUTIVE DISFUNCTION --- Professor Graham Rook from King's College London estimates the level of LOW GRADE INFLAMMATION in the US POPULATION is--- 95%.I think that may be why there is not a lot of SYMPATHY for bad behavior tied to neurodevelopmental or psychiatric disorders and associated poor executive functioning --- on some level most people are dealing with some of these executive functioning issues.

Further, there are MILLIONS of PEOPLE with some category of NEURO-DEVELOPMENTAL and/or PSYCHIATRIC DISORDER that are not homeless or justice involved.

WHAT's the DIFFERENCE? Generally 2 big issues:
- People who are Justice-Involved or Homeless can be a lot further along on that CONTINUUM, and/or
- Accessing Support may be more difficult if :
  - you are poor and marginalized, and
  - it is certainly more difficult if one has greater needs.

Addressing EXECUTIVE FUNCTIONING is the BIG NEED in Mental Health.
- Partly, that is rehabilitative attempts, BUT
- A much BIGGER PART is finding WORK-AROUNDS that even High IQ patients may be struggling with due to DEVELOPMENTAL EXECUTIVE FUNCTIONING DIFFERENCES.

Neurocognitive insight and executive functioning in schizophrenia (2015)

Affiliation
1a "Psychologie, Santé et Qualité de vie" , Univ Bordeaux ,Bordeaux , France.

Conclusion:

These results provide support for the hypothesis that executive dysfunctioning is a limiting factor for NI (neuro-cognitive insight), independently from depressive and anxiety symptoms.

Executive functioning but not IQ or illness severity predicts occupational status in bipolar disorder (2020)

Affiliations
1Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 15, 413 45, Gothenburg, Sweden.
2Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 15, 413 45, Gothenburg, Sweden.
3Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, 19104, USA.
4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
5Center for Autism Research, The Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19104, USA.

Conclusions:

Executive functioning was a more powerful predictor of occupational status in bipolar disorder patients than IQ and other clinical factors, including illness severity.

Executive function deficits and neurodevelopmental disorders in childhood and adolescence (2019)

Affiliations
1Universidad Pública de Navarra, Pamplona, España.
2Hospital San Juan de Dios, Pamplona, España.
3Hospital Universitario Marqués de Valdecilla, Santander, España.

Neurodevelopmental disorders are diverse, and even though they are independent diagnostic entities they share common manifestations in people with brain damage or dysfunction of the prefrontal cortex; that is, neurodevelopmental disorders present different alterations in executive functions.

Conclusions:

The dimensions of executive functioning are affected to a variable degree in different neurodevelopmental disorders.

We can hypothesis that the dimensions that are affected in the different neurodevelopmental disorders can be characterized in terms of the existence of a continuum, and occasionally those dimensions are too complex to establish categorical limits when comparing different neurodevelopmental disorders.

The structure of adult ADHD (2017)

Affiliations
1Department of Psychiatry and Child and Adolescent Psychiatry, New York University Langone School of Medicine and Psychiatry Service, New York, NY, USA.
2Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
3Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
4Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
5Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.
6Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.

Although DSM-5 stipulates that symptoms of attention-deficit hyperactivity disorder (ADHD) are the same for adults as children, clinical observations suggest that adults have more diverse deficits than children in higher-level executive functioning and emotional control.

These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but nonetheless part of the combined presentation of adult ADHD.

Autoimmunity in Neurodiversity and Psychiatric Disorders and Maternal Immune Activation

11/14/2021

Maternal Immune Activation as a Risk Factor for Schizophrenia: Evidence From Preclinical and Clinical Studies

Maternal immune activation and neuroinflammation in human neurodevelopmental disorders (Nature Reviews Neurology -- Aug. 2021)

The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift (2018)
- Abstract
  "A paradigm shift is now taking place in psychiatry with the emphasis on neurodevelopmental disorders with a neurobiologic emphasis and early onset including autism, ADHD, learning disability, schizophrenia and bipolar disorder.

"This paradigm superseded the attachment paradigm of the second half of the twentieth century with so many misguided theories such as, “blaming the mother”—the so-called refrigerated mother and the schizophrenogenic mother.

"The new paradigm allows more focused treatment interventions."

RIFFING

If you want to know why we are not on top of the Mental Health Crisis --- just read the abstract above.
I'll be 60 in 2023 -- and I've lived the bad paradigms of the late 20th Century and early 21st Century --- only now it's ----COPING SKILLS and RESILIENCE.
1. When I say "I've lived the bad paradigms" --- what do I mean?
  1. A movement disorder that is not really Tourette's but did come on at childhood and family members and co-workers (especially at The Legal Center --- now Disability Law Colorado -- were aware of --- "TOUCHDOWN" --- that's me with my arms in the air as I'm thinking)
  2. Two or Three Trips to the Psychologist in 4th Grade --- ultimate verdict -- my mom should chill out about my wardrobe choices and let me be me.
  3. Saw a therapist three or four times for depression when I was about 37 while pregnant.
  4. A psychotic episode when I was 43 that was potentially extremely dangerous.
  5. At 50, a diagnosis of ADHD.

[With the current paradigms--- it's pretty hard to do much with that.

But with the NEW PARADIGMS, we're bringing in:

Maternal Immune Activation
BLURRED DIAGNOSTIC CATEGORIES
DEVELOPMENTAL INFLAMMATION
The ENDOCRINE SYSTEM is involved
Etc.

-----With the NEW PARADIGMS --- we have a much better handle on what's going on --- even though it's not perfect.

Of course, knowing what the hell you're talking about is right up there, too.
1. This may seem IRONIC to say for someone who engages in as much CONJECTURE as I do
But we haven't known about DEVELOPMENTAL INFLAMMATION.
In 2021 many of our researchers do know --- BUT that hasn't been effectively transmitted to CLINICIANS, FAMILY MEMBERS, INDIVIDUALS and the SOCIETY at large,

Mental Health Patients have been written off for a long time as having "SOMATIC COMPLAINTS" in which the mental health professional often couldn't find a physical source.

At least in a significant number of cases, Maternal Immune Activation is not only often contributing to related IMMUNE DYSREGULATION such as THYROID DISORDERS and other IMMUNE DISORDERS, but that Maternal Immune Activation is a PRIMARY SOURCE of the NEURO-DIVERSITY and/or PSYCHIATRIC DISORDER .

This isn't saying that PSYCHIATRIC DISORDERS are not a brain disease, but many researchers are conceptualizing PSYCHIATRIC DISORDERS as MULTI-SYSTEM DYSREGULATIONS --- and certainly as well as the Central Nervous System --- the IMMUNE SYSTEM, MICROBIOME and the ENDOCRINE SYSTEM are prime systems associated with these DYSREGULATIONS.

I think it is going to take the NAMIs and Mental Health Americas to make bringing this research to clinicians a PRIORITY --- because it certainly doesn't seem to be a PRIORITY.

A few years ago, NAMI Montana did take on mental health's beleaguered diagnostic system. 

These new understandings can fuel policy reform even as they are INCOMPLETE. Knowledge is always incomplete.

The On-Going and Unfinished Pursuit of Knowledge is why a robust PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE is needed:

Psychiatric PARADIGMS are changing and we don't have the systems to incorporate those new understandings and consider the implications in a timely manner, AND
Those new understandings are going to keep coming and at a faster and faster pace --- we need something both more nimble and sophisticated than what we currently have to keep up.

Wrong Jungle --- But Can We Get Out Without the Knockout Treatment?

11/10/2021

Researchers are yelling "Wrong Jungle" when it comes to psychiatric disorders
Namely, in 2021 it is hard to understand psychiatric disorders without understanding the role of the IMMUNE SYSTEM --- BUT CLINICIANS are not up to speed on that.
One of the reasons for that is that Researchers don't understand how important these new conceptualizations are for policymaking --- even without the knockout treatment.
For a lot of people in the Criminal Justice System and Homeless who essentially have an IMMUNE DISORDER that affects the BRAIN ---
- These new conceptualizations are a GAME-CHANGER.

New theory suggests blood immune and clotting components could contribute to psychosis

A scientific review has found evidence that a disruption in blood clotting and the first line immune system could be contributing factors in the development of psychosis.

Immune dysregulation in depression: Evidence from genome-wide association -- 2020

Abstract

A strong body of evidence supports a role for immune dysregulation across many psychiatric disorders including depression, the leading cause of global disability.

Recent progress in the search for genetic variants associated with depression provides the opportunity to strengthen our current understanding of etiological factors contributing to depression and generate novel hypotheses.

Here, we provide an overview of the literature demonstrating a role for immune dysregulation in depression, followed by a detailed discussion of the immune-related genes identified by the most recent genome-wide meta-analysis of depression.

These genes represent strong evidence-based targets for future basic and translational research which aims to understand the role of the immune system in depression pathology and identify novel points for therapeutic intervention.

Immune dysregulation in depression: Evidence from genome-wide association -- 2020

Conclusions: The link between immune dysregulation, autoimmunity, and bipolar disorder may be closer than previously thought.

Psychiatrists should be vigilant for autoimmunity in presentations of bipolar disorder due to its high morbidity and therapeutic implications.

Advances in neuroimaging and biomarker identification related to immune dysregulation and neuroinflammation will contribute to our knowledge of the pathophysiology of bipolar disorder.

Neuroinflammation in Mood Disorders: Role of Regulatory Immune Cells ---2021

Abstract

Mood disorders are associated with chronic low-grade systemic (sterile) inflammation, with increased plasma levels of pro-inflammatory mediators targeting all tissues including the brain. Importantly, pro-inflammatory cytokines (ex., tumor-necrosis factor alpha [TNF-α], interleukin [IL]-6) regulate mood behavior and cognition by influencing neurotransmitter levels, activating stress-responsive endocrine axes, among other effects.

However, the mechanisms underlying this enhanced inflammation are not well understood.

There is increasing evidence indicating that impaired immunoregulatory mechanisms may play a role in this context.

Patients with mood disorders (major depression [MDD] and bipolar disorder [BD]) have reduced numbers of major regulatory cells of both innate (natural killer regulatory cells and myeloid-derived suppressor cells [MDSCs]) and adaptive immune responses (CD4+CD25+FoxP3+, B regulatory cells).

Dysfunctional regulatory immune cells might contribute to systemic and neuroinflammation observed in mood disorders via different mechanisms, such as:
(i) failure to develop adequate stress-related responses,
(ii) indirectly through microglial activation,
(iii) lack of trophic support and pro-cognitive functions of T cells in the brain, and
(iv) dysbiosis.

In conclusion, maladaptive immunoregulatory mechanisms seem to be involved with both onset and progression of mood disorders.

A deeper understanding of these mechanisms may lead to the development of new therapeutic strategies

The immune system and psychiatric disease: a basic science perspective -- 2019

Summary

Mental illness exerts a major burden on human health, yet evidence-based treatments are rudimentary due to a limited understanding of the underlying pathologies.

Clinical studies point to roles for the immune system in psychiatric diseases, while basic science has revealed that the brain has an active and multi-cellular resident immune system that interacts with peripheral immunity and impacts behavior.

In this perspective, we highlight evidence of immune involvement in human psychiatric disease and review data from animal models that link immune signaling to neuronal function and behavior.

We propose a conceptual framework for linking advances in basic neuroimmunology to their potential relevance for psychiatric diseases, based on the subtypes of immune responses defined in peripheral tissues.

Our goal is to identify novel areas of focus for future basic and translational studies that may reveal the potential of the immune system for diagnosing and treating mental illnesses

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