Abstract

Substance use disorders (SUDs) are debilitating neuropsychiatric conditions that exact enormous costs in terms of loss of life and individual suffering.

While much progress has been made defining the neurocircuitry and intracellular signaling cascades that contribute to SUDs, these studies have yielded limited effective treatment options.

This has prompted greater exploration of non-traditional targets in addiction.

Emerging data suggest inputs from peripheral systems, such as the immune system and the gut microbiome, impact multiple neuropsychiatric diseases, including SUDs.

Until recently the gut microbiome, peripheral immune system, and the CNS have been studied independently; however, current work shows the gut microbiome and immune system critically interact to modulate brain function.

Additionally, the gut microbiome and immune system intimately regulate one another via extensive bidirectional communication.

Accumulating evidence suggests an important role for gut-immune-brain communication in the pathogenesis of substance use disorders.

Thus, a better understanding of gut-immune-brain signaling could yield important insight to addiction pathology and potential treatment options.

Abstract

Background:   Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS).

However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs.

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Conclusions:  The findings confirm the presence of significant numbers of people with NDD in a male prison.

Services across the CJS [Criminal Justice System] are required for this group [people with Neurodevelopmental Disorders];

[S]pecifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD.

Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities,

Affiliations

• 1 Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Reykjavik University, Iceland.
• 2 Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Child and Family Consultation Service, East London NHS Foundation Trust, UK.
• 3 Psychology Department, Bath University, UK.
• 4 Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
• 5 Reykjavik University, Iceland; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

Abstract

The identification and management of inmates with neurodevelopmental disorders (ND) has been insufficiently addressed in the literature.

We estimated the proportion of cases with Attention deficit/hyperactivity disorder (ADHD), Autism spectrum disorder (ASD) and Intellectual disability (ID) in prison, their comorbidity, and associations with disruptive behaviours and with psychiatric symptoms.

Further, we examined the role of coexisting ND on psychiatric symptoms and attitudes toward violence. All 390 male inmates underwent an assessment that included the Diagnostic Interview for ADHD in Adults 2.0, the Autism Quotient, the Learning Disability Screening Questionnaire, the Brief Symptom Inventory (BSI), and measures of disruptive behaviours and attitudes towards violence.

The percentage of cases with ADHD, ASD and ID were 25%, 9% and 9%.

Inmates with ADHD and those with ID had significantly higher levels of disruptive behaviours.

The combined ADHD/ASD group had significantly higher scores on global severity symptoms than either ADHD or ASD only.

Meanwhile, the combined ADHD/ID group had significantly higher scores of behavioural disturbance than the ADHD-only group.

Our findings show the extent of ND [Neuro-Developmental Disorders] in prison, their inter-relations and associations with further mental health problems.

Vulnerabilities conferred by ND within the criminal justice system should be addressed via interventions and preventative strategies.

Abstract

For decades, it was commonly accepted that the brain is secluded from peripheral immune activity and is self-sufficient for its maintenance and repair.

This simplistic perception was based on the presence of resident immune cells, the microglia, and barrier systems within the brain, and the assumption that the central nervous system (CNS) lacks lymphatic drainage.

This view was revised with the discoveries that higher functions of the CNS, homeostasis and repair are supported by peripheral innate and adaptive immune cells.

The findings of bone marrow-derived immune cells in specialized niches, and the renewed observation that a lymphatic drainage system exists within the brain, further contributed to this revised model.

In this Review, we describe the immune niches within the brain, the contribution of professional immune cells to brain functions, the bidirectional relationships between the CNS and the immune system and the relevance of immune components to brain aging and neurodegenerative diseases.

Abstract

The brain and gastrointestinal tract are critical sensory organs responsible for detecting, relaying, integrating, and responding to signals derived from the internal and external environment.

At the interface of this sensory function, immune cells in the intestines and brain consistently survey environmental factors, eliciting responses that inform on the physiological state of the body.

Recent research reveals that cross-talk along the gut-brain axis regulates inflammatory nociception, inflammatory responses, and immune homeostasis.

[Val's Take:  Immune Homeostasis may be pretty hard to maintain with Maternal Immune Activation resulting in significant DEVELOPMENTAL INFLAMMATION --. especially in an atmosphere of IGNORANCE.]

Here, we discuss molecular and cellular mechanisms involved in the signaling of inflammation across the gut-brain axis.

We further highlight interactions between the gut and the brain in inflammation-associated diseases.

Abstract

The innate immune regulator STING is a critical sensor of self- and pathogen-derived DNA. DNA sensing by STING leads to the induction of type-I interferons (IFN-I) and other cytokines, which promote immune-cell-mediated eradication of pathogens and neoplastic cells.

STING is also a robust driver of antitumour immunity, which has led to the development of STING activators and small-molecule agonists as adjuvants for cancer immunotherapy.

Pain, transmitted by peripheral nociceptive sensory neurons (nociceptors), also aids in host defence by alerting organisms to the presence of potentially damaging stimuli, including pathogens and cancer cellsHere we demonstrate that STING is a critical regulator of nociception through IFN-I signalling in peripheral nociceptors.

We show that mice lacking STING or IFN-I signalling exhibit hypersensitivity to nociceptive stimuli and heightened nociceptor excitability.

Conversely, intrathecal activation of STING produces robust antinociception in mice and non-human primates. STING-mediated antinociception is governed by IFN-Is, which rapidly suppress excitability of mouse, monkey and human nociceptors.

Our findings establish the STING-IFN-I signalling axis as a critical regulator of physiological nociception and a promising new target for treating chronic pain.

A substantial rate of overlap between the NDDs [Neurodevelopmental Disorders] was found.

The combined NDD group had an earlier onset of antisocial behavior, had more aggressive behavior and lower school achievements than the non-NDD group.

The results highlight the need for prison and probation services to be attentive of and screen for neurodevelopmental disorders in young violent offenders.

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). ...In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD …

Alternative behavioral health services--Administration of non-traditional, community-
based services not available through the State Plan but authorized through the
Department’s 1915(b) waiver with the Centers for Medicare and Medicaid Services.

a. Assertive Community Treatment (ACT) – Comprehensive, locally-based,
individualized treatment for adults with serious behavioral health disorders, that is available 24 hours a day, 365 days a year. The ACT team actively engages  Members in their community to develop skills and monitor status, rather than function as an office-based team. Services include case management, initial and ongoing behavioral health assessment, psychiatric services, employment and housing assistance, family support and education, and substance use disorders
services.

b. Clubhouse and Drop-in Center services – Peer support services for people who have behavioral health disorders, provided in a Clubhouse or Drop-In Center setting. Clubhouse participants may use their skills for clerical work, data input, meal preparation, providing resource information and outreach to clients. Drop-in
Centers offer planned activities and opportunities for individuals to interact socially, promoting and supporting recovery.

c. Intensive Case Management -- Community-based services averaging more than one hour per week, provided to adults with serious behavioral health disorders who are at risk of a more intensive 24 hour placement and who need extra support to live in the community. Services are assessment, care plan development, multi-system referrals, assistance with wraparound and supportive living services, monitoring and follow-up. Intensive case management may be provided to children/youth under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

d. Mental Health Residential Services – Twenty-four (24) hour care, excluding room and board, provided in a non-hospital, non-nursing home setting, appropriate for Members whose mental health issues and symptoms are severe enough to require a 24-hour structured program but do not require hospitalization. Services are provided in the setting where the client is living, in real-time, with immediate interventions available as needed. Clinical interventions are assessment and monitoring of mental and physical health status; assessment and monitoring of safety; assessment of/support for motivation for treatment; assessment of ability
to provide for daily living needs; observation and assessment of group
interactions; individual, group and family therapy; medication management; and behavioral interventions. Residential services may be provided to children/youth under EPSDT.

e. Prevention/Early Intervention Services – Proactive efforts to educate and empower individuals to choose and maintain healthy life behaviors and lifestyles that promote positive behavioral health. Services include behavioral health screenings; educational programs promoting safe and stable families; senior workshops related to aging disorders; and parenting skills classes.

f. Recovery Services – Community-based services that promote self-management of behavioral health symptoms, relapse prevention, treatment choices, mutual support, enrichment, rights protection, social supports. Services are peer counseling and support services, peer-run drop-in centers, peer-run employment services, peer mentoring, consumer and family support groups, warm lines, and advocacy services.

g. Respite Care – Temporary or short-term care of a child, youth or adult client provided by adults other than the birth parents, foster/adoptive parents, family members or caregivers that the Member normally resides with. Respite is designed to give the caregivers some time away from the Member to allow them to emotionally recharge and become better prepared to handle normal day-to-day challenges. Respite care providers are specially trained to serve individuals with behavioral health issues.

h. Vocational -- Services designed to help adult and adolescent clients who are ineligible for state vocational rehabilitation services to gain employment skills and employment. Services are skill and support development interventions, educational services, vocational assessment, and job coaching