All posts by Dr. M Blatstein

COVID-19 | BOP | 2019 – Current

By inDr. M Blatstein's Blog

6′ of Separation (In The BOP)

COVID

Then and now, Today BA.5 is a spreader, but


COVID-19 

  • Prisons (Federal, State) and 
  • Jails,
  • like Cruise Ships,

Unfortunately, act as perfect breeding grounds for any kind of virus and especially one that currently has few treatment protocols.

7/9/2020 (6 South Florida)

South Florida Federal Corrections Officers Warn of Potential Coronavirus Crisis Brewing

6/30/2020 (Reason)

These Women Received a Death Sentence for Being Sick In Prison – alleged medical neglect at FCI Aliceville, a federal women’s prison.

6/28/2020 (Forbes)

Otisville Federal Prison Camp Is More Like A Higher Security Prison In Fight Against Covid-19

6/11/2020 (Fort Worth Star)

11th inmate from a federal medical prison in Fort Worth died from coronavirus. This is discouraging as Fort Worth is a BOP Federal Medical Center.

5/28/2020 (Lexington Herald Leader)

Federal Medical Center prison helps drive a single-day spike in Lexington (FMC) COVID-19 cases.

5/28/2020 (LA Times)

Inmate labeled as ‘recovered’ from coronavirus dies at Terminal Island

 

5/28/2020 (Morning Journal)

Forest City Low-FCI prison in Arkansas currently has more federal prison coronavirus cases, according to the BOP website.

 

5/27/2020 (The Crime Report)

A task force led by current and former justice officials has proposed a 15-point platform to improve the federal criminal justice system.

5/27/2020 (Salon)

Even as the Justice Department announced that federal prisons would release vulnerable, nonviolent inmates to home confinement to avoid the spread of COVID-19, the agency was quietly adopting a policy that makes it harder for inmates to qualify for release, not easier.

5/27/2020 (AP)

TERRE HAUTE – An inmate at the federal prison complex in Terre Haute who had COVID-19 has died, and three others there also have tested positive for the disease, the Bureau of Prison said Tuesday.

 

5/26/2020 (Government Executive)

…a secret BOP policy has kept all but 1.8% of federal inmates behind bars where the virus rages.

May 22, 2020 (KSAT.com)

A Federal Bureau of Federal Prisons truck drives past barbed wire fences at the Federal Medical Center prison in Fort Worth, Texas, Saturday, May 16, 2020. Hundreds of inmates inside the facility have tested positive for COVID-19 and several inmates have died with numbers expected to rise. (AP Photo/LM Otero) (Copyright 2020 The Associated Press. All rights reserved.)

Federal prison system to begin moving nearly 7K inmates to one of three designated quarantine sites — FCC Yazoo City in Mississippi, FCC Victorville in California, and FTC Oklahoma City — or to a Bureau of Prisons detention center.

May 16, 2020 (The Review)

Of the 399 accumulated COVID-19 cases in Columbiana County, the health department reports nearly 25 percent, 94 of the cases, have been inmates from FCI-Elkton, totaling 118 for inmates and 12 corrections staff.

May 11, 2020

Inmates, families fear worst for Fort Worth Federal Medical Center – as the prison is ‘consumed’ by coronavirus where 636 inmates — 43% of the total population — had tested positive, and five have died.

May 10, 2020 (CBS DFW)

Tarrant County Public Health (TCPH) reported 485 new cases of the coronavirus Sunday, of which 423 were caused by the Texas Fort Worth Federal Medical Center prison outbreak. So far, the county has seen 3,695 positive cases and 780 recoveries.

May 9, 2020 (FCI Lompoc):

But covid-19 at FCI Lompoc is straining the relationship with LOMPOC, Calif. residents, part of this central California agricultural community.

70% of inmates test positive for coronavirus at Lompoc federal prison.

May 8, 2020 (KTLA5):

As of Friday 5/8/2020, 823 inmates tested positive in FCI Lompoc (2 have died), and another 644 at FCI Terminal Island (6 have died at the San Pedro facility).

May 8, 2020 (The Appeal):

FCI Hazelton is one of 11 federal prisons designated quarantine facilities. When new people are convicted or otherwise brought into the federal system, they will be sent to one of the facilities for a two-week quarantine period, BOP spokesperson Justin Long told The Appeal.

May 5-6, 2020 (Lex 18):

70 inmates test positive at the Lexington Federal Medical Center (FMC) in Lexington, Kentucky, however “communication with [FMC Lexington] has been sporadic, and sometimes it’s non-existent,” Lexington Health Department Spokesman Kevin Hall

May 5-6, 2020 (Lex 18):

LEXINGTON Federal Medical Center is quickly emerging as a hot spot for Coronavirus in Kentucky, without providing the needed communication with Lexington Fayette County Health Department.

May 1, 2020 (Penn Live Patriot-News):

LEWISBURG – Lewisburg Federal Penitentiary will transition into a medium-security facility is complete (and every unit will have multiple rooms with televisions, computer stations, and telephones).

May 1, 2020 (The Marshall Project):

COVID-19 continues to spread through Ohio prisons, with the FCI Marion and Pickaway correctional institutions combining for nearly 2,500 confirmed cases of the coronavirus. That is an estimated 80 percent of the inmates in those two prisons.

 

April 30, 2020 (The Marshall Project):

Texas prison system failed for years to equip employees with personal protective equipment…

Over 70 percent of tested inmates in the federal prison system have COVID-19. AP

COVID-19 outbreak at FCI Terminal Island is now the largest within the Bureau of Prisons system…

 

April 28, 2020 (ABC, WQAD8)

Thomson USP is one of 11 facilities designated as a “quarantine location,” now concerns over-testing.

April 23, 2020

…a federal judge dismissed a class-action lawsuit that was aimed at getting medically vulnerable prisoners released from the federal prison in Oakdale, Louisiana.

 

April 22, 2020 (Forbes):

Bureau Of Prisons Removes Webpage FAQ Home Confinement On COVID-19. BOP Website Displays…..

 

April 20, 2020 (Government Executive):

Union Files National Grievance Over Alleged Safety Violations at Federal Prisons During Coronavirus Pandemic. Forced leave, lack of protective gear, and privacy breaches are among the allegations.

April 18, 2020 (NYT):

‘Something Is Going to Explode’: When Coronavirus Strikes a Prison. An oral history of the first fatal outbreak in the federal prison system, in Oakdale, La.

 

Friday, April 17, 2020 (ABC):

Butner ( a BOP Federal Medical Center) has more COVID-19 cases than any other prison in the federal system: 66 inmates and 25 staff members have tested positive for COVID-19 at Butner; four inmates have died

 

April 15, 2020 (Forbes):

COVID-19 Positive Tests in Bureau of Prisons Institutions (April 14, 2020) W PAVLO

Federal Bureau Of Prisons Institutions Not Showing Any Signs Of “Flattening Curve”, By Walter Pavlo

The continued inaction of the BOP to swiftly reduce the population of inmates, particularly the elderly and those with underlying health conditions, is an unfolding story with tragic consequences.

April 14, 2020 (Marshall Project):

Nearly 600 prisoners and staff members are infected with COVID-19 in the federal system. Thirteen prisoners have died. Bureau of Prisons

 

April 8, 2020 (The Appeal):

Don’t Look to the DOJ to Keep Federal Prisons and Their Surrounding Communities Safe During the COVID-19 Pandemic. By  Shon Hopwood/Felon turned Georgetown Law Professor, Apr 08, 2020

April 8, 2020 (NYT):

…1,324 confirmed coronavirus cases are tied to prisons and jails across

Prisoners hung signs pleading for help in a window of the Cook County jail on Tuesday.Credit…Jim Vondruska/Reuters

the United States

 

April 7, 2020 (News Observer):

The Federal Correctional Complex at Butner is moving to the top of the list of prisons for early release 

April 6, 2020 (NPR):

Inmates, Staff On Edge As COVID-19 Spreads Through Federal Prisons  The Federal Bureau of Prisons says 138 inmates and 59 employees have tested positive and at least seven inmates have died.

April 4, 2020 (FEDweek):

 

Brooklyn, NY - Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Brooklyn, NY – Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Bureau of Prisons Implements Partial Lockdown to Halt Spread; The challenge is that prisons and jails are not built to provide 6′ of separation to inmates and correction staff.  I have to assume that PPE, cleaning materials and testing for all parties are not diligently implemented.

April 2, 2020:

Marshall Project: Coronavirus Tracker By State: How Justice Systems Are Responding in Each State; Coronavirus • Published 03.17.2020 • Updated 2:03 P.M. 03.25.2020

April 1, 2020 (Gov Exec Daily):

Federal Prison System Goes Into ‘Modified Lockdown’.

The Metropolitan Detention Center in Brooklyn, N.Y., had the first known case of coronavirus in the federal prison system. The facility is shown here in February 2019. KATHY WILLENS / AP

New procedures due to coronavirus concerns will last 14 days, after which the agency will re-evaluate. By COURTNEY BUBLÉ

Mar 31, 2020 (The Appeal, MedPage):

BOP Halfway House Residents Describe ‘A Scary Situation’ As Coronavirus Sweeps The U.S. By Lauren Gill. These halfway houses appear ill-prepared for the influx of those who may have (or haven’t yet contracted), COVID-19.

 

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

Could Wearing a Face Mask Be a COVID-19 Game Changer?— Augmenting protection during a global pandemic. by Rossi A. Hassad Ph.D., MPH

An easy and cheap option for all inmates and correction staff, in either Jail, Halfway House, State, Federal or Private facility. We can argue the efficacy benefit later.

Mar 30, 2020 (Vice News, NYT):

Inside the Federal Prison, That’s ‘Ground Zero’ For the Coronavirus Outbreak, By Keegan Hamilton

Mar 27, 2020 (The Marshall Project):

156-beds-in-Elm-Hall-a-minimum-security-dormitory-at-the-California-Institution-for-Men

No such thing as social distancing in prison. From THE MARSHALL PROJECT

PUBLIC HEALTH DOCTOR AND HEAD OF CORRECTIONS AGREE: WE

MUST IMMEDIATELY RELEASE PEOPLE FROM JAILS AND PRISONS; By Brie Williams, Leann Bertsch

Mar 26, 2020 (The Hill):

COVID-19 gives us an urgent argument for compassionate release, BY KEVIN RING, OPINION CONTRIBUTOR – The Hill

Mar 24, 2020 (wbur):

A medical exam room in the Worcester County jail in West Boylston

A medical exam room in the Worcester County jail in West Boylston

Pain And Profits: Sheriffs Hand Off Inmate Care To Private Health Companies; By Christine Willmsen  and Beth Healy

Entering The BOP – Verifying The Availability of Your Medications

By inDr. M Blatstein's Blog Tag , , , , ,

Verifying Medication  Availability

Will Go A Long Way To Easing Your Client’s Fears

    • They assume that they will still get medical care on the inside.
    • The assumption may also be that they will also get the same medications that they got on the outside,
    • This will likely be a False assumption.

 

Medication availability (~ 3500 different drugs), falls into 3 categories.

1st) On Formulary -Available:

    • These medications are available for BOP healthcare providers for inmate use.

2nd) Non-Formulary –These require a lengthy Preauthorization Process

    • While they are stocked, these medications are not available and require lengthy pre-authorization.
    • As the BOP Formulary is available online, and should your medication fall into this category, this discussion should occur long before the Presentence Interview for obvious reasons.

3rd) Similar equivalents – Not On Formulary (Not Available)

    • Here, similar or equivalent substitutions are used. After consulting with the current treating physician of record, the defense needs to make appropriate decisions regarding this medical problem before this point and long before the PSI.
      • However, addressing it before the PSR is complete, with the backing of the US Attorney and, finally, the court.
        1. Examples of medication confusion for Cholesterol Control:
          • PCSK9 Inhibitors vs. Statins. Statins are a popular treatment that has been available since the 1980s. PCSK9 inhibitors, on the other hand, are a new type of cholesterol drug. They were approved by the Food and Drug Administration in 2015.

Generics

    • These are the drug of choice for the BOP as they are cheaper than brand-name medications.
    • It may be beneficial to inform your client ahead of time that, while they’ll be taking a generic medication
      • since there are many manufacturers who each produce similar generic drugs
      • these same drugs, while may differ in color, size, and shape;
      • they should be the same
    • Nobody likes surprises, especially if they are entering prison for the first time.

                                                              Generic Lipitor Good Rx

 

COVID-19 Long-Term Complications

By inDr. M Blatstein's Blog Tag , , , , , , ,
long covid

Post COVID-19 Longterm Complications;

The world’s medical and scientific communities are now facing an ever-increasing list of symptoms, in early 2020.

With the pandemic just months old,

  • no one knows how far into the future symptoms will endure, and
  • whether COVID-19 will spur the onset of chronic diseases.
  • Ongoing problems include
    • fatigue,
    • a racing heartbeat,
    • shortness of breath,
    • achy joints,
    • foggy thinking,
    • a persistent loss of sense of smell, and
    • damage to the heart, lungs, kidneys, and brain.

Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder[1]

  • Beyond the fatigue, neuropsychological problems range from headaches,
  • dizziness, and
  • lingering loss of smell or taste to mood disorders and deeper cognitive impairment.

Doctors have concerns that patients may also suffer lasting damage to their

  • heart, kidneys, and liver from the inflammation and blood clotting the disease causes.
  • Additionally, between 30% and 50% of people with an infection that has clinical manifestations are going to have some form of mental health issues,” said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine.

So far the virus appears to cause its damage to the brain and nervous system not as much through direct infection as through the indirect effects of inflammation, said Victoria Pelak, professor of neurology and ophthalmology at the University of Colorado School of Medicine.

“Strokes are larger, potentially more damaging with this disorder. Once inflammation or blood vessel problems occur within the nervous system itself, those people will have a lot longer road to recovery or may die from those illnesses,” Colorado’s Pelak said.

Doctors are also watching for a syndrome called demyelination, as in the autoimmune disease multiple sclerosis, which can cause weakness, numbness, and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations. “We’re just not sure if this virus causes it more commonly than other viruses,” Pelak said.

The COVID-19 infection might also act as a “priming event” for problems to resurface in the future said Teodor Postolache. Psychological stress could reactivate behavioral and emotional problems that were initially triggered by the immune system responding to the virus. “What we call psychological versus biological may actually be quite biological,” he said.

Ely of Vanderbilt suggests three things to do now.

  1. “We can open the hospitals back up to the families. That’s important,” he said.
  2. “We can be aware of these problems and tell the families about them so that the families will know that this is coming. [And]
  3. we can do counseling and psychological help on the back end.”

8/12/2020, MIT Technology Review:[2] Covid-19 “long haulers” are organizing online to study themselves.

Slack groups and social media are connecting people who have never fully recovered from coronavirus to collect data on their condition.

Gina Assaf was running in Washington, DC, on March 19 when she suddenly couldn’t take another step. “I was so out of breath I had to stop,” she says. Five days earlier, she’d hung out with a friend; within days, that friend and their partner had started showing three classic signs of COVID-19: fever, cough, and shortness of breath.

Assaf had those symptoms too, but a full month after falling ill, she attempted to go grocery shopping and ended up in bed for days. In those first few months, Assaf found a legion of people in situations similar to her own in a Slack support group for COVID-19 patients, including hundreds who self-identified as “long-haulers,” the term most commonly used to describe those who remain sick long after being infected.

It wasn’t until late July that the US Centers for Disease Control published a paper recognizing that as many as one-third of coronavirus patients not sick enough to be admitted to the hospital don’t fully recover. So Assaf, a technology design consultant, launched  Patient-Led Research for Covid-19[ii], and released its first report[iii].

The Body Politic COVID-19 Support Group[iv]

On 8/12/2020, Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studies delirium during intensive care (watch video)[22] stay. “The problem for these people (when coming off ventilators), is not over when they leave the hospital.”

Long-term effects are health issues that are caused by an illness, disease, or treatment that lasts for several months or years after infection. Long-term effects can be physical, mental, or emotional and can occur even if the initial illness or disease is no longer present in the body.[23].

This applies to post-COVID-19 patients (Long-Haulers), as physicians and scientists from around the globe begin to study these patients post-hospitalization.

The long haul | Science science.sciencemag.org Screenshot

Also found in my LinkedIn: Compassionate Relief – COVID-19 Emerging Long-Term Complications 

[1] https://www.statnews.com/2020/08/12/after-covid19-mental-neurological-effects-smolder/

[2] https://www.technologyreview.com/2020/08/12/1006602/covid-19-long-haulers-are-organizing-online-to-study-themselves/

[3] https://docs.google.com/forms/d/e/1FAIpQLScM2EeJhgisTUdo5Op6euyx1PYu8O-aNeDVYhXuPFa_Gs9PnQ/viewform

[4] https://patientresearchcovid19.com/

[5] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[6] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[7] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[9] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[10] https://www.medpagetoday.com/neurology/dementia/87543

[11] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[12] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[13] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[14] https://www.ptsd.va.gov/covid/COVID_effects_ptsd.asp#:~:text=PTSD%20Symptoms%20Can%20Be%20Affected,things%20most%20people%20consider%20safe.

[15] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[16] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain#:~:text=A%3A%20Cases%20around%20the%20world,Seizures

[17] https://www.frontiersin.org/research-topics/14627/impact-of-the-coronavirus-pandemic-covid-19-on-mood-disorders-and-suicide#:~:text=During%20the%20coronavirus%20COVID%2D19,problems%20and%20perceived%20social%20isolation.

[18] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[19] https://www.healthline.com/health-news/the-covid-19-symptoms-most-people-could-miss

[20] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[21] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[22] https://www.icudelirium.org/

[23] https://www.talktomira.com/post/what-are-the-long-term-side-effects-of-coronavirus-covid-19

[i] https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html?deliveryName=USCDC_2067-DM35559

[ii] https://patientresearchcovid19.com/

[iii] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[2] https://www.technologyreview.com/2020/08/12/1006602/covid-19-long-haulers-are-organizing-online-to-study-themselves/

[3] https://docs.google.com/forms/d/e/1FAIpQLScM2EeJhgisTUdo5Op6euyx1PYu8O-aNeDVYhXuPFa_Gs9PnQ/viewform

[4] https://patientresearchcovid19.com/

[5] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[6] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[7] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[9] https://www.medpagetoday.com/neurology/dementia/87543

[10] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[11] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[12] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[13] https://www.ptsd.va.gov/covid/COVID_effects_ptsd.asp#:~:text=PTSD%20Symptoms%20Can%20Be%20Affected,things%20most%20people%20consider%20safe.

[14] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[15] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain#:~:text=A%3A%20Cases%20around%20the%20world,Seizures

[16] https://www.frontiersin.org/research-topics/14627/impact-of-the-coronavirus-pandemic-covid-19-on-mood-disorders-and-suicide#:~:text=During%20the%20coronavirus%20COVID%2D19,problems%20and%20perceived%20social%20isolation.

[17] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[18] https://www.healthline.com/health-news/the-covid-19-symptoms-most-people-could-miss

[19] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[20] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[21] https://www.icudelirium.org/

[22] https://www.talktomira.com/post/what-are-the-long-term-side-effects-of-coronavirus-covid-19

[i] https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html?deliveryName=USCDC_2067-DM35559

Healthy Steps for Older Adults 2022

By inDr. M Blatstein's Blog Tag , , , , , , , , , , , , , , ,
FSA - First step act

FSA, Productive Activities (PA)
Healthy Steps for Older Adults 2022

Program Description Healthy Steps for Older Adults is an evidence-based falls prevention program designed to raise participants’ knowledge and awareness of steps to take to reduce falls and improve health and well-being. The goal of the program is to prevent falls, promote health, and ensure that
older adults remain as independent as possible for as long as possible.
Hours 3
Location(s) All institutions
Needs Addressed Medical/Recreation/Leisure/Fitness
Program Delivery Contractors
Health Services
Recreation
Unit Team
Volunteers

AARP Foundation Finances 50+ (2022)

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FSA - First step act

AARP Foundation Finances 50+ (2022)

Program Description

This program provides financial education and counseling for vulnerable households, particularly adults age 50+.

Older adults face unique challenges in financial planning and weak job prospects. This program will assist the older adult in financial goal setting that translates into positive financial behaviors.
Hours 1.5
Location(s) All BOP Locations
Needs Addressed Finance/Poverty

Female Integrated Treatment (FIT) Program

By inDr. M Blatstein's Blog Tag , , , , , ,
FSA - First step act

The Female Integrated Treatment (FIT) Program

  • An evidence-based approach designed to ensure that each participant has an individually tailored treatment plan and
  • receives a full range of services to address their needs.
  • The program will combine 3 psychology treatment programs, including
  • The Residential Drug Abuse Program is for those who are eligible.

Women are twice as likely as men to experience PTSD, according to the World Health Organization.

  • A woman’s chances of experiencing trauma are higher —
  • 10% of women will experience PTSD versus 4% of men.
  • “It’s tough to say there are sure symptoms of PTSD since no two people will have the same experience,” Pereau says.

DSM-V Revisions to Signs and Symptoms of PTSD

  • In the most recent publication of the DSM, the DSM-V, PTSD symptoms are grouped into five different clusters.
  • One or more symptoms are required from each of these clusters in order for a patient to receive a full diagnosis.

Those clusters include:

Stressor– (one required)

  1. The person was exposed to injury or severe illness that was life-threatening, which includes actual or threatened injury or violence. This may include at least one of the following:
    • Direct exposure to the trauma
    • Witnessing a trauma
    • Exposure to trauma by being a first responder, such as a police, firefighter, medic, or crisis counselor
    • Learning that someone close to you experienced the trauma

Intrusion Symptoms(one required) –

  1. The person who was exposed to trauma then re-experiences the trauma in one or more ways, including:
    • Flashbacks
    • Nightmares
    • Distressing and intense memories
    • Distress or physical reactions after being exposed to reminders, known as “triggers”

Unpleasant Changes to Mood or Thoughts(two required) –

    • Blaming self or others for the trauma
    • Decreased interest in things that were once enjoyable
    • Negative feelings about self and the world
    • Inability to remember the trauma clearly
    • Difficulty feeling positive
    • Feelings of isolation
    • Negative affect, and difficulty feeling positive

Avoidance(one required) –

  1. This occurs when a person tries to avoid all reminders of the trauma, including:
    • Avoiding external reminders of what happened
    • Avoiding trauma-related thoughts or emotions, sometimes through the use of drugs or alcohol

Changes in Reactivity(two required) –

  1. This occurs when a person becomes more easily startled and reacts to frightful experiences more fully, including symptoms of:
    • Aggression or irritability
    • Hypervigilance and hyper-awareness
    • Difficulty concentrating
    • Difficulty sleeping
    • Heightened startle response
    • Engaging in destructive or risky behavior
    • Difficulty sleeping or staying asleep

All of these symptoms must have persisted for at least one month, and they must be causing distress or functional impairment of some kind.

These symptoms must not be related to any substance use, illness, or medications.

Also seen:

Schizophrenia in Federal Prison

By inDr. M Blatstein's Blog Tag , , , , , , , , , , , , ,
Schizophrenia in Federal Prison

 

In federal prison, Schizophrenia is a mix of symptoms that varies from person to person and affects the mind. When severe, people have trouble staying in touch with reality. It’s hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. There is no cure, and treatment requires a psychiatrist-guided team approach, which includes a psychologist, social worker, psychiatric nurse, and possibly a case manager to coordinate care.

Anxiety may present as a component, along with Posttraumatic stress disorder, as a symptom of a co-occurring disorder. While Schizophrenia is a serious brain illness, there is no test for it. Diagnosis requires eliminating what it’s not occurring, in order to identify the symptoms that are present.

There are three types of symptoms:

  1. Psychotic symptoms may distort thinking, including hallucinations, delusions (beliefs that are not true), and organizing thoughts.
  2. Negative symptoms: where you’re not able to show emotions – leaving you to present yourself as depressed and withdrawn.
  3. Cognitive symptoms: Trouble making decisions and paying attention.

There is no cure. Different medications may have to be tried to see which are effective because medications affect each person individually. Once you find the medication(s) that work, stay on them daily, keep your doctor’s appointments and follow their recommendations.

Schizophrenia

Changes in behavior;

Includes delusions and hallucinations – which may last a lifetime.

Delusions; False beliefs, not based on reality, such as another person is in love with you, or a major catastrophe is about to occur.

Hallucinations involve seeing or hearing things that don’t exist. They can be in any of the senses, hearing voices is the most common hallucination.

Disorganized thinking and speech may include putting together meaningless words that can’t be understood, sometimes known as word salad. Extremely disorganized or abnormal motor behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. All of these behaviors can result in less than optimal interactions between other inmates or with correction staff. The result may be a trip to the hospital or the SHU (isolation), neither is acceptable, and both are preventable.

Negative symptoms can be expressed as, neglecting personal hygiene, appearing to lack emotion, (not; making eye contact, changing facial expressions, or speaking in a monotone), and losing interest in everyday activities, including socially withdrawing.

Treatment is accomplished under the psychiatrist-guided treatment team approach with a case manager coordinating care. The full-team approach may be available in clinics with expertise in schizophrenia treatment. These delusions and hallucinations — may last your lifetime.

First-generation older antipsychotics, introduced in the 1950s – As a class, these provided treatment for acute agitation, bipolar mania, and other psychiatric conditions.

On- Formulary Medications: Haloperidol (Haldol), Perphenazine (Trilafon), Loxapine, Trifluoperazine(Stelazine), and Fluphenazine

Not Available: Flupentixol, Zuclopentixol, Sulpiride, Pimozide, Molindone, Prochlorperazine, Thioridazine, and Thiothixene

Second-generation or atypical antipsychotics,

Some associated side effects; “Schizophrenia in adults, “Bipolar mania and hypomania in adults“,  “Unipolar major depression with psychotic features“,  “Delusional disorder”,   “Brief psychotic disorder”, and  “Treatment of postpartum psychosis”

On Formulary: Clozapine (Clozaril) “Clozapine remains the only antipsychotic that has been FDA-approved for treatment-resistant schizophrenia,” “and it provides effective treatment even when patients do not respond to other second-generation antipsychotics. No existing first- or second-generation antipsychotic is as effective as clozapine monotherapy in treatment-resistant patients. Deanna Kelly, Pharm.D., of the Maryland Psychiatric Research Center (MPRC)” Other Medications: Olanzapine (Zyprexa), and Risperidone (Risperdal).

Medications Non-Formulary: Quetiapine (Seroquel)

Some of the more recent atypical antipsychotics:

Medications Not Available: Asenapine (Saphris), Iloperidone (Fanapt), and Lurasidone (Latuda).

Schizophreniform

Symptoms of schizophreniform

Schizophreniform is a similar disorder that affects how you act, think, relate to others, express emotions, and perceive reality.

Unlike schizophrenia, it lasts one to six months.

A mental condition that can distort the way you:

  • Think.
  • Act.
  • Expresses emotions.
  • Perceive reality.
  • Relate to others.

Medication and Psychotherapy —to help the patient manage everyday problems related to the disorder.

Medications On Formulary: Click here for the article…

Brief psychotic disorder

Involves a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month.

The first line of treatment may include atypical antipsychotics.

Medications On Formulary: Click here for the article…

Medications Non-Formulary:   Click here for the article…

For those that have an increased risk of having depression, medications that address this symptom can be an important part of their treatment.

Delusion disorder

The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn’t, such as being followed, being plotted against, or having a disease. The delusion lasts for at least 1 month.

The exact cause is not yet known, but researchers are looking at genetic, biological, environmental, or psychological factors.

A cold, detached manner with the inability to express emotion

  • …has an over-inflated sense of worth, power, knowledge, or identity.
  • Jealous
  • …that someone is spying on them or planning to harm them.
  • …believes that he or she has a physical defect or medical problem.
  • …have two or more of the types of delusions listed above.

Symptoms that are ‘non-bizarre’:

  • An irritable, angry, or low mood
  • Hallucinations

Diagnosis: There are no laboratory tests to yield positive results, they are only good to rule out what it is not.

Treatment:

  • Psychotherapy is primary
  • Conventional antipsychotics

First-generation older antipsychotics, introduced in the 1950s – 

1st Generation, Medications On- Formulary for available medications: Click here for the article…

2nd Generation, Medications On- Formulary for available medications: Click here for the article…

Medications Non-Formulary medications require pre-authorization; click here for the article…

Other types of medications:

  1. Antidepressants might be used to treat depression, which often happens in people with delusional disorder
  2. Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and their impact on their lives.
  3. Sedatives and antidepressants might also be used to treat anxiety or mood symptoms if they happen with delusional disorder.
  4. Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

Shared psychotic disorder (also called folie à deux)

Here one person in a relationship has a delusion and the other person in the relationship adopts that same delusion.

Diagnosing is difficult, possibly with an MRI.

Treatment: Psychotherapy aims to ease emotional distress, with medication to ease the symptoms of anxiety.

It cannot be prevented, and the key is to diagnose and treat them as soon as possible.

Substance-induced psychotic disorder

Substance-related disorders involve drugs that directly activate the brain’s reward system which typically causes feelings of pleasure.

The classes of drugs include

·       Alcohol

·       Caffeine

·       Cannabis and synthetic cannabinoids

·       Hallucinogens (eg, LSD, phencyclidine, psilocybin)

·       Inhalants (volatile hydrocarbons [eg, paint thinner, certain glues])

·       Opioids (eg, fentanyl, morphine, oxycodone)

·       Sedatives, hypnotics, and anxiolytics (eg, lorazepam, secobarbital)

·       Stimulants (eg, amphetamines, cocaine)

·       Tobacco

·       Other (eg, anabolic steroids)

Treatment/Management

Clinical judgment, with a proper history, creates a safe environment during the withdrawal period. Due to the relative safety of most antidepressants in the setting of depressive symptomatology, and manic episode guidelines, second-generation antipsychotics, such as Quetiapine (Non-Formulary) or Olanzapine (On Formulary), may also be beneficial as they are faster-acting than mood stabilizers.

Psychotic disorder; due to other medical conditions;

Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

Paraphrenia: symptoms similar to schizophrenia.

It starts late in life in the elderly,

  • Generally has a much better prognosis than other psychotic disorders.
  • Antipsychotic medication can be helpful,
  • Paraphrenia sometimes co-occurs with depression and anxiety

I) BOP Placement Based On Security Level Alone – Without Multiple Medication Needs

The Challenge Program – an EBBR FSA Evidence-based Recidivism Reduction Program for male inmates in Penitentiary (High Security) facilities. Treats those with substance abuse and/or mental illness disorders (psychotic, mood, anxiety, or personality).

II) BOP Placement- With Multiple Medication Needs v Prior Hospitalizations

Here, it depends;

  • the number of types of psychiatric hospitalizations, not related to substance abuse, and
  • the number of multiple diagnoses treated with antipsychotic and/or different psychotropic medications

Influences Mental Healthcare (MH) CARE LEVEL I-IV facility placement.

Sex Offender Programs – Federal Prison

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FSA - First step act

FEDERAL PRISON SEX OFFENDER:

BOP PROGRAMMING WITH 2 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM RESIDENTIAL (SOTP-R) is a voluntary program (P5324.10) for Sex Offenders, and those with a history of multiple sexual offenses, re-offense, extensive non-sexual criminal histories, and/or a high level of sexual deviancy or hypersexuality. Inmates ordinarily participate in the program during the remaining 36 to 48 months of their sentence. The duration of the program is 12-18 months. Placement in the SOTP-R is reserved for inmates with more extensive sex offense histories, and cohousing participants permit the implementation of a modified therapeutic community, separate from the general population.

Having only 2 SOTP-R facilities nationwide – before they enter the program, initial placement into a free-standing Federal Prison Camp (FPC), or satellite minimum camp (adjacent to a higher secure facility), if practical, should be part of the court’s calculation.

This is because should an inmate consider acting violently towards your client – most would likely refrain as a single incident would have them transferred behind the wall, to a higher security facility, which they would not want.

Ultimately it just may come down to you knowing your client and the facility recommendation options available during the period before SOTP-R placement. Keep in mind that no matter what the BOP says, this could be a real-life event, therefore having this discussion with your client may prove crucial.

BOP PROGRAMMING WITH 9 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM NON-RESIDENTIAL (SOTP-NR), is also a voluntary program (P5324.10) for low to moderate first-time sex offenders with a single history of Internet Sex Crime, intended to identify offenders who are likely to re-offend. Inmates ordinarily participate in the program during the remaining 36-48 months of their sentence. SOTP-NR participants reside in the general population.

Having only 9 facilities nationwide – before they enter the SOTP-NR program, if practical, other than an FPC, or satellite minimum camp, should an inmate act violently towards your client – again, they would most likely refrain, as a single incident would have them transferred behind the wall, to a higher security facility. Otherwise, any other placement could result in a life-threatening sentence.

Consideration may again come down to knowing your client and understanding the facility options available for the period before their SOTP-NR placement.

BOP, 1 LOCATION NATIONWIDE

BUTNER’S COMMITMENT AND TREATMENT PROGRAM FOR SEXUALLY DANGEROUS PERSONS (2022-2023), “This FCI remains a flagship facility and is frequently chosen to pilot new programs such as the Sex Offender Commitment and Treatment Program,” (Page 6).

  • FCI Butner is responsible for the psychological treatment and implementation of behavior management plans, with the coordination of the multidisciplinary treatment teams. Treatment is holistic and multidimensional with the ultimate goal of reducing sexual dangerousness and criminal recidivism potential.
  • FCC Butner has an internship integrated practitioner-scholar model which seeks “the productive interaction of theory and practice in a primarily practice-based approach to inquiry”. The internship component of the Psychology Service strives to meet the training needs of doctoral candidates in applied psychology through supervised experience, didactic programs, and focused scholarship.
  • As there is only 1 location, which appears ‘court ordered’, there should be no other issues regarding inmate threats.

Fore more…

SEX OFFENDER SAFETY IN PRISON- PART OF YOUR SENTENCING CALCULATION

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PPRS - PPRSUS - Physician Presentence Report Service

SEX OFFENDER SAFETY – PART OF YOUR SENTENCING CALCULATION

It is important for the court to consider your client’s, (sex offender) safety, by requesting the court grant initial placement into a Sex Offender Management Program (SOMP), while waiting for your client’s voluntary admittance into a SOTP Program.

Following their interview and investigation, the Probation Officer will draft the official Presentence Report (PSR). Together with preparation, your message stands a better chance of being part of the PSR, and is included “on the record”.

Not being placed into a SOMP, and should an incident occur, could at best result in your client spending the remainder of their sentence in isolation for their protection. Then over time, this may yield a host of mental health phobias, leading to more severe ailments.

The benefit of being proactive as you help your client during their transition into the prison environment safely; cannot be overstated. This is especially significant if the PSR includes the documentation of a mental illness with diagnosis, including the treating physician’s records and testimony.

 

ENSURING THE PHYSICAL SAFETY OF YOUR CLIENT

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Among inmates and convicts, sex offenders are at the bottom of the prison hierarchy and generally, are greeted with hostility.

The BOP, where needed, assigns sex offenders to higher security facilities, which may not be perfect. But this can be especially evident when they’re placed in general population.

Next, when the new sex offender first arrives and meets their new bunkmate, it is not unusual for them to be asked, what did you do?

No matter how they answer, eventually, their roommate or bunkmate Will Find Out! After that, at best, the sex offender is avoided – at worse, they could be robbed, beaten, or even killed. Then he/she may have to spend the rest of their entire sentence in solitary confinement?

Therefore, in your memorandum, safety may dictate placement in either a facility with a Sex Offender Management Program (SOMP) or at minimum, a camp.

For more…

Post-COVID Virus Causes Lingering or Ongoing Symptoms

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PPRS - PPRSUS - Physician Presentence Report Service

The complicated care required for Post-COVID Long-Haulers is likely beyond the mission of most (if not all) prisons, jails, and detention centers.

According to researchers, this is still an active area of investigation. As we are approaching spring/fall 2022/2023, the Post-COVID Pandemic may be becoming an Endemic. Still, with that in mind, treating Post-COVID Long-Haulers and the amount and variety of staff, equipment, finances, and time needed, may just not be available to those incarcerated.

“COVID is a true roller coaster of symptoms and severities, with each new day offering many unknowns.”

 “The difficulty is sorting out long-term consequences,” says Joseph Brennan, a cardiologist at the Yale School of Medicine.

While some patients may fully recover, he and other experts worry others will suffer long-term damage, including lung scarring, heart damage, and neurological and mental health effects.

Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder[1]. ‘Long-Haulers’ after the initial COVID-19 hospitalization: fall into 3 categories (Dr. Sanghavi)

1st) The COVID virus causes lingering or ongoing symptoms, meaning that “ symptoms do not recover completely and are ongoing because of direct cell damage from the virus,”

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2nd) involves chronic ICU hospitalization for weeks. This causes:

  • muscle weakness,
  • cognitive brain dysfunction,
  • psychosocial stress-causing post-traumatic stress disorder (from chronic hospitalization).

3rd) symptoms appearing after recovery. “Interplay with the immune system of a person, and then the impact that both those things have on the body.”

“We are still trying to understand exactly how this interplay between the immune system and inflammatory markers work, but there’s no doubt that that is a group of symptoms because of ramped up immunity or ramped up inflammatory system,” Dr. Sanghavi added.

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Peripheral nerve issues, such as Guillain-Barré Syndrome, can lead to paralysis and respiratory failure.

Post-COVID Stress Disorder is another emerging consequence of the global pandemic.

Although most cases of COVID-19 appear to be mild with a recovery time of a few weeks, health experts are seeing more patients who suffer symptoms for months or get better, and then relapse down the road.

Isolation Is Not the Answer, Precautions for Adults with COVID-19[ii]

For more…