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Topic: Genesee County Corruption - Judge Beagle and Sheriff Pickell
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untanglingwebs
El Supremo

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Abnormal mental states in multiple sclerosis
Dr Hugh Rickards, consultant in neuropsychiatry, Queen Elizabeth Psychiatric Hospital, Birmingham


Way Ahead 2003;7(1):6-7


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"The mind is what the brain does" - Prof. Steven Pinker: How the mind works.

MS is primarily a disease of the brain. As this is where mental functions are controlled, it isn't surprising that changes in mental status are common in people with MS (PWMS).

However, mental disorders in MS are frequently overlooked for a number of reasons:

◾Changes in mental state are considered to be solely a 'reaction' to having a chronic illness
◾Many mental health services have retracted so they only treat 'functional' mental illnesses
◾The relatively few neurologists in the UK often restrict themselves to diagnostic issues and managing physical symptoms
◾Understanding symptoms of mental disorder is a complex process, often touching on personal and family issues. It can be easier to stick to the physical and practical aspects of care.
The burden of responsibility for mental illness in MS usually falls on relatives, carers and MS specialist nurses, who don't always feel adequately skilled to advise. This burden is heavy and may contribute to reduced quality of life in MS.

Practitioners need a number of skills to manage mental disorder in MS, including knowing how MS affects the brain, understanding the effects of prescribed and non-prescribed drugs on mental function and being able to recognise major mental disorders, such as depression, psychosis and cognitive impairment. Additional skills include understanding psychodynamic theory and "family systems" theory.

Depression in MS
Depression is a very common mental illness in MS. Around half of all PWMS will have clinical depression at some time, around three times the incidence in the general population. Depression in MS can sometimes be difficult to diagnose as many symptoms, such as fatigue, weight loss and lethargy, may occur in both conditions. Important clues in the diagnosis of depression include: pervasive low mood, sometimes with diurnal variation - often the mood is particularly bad in the morning; reduction in physical function that is disproportionate to their level of physical disability - level of physical disability does not correlate well with the risk of getting depression; and suicidal ideation. Suicidal ideas are quite common in PWMS who attend clinics, occurring in 25% at any one time. One study showed around 3% of PWMS will take their own lives, especially socially isolated young men with MS.

Transient low mood is normal in the period immediately after diagnosis and is known as adjustment disorder. Various common medications in MS, such as steroids, baclofen, dantrolene and interferon can cause changes in mood in either direction. Physical conditions, such as anaemia, vitamin deficiencies and thyroid disease can present with depression and need to be excluded.

Treating depression in MS is often rewarding and drugs in the Specific Serotonin Reuptake Inhibitor (SSRI) group are probably safest. Common side effects, usually transient, include nausea, sexual dysfunction and gastrointestinal disturbance. Withdrawal from these drugs should be gradual, especially with I am a moron (Seroxat).

Mania is relatively rare and, where it occurs, one should consider whether prescribed or non-prescribed drugs have been the trigger.

Paroxysmal emotional states
Paroxysmal emotional states are transient changes in behaviour or emotion, which resolve quickly. These are divided into pathological laughing and crying and emotional lability.

Pathological laughing and crying can occur in up to 10% of PWMS. The response can be to random stimuli and not related to how the person is feeling. Such laughing or crying may be short-lived (lasting only a few seconds) and is particularly seen in people with chronic MS with cognitive impairment. Pathological crying can be mistaken for depression but the mood is usually not pervasively low. Where it causes distress or disability treatment may be with amitryptilline, l-dopa or amantadine.

Emotional lability is characterised by an excessive emotional response to a minor stimulus, eg excessive emotional responses to soap operas on TV. Again the response is transient and has been described as 'an April shower'. Effective treatment has been described with carbamazepine and SSRIs.

Psychosis in MS
Psychotic symptoms - delusions, hallucinations and thought disorder - are uncommon in MS but extremely distressing. This may result in family breakdown and nursing home placement. Symptoms are similar to those seen in 'functional' psychoses such as schizophrenia, although visual hallucinations are more prominent and the mean age of onset (36 years) is later.

If a PWMS becomes psychotic (especially if there is acute onset) it is important to rule out physical triggers such as chest and urinary tract infections and metabolic disturbances. Steroids, baclofen and dantrolene have all been reported to trigger psychosis in people with MS so a close review of the treatment history is vital. People with severe depression may develop psychotic symptoms congruent with their mood - for instance delusions of poverty or guilt - and here treatment should be aimed at the depression. Finally, psychotic symptoms in MS may be the presenting feature of dementia.

People with MS are particularly sensitive to neuroleptic (anti-psychotic) medications. Rigidity and bradykinesia are commonly encountered even at low doses of conventional neuroleptics such as haloperidol. Therefore, atypical antipsychotics (quetiapine or olanzapine) should be first line therapy in this situation. The few studies about the prognosis of psychosis in MS suggest that treatment response is fair.

Cognitive changes
Many PWMS experience significant changes in cognitive function over time. Around 40% of PWMS in the community have some cognitive impairment. Typical problems include reduced speed of processing, reduced attention span and problems with executive function. Such problems may be the source of considerable disability but may not register on standard tests, such as the Folstein Mini Mental Status Examination or MMSE, or at clinical interview as verbal skills may be unaffected. Occupational therapy assessment at home is one of the best ways of detecting impairments in executive function. Specific tests that can reveal executive dysfunction include the Addenbrookes Cognitive Examination (ACE), the Frontal Assessment Battery (a short, sensitive, 'bedside' test) and the Behavioural Assessment of Dysexecutive Syndrome (BADS).

Conclusion
Mental status changes are extremely common in MS and are relatively neglected. They need thorough assessment with particular attention given to mood changes, cognition and perception. Many treatment or management strategies are effective.

There is a real danger that people with MS and mental illness will be excluded from services and it is vital that health professionals in neurology, psychiatry and rehabilitation work together to prevent this.

In the latest issueResearch newsDefining the values of allied health professionalsPilates based training for MSShared decision makingHow the care team can help at the end of life Highlights from the MS Trust 2013 Annual Conference .Disclaimer
Way Ahead articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.
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Post Thu Apr 10, 2014 8:19 pm 
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untanglingwebs
El Supremo

Conclusion
Mental status changes are extremely common in MS and are relatively neglected. They need thorough assessment with particular attention given to mood changes, cognition and perception. Many treatment or management strategies are effective.

There is a real danger that people with MS and mental illness will be excluded from services and it is vital that health professionals in neurology, psychiatry and rehabilitation work together to prevent this.
Post Thu Apr 10, 2014 8:20 pm 
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jh88718
F L I N T O I D

Looks like there are pros and cons to everything. Since this blog, the courts have scheduled an evidentiary hearing to review the Michigan Court of Appeals ruling (one positive) but as of today, the Hodge family was advised that Genesee County Jail is transferring Hodge to Midland to get her as far away as possible (another negative).
Post Fri Apr 11, 2014 9:38 am 
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jh88718
F L I N T O I D

I may have spoke to soon. I personally contacted Midland Intake Division and they advised me that they discussed the transfer of Hodge; however, their jail is full and they will not accept the transfer. One thing is for sure, nobody wants to be responsible for housing a 60 year disabled woman and I can't blame them. We will see how long it takes Genesee County to toss the "hot potato" onto somebody else's plate. In the past, we released convicted criminals due to "overcrowding" so I ask the question, why not release Hodge due to overcrowding? She is not a threat to society and if anything, she is a liability to the county which will cost the tax payers a lot of money.
Post Fri Apr 11, 2014 9:57 am 
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jh88718
F L I N T O I D

http://www.gcsdmi.com/images/elder_abuse_letter.jpg

Sherriff Pickell, please enforce your "Elder Abuse" clause that you signed. Hodge needs medical treatment.
Post Fri Apr 11, 2014 1:27 pm 
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jh88718
F L I N T O I D

Medical records for Hodge were transferred to Genesee County Jail on 04/07/14. Today, attorneys notified Genesee County and Midland County of Hodge's medical conditions and they were put on Notice to comply with requested treatment. Failure to comply will result in a 1983 Civil Action lawsuit for deprivation of rights pursued against the Sheriff, the jail, Genesee County and Major Phil Hart. Now comes the beginning of a long legal battle, Genesee County tax payers will need to get off their pocket book to defend said allegations. In addition, Michigan Advocacy Department has begun their investigation, left messages at the jail and the jail has not returned any calls. This is getting escalated within their department. Hodge deserves justice and public awareness appears to be the only strategy that is working right now.
Post Fri Apr 11, 2014 3:52 pm 
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untanglingwebs
El Supremo

WOW! You certainly are an advocate for this unfortunate woman. Hoping for a successful conclusion!
Post Sun Apr 13, 2014 7:23 am 
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untanglingwebs
El Supremo

When advised of the situation, Pickell stepped in and made sure the woman went to the hospital and received IV treatment. She is now receiving her meds and other medical treatment. I understand motions are being made in an attempt to get her released from jail.

We can't always assume the head guy knows everything.
Post Tue Apr 15, 2014 12:12 pm 
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jh88718
F L I N T O I D

Hmmm, previous statement is not true at all. The family met with Hodge yesterday. Status is as follows:

1) Hodge has not received any injections or treatment for her MS. Hodge has issues with her balance and she is currently having issues with blurred vision (I.e., appears as if she is going through a relapse).
2) Hodge has been treated for her Gerd with cheaper low cost meds.
3) Hodge has a terrible compression wound on her leg which is causing issues and requires treatment.

As of last night, a grievance was issued to Lieutenant Rue and thankfully, the Lieutenant investigated the issue. Hodge was advise that she will see the Dr. today. As of late last night, the medical treatment provided to Hodge has been sub par at best. The county can't afford to treat her condition properly; therefore, they have been ignoring it. Hodge continues to be a liability for the county. A motion for reconsideration has been submitted to the Judge. It is up to Judge Beagle and Sheriff Pickell to do the right thing before Hodge suffers irreversible damage, assuming its not too late!
Post Tue Apr 22, 2014 12:57 pm 
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jh88718
F L I N T O I D

Today is day 24 of Hodge's 90 day mandatory sentence. Currently, no treatment or injections have been provided for Hodge's medical disability and her medical condition continues to worsen. Jail nurses and staff have agreed that Hodge is a liability and she should be released; therefore, they are sending a letter to the Judge asking that he reconsider his position. On Monday, April 28, 2014 at 2:30 pm, in Judge Beagles courtroom, Hodge and her attorney's will discuss a motion for reconsideration with Judge Beagle. We can only hope that Judge Beagle will do the correct thing. Public awareness is the best option at this time. If anyone wishes to attend the court appearance, I greatly urge your support. If the courtroom is full, it may be more difficult for the Judge to continue pushing his egregious position.

On a side note, the jail continues to release convicted felons who are habitual offenders (including sex offenders). Without going into detail, we do not have room for the felons but we have plenty of room for the elderly and disabled who have a clean record with no known criminal history. What is happening to our system? I ask the question, has our judicial system failed our community and society?
Post Thu Apr 24, 2014 8:06 am 
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jh88718
F L I N T O I D

Hodge was released at 9:30 am yesterday. The county nurse and Dr. wrote a letter to Judge Beagle indicating that Hodge's medical condition and needs support the release of Hodge. Hodge was rushed to UofM emergency upon release where she was admitted and held overnight. Hodge's medical condition and impairment have been greatly jeaprodized by the the lack of treatment provided while detained at Genesee County.
Post Sun Apr 27, 2014 12:27 pm 
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00SL2
F L I N T O I D

quote:
jh88718 schreef:
Hodge was released at 9:30 am yesterday. The county nurse and Dr. wrote a letter to Judge Beagle indicating that Hodge's medical condition and needs support the release of Hodge. Hodge was rushed to UofM emergency upon release where she was admitted and held overnight.
If she was only held overnight in UofM emergency, was she released in your care to go home, or were arrangements made to transfer her to nursing home where she can get her "medical conditions and needs" treated?
Post Sun Apr 27, 2014 2:28 pm 
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jh88718
F L I N T O I D

Hodge was released to her family to care for her. Hodge's family will insure that she obtains the proper medical treatment and injections that she needs.
Post Sun Apr 27, 2014 3:53 pm 
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untanglingwebs
El Supremo

Voters need to stop going to the polls uninformed. This city cannot keep placing people in office because the public thinks they are nice guys. Judges especially have great power over the lives of those who come before them in their courts. There needs to be a way to inform the public when a Judge oversteps their roles and behaves irrationally .

Thank You JH88718 for bring this matter to light and for seeking an equitable solution for this woman. I hope you continue to be an advocate.
Post Wed Apr 30, 2014 8:11 am 
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jh88718
F L I N T O I D

Agreed, we need to start acting on morals and ethics, not money and politics. As a voter, we need to assess the "real" data and facts to make our decision. Unfortunately, we are ill informed and we don't put in the time necessary to understand the ramifications of our choices. Educated citizens and public awareness are the best thing. Unfortunately, the decisions of the judge have set back Hodge substantially. One month in jail has completely destroyed the last four years of treatment and therapy. Prior to jail, Hodge was walking, dancing and working out at the gym regularly. Now this week, she is walking with a cane, has blurred vision and a loss of sensory feeling. She almost lost her balance and fell over twice the other day when I saw her. This is a real lifetime story that requires accountability and justice.
Post Wed Apr 30, 2014 1:20 pm 
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