Subject: Re: Limbic system update
“Elizabeth does have capacity to consent to those tests. I am a senior lecturer in medical ethics and law and since this study is to determine possible treatments for Elizabeth it is perfectly OK to carry them out.
I would have hoped that medical practitioners would have known that.”
From: susan bevis
To: ZB (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST)
Sent: Mon, 28 Mar 2022 19:05
Subject: Limbic system update
Are you trying to say that my daughter has no capacity?
Where is the study being done and who do I contact to get the necessary forms?
Elizabeth has agreed, witnessed by more than one family member.
I look forward to receiving the necessary forms. The tests are very important I am sure you will agree and this has already been agreed by Dr HMS in any case. His important research needs to be widely publicised and I have proof she has already agreed. The more people who know about his research the better as this could widely benefit more than my daughter.
The entire family are witnesses to this consent in any case.
NEAREST RELATIVE, POA, MCKENZIE FRIEND AND MOTHER
Sent from Mail for Windows
From: ZB (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST)
Sent: 28 March 2022 17:35
To: susan bevis
Subject: Limbic system update
I have spoken with Dr HMS and the bloods that need to be taken for the Limbic system are not able to be Done as it’s as part of a study, and the study requirements stipulate that the patient must have capacity to consent to have those particular bloods taken.
Sent: 20 March 2022 15:44
Subject: The Limbic System
All the doctor has to do is repeat the tests he did on the other patient. It was his research for god’s sake he should not need it explaining!
If it was not possible for a psychiatric patient to take part in a ‘study’ you might want to ask Z how Dr Shahpesandy managed to do the study on the 51 year old admitted with acute psychosis who turned out to have inflammation in the temporal zones cause by some problem in the Limbic system.
Upon admission he too had been put on Clopixol for his psychotic symptoms that were in fact a result of the inflammation in the brain.
It is hardly ‘responsible’ to ignore a possible cause or diagnosis. If physical symptoms are being ignored he needs to be reminded of clinical negligence and the case of Bolitho.
Subject: Anti-voltage-gated potassium channel complex antibody–mediated limbic encephalitis: a case report of a 53-year-old man admitted to intensive care psychiatric unit with psychotic mania
- Homayun Shahpesandy1,
- Rosemary Mohammed-Ali1,
- Ahmed Oladosu2,
- Tarik Al-Kubaisy3,
- Moses Anene4 and
- Umesh Sira Ramaiah5
- Correspondence to Dr Homayun Shahpesandy; email@example.com
zuclopenthixol deaconate (600 mg/weekly)
On further assessment, cognitive decline and severe short-term memory were noted; Addenbrooke’s Cognitive 55/100. CT, EEG and lumbar puncture were normal; however, MRI on 29 November 2017 demonstrated bilateral high signal around the temporal horn and diffusion abnormality, suggestive of encephalitis. Consequently, the patient was transferred to medical ward and zuclopenthixol decanoate was stopped.
I have been reading follow ups to Dr HMS’s interesting observations on damage to the limbic system. It is very strange that he acknowledges that inflammation or lesions in this part of the brain can and do cause psychiatric disorders but does not want to investigate this in Elizabeth’s case.
Since the psychotic episodes experienced by Elizabeth are characterised by anger and fear and clearly from the photographs there are comorbid endocrinal problems associated with her illness, damage to limbic structures could be responsible for both. It is of course possible that the endocrinal problems are caused by ADR’s to the drugs she is medicated with.
The limbic system is the part of the brain where emotions are controlled (or not as the case might be in psychosis) Emotional responses to stimuli are triggered in the Limbic Structures such as the hippocampus and the amygdala. Lesions or inflammation here would be likely to cause a marked and even severe display of exaggerated anger fear or both. Dr HMS commented on this in his joint paper on neuropsychiatry so it is not as though he is unaware of the research. An MRI scan would indicate this an it could be backed up by a serum antibody test for any type of antibody affecting inflammation or lesion healing in brain tissue.
In the severest form of PTSD or disorder of extreme stress, known as Selyes Generalised Adaptational Syndrome serious endocrinal and neurological symptoms are observed and the syndrome can cause permanent damage.
Researchers are examining the possibility of treatments directed at the limbic system for the treatment of acute anxiety disorders. The fact that new neurons are made in the limbic system indicates that stimulating such growth might offer a possible treatment for number of psychiatric disorders.
I am now going to suggest this as a research topic at my pharmacy school for the next academic years research students starting in October.
Dr HMS had an interesting case in 2017 when a man was admitted to the psychiatric intensive care unit. The patient presented, following almost a 2-month deterioration of his mental health with physically aggressive behaviour, elevated mood, paranoid-persecutory and grandiose delusions. Prior to his admission, he assaulted one of his neighbours. He presented with pressured speech and flights of ideas. He believed he had contact with politicians, including heads of states and powerful individuals. No cognitive deficit, no neurological symptoms.
After tests which included an MRI scan it was determined that the man did not have an underlying psychiatric disorder and that his psychosis was induced by encephalitis around the temporal horn. Further examination indicated the presence of anti-VGKC antibodies in the serum.
He had been treated with zuclopenthixol decanoate for the psychosis and on detection of the inflammatory condition in the temporal lobe area of the brain it was terminated. Inflammation in the temporal horn can cause disruption to the limbic system which can result in presentation of psychotic symptoms. Here are Dr HMS’ and his colleagues actual words used in the paper.
“Disruption of limbic structures has huge clinical implications and is presented with a variety of neuropsychiatric disorders including epilepsy, dementia, anxiety and mood disorders, schizophrenia as well as attention deficit and hyperactivity disorder”
I have encountered this before. A few years ago a woman presented with acute psychosis. The psychiatrist did not read he complete medical notes and proceeded to administer a range of neuroleptic medications. Had she read the notes she would have seen that the patient had undergone surgery on her thyroid and it was clear that damage to the parathyroid had occurred during this intervention.
Damage to the parathyroid is commonly associated with psychosis.
Dr HMS’ patient made a full recovery after the Clopixol was stopped and anti-inflammatory and anti-seizure medication was used to treat the encephalopathy and temporal lobe seizures.
The patient in the second case also fully recovered from the psychosis after the psychiatric medication was stopped and appropriate treatment for the endocrine (thyroid) disorder was prescribed
It always pays to investigate whether the psychosis is induced by lesions or infections especially of an inflammatory variety. Dr HMS went to great lengths to investigate his patients psychosis including EEG, CT and MRI scans as well as lumbar fluid.
Dr HMS has written research papers on neuropsychology that indicate he is positive about carrying out brain scans to detect lesions and or neurological causes of psychotic disorders. I just read one where he discovered that the patient had a limbic encephalitis and that it was that physical brain disorder that was causing the psychosis.
Therefore it seems odd that he would block Elizabeth from getting a scan since his research indicates he is in favour of carrying them out.