Wednesday, 31 December 2014

Liverpool Care Pathway - A New Year Life Café

What does 2015 have in store...?

2015 - The deadline to create £20 bn in savings.

Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge. Why £20 Billion?
With the number of deaths set to increase by 17% to 590,000 by 2030, we are facing a ticking time bomb when it comes to end of life care. A rapidly ageing population and increases in the number of people with complex long-term conditions will lead to greater demands on providers of end of life care and rocketing costs for the NHS predicted to rise from £20billion to £25billion by 2030. This issue is the subject of a series of fringe events Patient Choice V Care being held by Marie Curie is partnership with Sue Ryder and Help the Hospices, during the political party conference season. 
 Huffington Post
From The Mandate (April 2014 to March 2015) -
"These priorities reflect the Government’s absolute commitment to high quality healthcare for all, while highlighting the important additional role the NHS can play in supporting economic recovery."

"The NHS Commissioning Board’s objective is to ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth. This includes ensuring payment of treatment costs for NHS patients taking part in research funded by Government and Research Charity partner organisations."
The important additional role the NHS can play is in supporting economic recovery and contributing to economic growth.

The Third Sector will continue to work hand-in-glove with government.

Lord Shawcross has said that some charities risk becoming too dependent on the State. Actually, some charities, possessing a valuable branding, behave less and less as you would expect charities to behave and more and more like for-profit corporate entities.

NHS patients will be taking part in research...

According to the NHS England Business Plan 2015/16 -
We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.
NHS England Business Plan 
...a policy of presumed consent is being investigated.

The focus of any health provider is to restore the patient to a condition of health. A healthy population is constructive to maintaining and encouraging a healthy economy but that is an entirely incidental consequence.
Liverpool Care Pathway - A Cost Efficiency
From April 2015...

This is the South Warwickshire CCG Commissioning Intentions 2014/2015 
By November 2013 we will have commissioned an Admission Avoidance Programme (Phase 1) to keep people at home. This willprovide patients with access to specialist opinion and/or diagnosticswithin 24-48 hours for patients. In November 2013 we will start the more comprehensive Admission Avoidance Programme (Phase 2). This will impact on services outsideof the hospital and is anticipated to significantly change the number and type of contracts we have with providers from April 2015.
If The Facts Fit...?
On the basis that each year 1% of our population dies, we want our end of life registers to reflect this.By March 2016 we want 0.8% of our population on an End of Life Register.
"On the basis that each year 1% of our population dies, we want our end of life registers to reflect this. By March 2016 we want 0.8% of our population on an End of Life Register" (irrespective of whether these 0.8% selected for the Death Lists would have been part of the actual statistical cohort or not?).

The DoH raised a national alert in 2010 after a number of errors occurred in syringe driver use.

This is the Rapid Response Report –

 Ambulatory syringe drivers are widely used for palliative care and long term therapy in all clinical settings and at home. Some ambulatory syringe drivers have rate settings in millimetres (mm) of syringe plunger travel. The use of millimetres rather than millilitres (ml) as a basis for medication calculation is unique to ambulatory syringe drivers. This is not intuitive for many users and not easy to check. Errors include the wrong rate of infusion caused by inaccurate measurement of fluid length or miscalculation or incorrect rate setting of the device. Errors can also be made through confusion between models calibrated for mm per hour or mm per 24 hours. Syringes in some of these devices can become dislodged in use. Some have inadequate alarms and no internal memory (which makes establishing the reason for any over or under-infusion difficult). Because ambulatory syringe drivers are often used to deliver opioids and other palliative care medication, over-infusion can cause death through respiratory depression while under-infusion can cause pain and distress.

Changes must be implemented by 2015...

The national programme to replace this type of syringe driver was piloted at the James Paget University Hospital where Michael Shuckford had his life ended.

Norfolk Coroner, William Armstrong expressed concern that the Trust had until 2015 to implement changes to replace it. Mr. Armstrong said this was a too generous time scale.

2015 - Chasing the 1% and chasing the EPACCs...

According to Community Care -

Norman Lamb has said that NHS England wants to expand the use of electronic palliative care co-ordination systems (EPACCs) to increase national coverage form 30% to 70% by 2015.

Come to us all it must and, asked where you would prefer to die, it is almost certain that the response will be in your own home with loved ones at your side. Mr. Lamb is determined to grant that wish. An ACD might well include that wish...

But that doesn't mean you want them to give up on any chance to save your life.

The Health and Wellbeing Boards have been productive in developing EoLC provision and the move to ‘respecting and acting upon’ EoL wishes - code for Advance Care Directives.

According to the The King's Fund, the Better Care Fund has been implemented in the context of an ageing population. This is spending money not to provide for demand but to reduce that demand. This is spending money to save money.

The National Audit Office announced that the Better Care Fund will pool £5.3 bn of existing NHS and local authority funding and will run from April 2015.
End-of-Life documents include not merely attitudes to refusal of treatment but to such things as organ donation.

2015 - The coming of presumed consent.

In Wales, from December 2015, there will proceed organ harvesting. New legislation will require people to opt out of donating their organs when they die, rather than opting in by signing the donor register.

And has this been properly and appropriately risk assessed...?

BBC News Wales
Danny Dorling writes in the New Statesman 
The government said that it would look after pensioners. It brought in the so-called triple lock on state pensions and protected the free bus pass, but it has not looked after all pensioners equally. It will be those who were poorer and lived in poorer areas who will have made up the majority of the prematurely dead, and who will make up the majority of the thousands more who will die between now and May 2015, should the situation not improve. These are the last of all those people who, in their millions, voted for Labour in that landslide election victory of 1945.
Where have all the old ones gone, long time passing...?

Why are old people in Britain dying before their time?

Excess deaths!

National Audit Office
The headlined report, 'Securing the future financial sustainability of the NHS', maintains that the NHS delivered a £2.1 billion surplus in 2011-12 but that there is some 'financial distress' in NHS Trusts with some very large deficits.

On target, perhaps. Much has been achieved already, then.

There is still much more to achieve, however. The pensions black hole still gapes its maw ready to gulp down the careless or unwary economist and politician.

Essential reading -
Liverpool Care Pathway - Time To Wise Up
A Trial in Flanders' killing wards, where they euthanase patients without their prior permission, hosted on a US dot Gov website, is approaching its Estimated Primary Completion Date in March 2015.

The Independent reports -
The Belgian study is recruiting 600 dying patients, half of whom will get usual palliative care, while the others will be cared for using the LCP.

"Although the LCP has been adopted in 21 countries outside the UK and has been recognised to be the gold standard for practice, the evidence supporting such practice is insufficient," say the researchers leading the new trial. "Due to the scarcity of available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made at the present time. Randomised clinical trials or other well designed studies are needed to obtain additional evidence about [its] effectiveness."
Further reading -
Liverpool Care Pathway - Over Here, Over There, And Coming Your Way Soon
2015 - Another new year, fresh start, off with the old, on with the new...

And the new year begins with the ED in need of some emergency resus.

This report began the new year 15 years ago in The Guardian -

The Guardian
Britain's accident and emergency wards are so overstretched that seriously ill elderly patients are being left on trolleys for more than two days, and patients waiting to be seen are left lying on the floor, according to a shocking new survey.

The full scale of the chaos in casualty departments will be revealed in a report this week by the Association of Community Health Councils, based on spot checks on most A&E departments in the country. One recent check found a 71-year-old woman with angina who was left on a trolley at East Surrey Hospital, near Gatwick, for 49 hours. Government guidelines say no one should be left on a trolley for more than four hours.
2015 – Is Gosport War Memorial finally, finally to open its cobwebbed doors and permit the light of truth to penetrate each last nook and cranny of deceit, deception and dishonesty?

The Portsmouth News reports -

Bishop James Jones, who previously chaired the Hillsborough Independent Panel will chair the independent investigation and today Mr Lamb confirmed four additional members.

They are geriatric medicine specialist Dr Colin Currie, investigative journalist David Hencke and former Scotland Yard Commander Duncan Jarrett will join the Gosport Independent Panel immediately, whilst pathology and medical records expert Dr Bill Kirkup will join after his work with the Morecombe Bay investigation concludes.

The stepson of Arthur ‘Brian’ Cunningham, who died at the hospital in 1998, aged 79, believes that it is long overdue.

Charles Farthing, said: ‘There’s been a blatant cover-up from the beginning.

‘There may have been investigations, but someone has been controlling what’s coming out and what information is not.

‘This has all been dreadful and an investigation like this should have happened 10 years ago.

‘But the system has been covering things up for whatever reason, and now I hope this investigation will get to the bottom of it all.’
Will the Morecombe Bay Investigation chaired by Dr Bill Kirkup finally penetrate the smog of obfuscation that has cloaked the awful truth for so long, too long?

This is the Morecombe Bay Investigation (last updated 19 December 2014) -

It is expected that the interview programme will conclude during the week commencing 5 January 2015...

But let's end the old year with some wholesome Life Café with this report from the Metro...

...What's yours, an Americano or a latte?

Sunday, 28 December 2014

Liverpool Care Pathway - Difficult Questions; Reasoned Answers...

When dignity in death takes precedence over dignity of life...

In determining that this unborn child may have little or no prospect of a positive outcome to life and that, therefore, that diagnosed outcome shall be pre-empted with a determined act to produce an outcome of death, are they actually performing an act of illegal euthanasia?

This is the Irish Times -

A young pregnant woman declared clinically brain dead more than three weeks ago may be taken off life support because there is no genuine prospect of her baby being born alive, a three-judge High Court has ruled. 
Due to the woman’s rapidly deteriorating condition, the prospect for the unborn is “nothing but distress and death”, the court said. 
After giving the court’s ruling, the President of the High Court, Mr Justice Nicholas Kearns, said he was “grateful” to be told there will be no appeal to the Supreme Court.
The child may not answer, may not come to their own defence, and those so appointed will not pursue it.
Mr Justice Kearns, sitting with Ms Justice Marie Baker and Ms Justice Caroline Costello, said the court was awarding costs of the case to the woman’s family, and to the lawyers representing the interests of the woman and unborn, as it had raised issues of “great public importance”. 
The woman is 18 weeks pregnant and was at 15 weeks gestation when she was declared clinically dead on December 3rd at a Dublin hospital as a result of a brain trauma suffered at a hospital outside Dublin on November 29th, two days after she was admitted there complaining of severe headaches. 
This was not a case where the woman had ever indicated she wanted an abortion, he said. On the contrary, she had apparently posted a scan of her unborn on her Facebook page to share her pleasure and excitement about her pregnancy. From the available evidence, the court believed she would “have fought long and hard to bring her unborn child to term”.
The woman suffered "catastrophic" brain injuries in an accidental fall in the hospital where she initially sought treatment. She was transferred to a specialist Dublin hospital where she was placed on life support. On December 4, 2014, she was declared brain dead by doctors.

Is liability to be considered for the fall?

Lawyers representing the interests of the woman made the argument that the treatment should continue. Issue was raised that, given she was a full-time mother devoted to her children, she would have wanted her child to have the chance of life [The Irish Times].

Lawyers on the family's part said that the prospect for the unborn is “nothing but distress and death”. That is the most certain prospect if life support is withdrawn. This argument, then, is one of futility and not for concern for the unborn.

The matter of significance in this case for the Justices, however, extends further for they proclaim that it has raised issues of “great public importance”. The debate on the rights of the unborn are now certain to proceed.

There is concern expressed for the awful predicament and distress of this poor family who have witnessed this.

The language of the EoLC Programme and Strategy was always couched in phraseology that demonstrated most concern for how a death is perceived to be by those who witness it than how it is actually experienced.

Dame Cicely Saunders, one of the pioneers of the Hospice movement, said: “How people die remains in the memory of those who live on.”

Then does concern for the interests of the stricken take secondary place to that of those who must witness the predicament of the stricken...?
Liverpool Care Pathway - "No Midazolam"
These are all valid questions to ask.

The PROMs (Patient Reported Outcome Measures) for EoLC are among the Quality Markers to document quality of care. Patients on the death pathways may not respond upon their experience for they will be dead. It is the 'Friends and Family' then who will report how smoothly it all went.

The perception of the dying, likewise, might be misleading and misinformed. It is wholly a subjective view, reported by the perceiver of the death and not by the person who has died. A sedated patient is not in a position to complain. A dead patient cannot complain.

Knock them out with Midazolam and they will be pliant, compliant and uncomplaining.

Archbishop of Dublin Diarmuid Martin is reported as saying that, “A woman isn’t simply an incubator.”

That is evident. A woman is a person, whole and complete with personal interests and attributes that Nature, God or evolution have bestowed upon her. One of these attributes is the continuity of the species.

A woman is not simply a vessel to bear children. Neither is any person simply a vessel from which to harvest organs for transplant, but many promote that concept through presumed donor consent.

The Archbishop is also reported as saying that, “From the point of view of Catholic teaching in general medical ethics, there is no obligation to use extraordinary means to maintain a life." That simplistic argument will be taken up and be used as a cudgel against him.

The Justices have plainly considered it a matter of import to consider the argument of the family and to respect and understand what they must be going through.

There are, however, issues of “great public importance” which have also been raised.

Health Minister, Leo Varadkar, has said the constitutional rules around abortion are “too restrictive” and have a “chilling effect” on doctors.

“Difficult decisions that should be made by women and their doctors, a couple or next-of-kin… on the basis of best clinical practice, are now often made on foot of legal advice. That is not how it should be.”

"Difficult decisions..."

In May 2012, David James walked into Fazakerley Hospital, Liverpool, with a stomach complaint. He became critically ill after contracting hospital acquired pneumonia that led to multiple organ failure.
"This is one of the terrible things. Aside from the pneumonia, we’ve never really had a diagnosis. All we know is that from the moment he went into hospital, he went catastrophically downhill." (May James)
Mr. James ended up on life support and the good doctors of Fazakerley went to court to fight the family's wishes to keep David on life support...
Liverpool Care Pathway - In Whose "Best Interests"?
Liverpool Care Pathway - A Bad Decision Left To Stand
The wishes of next-of-kin in this particular "difficult decision" were not to be respected.

It would appear that the 'right to life' of a brain-live child is, apparently, secondary to the 'right to life' of a brain-dead child...
Liverpool Care Pathway - Cold, Cruel, Callous, Heartless, Without Pang Of Remorse
Curiously, in each of these cases a possible harm has occurred in which liability may be attributed to the hospital concerned.

Does that have some weight of significance? In the Dublin case, all that stood the doctors' hands in withdrawing life support was the contentious Eighth Amendment and legal action.

In this case, the parents and partner of the woman filed lawsuits asking for the hospital to switch off her life support.

Historically, hospitals in the republic have kept pregnant women on life support in hopes of saving the unborn.

Should apparent futility sway us in determining should a life be saved or abandoned? Is it not human instinct to rush in against all peril to attempt rescue?

This is the The Telegraph -

A baby boy has been delivered by Caesarean operation to an Italian woman who was declared clinically dead two months ago.

The 36-year-old woman from Milan suffered a massive brain haemorrhage in October, during her 23rd week of pregnancy.

After being taken to hospital, she was pronounced clinically dead and there were fears for her unborn child.

But doctors at San Raffaele hospital in Milan managed to keep her on life support, feeding the developing foetus through a tube inserted in the mother's stomach.

Against all the odds, the baby boy was born on Thursday by Caesarean operation, in the woman's 32nd week of pregnancy.
Last year in Mail Online -

A baby which was 15 weeks old when its mother was declared brain-dead was delivered by Caesarean section at 27 weeks, after doctors kept the mother alive on life support.

The Hungarian doctors who delivered the baby in July believe the birth is one of only three such cases in the world.

The child was born three months after its 31-year-old mother suffered a stroke. Her life support machine was switched off two days after the Casearean section.

In the spring, she had been rushed to hospital, operated on but was declared brain-dead. She was kept on life support and doctors were able to see through an ultrasound that the foetus was moving.

‘In the first two days we struggled to save the mother’s life and it was proven... that circulation and functions stopped,' said Dr. Bela Fulesdi, president of the University of Debrecen Medical and Health Science Centre.

There are many twits on Twitter...

Thursday, 25 December 2014

Liverpool Care Pathway - A Seasonal Life Café

An Xmas Life Café and taking a different tack, changing the 'culture' of care...

Needs must but 'needs' require time and the care that time permits.

This is Life Café...

This is Shots from NPR –

Though antipsychotics are approved to treat serious mental illnesses like schizophrenia and bipolar disorder, the FDA says the drugs can increase the risk of death for people with dementia. Still, they're prescribed for nearly 300,000 nursing home residents nationally.

A few years ago, antipsychotics were used frequently at Pathstone, too.

"We saw these as medications that were supposed to help the patient and, of course, we gave them to them with the feeling that we were doing good," says Shelley Matthes, a registered nurse who is head of quality assurance for the nonprofit Ecumen, which runs Pathstone and about a dozen other nursing facilities in Minnesota.

Dr. Tracy Tomac is a psychiatrist and medical consultant at Pathstone. In the old days, a resident might have been started on antipsychotics to deal with an emergency, Tomac says, "but they would just stay on it. They would never be taken off for many months or even years."

"At the end of six months or so," Tomac says, "we were able to get them all off any antipsychotics. "The next year they extended the policy to all of Ecumen's nursing homes. "Our goal, Matthes says, "was to reduce our antipsychotic use by 20 percent. And in the first year we reduced it by 97 percent."

At Pathstone these days, around 5 to 7 percent of residents get antipsychotic drugs. Not all of the Ecumen nursing homes have numbers that low, but they're almost all well below the national average. And Matthes says the changes in the residents were as dramatic as the drop in the numbers."They started interacting," recalls Matthes, "and people who hadn't been speaking were speaking. They came alive and awakened."

Which is why they decided to call their program Awakenings.
Antipsychotics act like a chemical straitjacket. The recipient ceases to feel. This is often a complaint that is made. ‘Side-effect’ tablets often accompany the prescription. The depot may be accompanied by its own terrors.

The fear of advanced dementia and ending up in such an institution, dumbed down not to think, not to feel is also a terrible prospect. Such prospects will be considered when assembling the ACD or, in the US, the POLST. Nothing is that clear or simple.

This is Laurel Baxter, the Awakenings Project Manager -
“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home.”
 This is from New York Times –

The woman, who was in her 90s, had lived for several years at the Ecumen Sunrise nursing home in Two Harbors, Minn., where the staff had grown accustomed to her grimaces and wordless cries. She took a potent cocktail of three psychotropic drugs: Ativan for anxiety and the antipsychotic Risperdal to calm her, plus an antidepressant. In all the time she’d lived at Sunrise, she hadn’t spoken. It wasn’t clear whether she could recognize her children when they came to visit.
The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)
Awakenings is a ‘hands-on’ approach.

With reduced medications, the woman at the Two Harbors home awoke.
She was able to speak — haltingly and not always understandably, but enough to communicate. And what she let Ms. Lanigan know, after years of being virtually nonverbal, was that she was suffering physical pain, the cause of her crying out. 
It took doctors a while to find effective medications for her nerve condition, but they were eventually able to make her more comfortable without further fogging her mind. She stopped taking psychotropic drugs altogether.
A Will to live and the commitment to care, not the ACD pushed by the pedlars of despair: this is the message of this Life Café. 

Liverpool Care Pathway - The Chemical Brothers

The drug payroll and the Chemical Brotherhood that is mental health.

The first WHO report on suicide prevention was published on 4 September 2014 at Geneva. According to this, one person commits suicide every 40 seconds. This provides an irony of its own to be published in a country to which people flock to end their lives...
Evidence from Australia, Canada, Japan, New Zealand, the United States and a number of European countries reveals that limiting access to these means can help prevent people dying by suicide. Another key to reducing deaths by suicide is a commitment by national governments to the establishment and implementation of a coordinated plan of action. Currently, only 28 countries are known to have national suicide prevention strategies.
The report says limiting access to the means of suicide can help avoid suicide. In Australia, Phil Nitschke actively promotes the means of suicide, provides access to and devises means of his own to obtain this exit, actually rationalising ‘rational’ suicide.

Complete Life
Liverpool Care Pathway - And "Rational" Suicide

Liverpool Care Pathway - So Readily Do Perceptions Change...

According to Western Australia's Mental Health Commissioner Tim Marney, "The contemplation of suicide is not a rational contemplation."
"I think it's extremely concerning that even just the terminology of rational suicide is being used ... it's an oxymoron."

Mr Marney says many people who survive after trying to take their own life are glad they did not die.

"I've had personal experience of a number of people who have committed suicide and a number of people who have tried to commit suicide and are still here, and I can tell you, they thought it was rational at the time," he said.

"Looking back, they're bloody glad they failed."

Psychiatrist Dr Chris Ryan says many people who want to end their lives are depressed and do not have the capacity to make decisions.
ABC News
Dr. Ryan says that many people who want to end their lives do not have the capacity to do so...


A decision may be taken under the Mental Capacity Act that a person 'lacks capacity'.

A decision to end life may be taken by doctors following the decision that the person 'lacks capacity'. This is a ‘rational’ assessment that such a course is more desirable than a decision to permit life to continue.

Such decisions are based, invariably, on quality of life but may such contemplation be a “rational contemplation”?

If it is the logic of the suicide that death is the preferred choice over life, then does life lack that ‘quality’ that makes it the preferred choice over death?

If the contemplation of suicide is not a ‘rational contemplation’ how may the contemplation of assisted suicide, either by action or non-action be a rational contemplation?

Then, when those AGE UK 5th Columnists come calling, beware of what you wish...
Liverpool Care Pathway - A letter To Mr. Cameron
A Pulse exclusive report revealed -
GPs across England are facing complaints or objections from patients who ‘resent being asked’ about symptoms of dementia as part of the controversial case-finding DES, a Pulse survey reveals.
A snapshot poll of 501 GPs in England who are taking part in this year’s DES has found that around one in five - 21% - have seen patients protest about the process, which involves asking those considered at risk if they are concerned about their memory.
This is the Cameron ‘Challenge on Dementia’.
Under the DES, GPs are encouraged to make opportunistic offers of dementia assessment to at-risk patients where they consider it appropriate.
Dr Zishan Syed, a locum GP, said: ‘Patients feel it is a tickbox exercise.’
'...there seems to be a political drive to push up prevalence levels for the sake of numbers and the care of patients suffers consequently as expectations of treatments do not actually match the results of the treatments that are currently available.’ Pulse Today
This is a tick box exercise to downsize care. 

To be eligible, according to Anna Gutierrez, Primary Care Facilitator at Barts and the Royal London, the New Dementia DES requires the following criteria :
• Patients aged 60 or over with CVD, stroke, PAD or diabetes
• Patients aged 50 or over with LD
• Patients aged 40 or over with Down’s syndrome
• Patients with long-term neurological conditions which have a known neurodegenerative component, e.g. Parkinson’s disease
This is Pulse –
GP commissioners are prioritising reductions in emergency admissions and increases in dementia diagnosis rates to achieve their quality premium payments, as figures obtained by Pulse reveal CCGs’ commissioning intensions on a national basis.
This is -
Liverpool Care Pathway - The DES
This is -
Liverpool Care Pathway - Experimentally My Dear Ellershaw
This is Pub Med Central –
It is established that chronic spirochetal infection can cause slowly progressive dementia, brain atrophy and amyloid deposition in late neurosyphilis. Recently it has been suggested that various types of spirochetes, in an analogous way to Treponema pallidum, could cause dementia and may be involved in the pathogenesis of Alzheimer's disease (AD). Here, we review all data available in the literature on the detection of spirochetes in AD and critically analyze the association and causal relationship between spirochetes and AD following established criteria of Koch and Hill. The results show a statistically significant association between spirochetes and AD (P = 1.5 × 10-17, OR = 20, 95% CI = 8-60, N = 247). When neutral techniques recognizing all types of spirochetes were used, or the highly prevalent periodontal pathogen Treponemas were analyzed, spirochetes were observed in the brain in more than 90% of AD cases.
Pub Med Central

Sources have also been cited to1911 that Multiple Sclerosis is caused by a bacterium. Sources cite likewise for dementia.
The Telegraph reported that...
A number of innovative drugs are due to enter clinical trials and a daily drink, which is not a drug, is thought to reduce damage to neurone membranes.
Amyloid Plaques

According to the Telegraph -

Recent research has focused on two pathological changes that take place in the brains of Alzheimer’s sufferers. The first is the deposition of amyloid plaques – lumps of protein that form in neurones and stop them working properly. The second is the build-up of “neurofibrillary tangles” caused by another abnormal protein, the tau protein.
This is Elsevier Health –
Cystic profiles of borrelia closely correspond to the diverse profiles of plaques, namely they are always round, and are capable of increase in size from little to big as cystic spirochetal growth progresses. Maturation of cysts parallels ‘‘maturation’’ of plaques of increasing age, based on observations of spirochetal cysts in a tissue culture model. Cystic spirochetes in tissue culture incorporate injured cells into their interior regions. Amyloid fibrils within blood vessels of the brain may wind up within the plaque region, now redefined as spirochetal cyst ‘‘territory’’, merely because the rounded cyst ‘‘landed on a blood vessel’’ which contained amyloid in its wall. DNA hybridization methods demonstrate the areas where Borrelia DNA is deposited in the Alzheimer brain. Hybridizations using DNA from the spirochete 
develop a ‘‘map’’ of the terrain of the brain where, like little rounded villages and cities, rounded ‘‘map sites’’ of spirochetal DNA appear. Spirochetal sites on these ‘‘DNA maps’’ match the sites of the plaques in the Alzheimer brain. Now is the time for a new opportunity to re-evaluate Alzheimer’s diseasewith DNA mapping methods.

Anti-psychotics are prescribed to address  difficult behaviour in cases of dementia such as Alzheimer's..

The corollary is that if spirochaete have been found in 7 out of 10 autopsy brain specimens from Alzheimer's victims may this also be the case in cases of the victims of Psychosis and other mental illness such as Bi-Polar?

The Mental Health profession does not use the psychiatric couch but the chemical straitjacket promoted by the pharmaceutical giants. Neither is going to relinquish their lucrative payroll readily.

Mental Health is also a political football. Those turned out of the institutions and psychiatric hospitals such as Netherne now live in the community in supported accommodation wandering, often wandering aimlessly filling their time at funded amenities, and the Community Health Teams are become the Recovery Services.

So-called generics are replacing the branded drugs, but the punters continually report that these 'supermarket' brands are just not the ‘real McCoy’.

The well-documented medical controversy between ILADS and the corrupt practices of IDSA are documented here -
Liverpool Care Pathway - The Action Plan
The so-called Third Sector - what used to be the voluntary or charitable sector - is now a £multi-million big business. Lord Shawcross has made accusation and laid criticism -
Liverpool Care Pathway - Either, Or... Else
There is a duplicity of interests. The Chemical Brothers have interests to protect and defend.