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BOP Challenge Program

Addresses Mental Illness Disorders

The BOP Challenge Program focuses on

• Is Part of The First Step Act
• Mental illness/
• Psychotic disorders and
• Should be included in a complete PSR,
• Will affect your client’s prison placement.

‘Psychotic disorders make up a group of serious mental illness disorders that affect the mind. Psychotic disorders make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When severe, those with mental illness disorders have trouble staying in touch with reality.

I) The BOP Challenge Program

• for high-security inmates
• in penitentiary settings
• with substance abuse problems, and/or
• mental illness disorders.

The inmate must meet one of the following criteria:

• Has a history of substance abuse/dependence or,
• Has a major mental illness as evidenced by a current diagnosis of a;
  1. Psychotic disorder
  2. Mood disorder
  3. Anxiety disorder
  4. Personality disorder

The responsibility for your client’s mental and physical health should be safeguarded in order to protect them from themselves (and others) while providing a safe environment for the duration of their incarceration.

This should be the responsibility of the legal counsel, the court, and BOP.

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Below is an overview of the

• • BOP Challenge Programs ‘types and symptoms of psychotic disorders along with an
  • List of BOP ‘Formulary’ and
  • ‘Non-Formulary’ Medications currently available

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A)   Types and Symptoms

I- Schizophrenia

• Changes in behavior.
• Delusions and hallucinations – lasting longer than 6 months.
• There are two groups of antipsychotics*, the older group of medications “first-generation*” typical, or “conventional” atypical antipsychotics*.
  • Haloperidol (Haldol) – On Formulary
  • Perphenazine (Trilafon) – On Formulary
  • Trifluoperazine (Stelazine) – On Formulary
• The newer ones are called “second-generation or “atypical” antipsychotics.
  • Clozapineviii (Clozaril) – On Formulary
  • Olanzapineix (Zyprexa) – On Formulary
  • Quetiapinex(Seroquel) – Non Formulary
  • Risperidonexi (Risperdal) – On Formulary
  • Ziprasidonexii (Geodon) – On Formulary

Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also indicated for decreasing suicidal behaviors in those with schizophrenia who are at risk.

II-    Schizophreniform, a Mental Illness Disorder

• Includes symptoms of schizophrenia.
• The symptoms last for a shorter time: between 1 and 6 months.
  • Medication* and Psychotherapy —to help the patient manage everyday problems related to the disorder.
    • Clozapine (Clozaril®) – On Formulary
    • Olanzapine (Zyprexa®)– On Formulary
    • Quetiapine (Seroquel®)– Non Formulary
    • Risperidone (Risperdal®)– On Formulary
    • Ziprasidone (Geodon®)– On Formulary

III- Brief Psychotic Disorder

• Involves sudden, short periods of psychotic behavior, often in response to a very stressful event such as a death. After the recovery is often quick, usually less than a month.
• The first line of treatment includes atypical antipsychotics*.
  • Clozapine (Clozaril). – On Formulary
  • Olanzapine (Zyprexa), – On Formulary
  • Quetiapine (Seroquel), – Non Formulary
  • Risperidone (Risperdal), – On Formulary
  • Ziprasidone (Geodon), – On Formulary

• Those that have an increased risk of having depression; medications* that address these symptoms can be an important part of their treatment.
  • Citalopramxv (Celexa), – On Formulary
  • Fluoxetinexvi (Prozac), – On Formulary
  • Sertralinexvii (Zoloft), – On Formulary

IV- Delusional 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 delusion. The delusion lasts for at least 1 month. Symptoms may include;
  • The cold, detached manner with the inability to express emotion.
  • Confused thinking;
    • Disorganized or incoherent speech.
    • Loss of interest in activities.
    • Loss of interest in personal hygiene.
    • Mood swings or other mood symptoms, such as depression or mania.
    • Problems at school or work and with relationships.
    • Slowed or unusual movements.
    • Strange, possibly dangerous behavior.
  • The primary typical medications* used;
    • Fluphenazine (Prolixin) – On Formulary
    • Haloperidol (Haldol) – On Formulary
    • Loxapine (Oxilapine) – On Formulary
    • Perphenazine (Trilafon), – On Formulary
    • Trifluoperazine (Stelazine) – On Formulary
  • Atypical antipsychotics* have fewer movement-related side effects;
    • Clozapine (Clozaril) – On Formulary
    • Olanzapine (Zyprexa) On Formulary
    • Quetiapine (Seroquel), – Non Formulary
    • Risperidone (Risperdal), – On Formulary
    • Ziprasidone (Geodon) – On Formulary
  • Other medications*:
    • Antidepressants might be used to treat depression, which often happens in people with delusional disorders.
    • 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 its impact in their lives.
    • Sedatives and antidepressants might also be used to treat anxiety or mood symptoms, if they happen with a delusional disorder.
    • Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

V- 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.

VI- Substance-Induced Psychotic Disorder

• This condition is caused by the use of or withdrawal from drugs, such as hallucinogens or crack cocaine that causes hallucinations, delusions, or confused speech.
• The hallucinations and delusions displayed should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient could also be intoxicated and/or going through withdrawal.
• Some precipitating substances:
  • Alcohol
  • Amphetamines
  • Cannabis
  • Cocaine
  • Hallucinogens
  • Opioids
  • Phencyclidine (PCP),
  • Sedative/hypnotics
• Treatments
  • A calm environment.
  • Often a benzodiazepine or antipsychotic in most substance-induced psychoses, stopping the substance and giving an anxiolytic (eg., a benzodiazepine [Not Available]) or an antipsychotic drug can be effective.
  • Psychosis due to:
    • dopamine-stimulating drugs such as amphetamine; an antipsychotic drug could be used here.
    • For drugs such as LSD, quiet observation may be all that is needed.
  • For substances with actions that do not involve dopamine, observation may be all that is needed, or possibly an anxiolytic may help.

VII- Psychotic Disorders 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.

VIII- 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.

IX- Mood Disorder

• Depression [Slide Show]; can be emotionally crippling.
• Bipolar disorder is also known as manic depression.
  • Can cause risky behavior, even suicidal.
  • Can cause periods ranging from overly happy and energized, to other periods feeling very sad, hopeless, and sluggish.
  • Symptoms of mania (“the highs”):
    • Angry, and hostile.
    • Becoming more impulsive.
    • Drug and alcohol abuse.
    • Excessive happiness, hopefulness, and excitement.
    • Increased energy and less need for sleep.
    • Making grand and unrealistic plans.
    • Rapid speech and poor concentration.
    • Restlessness.
    • Showing poor judgment.
    • Sudden changes from being joyful to being irritable.
    • Unusually high sex drive.
  • Symptoms of (“the lows”):
    • Appetite changes make them lose or gain weight.
    • Attempting suicide.
    • Feelings of hopelessness or worthlessness.
    • Insomnia.
    • Irritability.
    • Loss of energy.
    • Needing more sleep.
    • Sadness.
    • Thoughts of death or suicide.
    • Trouble concentrating.
    • Trouble making decisions.
    • Uncontrollable crying.

B) Other possible treatment medications*

• Carbamazepine (Tegretol), – On Formulary
• Lamotrigine(Lamictal), – Non Formulary
• Lithium, – On Formulary
• Medication- “mood stabilizers”
• Medication- antipsychotics;
  • Olanzapine(Zyprexa), – On Formulary
  • Valproate(Depakote). – On Formulary

C- Note: Psychotherapy, or “talk therapy,” is recommended.

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BOP  Challenge Facility Penitentiary (USP) Locations:

Allenwood, PA-High

Atwater, CA-High

Beaumont, TX-High

Big Sandy KY-High

Cannan, PA-High

Coleman I, FL-High

Coleman II, FL-High

Hazelton, WV-High

Lee, VA-High

McCreary, KY-High

Pollock, LA-High

Terre Haute, IN-High

Tucson, AZ-High

* Medication availability:

• On Formulary – These are available.
• Non-Formulary – These medications require a lengthy review process.  It is prudent to document these at the sentencing hearing and through their PSR.

PSR / Sentencing Preparation Software

240.888.7778 * info@PPRSUS.com

https://live-pprsus.pantheonsite.io/

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