Nucleophilic fluorination facilitated by a CsF-CaF2 packed bed reactor in continuous flow.

A simple to prepare, dry and handle packed bed reactor carrying CsF on CaF2, towards nucleophilic fluorinations in continuous flow, is reported. The reactor also proved adaptable for silyl-ether deprotection and trifluoromethylations with Ruppert's reagent. The study includes reactor stability and scale-up investigations.

Decarboxylative Reissert type trifluoro- and trichloro-methylation of (iso)quinoline derivatives in batch and continuous flow.

Two decarboxylative methods providing access to N-alkylated α-trihalomethylated heterocyclic amines have been developed. A batch protocol in which methyl trifluoroacetate acts both as a methylating reagent and subsequently as a nucleophilic trifluoromethyl anion precursor upon its addition to (iso)quinoline derivatives. Next, a telescoped continuous flow process, forming the corresponding α-trichloromethylated heterocyclic amines, utilizing a similar decarboxylation of trichloroacetic acid, was developed and taken to scale-up.

Do we agree about when patients are psychotic?

OBJECTIVE: To investigate into the use of the term 'psychotic' as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members. METHOD: Questionnaire investigation using 11 short case vignettes. RESULTS: Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff. CONCLUSION: In identifying a patient as 'psychotic' a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity.

[Description of a group of psychiatric patients difficult to place]. / Beskrivelse af en gruppe svaert integrerbare psykiatriske patienter.

INTRODUCTION: There are long-term patients in psychiatric hospitals, who are often referred to as new long-stay patients: the heavy users consumers of psychiatric services and difficult-to-place patients. MATERIAL AND METHOD: Social characteristics, diagnosis, need for care, function, and admission patterns were compared in a group of heavy user patients (N = 39) and a group of difficult-to-place patients (N = 14). RESULTS AND DISCUSSION: The difficult-to-place patients were more often men, more often had a diagnosis of schizophrenia, had a lower socio-economic status, and lower GAF scores. The difficult-to-place patients rated the same amount of need for care as did the heavy users, but were assessed by the staff to have a greater need for care. The results support the view that the difficult-to-place patients comprise a distinct group. Services for the difficult-to-place patients must combine highly differentiated care with few demands and greater tolerance with respect to problem behaviour.

[The staff's knowledge of patients' social function and needs--in connection with discharge planning]. / Kontaktpersoners viden om psykiatriske patienters sociale funktion og behov--i forbindelse med udarbejdelse af udskrivningsplaner.

The aim of the study was to assess the staff's knowledge about the social functioning and needs of the patients. A cross-sectional study interviewing 48 staff members using the Camberwell Assessment of Need--CAN was carried out. In nine of CAN's 26 areas more than 5% of the staff did not know if the patient had a problem. Among the patients with a problem more than 5% of the staff could not assess the need for care in four areas. The staff generally had a good knowledge concerning the patients' need for care. CAN seem to be a relevant instrument for the purpose of discharge planning.

Factors associated with referral to psychiatric care by general practitioners compared with self-referrals.

BACKGROUND: The gatekeeper function of the general practitioner (GP) in the pathway to specialized psychiatric services was investigated in this study, which is part of the Nordic Comparative Study on Sectorized Psychiatry. The question addressed in this paper is whether different sociodemographic and clinical factors as well as factors related to service utilization are associated with referral from the GP compared with self-referrals (including referrals from relatives). METHODS: The study comprised a total of 1413 consecutive patients, admitted during 1 year to five psychiatric centres in four Nordic countries. The centres included in this study were those that accepted non-medical referrals. Only new patients (not in contact with the service for at least 18 months) were included. RESULTS: Increasing age was the only sociodemographic factor significantly associated with referral by the GP. The clinical factors (psychosis, being totally new to psychiatry and being in need of in-patient treatment) and some treatment characteristics (planned out-patient treatment and involuntary in-patient treatment), were all significantly associated with referral by the GP. Some indication was found that self-referred patients have shorter episodes of care. CONCLUSIONS: The findings were remarkably stable across the different centres indicating a general pattern. This study extends previous work on the role of GPs in the pathway to specialized psychiatric services and indicates that the GP has an important gatekeeper function for the most disabled patients.

[Quality assurance of therapeutic plans]. / Kvalitetssikring af behandlingsplaner.

The purpose of this study is to examine how an adult psychiatric department carries out its statutory psychiatric treatment plans. The case records of 95 patients were examined after one month in hospital in order to show how the psychiatric treatment plan had been implemented. One-third of the patients were discharged within the first week, and did thus not require a treatment plan. One-third of the patients did not have a structured treatment plan. The main part of these patients had been rehospitalised as part of an ongoing treatment, and a treatment plan had been started earlier on. The purpose of the treatment plan is to assure the quality of the psychiatric treatment, and to create a framework which could be used in dialogue with the patients. It is concluded that the treatment plan does not accomplish the latter.

[Physician time and the direct contact with patients at Roskilde County Hospital Fjorden]. / Laegetidens anvendelse og den direkte patientkontakt på Roskilde Amtssygehus Fjorden.

Over a two week period (1994) the 27 physicians at Fjorden registered the time they used on direct and indirect treatment of in- and out-patients, administration, further training, supervision and research. Standardized criteria for the time spent on patient treatment were set up. Thirty-two percent of the total work time was used for direct treatment and a further 32% for indirect treatment (conferences, etc.) while the rest was used for other purposes. In relation to standardized 60 minutes or more treatment sessions, the survey revealed an average of 32-60% insufficient time spent on each patient per session. Fifty percent more physician time for direct treatment would be necessary to reach the standardized criteria for the total number of patients. We conclude that using 2/3 of the total work time available on treatment is acceptable. The great discrepancy between real and ideal use of physician time makes it important to further examine how to acknowledge dialogue as a psychiatric tool.

[Physician time spent on indirect treatment and administration at Roskilde county hospital Fjorden]. / Laegers tidsforbrug til indirekte patientbehandling og administration på Roskilde Amtssygehus Fjorden.

Over a two week period (1994) the 27 physicians at a psychiatric hospital registered the time used on indirect treatment (conferences, rounds, etc.). This amounted to 21-37% of total time, while time spent on administration amounted to 7-46% of total time depending on the seniority of the doctor involved. An estimated one hour per week per patient was used for indirect treatment. An insignificant amount of time was spent on interviews with relatives. We conclude that although it would be desirable to reduce the time spent on indirect treatment, the new demands made on community psychiatry with involvement of relatives, etc., would rather tend to give rise to more obligations in this area.

[Physician time spent on training, supervision and research at the Roskilde county hospital Fjorden]. / Anvendelse af laegetid til uddannelse, supervision og forskning på Roskilde Amtssygehus Fjorden.

Postgraduate training for young doctors is an obligation for clinical departments. However there is a general impression that it has been difficult to acknowledge training as an activity in importance to patient treatment, and thus to give it the necessary priority. For a period of two weeks in 1994, all activities performed by doctors at a psychiatric hospital during working hours were registered. Special attention was given to activities concerning training and educational issues. These consisted of element such as theoretical courses, tutoring in daily clinical work and supervision of psychotherapy giving sessions. Furthermore it was registered whether the doctor had been receiving or giving the training. Junior registrars, senior registrars and consultants used 15, 13 and 5% of their time on training activities, however, during the period concerned the activities mainly consisted of attending external courses. Tutoring in the daily clinical work was non-existent. It is proposed that clinical positions that have training as a described part of their function should be secured.

The Nordic Comparative Study on Sectorized Psychiatry. Part V. Contact rates, contact patterns and care level at index contact.

As part of a Nordic comparative study on sectorized psychiatry in seven Nordic catchment areas, a prospective investigation of contact rates of new patients and pathways to the psychiatric services was performed. The results showed that there was more than a twofold difference between the services in the total contact rates. Regarding diagnostic groups, contact rates for neurosis were predominant in three of the services, while adjustment disorders, dependencies and personality disorders were predominant in other the services. The contact rate of functional psychosis, as well as the ratio of psychotic patients to the total contact rate were highest in two catchment areas serving inner parts of big cities. The most common way of getting into contact with the services was by self-referral, 39.4% of total referrals, followed by primary care referrals, although there were large differences between the services. Psychotic patients made contact with the services to a significantly less extent by self-referral. The majority of patients were treated in outpatient care at entry to the services, with a large variation between the services. It was also found that inpatient care at index contact was predicted by clinical characteristics-a diagnosis of psychosis and a history of former inpatient care-as well as by social characteristics-male, widowed or divorced, sick pension/old age pension.

The Nordic Comparative Study on Sectorized Psychiatry. III. Accessibility of psychiatric services, degree of urbanization and treated incidence.

As part of a Nordic Comparative Study on Sectorized Psychiatry, accessibility of psychiatric services and degree of urbanization in seven catchment areas were related to treated incidence. One-year treated incidence cohorts were used. Accessibility was assessed according to referral practice, existence of a round the clock emergency service and geographical location of the services. Accessibility was surprisingly weakly associated with treated incidence. Easy access to the psychiatric services was not related to a high treated incidence of less severe psychiatric problems at the expense of patients suffering from severe illness. Geographical distance to the services did not predict the demand for services. A positive correlation was found between the degree of urbanization and treated incidence of psychoses but not of other diagnostic groups.

The Nordic comparative study on sectorized psychiatry. Part IV. The influence of patient social characteristics on treated incidence.

As part of a Nordic comparative study on sectorized psychiatry, sociodemographic characteristics (gender, age and marital status) were studied in relation to treated incidence in eight diagnostic subgroups. One-year incidence cohorts in seven sectorized psychiatric services were used. Women with a neurosis diagnosis had a significantly higher relative probability of contact with all services. Men with a dependence diagnosis had a significantly higher relative probability of contact with four of the seven services. Older people had a significantly higher relative risk for affective psychosis in six of the seven centres, and younger individuals had a significantly higher relative risk for personality disorders in six of the seven centres. Unmarried people showed a higher relative risk for functional psychosis and personality disorders in five of the seven services.

The Nordic comparative study on sectorized psychiatry. II. Resources of the psychiatric services and treated incidence.

As a part of a Nordic comparative study on sectorized psychiatry, treated incidence was related to the resources and dynamic qualities of psychiatric services in 7 catchment areas. One-year treated incidence cohorts were used. Data was collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in the services and availability of specialized services. A positive correlation was found between rates of outpatient staff and treated incidence. No statistically significant correlation was found between the dynamic qualities of the services and treated incidence. Treated incidence of dependence was the highest in a center that had a special service unit for abusers. Special services for young and old people were not clearly reflected in treated incidence in respective patient groups.