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1.
Artigo em Inglês | MEDLINE | ID: mdl-34729906

RESUMO

BACKGROUND: In the United Kingdom, schools play an increasingly important role in supporting young peoples' mental health. While there is a growing evidence base to support the effectiveness of school-based interventions, less is known about how these provisions impact on local Child and Adolescent Mental Health Service (CAMHS) referral rates. There is a concern that an increase in school-based provision might lead to an increase in CAMHS referrals and overwhelm services. We aimed to examine the longitudinal association between Place2Be counselling provision in primary schools on CAMHS referral rates in South London. METHOD: This was a retrospective cohort study using linked data from the National Pupil Database (NPD) and CAMHS referrals to the South London and Maudsley's NHS Foundation Trust (SLaM) identified through the Clinical Record Interactive Search (CRIS) tool. The cohort included a total of 285 state-maintained primary schools in four London boroughs for the academic years of 2007-2012. During the study period, 23 of these schools received school-based mental health provision from Place2Be. The primary outcome was the incident rate ratio (IRR) of school-level accepted CAMHS referrals in 2012/13 in schools with, or without, Place2Be provision. RESULTS: There was no significant association between elevated rates of CAMHS referral and Place2Be provision, even after comprehensive adjustment for school-level and pupil characteristics (IRR 0.91 (0.67-1.23)). School-level characteristics, including higher proportion of white-British pupils (IRR 1.009 (1.002-1.02)), medical staff ratio (IRR 6.49 (2.05-20.6)) and poorer Ofsted school inspection ratings (e.g. IRR 1.58 (1.06-2.34) for 'Requires Improvement' vs. 'Outstanding') were associated with increased CAMHS referral rates. CONCLUSIONS: Place2Be provision did not result in increased specialist mental health referrals; however, other school-level characteristics did. Future research should investigate pupils' Place2Be clinical outcomes, as well the outcomes of individuals referred to CAMHS to better understand which needs are being met by which services.

3.
Drug Test Anal ; 13(3): 709-719, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33025712

RESUMO

Quality assurance schemes for drug-screening programmes require access to large quantities of biological matrices for reference or control samples. This presents problems when the availability of a matrix, such as oral fluid (OF) for screening or for confirmatory purposes, limits the collection of large volumes. In such cases, synthetic alternatives of OF may provide a solution. The preparation of an artificial (synthetic) oral fluid (AOF) was conducted by dissolving its components (salts, surfactant, antimicrobial agent and mucin) in water. We characterised the physical properties of AOF to determine its suitability as a matrix for quality assurance purposes. The evaluation of pH, specific gravity (SG), conductivity (mS cm-1 ), freezing point depression (°C), light-scattering and kinematic viscosity (mm2 s-1 ) showed AOF to be a stable, reliable matrix. Synthetic OF was prepared using components (mucin, surfactants and so on) obtained from different suppliers and a comparison was performed. Our results suggest that AOF is a feasible matrix for the preparation of quality assurance samples for confirmatory or drug screening programmes.


Assuntos
Líquidos Corporais/química , Detecção do Abuso de Substâncias/métodos , Anti-Infecciosos/química , Humanos , Concentração de Íons de Hidrogênio , Mucinas/química , Garantia da Qualidade dos Cuidados de Saúde , Sais/química , Gravidade Específica , Tensoativos/química , Temperatura de Transição , Viscosidade
5.
Sultan Qaboos Univ Med J ; 18(2): e208-e210, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-30210852

RESUMO

Schizophrenia is a serious long-term mental disorder which usually presents in adolescence or early adulthood. However, poor adherence to oral antipsychotics can lead to relapse and rehospitalisation. We report an adolescent male with schizophrenia who was referred to the South London & Maudsley National Health Service Foundation Trust, London, UK, in 2015 due to worsening psychotic symptoms. Following poor compliance with oral medications, a four-week regimen of paliperidone palmitate long-acting injections was initiated, with an initial positive response. However, 10 days after the second dose, the patient developed severe acute-onset delirium with fluctuating levels of consciousness. Paliperidone palmitate was discontinued and the patient instead underwent a course of zuclopenthixol decanoate long-acting injections with a favourable outcome.


Assuntos
Antipsicóticos/efeitos adversos , Delírio/induzido quimicamente , Palmitato de Paliperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Atividades Cotidianas , Adolescente , Clopentixol/análogos & derivados , Clopentixol/uso terapêutico , Substituição de Medicamentos , Humanos , Masculino , Adesão à Medicação
7.
BMJ ; 358: j3618, 2017 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31055370
8.
Eur Child Adolesc Psychiatry ; 24(8): 909-17, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25481508

RESUMO

Children with conduct disorder (CD) are at increased risk of developing antisocial personality disorder and psychopathy in adulthood. Neuroimaging research has identified abnormal cortical volume (CV) in CD. However, CV comprises two genetically and developmentally separable components: cortical thickness (CT) and surface area (SA). Aim of this study is to explore the relationship between the cortical constituents of CV in boys with CD. We applied FreeSurfer software to structural MRI data to derive measures of CV, CT, and SA in 21 boys with CD and 19 controls. Relationships between these cortical measures were investigated. Boys with CD had significantly reduced CV and SA compared to non-CD boys in ventromedial and dorsolateral prefrontal cortex. We found no significant between-group differences in CT. Reduced prefrontal CV in boys with CD is associated with significantly reduced SA in the same regions. This finding may help to identify specific neurodevelopmental mechanisms underlying cortical deficits observed in CD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno da Conduta/patologia , Imageamento por Ressonância Magnética/métodos , Córtex Pré-Frontal/patologia , Adolescente , Transtorno da Personalidade Antissocial , Atenção , Estudos de Casos e Controles , Criança , Transtorno da Conduta/psicologia , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
9.
Dalton Trans ; 39(44): 10781-9, 2010 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-20941440

RESUMO

The first neutral, [IrClF(2)(NHC)(COD)] and [IrClF(2)(CO)(2)(NHC)] (NHC = IMes, IPr), and cationic, [IrF(2)py(IMes)(COD)][BF(4)] and [IrF(2)L(CO)(2)(NHC)][BF(4)] (NHC = IMes, L = PPh(2)Et, PPh(2)CCPh, py; NHC = IPr, L = py), NHC iridium(III) fluoride complexes, have been synthesised by the xenon difluoride oxidation of iridium(I) substrates. The stereochemistries of these iridium(III) complexes have been confirmed by multinuclear NMR spectroscopy in solution and no examples of fluoride-trans-NHC arrangements were observed. Throughout, CO was found to be a better co-ligand for the stabilisation of the iridium(III) fluoride complexes than COD. Attempts to generate neutral trifluoroiridium(III) complexes, [IrF(3)(CO)(NHC)], via the ligand substitution reaction of [IrF(3)(CO)(3)] with the free NHCs were unsuccessful.

10.
Dalton Trans ; 39(25): 5827-32, 2010 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-20498916

RESUMO

Two routes to iridium(III) fluorocomplexes are described. The direct reaction of tetrairidium dodecacarbonyl with elemental fluorine in aHF offers a clean, convenient, large scale route to [IrF(3)(CO)(3)]; addition of phosphines to [IrF(3)(CO)(3)] in THF affords mer-[IrF(3)(CO)L(2)] or [IrF(CO)L(2)]. Alternatively, cationic [IrF(2)(COD)L(2)](+) and [IrF(2)(CO)(2)L(2)](+) (L = phosphine, pyridine; L(2) = alpha-diimine) are accessible via the oxidation of the iridium(I) precursors with xenon difluoride.

11.
Br J Psychiatry ; 195(3): 257-63, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19721117

RESUMO

BACKGROUND: In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians. AIMS: To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity. METHOD: Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). RESULTS: Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise. CONCLUSIONS: Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Transtornos Mentais/psicologia , Serviços de Saúde Mental/legislação & jurisprudência , Adulto , Estudos Transversais , Inglaterra , Feminino , Liberdade , Humanos , Entrevistas como Assunto , Masculino , Competência Mental/psicologia , Cooperação do Paciente/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Violência/psicologia , Violência/estatística & dados numéricos , País de Gales
12.
Dalton Trans ; (34): 6861-70, 2009 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-19690699

RESUMO

Treatment of tetranuclear [RuF(-F)(CO)3]4 (1) with the free N-heterocyclic carbenes (NHCs), IMes (1,3-bis(2,4,6-trimethylphenyl)imidazol-2-ylidene) and IPr (1,3-bis(2,6-diisopropylphenyl)imidazol-2-ylidene), followed by work-up in carbon tetrachloride leads to fluoride-bridge cleavage in 1 and the formation of the mononuclear octahedral complexes cis,cis,trans-[RuF2(CO)2(NHC)2] [NHC = IMes (2a), IPr (2b)], respectively. Complexes 2a and 2b can also be obtained by interaction of 1 with the corresponding imidazolium chloride, [-N(Ar)CHN(Ar)CHCH-]Cl (Ar = 2,4,6-Me3C6H2, 2,6-i-Pr2C6H3), in the presence of KOtBu. However, extension of this latter base-assisted approach to [-N(Ar)CHN(Ar)CHCH-]Cl (Ar = 2,6-Me2C6H3, 2,4,6-i-Pr3C6H2) results in halide exchange with the work-up solvent (CCl4) to generate cis,cis,trans-[RuCl2(CO)2(IMe)2] (3) and dinuclear [RuCl(mu-Cl)(CO)2(ITPr)]2 (4), respectively. Reaction of 2a with gaseous BF3 in dichloromethane and subsequent carbonylation affords in high yield monocationic [Ru(FBF3)(CO)3(IMes)2](BF4) (5), while with 2b, BF3 addition alone results in solvent exchange to yield dinuclear monocationic [Ru2(mu-Cl)3(CO)4(IPr)2](BF4)/(F) (6). Conversely, interaction of 2a and 2b with BF3.OEt2 in acetonitrile furnishes dicationic cis,cis,trans-[Ru(CO)2(NCMe)2(NHC)2](BF4)2 [NHC = IMes (7a), IPr (7b)]; in the case of 7a carbonylation gives [Ru(CO)4(IMes)2](B2F7)2 (8). Single crystal X-ray structures are presented for 3, 4, 5, 6 and 8.

13.
Acta Crystallogr C ; 63(Pt 8): m383-4, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17675690

RESUMO

In the crystal structure of the title compound, [RuF(2)(C(26)H(24)P(2))(2)].2CHCl(3), the Ru atom lies on a centre of symmetry with a trans arrangement of the F atoms. A H...F contact (2.249 A) suggests weak intramolecular hydrogen bonding. The solvent molecules exhibit hydrogen bonding with the F atoms (H...F = 1.91 A).

14.
Acta Crystallogr C ; 63(Pt 7): m321-2, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17609556

RESUMO

The reaction between carbonyl fluoride and [Ir(COD)(PPh(3))(2)]BF(4) (COD is cycloocta-1,5-diene) in dichloromethane solution affords the novel title iridium salt, [IrCl(2)(C(18)H(15)P)(2)(CO)(2)]BF(4). The cation lies across a twofold rotation axis in the space group P2(1)2(1)2 and its structure confirms the presence in a cis relationship of two metal-bound chlorides, while the phosphine ligands occupy a trans pair of sites. The anion also lies across a twofold rotation axis, and the F atoms are disordered over two sets of sites.

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