Impact of counselling provision in primary schools on child and adolescent mental health service referral rates: a longitudinal observational cohort study.

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.

Reduced cortical surface area in adolescents with conduct disorder.

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.

Stability of drugs of abuse in synthetic oral fluid investigated using a simple "dilute and inject" method of analysis.

Human oral fluid is well established as a matrix for drug screening, particularly in the workplace. The need to synthesise synthetic oral fluid (SOF) has been recognised in order to overcome human oral fluid's composition variability. We have used SOF spiked with six common drugs of abuse or their primary metabolites: morphine, amfetamine, benzoylecgonine, cocaine, diazepam, and (-)-Δ9 -tetrahydrocannabinol (THC) in order to assess the suitability of this matrix for quality assurance purposes. For confirmation of a drug screening test, controls and spiked standards are normally required. All our analytes were detected by LC-MS/MS using a quick and easy "dilute and inject" sample preparation approach as opposed to relatively slower solid-phase extraction. The limit of detection (LOD) was 10 ng/ml for diazepam and THC and 5 ng/ml for morphine, amfetamine, benzoylecgonine and cocaine. Validation results showed good accuracy as well as inter- and intra-assay precision (CV [%] < 5). Our work highlighted the importance of adding Tween® 20 to the SOF and calibrants to reduce losses when handling THC. Furthermore, drug stability was tested at various temperatures (5°C, 20°C and 40°C), for a number of days or after freeze-thaw cycles. Recommendations regarding storage are provided, the spiked SOF being stable at 5°C for up to 1 week without significant drug concentration loss.

Artificial oral fluid characterisation: Potential for use as a reference matrix in drug testing.

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.

Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales.

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.

Paliperidone Palmitate-Induced Delirium in an Adolescent with Schizophrenia: Case report.

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.

Synthesis and characterisation of some iridium-carbonyl-fluoride complexes. Crystal structures of [IrF(CO){P(C6H4-2-CH3)3}2] and [IrF2(COD)py2][BF4].

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.

Stabilisation of iridium(III) fluoride complexes with NHCs.

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.

N-Heterocyclic carbene-containing ruthenium difluoro complexes and their reactivity towards BF(3).

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.

cis-Dicarbonyl-cis-dichlorido-trans-bis(triphenylphosphine-kappaP)iridium(III) tetrafluoridoborate, formed by reaction of (cycloocta-1,5-diene)bis(triphenylphosphine)iridium tetrafluoridoborate with carbonyl fluoride in dichloromethane solution.

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.

Bis[1,2-bis(diphenylphosphino)ethane-kappa2P,P']difluoridoruthenium(II) trichloromethane disolvate.

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).