Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Synthesis of stable isoxazolines by [3+2] cycloaddition of oxaziridines with alkynes.

N-Alkyl substituted oxaziridines undergo a [3+2] cycloaddition reaction with a variety of terminal alkynes to give the product isoxazolines, whose stability appears to depend on the electronic properties of the groups on the C-3 and C-5 positions. The presence of an electron withdrawing group on C-5 and/or an electron donating group on C-3 causes isomerization of the isoxazolines to beta-amino enones

Synthesis of new 3,5-diarylisoxazolidines by cycloaddition of oxaziridines and alkenes

This article reports a novel process of cycloaddition of C-aryloxaziridines with a variety of alkenes to afford stable, five-membered heterocycles 13–24. The steric hindrance of the tert-butyl group on the nitrogen atom of the oxaziridine is responsible for the high stereoselectivity of the cycloaddition reaction

Palladium-catalyzed cyclocarbonilation of unsaturated alcohols and amines. Chemoselective synthesis of heterocycle-substituted γ- and δ-lactones and lactams.

Unsaturated alcohols and amines react with carbon monoxide and hydrogen, in the presence of a catalytic amount of palladium acetate and a phosphine ligand, to afford selectively heterocycle-substituted γ- and δ-lactones and lactams. The distribution of five- and six-membered ring compounds can be modulated by an appropriate combination of solvent and phosphine ligand. The five-membered products are formed in two isomeric forms trans and cis with a modest diasteroselectivity (trans>cis)

[3+2] Cycloaddition of Oxaziridines with Nitriles: Synthesis of 2,3-Dihydro-1,2,4-Oxadiazoles

A new and simpler preparation of 2,3-dihydro-1,2,4-oxadiazoles by synchronus [3+2] cycloaddition between oxaziridines and nitriles is presented

Stereoselective Synthesis of Polyfunctionalized Aziridines

1,2,3-triHeterocycle-substituted aziridines were prepared by coupling of (alfa-chloroalkyl) oxazolinyllithium compounds with diheteroaryl imines. The trapping by different electrophiles of the corresponding aziridinyl anions, generated by treatment with strong bases, was investigated. The stereoselectivity of the synthesis and the functionalization reactions was studied highlighting the different stabilizing effects of the heterocycle substituents