RESUMEN
AIM: To describe principles and characteristics of mental health care in London. METHOD: Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways into care, user/carer involvement and specific issues are reported. RESULTS: London experiences high levels of need and use of mental health services compared to England as a whole. Inpatient and compulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community. CONCLUSION: Mental health services in the UK are undergoing considerable reform. These changes will not remove the greater need for mental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.
Asunto(s)
Áreas de Influencia de Salud/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/organización & administración , Trastornos Mentales/terapia , Servicios Urbanos de Salud/organización & administración , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/tendencias , Desinstitucionalización , Encuestas de Atención de la Salud , Política de Salud/tendencias , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Londres/epidemiología , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Evaluación de NecesidadesRESUMEN
The pharmacokinetics of fenfluramine enantiomers were studied in normal volunteers following the administration of single of multiple doses of racemic fenfluramine hydrochloride. Plasma concentrations and half-lives were similar for both enantiomers after single 40 mg of 60 mg doses. However following chronic administration (2 x 40 mg for 10 days), significant differences were observed between the kinetic parameters of the two enantiomers, the l-form of fenfluramine and norfenfluramine accumulating in plasms more than the d-forms.
Asunto(s)
Fenfluramina/metabolismo , Adulto , Fenfluramina/administración & dosificación , Fenfluramina/sangre , Semivida , Humanos , Cinética , EstereoisomerismoRESUMEN
1. Rats were treated with racemic amphetamine or separately with the single enantiomers. The two optical isomers were determined in several brain areas, in plasma and urine. 2. The concentration of d-enantiomer significantly exceeds that of the l-enantiomer in brain and plasma but not in urine, following administration of racemic amphetamine. In contrast, when the two isomers are given separately, their brain concentrations are similar. 3. Such a difference does not appear in the brain of mice treated with racemic amphetamine or in the brain of rats pre-treated with SKF 525-A, an inhibitor of amphetamine hydroxylation. 4. The possibility that the l-isomer can interfere with hydroxylation of d-amphetamine is discussed.
Asunto(s)
Anfetamina/metabolismo , Dextroanfetamina/metabolismo , Animales , Disponibilidad Biológica , Encéfalo/metabolismo , Femenino , Hidroxilación , Ratones , Proadifeno/farmacología , Ratas , Estereoisomerismo , Factores de TiempoRESUMEN
1. Rats were treated with d-, l-or dl-fenfluramine. The two optical isomers and their metabolites were determined in plasma, red blood cells and brain areas such as striatum and brainstem. 2. In all cases, the levels of d-fenfluramine were higher than those of the l-enantiomer, while levels of the metabolite norfenfluramine were lower for the d- than the l-form. 3. When metabolism of fenfluramine was inhibited by pre-treatment with SKF 525-A, the concentrations of the enantiomers no longer differed.