Helping self-mutilating adolescents: descriptions of Finnish nurses.

This study focused on the views of Finnish nurses in regards to providing help for adolescents who self-mutilate. Nine nurses participated, and when the interviews and written descriptions were qualitatively analysed, four main categories of information emerged. The first category comprises the nurses' views on self-mutilation. The second category describes the people who are able to be helpers. The third category describes the content of help, which is made up of a variety of acts provided by non-health professionals that promote the healthy development of adolescents. The fourth category describes care provided by nurses to adolescents who self-mutilate. Guidelines for caring for self-mutilating adolescents are needed, including information on the phenomenon of self-mutilation.

Transparent criteria for specialist level adolescent psychiatric care.

BACKGROUND: Rising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating ranging 0-100, with 50 as an entry threshold. OBJECTIVE: To create and test the psychometric properties of a point-count measure for prioritising entry to public specialist level adolescent psychiatric services. METHOD: Around 710 referred adolescents were given ratings on 17 items focusing on symptom severity, problem behaviours, functioning, progress of adolescent development and prognosis. The structured ratings were compared to an overall assessment of need for treatment on a VAS scale. In order to ensure that the tool was not inappropriately sensitive to confounding by non-disturbance related factors, the associations between the structured priority rating and sex, age, referring agent, study site and diagnosis were analysed. RESULTS: Of the 17 items, 15 were included in the final priority-rating tool. The requirement than threshold score for entry to services being set at 50 points necessitated scoring factors rather than individual items. Four blocks of items were formed: symptoms and risks; impaired functioning; other relevant issues, and prognosis without specialist level treatment. Most of the referred adolescents scored over the threshold of 50. When diagnosis was controlled for, scoring over 50 was largely independent of age, sex, referring agent or study site. CONCLUSION: The structured priority ratings corresponded well with clinical global rating of need for care. The tool was not inappropriately sensitive to age, sex, referring agent or study site. In the future, follow-up studies will be needed to evaluate the predictive value of priority ratings.

P3 amplitude and time-on-task effects in distractible adolescents.

OBJECTIVE: The aim of our study was to examine the role of brain activity related to stimulus evaluation processes in distractibility by analyzing the P3 event-related potential. METHODS: We studied the P3 response to target stimuli at the beginning, in the middle, and at the end of a two-tone auditory oddball task in easily distractible (n = 16) and non-distractible (n = 16) adolescents. RESULTS: Easily distractible adolescents showed enhanced frontal and reduced parietal P3 amplitude across the blocks relative to non-distractible adolescents. Also, the usual decline in P3 amplitude at the end of the task was significantly larger in distractible than in non-distractible adolescents. CONCLUSIONS: These results suggests that the P3 effects are not limited to the neuropsychiatric disorders, and that increased distractibility may be characterized by reduced amount of resources allocated to the task with continued testing. SIGNIFICANCE: The results of this study contribute to elucidation of the functional basis of distractibility.

Event-related potentials to elementary auditory input in distractible adolescents.

OBJECTIVE: The aim of our study was to examine the role of brain activity related to orienting in distractibility. METHODS: Event-related potentials (ERPs) were recorded in response to intermittently presented, non-attended trains of identical auditory stimuli in otherwise healthy but easily distractible (n=16) and non-distractible (n=16) 15-to-16 year old adolescents. RESULTS: In easily distractible adolescents, the first tone in each train elicited a significantly larger N1 response than in non-distractible adolescents. A later positivity in the P3 latency range, which may be correlated with the posterior part of the orienting-related P3, was also significantly larger in distractible than in non-distractible adolescents. CONCLUSIONS: The findings of this study suggests that the susceptibility to distraction in adolescence is characterized by abnormally strong orienting response as indexed by enhanced N1 component, and that distractible adolescents allocate proportionately more attentional resources to the irrelevant stimuli as indexed by larger parietal P3 amplitude to the first stimulus of each train. SIGNIFICANCE: The results of this study contribute to elucidation of the functional basis of distractibility.