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Biomedical subjects

Eila Laukkanen

Publications and source records attributed to Eila Laukkanen.

16 recordsLinked to original sources
PubMed2006

Improvement in cognitive and psychosocial functioning and self image among adolescent inpatient suicide attempters.

BACKGROUND: Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. This prospective study compared characteristics and changes in cognitive functioning, self image and psychosocial functioning among 13 to 18 year-old adolescent psychiatric inpatients with suicide attempts (n = 16) and with no suicidality (n = 39) METHODS: The two-group pre-post test prospective study design included assessments by a psychiatrist, a psychologist and medical staff members as well as self-rated measures. DSM-III-R diagnoses were assigned using the SCID and thereafter transformed to DSM-IV diagnoses. Staff members assessed psychosocial functioning using the Global Assessment Scale (GAS). Cognitive performance was assessed using the Wechsler Adult Intelligence Scale, while the Offer Self-Image Questionnaire (OSIQ) was used to assess the subjects' self-image. ANCOVA with repeated measures was used to test changes from entry to discharge among the suicide attempters and non suicidal patients. Logistic regression modeling was used to assess variables associated with an improvement of 10 points or more in the GAS score. RESULTS: Among suicide attempter patients, psychosocial functioning, cognitive performance and both the psychological self and body-image improved during treatment and their treatment compliance and outcome were as good as that of the non-suicidal patients. Suicidal ideation and hopelessness declined, and psychosocial functioning improved. Changes in verbal cognitive performance were more pronounced among the suicide attempters. Having an improved body-image associated with a higher probability of improvement in psychosocial functioning while higher GAS score at entry was associated with lower probability of functional improvement in both patient groups. CONCLUSION: These findings illustrate that a multimodal treatment program seems to improve psychosocial functioning and self-image among severely disordered suicidal adolescent inpatients. There were no changes in familial relationships, possibly indicating a need for more intensive family interventions when treating suicidal youths. Multimodal inpatient treatment including an individual therapeutic relationship seems recommendable for severely impaired psychiatric inpatients tailored to the suicidal adolescent's needs.

Adolescent↗
PubMed2006

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.

Adolescent↗
PubMed2006

Increased number of febrile seizures in children born very preterm: relation of neonatal, febrile and epileptic seizures and neurological dysfunction to seizure outcome at 16 years of age.

PURPOSE: In prematurely born population, a cascade of events from initial injury in the developing brain to morbidity may be followed. The aim of our study was to assess seizures in prematurely born children from birth up to 16 years and to evaluate the contribution of different seizures, and of neurological dysfunction to the seizure outcome. METHODS: Pre- and neonatal data and data from neurodevelopmental examination at 5 years of 60 prospectively followed children born at or before 32 weeks of gestation, and of 60 matched term controls from the 2 year birth cohort were available from earlier phases of the study. Later seizure data were obtained from questionnaires at 5, 9, and 16 years, and from hospital records and parent interviews. RESULTS: In the preterm group, 16 children (27%) exhibited neonatal seizures, 10 children (17%) had seizures during febrile illness and 5 children had epilepsy. Eight children had only febrile seizures, and 3 of these had both multiple simple and complex febrile seizures and neurodevelopmental dysfunction. None of the 8 children had experienced neonatal seizures, 6 had a positive family history of seizures, but none developed epilepsy. The children with epilepsy had CP and neurocognitive problems, and all but one had experienced neonatal seizures; two of them had also had fever-induced epileptic seizures. In controls 3 children (5%) had simple febrile seizures. CONCLUSION: Children born very preterm have increased rate of febrile seizures compared to the controls. However, no cascade from initial injury via febrile seizures to epilepsy could be shown during the follow-up of 16 years. Symptomatic epilepsy in prematurely born children is characterised by neonatal seizures, major neurological disabilities and early onset of epilepsy.

Adolescent↗
PubMed2006

Naming skills of children born preterm in comparison with their term peers at the ages of 9 and 16 years.

The linguistic abilities of children born preterm at 32 weeks' gestation or earlier at Kuopio University Hospital during 1984 to 1986 were evaluated during successive phases of a prospective study. The study protocol included the Rapid Automatic Naming test and Wechsler Intelligence Scale for Children - Revised at 9 years of age and a modified Stroop Color-Word test and the Wechsler Intelligence Scale - Revised at the age of 16 years. Fifty-one children born preterm (26 males, 25 females) and 51 age-matched and sex-matched term controls (26 males, 25 females) were studied at the age of 9 years. At the age of 16 years, 40 children born preterm (19 males, 21 females) and 31 term controls (14 males, 17 females) participated in the study. The children born preterm scored significantly lower in two naming tasks than the controls at the age of 9 years. However, there was no difference between the study groups in naming skills at the age of 16 years or in verbal IQ in either study phase. Maternal education level was not associated with naming skills. Thus, the consequences of preterm birth seem to be minor in relation to linguistic skills during school age and diminish by adolescence.

Adolescent↗
PubMed2006

School health nurses and substance use among adolescents - towards individual identification and early intervention.

Adolescents' health is today threatened by the use of alcohol and other psychoactive substances. It is therefore important to develop interventions related to substance use in school health care. The aim of this study was to examine the empowering or risk background factors related to substance use among adolescents, and the ability of school nurses (PHN) to identify these factors and to provide needed individual early intervention. The data were collected by semistructured questionnaires completed by 14- to 18-year-old adolescents (n = 326, response rate 79) and PHNs (n = 10) in 2004. The adolescent questionnaire consisted of items related to the respondents' background and Adolescents' Substance Use Measurement (ADSUME). Following individual consent, adolescents' ADSUME responses were sent to the PHNs for intervention. The PHNs assessed the adolescents' empowering background factors and intervention using the questionnaire, and 70% (n = 228) of their answers matched the adolescents' answers. The data were analysed with the SPSS software using the chi-squared test, Fisher's exact test, kappa coefficient and agreement percentages. Substance use among adolescents was associated with parental support, mother's education and smoking, the adolescents' knowledge about substances, peer support and hobbies. The PHNs' assessments regarding supportive background were not in agreement with the assessments of adolescents who were using hazardous substances. One-fifth of the adolescents received the brief intervention, although many of them might have needed extra support and follow-up on the basis of their ADSUME results. The research findings can be generalized only for alcohol use, because only 3% of the study informants used substances other than alcohol. Further research is warranted concerning PHNs' ability to identify hazardous substance use and to ensure preventive early intervention and requisite support among substance-using adolescents in order to improve evidence-based health promotion.

Adolescent↗
PubMed2006

Good working alliance and psychotherapy are associated with positive changes in cognitive performance among adolescent psychiatric inpatients.

The effects of therapeutic relationships on the treatment outcome in 45 adolescent inpatients, aged 14 to 18 years, were assessed using the Working Alliance Inventory, the Wechsler Adult Intelligence Scale, the Global Assessment Scale, and The Offer Self-Image Questionnaire at entry and on discharge. Multivariate analysis revealed that a better quality of working alliance and a greater number of therapy sessions were significantly associated with positive change in cognitive performance during treatment.

Adolescent↗
PubMed2005

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.

Acoustic Stimulation↗
PubMed2005

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.

Acoustic Stimulation↗
PubMed2005

Suicidal ideation among help-seeking adolescents: association with a negative self-image.

Self-image and factors associated with suicidal ideation were studied among adolescents (N=168, age 17.7+/-2.3 years, 72% girls) seeking psychiatric assessment. The Structured Clinical Interview, Beck Depression Inventory and Offer Self-Image Questionnaire were used. Suicidal ideation (SI) was reported by 64% of subjects, of whom 20% received no psychiatric diagnosis and 58% had depressive disorders. SI in boys associated with being bullied at school and talking about one's problems only with friends, and in girls with a negative attitude towards the future and a negative self-image of one's own mental health. Because suicidal ideation frequently occurs without formal psychiatric diagnosis it should be assessed separately. Special attention should be paid to adolescents' negative self-perception.

Adolescent↗
PubMed2003

Clinical recovery in cognitive functioning and self-image among adolescents with major depressive disorder and conduct disorder during psychiatric inpatient care.

This prospective study examined psychosocial and cognitive functioning among adolescents with major depressive disorder and conduct disorder under comprehensive psychiatric inpatient care. Nonverbal and general cognitive performance, self-image, and overall psychosocial functioning improved in both groups. Nevertheless, more changes in self-image and family functioning were found among patients with major depressive disorder. Mental health services should still have the capability of offering long-term residential care for adolescents with the most severe mental disturbance.

Adolescent↗
PubMed2003

A new priority in psychiatry: focused services for adolescents.

Finland was the first European country to give a high priority to the development of specialized psychiatric services for adolescents. The aim of this paper is to 1) describe the development of these services, 2) study the status and the functioning of psychiatric services for adolescents in 2000 and 3) present some future challenges. The data have been collected from the social welfare register, from a questionnaire sent to Health Districts and via telephone interviews. In addition, the functioning of the treatment system has been studied in detail in one Health District by means of interviews and questionnaires. The general targets set in 1987 giving national priority to focused psychiatric services for adolescents were mostly reached in 2000, and resources for adolescents have increased markedly. In spite of this, minors still have to be treated in adult psychiatric wards. Many problems were detected in the functioning of the chains of treatment for adolescents. The differentiation between primary and secondary care was unclear. Primary care had a limited capacity in the early detection of mental disorders in adolescents. The services for adolescents were broken down into small units. Furthermore, there were no comprehensive future plans. The need for specialized psychiatric services for adolescents is evident. In addition to developing adequate resources, the quality of care should also be guaranteed by training and by competent long-term planning of psychiatric service systems.

Adolescent↗
PubMed2002

Effect of major depression on cognitive performance among treatment-seeking adolescents.

We investigated the association between cognitive performance and major depressive disorder (MDD) in adolescents seeking outpatient treatment. We used several tests comparing cognitive capacities between 16 adolescents with MDD and 25 adolescents not diagnosed as suffering from psychiatric illness according to the Structured Clinical Interview for DSM-III-R (SCID). No difference in neuropsychological test performance was found between adolescents with MDD and those without psychiatric diagnosis. Logistic regression analysis showed the only independent factor associated with MDD to be Emotional Tone (S2; odds ratio 1.13). The specific effects of MDD on the adolescents were restricted to the emotional area and were expressed as a broad deterioration in psychosocial functioning.

Adolescent↗
PubMed2002

Externalizing and internalizing problems at school as signs of health-damaging behaviour and incipient marginalization.

This study aimed to investigate whether behavioural or emotional problems in adolescents detected by their teachers are signs of a common psychosocial maladjustment and of the beginning of social marginalization. Altogether, 171 pupils (15 years of age) from the eastern part of Finland participated in the survey. Behavioural and emotional problems and academic achievements were assessed separately by two teachers. Pupils filled in a questionnaire about alcohol use, smoking, physical exercise and fitness, self-rated health, psychosomatic symptoms, social relationships and future educational plans. Results showed that poor success at school and the absence of or limited educational plans were associated with both externalizing and internalizing problems. Externalizing problems were associated with health-damaging behaviour and with bullying others. Internalizing problems were associated with poor perceived health and a low level of exercise, with mental symptoms, and with problems in social relationships. Thus, the pupils in both problem groups had a clustering of different risk factors. We conclude that the accumulation in adolescents of self-reported health-damaging behaviour, problems related to school, to future educational plans and to social relationships are already obvious in pupils with externalizing and/ or internalizing problems detected by their teachers at the age of 15 years. The capacity of teachers to identify pupils at risk as early as possible should therefore be utilized. The development of a vicious circle might be prevented through early intervention at school, by offering pupils guidance, counselling and treatment.

Adolescent↗