Event-Related Potential Measures of Attention Capture in Adolescent Inpatients With Acute Suicidal Behavior.

Impaired executive functions, modulated by the frontal lobes, have been suggested to be associated with suicidal behavior. The present study examines one of these executive functions, attentional control, maintaining attention to the task-at-hand. A group of inpatient adolescents with acute suicidal behavior and healthy controls were studied using a passively presented auditory optimal paradigm. This "optimal" paradigm consisted of a series of frequently presented homogenous pure tone "standards" and different "deviants," constructed by changing one or more features of the standard. The optimal paradigm has been shown to be a more time-efficient replacement to the traditional oddball paradigm, which makes it suitable for use in clinical populations. The extent of processing of these "to-be-ignored" auditory stimuli was measured by recording event-related potentials (ERPs). The P3a ERP component is thought to reflect processes associated with the capturing of attention. Rare and novel stimuli may result in an executive decision to switch attention away from the current cognitive task and toward a probe of the potentially more relevant "interrupting" auditory input. On the other hand, stimuli that are quite similar to the standard should not elicit P3a. The P3a has been shown to be larger in immature brains in early compared to later adolescence. An overall enhanced P3a was observed in the suicidal group. The P3a was larger in this group for both the environmental sound and white noise deviants, although only the environmental sound P3a attained significance. Other deviants representing only a small change from the standard did not elicit a P3a in healthy controls. They did elicit a small P3a in the suicidal group. These findings suggest a lowered threshold for the triggering of the involuntary switch of attention in these patients, which may play a role in their reported distractibility. The enhanced P3a is also suggestive of an immature frontal central executive and may provide a promising marker for early identification of some of the risk factors for some of the cognitive difficulties linked to suicidality.

The State of Inpatient Psychiatry for Youth in Ontario: Results of the ONCAIPS Benchmarking Survey.

OBJECTIVE: Little is known about inpatient psychiatry settings and the services they provide for children and adolescents in Ontario. This paper provides the first broad description of unit characteristics, services provided, and patient characteristics in these settings. METHOD: Nominated representatives from Ontario hospitals with generic mental health beds (i.e., providing inpatient care across diagnostic groups) for children and adolescents were surveyed regarding data from April 2009 to March 2010. Response rate was 93%. Additional data were extracted from the Ontario Network of Child and Adolescent Inpatient Psychiatry Services (ONCAIPS) Directory and Ministry of Health and Long Term Care (MOHLTC) website. RESULTS: Settings provided primarily crisis services with some planned elective admissions. Higher rates of involuntary admissions, briefer stays, lower interdisciplinary diversity, and lower occupancy were typical of settings with higher proportions of crisis admissions. Services most commonly provided included stabilization, assessment, pharmacotherapy, and mental health education. Bed numbers provincially, beds per staff, and prominence of suicide risk, mood disorders, and utilization of cognitive and behavioural approaches were comparable to trends internationally. Inter-setting disparities were observed in access to inpatient services for different age and diagnostic groups, and availability of psychiatry and different professions. CONCLUSIONS: Lack of consistent performance and outcome evaluation, common measures, availability of psychiatry and interdisciplinary supports, and dissimilar treatments provincially, suggest the need to consider potential improvements through systematic monitoring of setting performance and outcomes, and development of provincial best practice standards for staffing and treatment.

OBJECTIF: On sait très peu de choses des unités d'hospitalisation en psychiatrie et des services qu'elles prodiguent aux enfants et aux adolescents en Ontario. Cet article offre la première description générale des caractéristiques des unités, des services dispensés, et des caractéristiques des patients de ces unités. MÉTHODE: Des représentants désignés des hôpitaux ontariens offrant des lits génériques de santé mentale, (c.-à-d., dispensant des soins aux patients hospitalisés de tous groupes diagnostiques) pour les enfants et les adolescents ont été interrogés sur les données d'avril 2009 à mars 2010. Le taux de réponse a été de 93%. Des données additionnelles ont été tirées du répertoire du Réseau d'unités de psychiatrie pour enfants et adolescents hospitalisés de l'Ontario (RUPEAHO) et du site Web du ministère de la Santé et des Soins de longue durée (MSSLD). RÉSULTATS: Les unités ont fourni des services principalement de crise et certaines hospitalisations non urgentes planifiées. Des taux plus élevés d'hospitalisations involontaires, de séjours abrégés, de diversité interdisciplinaire plus faible, et d'occupation plus faible étaient typiques des unités ayant des proportions plus élevées d'hospitalisations de crise. Les services les plus souvent dispensés étaient notamment la stabilisation, l'évaluation, la pharmacothérapie, et l'éducation en santé mentale. Le nombre des lits à l'échelle provinciale, les lits par employés, et la proéminence du risque de suicide, des troubles de l'humeur et le recours aux approches cognitives et comportementales étaient comparables aux tendances internationales. Des disparités ont été observées entre unités en ce qui concerne l'accès aux services d'hospitalisation pour différents groupes d'âge et diagnostiques, ainsi que la disponibilité de la psychiatrie et de différentes professions. CONCLUSIONS: L'absence de rendement constant et d'évaluation des résultats, les mesures communes, la disponibilité de la psychiatrie et de soutiens interdisciplinaires, et les traitements différents dans la province indiquent le besoin de songer à des améliorations possibles par la surveillance systématique du rendement et des résultats des unités, et par l'élaboration de normes de pratiques provinciales exemplaires en matière de dotation en personnel et de traitement.

Learning disability subtypes and the role of attention during the naming of pictures and words: an event-related potential analysis.

The role of attention in the processing of pictures and words was investigated for a group of normally achieving children and for groups of learning disability sub-types that were defined by deficient performance on tests of reading and spelling (Group RS) and of arithmetic (Group A). An event-related potential (ERP) recording paradigm was employed in which the children were required to attend to and name either pictures or words that were presented individually or in superimposed picture-word arrays that varied in degree of semantic relation. For Group RS, the ERP waves to words, both presented individually or attended in the superimposed array, exhibited reduced N450 amplitude relative to controls, whereas their ERP waves to pictures were normal. This suggests that the word-naming deficiency for Group RS is not a selective attention deficit but rather a specific linguistic deficit that develops at a later stage of processing. In contrast to Group RS and controls, Group A did not exhibit reliable early frontal negative waves (N280) to the super-imposed pictures and words, an effect that may reflect a selective attention deficit for these children that develops at an early stage of visuo-spatial processing. These early processing differences were also evident in smaller amplitude N450 waves for Group A when naming either pictures or words in the superimposed arrays.