Objectives: Up to 40% of adolescents with Major Depressive Disorder (MDD) do not respond to treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment in adults for MDD which shows promising efficacy in adolescents, however additional controlled investigations are needed. This pilot study compared rTMS applied to the left-side of the head and right-side in a randomized controlled trial. We hypothesized rTMS treatment would lead to an improvement in Children’s Depression Rating Scale Revised (CDRS-R) depression scores of adolescents with MDD at 1-month follow-up compared to baseline. No difference in response between left- and right-sided rTMS was expected.Methods: Fourteen adolescents who had been previously treated for MDD but had continued to suffer with MDD for an average of 2 years were randomly allocated to right (low frequency) or left (high frequency) rTMS. rTMS was applied to the scalp over the dorsolateral prefrontal cortex over 20 treatments given over four weeks. The primary outcome measure was the CDRS-R. Outcome assessments occurred at 10 sessions and 20 sessions, with follow-up at one month and six months.Results: CDRS-R scores improved significantly across the 20 rTMS treatments, with peak response at 1-month follow-up. Two (14%) adolescents had ≥ 50% score improvement and a further four (29%) demonstrated partial response (between 25 and 50% reduction) by 1-month follow-up. Treatment gains were sustained at 6-month follow-up. There was no significant difference in efficacy between left- and right-sided treatment.Conclusion: This small study found preliminary evidence that adolescents with MDD benefited from rTMS.

Problem Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit. Methods Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit. Findings Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion. Conclusions Nurses play a unique role in seclusion outcomes that are separate to patient‐factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse‐factors contribute to seclusion.

Inpatient psychiatric care may be required to manage adolescents with severe mental health problems. As the ward can be a challenging environment, this study explored the influence of clown doctors on adolescents. Seventy-seven adolescents (13–18 years) and 22 staff from the Monash Health Stepping Stones Adolescent Unit, and 11 clown doctors from The Humour Foundation participated in the study. Bespoke surveys were developed by the research team to collect quantitative self-report data and qualitative responses. Descriptive statistics and thematic analysis suggested that adolescents experienced high levels of fun as well as positive mood during a clown doctor session. Clown doctor programs show promise within an inpatient unit with opportunities for further development being identified. With considerations of the findings, future clown doctor training could include tailoring sessions to the developmental needs of adolescents and developing strategies on how to interact with adolescents who have a mental health disorder.

Inpatient psychiatric care is often required to manage adolescents with severe mental health problems. As the ward can be a confronting and challenging environment, this study explored the influence of clown doctors on adolescents. Seventy-seven adolescents (13–18 years) from Monash Health Stepping Stones Adolescent Unit and 11 clown doctors from The Humour Foundation participated in the study. Bespoke surveys were developed by the research team to collect quantitative self-report data and qualitative responses. Descriptive statistics and thematic analysis suggested that adolescents experienced high levels of fun as well as positive mood and feelings during a clown doctor session. Clown doctor programs show promise within an inpatient unit with opportunities for further development being identified. With considerations of the findings, future clown doctor training could include tailoring sessions to the developmental needs of adolescents and developing strategies on how to interact with adolescents who have a mental health disorder.