Bifrontal active and sham rTMS in treatment-resistant unipolar major depression.

BACKGROUND AND AIM: Prevention of the recurrence of major depression and its residual symptoms requires effective treatment. Our aim was to study the effects of bifrontal active rTMS controlled by sham rTMS in treatment-resistant unipolar major depressive disorder (MDD). METHODS: Thirty-seven patients with treatment-resistant MDD were randomized into two groups. One group received a total of 30 sessions of active bifrontal rTMS (10 Hz rTMS on left dorsolateral prefrontal cortex (DLPFC) and 1 Hz rTMS on right DLPFC) and the other group received bilateral sham rTMS on five days a week for six weeks. RESULTS: Depressive symptoms significantly improved in both the groups, but without a significant group difference. Furthermore, patients with psychotic depression improved similarly to those with moderate or severe depression. CONCLUSIONS: The results of present study indicate a large sham effect of stimulation treatment. The intensive structured treatment protocol may explain the positive outcome in both the groups. It is important to recognize, appreciate, and utilize placebo effects as a significant means of rehabilitation in psychiatric care.

Hospital care and drug costs from five years before until two years after the diagnosis of Alzheimer's disease in a Finnish nationwide cohort.

AIMS: The aim of our study was to investigate costs related to hospital care and drugs utilizing register-based data from five years before until two years after the diagnosis of Alzheimer's disease (AD) in a nationwide cohort. METHODS: Finnish nationwide MEDALZ cohort includes all incident cases with clinically verified diagnosis of AD diagnosed during 2005-2011. The study population included 70,718 persons with AD and age-, gender- and region-of-residence-matched control persons. Data of medical care costs was derived from the prescription register and hospital discharge register. Costs of hospital care were calculated according to Finnish healthcare system unit costs. Costs in six month periods before and after the diagnosis per person-years were analyzed. RESULTS: Persons with AD had higher mean total medical care costs per person-years starting from 0.5-1 years before the diagnosis of AD and remained at a higher level until two years after the diagnosis. The difference in mean total medical care costs was at its highest at six months after the diagnosis (cost difference €5088). After that, persons with AD had costs that reached approximately double those without AD. Hospital care costs constituted the major share (78-84%) of the total medical care costs in both persons with and without AD, whereas drug costs had a minor role. Increase in drug costs was caused by anti-dementia drugs. CONCLUSIONS: Costs of hospital stays constituted the most significant portion of medical care costs for persons with AD. Further research should be focused on the causes of hospitalization periods.

Auditory event-related potentials in patients with psychotic illness: a 5-year follow-up.

The auditory processing is diversely impaired in patients with the first-episode psychosis. During acute phase we previously reported reduced amplitudes in attention-dependent auditory evoked electrical brain potentials but not in those of early automatic components. Here seven first-episode patients at the disease onset and 5 years later were studied and compared to control subjects. At follow-up, also the unattended auditory stimuli elicited reduced amplitudes both in primary sensory component (N100, p = .043) and in automatic deviance detection (N200, p = .013) as compared to acute phase. Patients' psychopathology had improved, however they still showed alterations in components detecting automatic stimulus classification which may convey persisting tendency for misinterpretation in auditory perception.

Outcome of patients after market withdrawal of thioridazine: a retrospective analysis in a nationwide cohort.

OBJECTIVE: Thioridazine is a first-generation antipsychotic drug that was withdrawn from the market worldwide in 2005. The outcome of clinically stable schizophrenia patients who used thioridazine before market withdrawal was evaluated. METHODS: Nationwide registers in Finland were utilized to study thioridazine use, hospitalization rate and length of hospital stay. RESULTS: Although thioridazine use continued to diminish year after year, the hospitalization rate remained constant until the withdrawal year of 2005, when the percentage of patients hospitalized for schizophrenia doubled. CONCLUSION: The market withdrawal of thioridazine predisposed many stable patients towards psychotic relapses. In order to minimize this kind of risk, an overall risk-benefit assessment and a clear-cut plan for the replacement of an antipsychotic should be established before market withdrawal.

[Anxious elderly person]. / Ahdistunut vanhus.

Anxiety disorder occurs in approx. 6% of persons over 65 years of age. A large proportion of elderly patients suffering from anxiety seek medical help at a general practitioner, complaining somatic symptoms. Clinical examinations include evaluating the patient's psychic and social situation, and adequate somatic investigations. Most patients are treatable by the general practitioner; those with the most difficult symptoms and refractory ones belong to specialized care. Essential forms of treatment include supportive therapy, psychotherapies and SSRI drugs.

The impact of stimulus type and early motherhood on attentional processing.

The present study evaluated the impact of stimulus type and early motherhood on attentional processing. Auditory ERPs were recorded with a modified novelty oddball paradigm both in mothers who had recently given birth and in control women who were not in the state of early motherhood. Conventional tone pips were used as standards and deviants, and an infant cry served as an experimental stimulus of novelty value. Differences were revealed in the N100 amplitudes between the study groups with higher amplitudes in the mothers. A few days after childbirth the mothers seemed to be in a stage with an increased level of alertness and different types of surrounding stimuli may elicit a stronger arousal response than normally, not just those directly related to the new baby. The gating and the mechanisms of further processing of stimulus information were not different in mothers from controls and seemed to guarantee normal control of stimulus-elicited cognitive load in early motherhood.

Nascent body ego: metapsychological and neurophysiological aspects.

For Freud, body ego was the organizing basis of the structural theory. He defined it as a psychic projection of the body surface. Isakower's and Lewin's classical findings suggest that the body surface experiences of nursing provide the infant with sensory-affective stimulation that initiates a projection of sensory processes towards the psychic realm. During nursing, somato-sensory, gustatory and olfactory modalities merge with a primitive somatic affect of satiation, whereas auditory modality is involved more indirectly and visual contact more gradually. Repeated regularly, such nascent experiences are likely to play a part in the organization of the primitive protosymbolic mental experience. In support of this hypothesis, the authors review findings from a neurophysiological study of infants before, during and after nursing. Nursing is associated with a significant amplitude change in the newborn electroencephalogram (EEG), which wanes before the age of 3 months, and is transformed at the age of 6 months into rhythmic 3-5 Hz hedonic theta-activity. Sucking requires active physiological work, which is shown in a regular rise in heart rate. The hypothesis of a sensory-affective organization of the nascent body ego, enhanced by nursing and active sucking, seems concordant with neurophysiological phenomena related to nursing.

Month and Season of Birth as a Risk Factor for Alzheimer's Disease: A Nationwide Nested Case-control Study.

OBJECTIVES: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer's disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. METHODS: A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005 to 2012 (n=70 719) and up to four age- sex- and region of residence-matched controls (n=282 862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression. RESULTS: Month of birth was not associated with AD (p=0.09). No strong associations were observed with season (p=0.13), although in comparison to winter births (December-February) summer births (June-August) were associated with higher odds of AD (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05). However, the absolute difference in prevalence in winter births was only 0.5% (prevalence of those born in winter were 31.7% and 32.2% for cases and controls, respectively). CONCLUSIONS: Although our findings do not support the hypothesis that season of birth is related to AD/dementia risk, they do not invalidate the developmental origins of health and disease hypothesis in late-life cognition. It is possible that season does not adequately capture the early life circumstances, or that other (postnatal) risk factors such as lifestyle or socioeconomic factors overrule the impact of prenatal and perinatal factors.

Four-month-old infants process own mother's voice faster than unfamiliar voices--electrical signs of sensitization in infant brain.

Four-month-old infants heard their own mother's voice and a voice of an unfamiliar female as "oddballs" in a stream of acoustic information. The neuronal processing from 50 to 500 ms (as evaluated with event-related brain potentials, ERPs) was expected to be obligatory and from 500 to 900 ms to include cognitive processing. There was a clear shift in the processing speed between the mother's and unfamiliar voices at around 350 ms. While earlier obligatory ERP components occurred at significantly shorter latency to the mother's voice, later endogenous components were significantly delayed relative to the unfamiliar voice. The amplitude differences between the experimental stimuli were clearest for the last ERP potential, which presumably includes largest cognitive component. The size of the potential was significantly lower for mother than for unfamiliar voice. The results suggest that the behaviorally well-documented mutual sensitization between infant and mother and the special importance of output from mother is seen as an enhanced arousal to mother's voice and as signs of a clear memory template for own mother's voice at very early age.

Altered auditory processing in acutely psychotic never-medicated first-episode patients.

UNLABELLED: Individuals with psychosis fail to differentiate external impulses and suffer from distortions of reality testing. Schizophrenia group illnesses are also associated with deficits in working memory and perception. We examined the manifestations of a very early phase of psychotic illness to automatic auditory deviance detection to clarify the basic mechanisms underlying misinterpretations of perception. METHODS: Twenty-five never-medicated patients admitted for hospital evaluation of acute psychosis were studied. Fifty-eight EEG channels were recorded during an auditory oddball paradigm. Event-related potentials (ERPs) time-locked to non-attended deviant auditory stimuli were studied in patients and compared with healthy controls. Auditory processing was examined both at the level of the measured biosignals (standard and deviant responses) and with subtraction waveforms. Topographical differences were characterized using global field power (GFP) and minimum norm estimates. RESULTS: The maximum GFP amplitudes and mean amplitudes of the 58 channels within the time windows corresponding to the previously known 'N2b', 'P3a' and 'P3b' components were clearly reduced in patients when compared to healthy controls. However, the groups did not differ during attention-independent automatic processing corresponding to the 'N1' and 'MMN' components, or with respect to the peak latencies of the GFP maxima. CONCLUSIONS: Impairment of the processing of a deviance in simple auditory input in acutely ill drug-naive first-episode psychotic patients only appears in attention-dependent processing after about 250 ms. The alterations in auditory processing differed between stimulus types, suggesting at least two mechanisms underlying the auditory discrimination impairments in acute psychosis. After 250 ms there was a linear and gradually increasing difference in magnitude between the groups in their responses to deviant stimuli, probably related to arousal. In addition, however, there was a striking difference between the groups in the processing of standard stimuli. The early processing was similar in patients and controls, but the striking difference appeared in later processing. The sensory memory deficits associated with psychosis may be explained by an abnormality in sensory model formation rather than by impaired deviant detection.

Cerebral processing of mother's voice compared to unfamiliar voice in 4-month-old infants.

In order to investigate the neurophysiological mechanisms related to the infant's preference of maternal stimuli over other stimuli, auditory event-related potentials (ERPs) were recorded in responses to the mother's voice and to a voice of an unfamiliar female in 15 infants at the age of 4 months. Stimuli were presented in intermittent and alternating trains of four identical stimuli (mother's voice or an unfamiliar voice). A significant amplitude difference was observed in the responses. This was seen as a negative 'shift' in the responses to mother's voice after approximately 350 ms. The finding suggests that the infants allocate more attention to process their own mothers' voices compared to unfamiliar voices and it may work in favor of establishing and strengthening an emotional tie between the infant and its mother.

The effects of feeding on the electroencephalogram in 3- and 6-month-old infants.

The human infant's neurophysiological responses to feeding are poorly understood. We found recently a significant increase of EEG amplitude in the newborn during nutritive feeding, but not during pacifier sucking. In this study, we report EEG responses to feeding in 13 infants at the ages of 3 and 6 months. The undifferentiated response of the newborn was found to wane until the age of 3 months, whereas in 6-month-old infants, relatively abundant rhythmic 3-5 Hz theta activity was recorded during feeding with an amplitude maximum in right posterior areas. Cessation of feeding was followed by cessation of theta activity. The rhythmic 3-5 Hz theta response to feeding is likely to represent emotional arousal, as it is similar to previous findings showing posterior theta increase in other settings connected with emotional arousal in infants.