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Biomedical subjects

Johannes Lehtonen

Publications and source records attributed to Johannes Lehtonen.

At least 19 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

Midbrain binding of [123I]nor-beta-CIT in atypical depression.

BACKGROUND: Altered serotonin (SERT) and dopamine transporter (DAT) densities have been recorded in major depression. Atypical depression (ATD) has been suggested to be connected to decreased serotonergic transmission, but no studies have been published on the association between brain serotonin transporter density and ATD. METHODS: PATIENTS with depression (n=29) were divided into three groups according to DSM-IV criteria: atypically depressed, melancholic patients, and "undifferentiated" patients. Depressive symptoms were evaluated with the 29-item Hamilton Depression Rating Scale (HAM-D-29). Single photon emission computed tomography (SPECT) with [(123)I]nor-beta-CIT was used to evaluate serotonin transporter density (SERT) in the midbrain and dopamine transporter density (DAT) in the striatum of patients and healthy controls (n=18). RESULTS: All subgroups except those with undifferentiated depression had lower SERT densities compared to controls. No significant differences were found in the densities between the subgroups. Atypical scores of HAM-D-29 were associated with SERT densities in the midbrain (beta=-0.40, t=-2.3, p=0.03), even after adjustment for age, gender and HAM-D-21 scores (beta=-0.39, t=-2.32, p=0.03). CONCLUSIONS: The association between atypical scores of HAM-D-29 and midbrain SERT densities suggests a relationship between serotonergic dysfunction and ATD.

Adult↗
PubMed2006

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.

Affect↗
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↗
PubMed2006

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Journal Article↗
PubMed2005

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.

Attention↗
PubMed2005

Electrical brain responses evoked by human faces in acute psychosis.

Patients with schizophrenia are known to have behavioral deficits in recognizing faces and facial expressions. However, the ability to process simple visual stimuli appears to be intact in first-episode psychosis. The aim of this study was to examine complex visual processing, especially the event-related potentials (ERPs) elicited by human faces, in early psychosis. Never-medicated patients in acute psychosis (n=18) were compared with healthy controls (n=19). Photographs of human faces were presented in a classic oddball paradigm requiring a motor response to a smiling face. Cerebral sources of ERPs were analyzed of the averaged responses, using minimum norm estimates, and dipole models. Face-sensitive response at 145 ms after the face stimuli was of significantly higher amplitude in our never-medicated patients, and the activity distribution between the groups was clearly different. At the early phase of a psychotic illness, these alterations in face-related neuronal network processes represent perceptual disturbance in psychosis, possibly including state and trait, as well as potential physiological compensatory features.

Acute Disease↗
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↗
PubMed2005

Enhanced attention-dependent auditory processing by electroconvulsive therapy in psychotic depression.

There is a lack of knowledge about the effect of electroconvulsive therapy (ECT) on auditory event-related potentials (ERPs) in severe psychotic depression. The aim of this study was to investigate both the effect of ECT on attention-dependent ERP (P300) and the correlation of P300 values with depression level. We recorded the auditory ERPs of 23 patients expressing psychotic symptoms and fulfilling the DSM-III-R criteria for treatment-resistant severe major depressive episode before and a week after successful bitemporal ECT. The clinical status was assessed with Hamilton (Ham-D) and Montgomery and Asberg (MADRS) depression scales. ECT was clinically very effective with these scales. On the level of auditory processing, ECT increased P300 amplitude with no significant effect on latency. Small amplitudes over the left hemisphere before treatment were associated with bigger Ham-D-score decrement. ECT produces a significant increase in brain activity at the level of attention-dependent auditory processing in severe depression. The change in electrical responses seems to represent a largely independent variable from the clinical assessment scales, even if the recovery rate was remarkable, because the change in overall symptom scores did not correlate with the P300 changes.

Adult↗
PubMed2005

An outcome of psychodynamic psychotherapy: a case study of the change in serotonin transporter binding and the activation of the dream screen.

We explored the outcome of psychodynamic psychotherapy of a female patient with major depression using clinical evaluation and serotonin transporter (SERT) binding assessed with [123I]nor-beta-CIT SPECT. The psychotherapy process was analyzed with special emphasis on the change that was recognized in the dreaming process. The activation of the dream screen in transference seemed to form a turning point during the psychotherapy. Normalization of SERT binding at the midbrain level was found on 12-month follow-up. Major alleviation of depressive symptoms assessed by rating scales was evident only six months after SERT normalization.

Adult↗
PubMed2004

Elevated midbrain serotonin transporter availability in mixed mania: a case report.

BACKGROUND: Results obtained from brain imaging studies indicate that serotonin transporter (SERT) and dopamine transporter (DAT) densities are altered in major depression. However, no such studies have been published on current mania or hypomania. CASE PRESENTATION: In this single photon emission computed tomography (SPECT) study with [123I]nor-beta-CIT we present a case with simultaneous symptoms of major depression and hypomania. She had an elevated serotonin transporter availability (SERT) in the midbrain and elevated dopamine transporter availability (DAT) in the striatum, which normalised in a one-year follow-up period during which she received eight months of psychodynamic psychotherapy. CONCLUSIONS: To our knowledge, this is the first report on SERT and DAT associated with mania. In our case the availability of both SERT in the midbrain and DAT in the striatum were elevated at baseline and declined during psychotherapy, while the SERT and DAT of the depressed controls increased during psychotherapy. Symptoms of hypomania in the case were alleviated during psychotherapy. Clinical recovery was also reflected in the Hamilton Depression Rating Scale (HDRS) scores.

Adult↗
PubMed2004

123I-beta-CIT binding and recovery from depression. A six-month follow-up study.

Eighteen depressive outpatients were investigated using single-photon emission computerized tomography (SPECT) with a high-affinity dopamine (DA) and serotonin transporter (SERT) specific radioligand, (123)I-labeled beta-CIT (2 beta-carbomethoxy-3 beta-(4-iodophenyl)-tropane). The patients were tested at the beginning of the study and on follow-up after six months. The severity of depression was evaluated using the 17-item Hamilton Rating Scale of Depression (HRSD). Eight of the eighteen patients had an HRSD score below the median (12 points) on follow-up, and they had a significantly greater increase in (123)I-beta-CIT binding in the midbrain region compared with those patients who did not recover (ANCOVA: F = 8.12; df = 1, 14; p = 0.013). These results indicate that recovery from depression is associated with an increase in (123)I-beta-CIT binding in the midbrain.

Adult↗
PubMed2004

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.

Adult↗
PubMed2004

Gender-related changes in suicide rates and methods in Eastern Finland from 1988 to 1997.

The first aim of the study was to investigate the changes in regional suicide rates for the province of Kuopio, Eastern Finland, from 1988 to 1997 and compare rates with those for the whole Finland. The second aim was to investigate gender-related changes in suicide rates and methods during the study period. Altogether, 777 suicides were examined. Between 1988 and 1997, regional male suicide mortality decreased, approaching the mean national level, which was rising during the same interval. From 1992 to 1997, there was a rise in regional suicide mortality, which coincided with a decrease at the national level. Female suicide rates in Eastern Finland also initially decreased, but thereafter remained variable and slightly higher than the national level. Gender-related differences in suicide mortality diminished. The initial difference between genders in mean age (49.5 years in women, 41.8 years in men) disappeared towards the end of the study period (47.0 years in women, 45.2 years in men). The decline in mean ages of women was mostly due to change in urban suicides, whereas the increase in the mean age of men was caused by change in rural suicides. Among men, the relative proportion of self-poisoning suicides rose significantly. The divergent development of suicide rates from the province of Kuopio and the entire nation may reflect differences in the development of social structures in rural Eastern Finland compared to more densely populated parts of the country. Gender differences and local variation in suicide mortality should be taken into account when assessing and developing further suicide prevention strategies.

Adolescent↗
PubMed2003

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.

Acoustic Stimulation↗