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In many economically struggling societies forensic psychiatry is still in its initial developmental stages and thus forensic patients pose an ongoing challenge for the healthcare and juridical systems. In this article we present the various issues and problems that arose when establishing the first forensic psychiatric institute in Kosovo- a country whose population has constantly been reported as suffering from a high psychiatric morbidity due to long-lasting traumatic experiences during the war of 1999. The implementation of a new forensic psychiatric institute in the developing mental healthcare system of Kosovo, still characterized by considerable shortages, required substantial effort on various levels. On the policy and financial level, it was made possible by a clear intent and coordinated commitment of all responsible national stakeholders and authorities, such as the Ministries of Health and Justice, and by the financial contribution of the European Commission. Most decisive in terms of the success of the project was capacity building in human resources, i.e. the recruitment and training of motivated staff. Training included essential clinical and theoretical issues as well as clearly defined standard operation procedures, guidelines and checklists to aid daily routine work and the management of challenging situations.

Processing of simple and complex sounds in the human brain was compared by recording extracranial magnetic mismatch responses (MMNm; the magnetic counterpart of the mismatch negativity, or MMN) to frequency changes in these sounds. Generator sources, modeled as equivalent current dipoles (ECDs), of MMNm responses to a change in one frequency element of complex sounds (a chord and a serial tone pattern) were located in supratemporal auditory cortex, on average, 10 mm medially to the source of an MMNm elicited by an identical frequency change in a simple tone. These results suggest that at least partially different supratemporal neuron populations are involved in processing changes in simple and complex sounds and that sensory-memory representations for these sounds may be located in different fields of the auditory cortex.

We used a whole-scalp magnetometer with 122 planar gradiometers to study the activity of the visual cortex of five blind humans deprived of visual input since early infancy. Magnetic responses were recorded to pitch changes in a sound sequence when the subjects were either counting these changes or ignoring the stimuli. In two of the blind subjects, magnetic resonance images were also obtained, showing normal visual cortex macroanatomy. In these subjects, the magnetic responses to counted pitch changes were located at visual and temporal cortices whereas ignored pitch changes activated the temporal cortices almost exclusively. Also in two of the other three blind, the visual-cortex activation was detectable in the auditory counting task. Our results suggest that the visual cortex of blind humans can participate in auditory discrimination.

The mismatch negativity (MMN) of the auditory event-related potential is elicited when a stimulus deviates from that represented by the neural memory trace developed by preceding stimuli. The effect of stimulus duration on this trace was studied by presenting sequences of 1000 Hz, 80 dB stimuli to subjects engaged in silent reading. Stimuli were, in different blocks, either of 4, 10, 30, 100 or 300 ms in duration. 5% of the stimuli were deviants which were either higher in frequency (1050 Hz) or lower in intensity (70 dB) than the standards. The "silent" period between two successive stimuli was constant at 300 ms. The minimum stimulus duration with which a distinct MMN was elicited by frequency deviants was 30 ms, but the MMN amplitude was not increased when stimulus duration was further prolonged. In contrast, the intensity MMN was elicited even when stimulus duration of 10 ms and its amplitude increased as a function of stimulus duration. Reaction times and hit percentages in response to these deviant stimuli in a separate discrimination task displayed analogous patterns of results.

Auditory event-related potentials (ERPs) were recorded from reading subjects while they were presented with 50 ms tone pips intervened by regular silent intervals of 550 ms. This interval was occasionally shortened either to 250, 100, 25, 10, or 2 ms, which resulted in the elicitation of the mismatch-negativity (MMN), a change-specific ERP component not elicited by tones appearing after the regular, longer intervals. This indicates that the MMN is not just due to new afferent elements activated by deviant but not standard stimuli. In addition, the present results suggest that the temporal parameters of acoustic stimulation are also encoded in memory traces which therefore are representations of auditory events rather than only of static stimulus aspects.

The effect of alcohol (ethanol) on cortical processing of Finnish vs. English words in Finnish-speaking subjects was studied by recording auditory event-related potentials in 10 subjects who had started studying English at the age of 9-10 years. At the beginning of the block of 100 words, the subject heard an introductory sentence. Half of the words completed the sentence well and the other half did not. The subject pressed a reaction key immediately after hearing a proper word. After the control condition, the subject ingested alcohol (1 ml/kg). Alcohol attenuated the amplitude of N100 to both Finnish and English words, this attenuation being significantly stronger for English than for Finnish words. The early differential effect of alcohol suggests that language-specific information is extracted in the cortex already approximately 100 ms from the word onset. The results are in line with animal experiments demonstrating that alcohol selectively affects the activity of single units involved in newer forms of behavior.

Invasive microelectrode measurements have demonstrated binaural interaction effects of summation, occlusion, and suppression. Here we demonstrate these phenomena in humans using non-invasive long-latency cortical event-related potential (ERP) components N1 and mismatch negativity (MMN). Subjects were presented with monaural and binaural stimulus trains consisting of frequent standard stimuli and deviant stimuli deviating from the standard either in frequency, intensity, or duration. The binaural N1 was smaller than the monaural N1. MMN for the intensity change was larger with binaural than monaural stimulation, whereas for the frequency and duration change, the MMN amplitude remained unchanged. Thus, cortical binaural interactions reflected suppression in the N1, summation for the intensity MMN, and occlusion for the frequency and duration MMNs.

Previous studies have shown that a frequency change in a continuous tone elicits an NI type of ERP (event-related potential) component. It remained unclear, however, whether this response is a “genuine” N1 (onset detector response) or the mismatch negativity (MMN), a change-detector type of ERP response, elicited in previous studies by an infrequent change in a sequence of homogeneous stimuli. A further possibility is a nearly perfect overlap of the two types of ERP components. The advent of modern, high-resolution magnetometers has opened a new, powerful way to tackle such component-overlap problems. Subjects were presented with a continuous tone of 988 Hz which was occasionally increased to 1108 Hz for a period of 100 msec. The magnetic responses to this change consisted of two partially overlapping components with peaks separated by 30 msec. The earlier component was probably generated by neuronal populations of the auditory cortex corresponding to the supratemporal N1, whereas the later one, generated anteriorly and inferiorly to the first, probably reflects a mismatch process causing the magnetic equivalent of the electrical MMN.

Effects of selective attention on the auditory event-related potential were studied by delivering two tones in a rapid, randomized sequence. One of the tones was designated as relevant and the other as irrelevant, the subject's task being to discriminate occasional softer tones within the relevant tones. Relevant and irrelevant tones differed from each other either in location (left vs. right ear) or pitch (300 vs. 6000 Hz). In both conditions, relevant tones elicited a larger N1 deflection (peak latency about 120 ms) than did irrelevant tones. In contrast to the exogenous N1 elicited by unattended tones, the scalp distribution of this attentional “N1 effect” did not depend on the stimulated ear and, further, its amplitude was not affected by the frequency of attended tones. These results suggest that the present attention effect was caused, at least mainly, by an endogenous processing negativity rather than by an enhancement of exogenous N1 components.

The major intent of this study was to compare the role of stimulus repetitioon and change in the elicitation of the MMN, an ERP component specific to stimulus change, and N2b, usually partially overlapping the MMN when stimuli are attended. Event-related potentials were recorded in one set of conditions where subjects ignored the stimuli and read a book, and in another set of conditions where subjects counted stimuli designated as targets. Stimuli were delivered in 4 ways, the common feature between all these conditions being the occurrence of infrequent events at a probability of 0.20: (1) an oddball paradigm with 1 deviant, (2) an odddball paradigm with 2 deviants, each with a probability of 0.10, (3) a regular alternation of tones of 2 pitches where either of the 2 tones infrequently repeated (P=0.20), and (4) a random presentation of tones of 5 different pitches, where any of the 5 tones infrequently repeated (P=0.20). In the count conditions, the infrequent events were designated as targets. It was found that the MMN was elicited by stimulus change and not stimulus repetition in the ignore and count conditions, whereas the N2b was elicited by both stimulus changes and repetitions in the count conditions. It was also possible, in the count conditions, to disentangle the part of the late positive complex which is related to stimulus deviation and the part which is related to stimulus significance (target).

Event-related potentials (ERPs) were recorded in subjects receiving tones (left ear 300 Hz, right ear 6000 Hz) at a rapid rate and trying to detect occasional higher-pitched stimuli in a designated ear. ERPs to attended stimuli showed enhanced negative amplitudes whose topographical distribution differed from that of the exogeneous N1 component. Moreover, the latter was considerably larger for low than high tones, whereas the attention effect had similar amplitudes for the two tones. Consequently, the attention effect, even when perfectly coinciding in time with N1, does not seem to be caused by modulation of the exogeneous N1 but rather by a separate process activated by attention. This suggests that attention does not modulate initial stimulus representations in audition.

STUDIES of human auditory1–3 and somatosensory3 modalities have shown that there is an oscillatory response in the γ-band (at about 40 Hz) frequency which is elicited by either steady state1–3 or transient4 stimulation. The auditory 40-Hz response is generated at least partially in the auditory cortex4,5as a result of thalamocortical interaction6 and may serve perceptual integration7,8 and conscious perception9. A connection to selective attention has been implied in human10 and animal11 studies, although the evidence is inconclusive12. Moreover, fundamental differences between the human and animal 40-Hz responses13 prohibit generalization. Furthermore, most experiments have used steady-state stimulation during which the brain does not regain its resting state between stimuli as it does when transient stimulation is used14. Here we study the effect of selective attention on the auditory γ-band (40-Hz) transient response using subjects listening to tone pips presented in one ear while ignoring a concurrent sequence of tone pips in the other ear. The 40-Hz response was larger when subjects paid attention to stimuli rather than ignored them. This attention effect was most pronounced over the frontal and central scalp areas. Our results demonstrate a physiological correlate of selective attention in the 40-Hz transient response in humans.

Cortical activation in response to two types of auditory stimuli, constant-frequency tones and frequency glides, was studied by measuring the magnetic field outside the head using a whole-head 122-channel magnetometer. Both the magnetic N1m and sustained responses were located in the supratemporal plane of the primary auditory cortex. The sustained responses both to constant-frequency tones and frequency glides reflect tonotopic organization of the auditory cortex both in depth and direction, thus revealing the underlying neuroanatomical structure of the auditory cortex.

Our previous event-related brain potential (ERP) results suggest that during selective listening, relevant stimuli are selected for further processing by comparing each stimulus to an "attentional trace," a neuronal representation of the physical features of the relevant stimuli that distinguish them from the irrelevant stimuli. This comparison process is reflected by the early component of the processing negativity (PN), which is largest and longest to the relevant stimuli (perfectly matching with the trace). In the present study, the subjects selectively listened to designated tone stimuli which randomly appeared among irrelevant tones of a different pitch. The probability of relevant stimuli in a block was varied. The processing negativity elicited by relevant stimuli was smaller the less frequent they were. The results support the attentional-trace theory of selective attention, which proposes that, in addition to active maintenance, the trace also depends on the rate of sensory reinforcement provided by the relevant stimuli.

Previous studies using magnetoencephalographic (MEG) recordings have revealed neuronal populations responding to discrete auditory stimuli in the supratemporal cortex of the human brain. We used the novel whole-head magnetometer (Neuromag-122) to determine whether regions outside the auditory cortex are activated by auditory stimulation as well. In the present study we report evidence for activation of the parietal cortex of the human brain in response to auditory stimuli.

The neurophysiological basis of sensory memory was studied by measuring the magnetic counterpart (MMNm) of the mismatch negativity (MMN) with a whole-head 122-channel magnetometer. The MMNm is a response to a difference in the presented stimulus and a neuronal memory trace formed by repeated standard stimuli. This trace must contain information about the feature differing in the deviant. Keeping one feature (frequency) constant, we studied how other stimulus features affect the strength of the MMNm. The MMNm to a frequency change was weaker when the other features varied than when they were constant. This suggests that the MMNm to a frequency change is not independent of other stimulus features.