Psychiatry - August 2008 - (Page 32)

reward and shut down avoidance circuits. Fisher and colleagues37,38 are also looking at brain activity of romantic love, which is perhaps related to parental love. Using picture stimuli, they have differentiated brain responses corresponding to “wanting” and “liking,” in which wanting was associated with dopaminergic circuits activations and involved medial frontal cortex. In addition, they found that length of relationship was related to cingulate and insular cortex activation. Nitschke and colleagues35 looked at primiparous mothers 2 to 4 months postpartum (n=6) responding to pictures of their own infants compared to age-matched control subjects. They reported bilateral orbitofrontal cortex activations, which were correlated with ratings of pleasant mood. These data point to the orbitofrontal cortex (OFC) as a center important for positive attachment of mother and child. Using photographs of older children (5–12 years old), Leibenluft and colleagues34 found that own versus other comparison in a sample of seven mothers activated amygdala, insula, and anterior paracingulate regions, which they interpreted as emotion and theory-of-mind regions relating to the ability to predict and explain other peoples’ behaviors. Using 40-second blocks of silent video of own versus other infants (4–8 months old) as stimuli for nine mothers, Ranote and colleagues39 reported activations in amygdala, temporal pole, and occipital regions. While gazing at 30-second blocks of own versus other infant photographs, both mothers and fathers 2 to 4 weeks postpartum activated a familiar set of regions, including brainstem, amygdala, basal ganglia, cingulate, and occipital cortices.26 Thinking about the contribution of the infant’s affect to maternal brain function prompted a recent study by Noriuchi and colleagues40 that used silent video clips of their 32 Psychiatry 2008 [ A U G U S T ] own and other infants in play or separation situations. First, they confirmed the increased activity, associated with recognizing own baby pictures, in certain brain regions, including cortical orbitofrontal, anterior insula, and precuneus cortical areas, as well as subcortical regions, including the periaqueductal gray and putamen. These are areas active in arousal and reward learning. Furthermore, they found strong and specific differential responses of mother’s brain to her own infant’s distress in substantia nigra, caudate nucleus, thalamus, posterior and superior temporal sulcus, anterior cingulate, dorsal regions of OFC, right inferior frontal gyrus, and dorsomedial prefrontal cortex. They interpreted OFC and related activations as part of circuits required for the execution of well-learned movements. This could also be interpreted as activation in emotion regulation and habitual behavioral response systems that are active in a range of normal and abnormal emotion-control states, including obsessive compulsive disorder.41 They also found correlations in OFC with own baby response and happiness as well as to their own distressed baby response in the superior temporal regions. This is consistent with the importance of these areas in social thoughts and behaviors. Indeed, it seems that movies and other more complex stimuli may be used to stimulate parents’ brains in ways that may be measured and combined with behavioral measures to better understand the functional architecture of parenting brain systems. Finally, Strathearn and colleagues have also been studying healthy mother-infant dyads using fMRI to examine maternal brain regions activated in response to visual infant facial cues of varying affect (smiling, neutral, and crying). They have completed a pilot study of eight healthy, righthanded mothers without a history of psychiatric impairment or child maltreatment along with their infants aged between 3 and 8 months. They assessed serum oxytocin levels sequentially from the mothers during a standardized period of mother-infant interaction, during which they acquired infants’ facial expression videotapes. Maternal brain activity was then assayed with fMRI in response to six-second exposures to the facial images of their own infants compared with familiar and unknown infant facial images.42 Areas of significant activation (uncorrected p<0.005) unique to own-infant viewing included brain reward areas with dopaminergic projections (ventral striatum, thalamus and nucleus accumbens), areas containing oxytocin projections (amygdala, bed nucleus of the stria terminalis, and hippocampus), the fusiform gyrus (involved in face processing), and bilateral hippocampi (involved in episodic memory processing). Further, a positive, but nonsignificant, trend in this small sample was seen in serum oxytocin concentrations before and after mother-infant interaction (prior to scanning), suggesting a possible correlation between brain activation and peripheral affiliative hormone production. A further study using crying infant faces as fMRI stimuli revealed bilateral activation of the anterior cingulate and insula.43 While our group/composite data is under review elsewhere, I would like to present some provocative single-subject data that will give the reader an impression of the kind of work that is underway in a number of laboratories around the world. Replication in groups with reliable statistics and across research groups over the coming years may confirm some of these findings. The results of an experiment on a single primiparous mother and father at two early postpartum time points are presented next and suggest some of the parental circuits important for response to baby stimuli and how they may shift in

Table of Contents Feed for the Digital Edition of Psychiatry - August 2008

Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

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