Psychiatry - August 2008 - (Page 33)

the early postpartum (Figures 1A–D). The responses in the amygdala in a first-time mother 2 to 4 weeks postpartum are in keeping with animal studies, supporting its importance in fear and arousal.44 Human imaging research supports the notion that the amygdala in humans, among other functions, serves in the detection of environmental threat45 and emotional vigilance.46 The basal ganglia have been implicated in obsessive thinking, and the frontal cortex is involved in planning. Thus, the involvement of amygdala, basal ganglia, and frontal areas could be interpreted to be part of an “own” baby-cry response circuitry that involves an alarm-like consideration of salience and fear of harm coming to the infant, activation of preoccupations to ensure that all considerations regarding the safety of the baby are reviewed, and planning to respond appropriately. Perhaps by 3 to 4 months postpartum (Figure 1B), the “own” baby-cry is less anxiety-provoking to a mother and more associated with responses in the hypothalamus and anterior cingulate—areas for hormonal regulation systems as well as emotional arousal. Data from one first-time father, unlike that of one first primiparous mother presented in Figures 1A and B, did not appear to show activations in the amygdala in response to own baby-cry, but instead showed activity in the anterior cingulate and visual areas in response to own baby-pictures (Figure 2A). It is interesting that in this subject, baby cry appears to be activating visual areas—perhaps involving visualization of the subject’s own baby. At 3 to 4 months postpartum (Figure 2B), additional activations are seen in medial frontal and parietal areas. Medial frontal activity (close to the anterior cingulate activity seen in the mother [Figure 1B]) in this experiment is consistent with number of studies for a range of emotional states.47 frontal cortex amygdala anterior cingulate FIGURE 1A. First-time mother, 2–4 weeks postpartum, own vs. other baby cry FIGURE 1B. First-time mother, 3–4 months postpartum, own vs. other baby cry amygdala, basal ganglia, cerebellum, frontal cortex hypothalamus, anterior cingulate anterior cingulate visual cortex parahippocampal FIGURE 2A. First-time father, 2–4 weeks postpartum, own vs. other baby cry medial frontal cortex parietal cortex FIGURE 2B. First-time father, 3–4 months postpartum, own vs. other baby cry anterior cinglate, visual, temporal/parahippocampal anterior and cingulate, medial frontal, parietal PARENTAL BRAIN MODEL Based on brain imaging of human parents and informed by animal work,41 the following rudimentary model is presented in Figure 3 in an attempt to begin to account for parenting behaviors with brain circuits. First, key parenting sensory signals, including cry, visuals as well as touch and smell , must be organized in sensory cortices, which appraise the input and interact with subcortical memory and motivation structures. With sufficient motivation, brain circuits are activated, that are designated as corticolimbic modules, that we have delineated as reflexive caring impulses, such as those studied in preclinical animal models and requiring little or no cortical input, such as licking, grooming, and nursing, in which the hypothalamus, MPOA, and other limbic and thalamocingulate circuits are of primary importance.48 In humans, this might be a caring endophenotype49 amenable to further study. In addition, cognitive circuits would be brought online, including those that regulate “mirroring,” empathy, planning and further cognitive flexibility, including the inferior frontal, insular, and superiortemporoparietal cortical regions. These regions might allow accurate modeling [AUGUST] Psychiatry 2008 33

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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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