What Israeli policy can teach us about elective sex selection.

PIGD for gender selection for non medical reasons has been a subject of ethical, legal, and moral debate in many Western countries. This article discusses the background of elective sex selection, and highlights the impact of new technological developments on this dynamic discussion. The article published by Pessach et al., in this Journal, is an excellent study of Israeli health policy on non medically indicated preimplantation genetic screening for sex selection. In Israel, elective sex selection is prohibited, but exceptions can be made by application, for family balancing, and emotional and religious reasons. This review of a health policy over seven years is concordant with evolving views in many Western countries. The classic medical model for allowing sex selection for serious medical disorders may be too restrictive. There are different reasons that may be assessed in light of ethical criteria including a wider delineation of medical reasons, which may include emotional and psychological well being of the family, indirect medical reasons, as well as risk reduction for the following generations. The Israeli model may be a useful approach with wide application to reproductive health policies in many countries.

The neural processing of negative emotion postpartum: a preliminary study of amygdala function in postpartum depression.

While contemporary diagnostic nosology characterizes postpartum depression (PPD) as a specifier of a major depressive disorder (MDD), this classification continues to be questioned. Functional magnetic resonance imaging (fMRI) holds the promise of helping to characterize the neuroanatomical dysfunction associated with dysregulated emotion after childbirth. Twenty postpartum women underwent fMRI in the presence of emotionally valenced stimuli. The observation of relative amygdala non-responsivity in subjects demonstrating greater depression symptomotology stands in contrast to imaging studies of MDD and provides insight into possible phenotypic differences of PPD.

Neural dysfunction in postpartum depression: an fMRI pilot study.

INTRODUCTION: With approximately 4 million births each year in the United States, an estimated 760,000 women annually suffer from a clinically significant postpartum depressive illness. Yet even though the relationship between psychiatric disorders and the postpartum period has been documented since the time of Hippocrates, fewer than half of all these cases are recognized. OBJECTIVE: Because postpartum depression (PPD), the most common complication of childbearing, remains poorly characterized, and its etiology remains unclear, we attempted to address a critical gap in the mechanistic understanding of PPD by probing its systems-level neuropathophysiology, in the context of a specific neurobiological model of fronto-limbic-striatal function. METHODS: Using emotionally valenced word probes, with linguistic semantic specificity within an integrated functional magnetic resonance imaging (fMRI) protocol, we investigated emotional processing, behavioral regulation, and their interaction (functions of clinical relevance to PPD), in the context of fronto-limbic-striatal function. RESULTS: We observed attenuated activity in posterior orbitofrontal cortex for negative versus neutral stimuli with greater PPD symptomatology, increased amygdala activity in response to negative words in those without PPD symptomotology, and attenuated striatum activation to positive word conditions with greater PPD symptomotology. CONCLUSION: Identifying the functional neuroanatomical profile of brain systems involved in the regulation of emotion and behavior in the postpartum period will not only assist in determining whether the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnostic specifier of PPD has an associated, unique, functional neuroanatomical profile, but a neurobiological characterization in relation to asymptomatic (postpartum non-depressed) control subjects, will also increase our understanding of the affective disorder spectrum, shed additional light on the possible mechanism(s) responsible for PPD and provide a necessary foundation for the development of more targeted, biologically based diagnostic and therapeutic strategies for PPD.