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Expert to talk about suicide risk

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jn01_jd_09oct_oquendoSome day, a brain scan might be able to sound the alarm that someone is likely to kill themselves.

Emphasize “some day” and “might.”

While suicide screenings today rely primarily on a behavioral checklist, scientists are uncovering intriguing new information about what is happening in the brain of someone at higher than normal risk of ending his or her own life.

Dr. Maria A. Oquendo, professor and vice-chair of the psychiatry department at Columbia University, will discuss those findings and other aspects of suicide in a lecture, one of the activities planned for Mental Illness Awareness Week.

Other activities include a performance of Minds Interrupted at 7 p.m. today at the Lensic; a presentation by Santa Fe Doorways at 11:45 a.m. Thursday at the Unitarian Universalist Church; and an Inside Out art exhibition and fundraiser, with an opening reception at 5-7 p.m. Thursday at El Museo Cultural de Santa Fe and the exhibit on view through Sunday.

As part of the University of New Mexico’s IDEAS in Psychiatry program, which brings in nationally recognized speakers on mental health, Oquendo will talk about “Suicide: Risk Factors and Strategies for Prevention” at 6 p.m. Friday at the CCA Cinematheque in Santa Fe.

While the program has been active in Albuquerque for some time, this is its first foray outside the Duke City.

“We’ve had such success with IDEAS in Albuquerque, we thought it was time to expand our programming to Santa Fe,” said Dr. Mauricio Tohen, chairman of UNM’s Department of Psychiatry, in a news release.

About 950 people turned out for a past talk by former First Lady Rosalynn Carter, while about 500 came out for a talk by Kay Redfield Jamison, an author and psychiatrist who has bipolar disorder, according to Pari Noskin, the program manager for IDEAS.

“That shows how hungry people are for information,” she said. “We have great speakers … who can reach northern New Mexico with a message that is important.”

One of those messages, Oquendo said in a telephone interview, is that, while many people think of suicide as a response to a catastrophic event, it more often is part of an underlying psychiatric condition.

“When we study brains, there are interesting differences between those who are depressed but not suicidal,” and those who are, she said.

One of those differences is linked to fight-or-flight response, which is ignited by stress or danger, but rarely turns off in some people.

The function of serotonin, a calming hormone, in that system appears to be “quite abnormal” in suicidal people, Oquendo said.

That also appears to be connected to an impulsive-aggressive nature shown by some suicidal people, she said.

But not everyone is in that group, she added. Another suicidal type might be a very controlled, perfectionist person – the ones about which loved ones might say they never indicated anything was wrong, she said.

“They don’t like to show they feel out of control,” Oquendo said.

What shows up in brain scans often is the result of an interplay of genetics and environment, she said. Both nature and nurture affect how a person develops, even to the point of changes in body chemistry that determine which genes may be silent and which become active.

Oquendo has taken a look at cultural factors in mental health, particularly among Hispanics.

Research has shown interesting variations among the sub-groups, with Mexican-Americans showing the numbers of suicide attempts or completions very low in relation to levels of depression, with Cuban-Americans in the middle and Puerto Rican-Americans showing the highest numbers.

Also, she said, research primarily among Mexican-Americans shows that the younger an individual is upon arrival in the United States, the more likely that person is to “develop all sorts of psycho-pathologies,” from suicide to addictions, she said.

No suicide test

Adversity early in childhood, such as physical, emotional or sexual abuse, as well as concerns about adequate food and safety, are related to suicide later in life, Oquendo said. And the earlier the adversity hits a child in life, the more intense later suicidal planning appears to be, she said.

Despite these advances, there’s still no test to show if a person is planning suicide or not.

“That’s one of the things we’re desperately looking for,” Oquendo said. “We need to identify predictors … we don’t have a blood test or a brain scan.”

Instead, physicians and others might need to review a number of factors, she said. “Maybe measures of aggression, insomnia, serotonin receptors in the brain … .” That serotonin test costs $1,500, she added.

Functional magnetic resonance imaging can trace how the brain is working when a person is performing a test while ignoring distractions – a classic example is when a word such as “red” is shown in yellow print and the person has to ignore the word to quickly identify the color of the letters.

An inability to ignore such a distraction also seems tied to a bent toward suicide, Oquendo said.

People with blood markers indicating inflammation and low levels of omega-3 fatty acids also show a higher risk for suicide, she said.

Inflammation can indicate both chronic stress and an infection, Oquendo said. And omega-3 fatty acids are important in neuronal development.

Until a better test can be found, though, parents worried about suicide risk in their children, for example, still face the classic questions: Does the child lack friends? Have there been changes in appetite, sleep patterns or appearance? Has schoolwork slipped? Has she or he started making despondent comments?

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