How to prevent suicide     

 

      Suicidal behavior can occur due to a combination of existential reasons, biological vulnerabilities, and environmental factors. The existential reasons include lack of satisfaction with current life (health, finances, social importance), lack of hope for the future, and not being/feeling needed (especially by progeny and family). The biological vulnerabilities include mental health issues and addictions, including a genetic vulnerability to suicide as reflected in a family history of suicides among biological relatives. The environmental factors include increased stress and pain (physical and psychological), as well as cues that enable this behavior (previous attempts, knowing examples of other people who have done it, living in an environment and (sub-) culture where suicide is an option, seems attractive, and the means are available). 

      The opposites of each of the above items are protective. Individuals can have a mixture of risk factors and protective factors.

      A simple checklist of all these factors, tabulating risk factors and protective factors, along with improved objective biomarkers, should lead to very high levels of identification of individuals at risk, combining specificity with sensitivity of detection. This would permit preemptive intervention- changing and saving lives.

 

      We are working on that.

Trend of the Year 2013:

Genomics out, biochemistry in, for curing diseases?

Genomic variation and complexity are such that the genetic basis of most  human diseases is  going to require another decade or more to unravel completely, and even then it will be only partially explanatory, due to the profound role of the environment and of developmental history. Even when driver mutations are found and are targeted by a drug, the disease process may not be completely blocked, and alternative biological pathways may be recruited by the disease, as is the case in cancers.

However, diseases have key "vulnerabilities" at a metabolic and biochemical level that can be therapeutically attacked much sooner than that. Such metabolic targets are the result of the combinatoric integration of myriad mutations and environmental effects. For example, in psychiatry, the use of DHA (an omega-3 fatty acid), may correct membrane, signalling and inflammatory abnormalities that are responsible for vulnerability to stress, anxiety, mood and cognitive symptoms.

Genomics will still be important for scientific understanding in the long run, and for risk stratification and diagnostics in the short run.


Alexander B. Niculescu, III, MD, PhD