Impact News

Responding to Violence, Suicide, Psychosis and Trauma

The Dangerous Behaviour Masterclass 5 – Reading: Violence and Dissociation

Another reading, this time an excellent review of the literature on Violence and Dissociation by Andrew Moskowitz. In the following Masterclasses we will begin to explore how violence, dissociation and and understanding of brain function can come together to highlight effective de-escalation (and ineffective) strategies. Unusually, the full text, originally published in Trauma, Violence & Abuse (a review journal)/ January 2004, is available online at:

http://www.hawaii.edu/hivandaids/Dissociation_and_Violence__A_Review_of_the_Literature.pdfHappy reading!

Iain Bourne

 impact@dangerousbehaviour.com

www.dangerousbehaviour.com

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Filed under: Violence, , , , , , ,

The Dangerous Behaviour Masterclass 4 – Reading: The Biology of Violence

For this Masterclass, instead of continuing with my own discourse, I’d like you to read the following article taken from Neuropsychiatry Reviews, Vol .8, N0. 5, May 2007. Later on, I will expand upon how understanding the interplay between brain function and violence can highlight effective strategies for responding to imminent violence.

Does Biology Play a Role in Domestic Violence?

TUCSON—Between 20% and 30% of all men and women in the US will be victims of domestic violence in their lifetime. Domestic violence accounts for 20% of all emergency department visits, 50% of police calls, and about 30% of murdered women. While considerable research into understanding the perpetrator’s mindset has focused on learned behaviors and psychosocial issues, comparatively little effort has been devoted to exploring possible biological causes of the problem, according to David George, MD.

“Most people look at domestic violence from a psychodynamic/psychosocial perspective,” said Dr. George, Section Chief of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland. “These people believe that perpetrators feel inadequate and try to control other people by their behaviors or that they grew up in homes where they were exposed to violence, and, therefore, they’ve learned these patterns. I was particularly interested in the fact that there has been so little emphasis given to any biological understanding of what might be taking place.” Dr. George made his presentation at the 18th Annual Meeting of the American Neuropsychiatric Association.

The first step in determining whether biological abnormalities may lead to acts of domestic violence is to closely examine who the perpetrators are, according to Dr. George. The incidence of domestic violence is approximately equal in men and women, and about 70% of perpetrators abuse alcohol, he noted. Based on interviews with several hundred people who have committed acts of domestic violence, as well as their spouses and significant others, Dr. George has observed several recurring patterns. One of these patterns is that perpetrators are likely to have been in multiple fights during their childhood. “They are going to push their teachers,” noted Dr. George. “They fight with their siblings and with the kids down the street. As they grow older, most of them tend to limit their violence to the home and direct it toward their spouse or significant other.”

Perpetrators also have little insight into why they become violent, and most acts of domestic violence are impulsive, said Dr. George. “There are those with a predatory side, but I do not see it often. Alcohol plays an important role in domestic violence. Alcohol is a two-edged sword. Perpetrators are going to use alcohol to calm down, but often the alcohol contributes to the likelihood of violence.”

Typical behavioral symptoms in perpetrators include racing thoughts, supersensitivity to environmental stimuli, and mood swings that range from shutdown to flight, fight, and stalking. “I had one person tell me, ‘If you ever got in my mind, you would probably lock me up. You would think I was crazy.’ This is something that is going on inside of them,” said Dr. George. “Little things are going to set them off—spilled milk at the dinner table, dirty dishes that aren’t taken care of in the sink, the dinner that’s late. The most interesting thing was that they feel afraid at the time of the aggression. That was very difficult for me to comprehend, because so often we are working with large and aggressive perpetrators whose victims are smaller in stature. Fear just doesn’t look like it should be a significant factor.”

ANXIETY, PERSONALITY DISORDERS, AND SUBSTANCE ABUSE

Dr. George has conducted a number of studies regarding domestic violence. One trial included perpetrators of domestic violence with alcohol dependence, nonviolent alcoholics, and healthy controls. The researchers found that violent alcoholics had a higher incidence of major depression, panic attacks, social phobia, obsessive-compulsive disorder, generalized anxiety, and certain personality disorders than did nonviolent alcoholics.

In a double-blind, placebo-controlled trial involving the administration of sodium lactate to participants, Dr. George and colleagues found that behavioral symptoms such as speech, breathing, facial grimacing, and motor activity in the arms and legs were much more accentuated in the perpetrators, as was their sense of fear, panic, and rage, compared with nonviolent controls. “These results were instrumental in changing my thinking about perpetrators of domestic violence,” commented Dr. George. “It moved me from seeing them as offensive individuals to seeing them as defensive individuals. This was extremely important to me, because it directed my attention to the neuropathways that have been shown in animals to mediate defensive aggression.”

PSYCHOPATHOLOGY AND FEAR RESPONSE

Dr. George devised a basic model for understanding the psychopathology of perpetrators of domestic violence. “Perpetrators frequently misinterpret environmental stimuli, which gives rise to a perceived sense of threat,” he explained. “Sensory stimuli enter the thalamus, and from there are processed by both the cortex and the amygdala. The processing of the sensory stimuli in the amygdala is extremely fast and serves as an early warning system. The processing of the sensory stimuli in the cortex is going to be much slower and much more detailed than in the amygdala…. The cortex and the amygdala talk to each other. In certain situations, these sensory stimuli give rise to defensive behavior, autonomic arousal, and hypoalgesia…. If you talk to these people and ask them what it is like when they are hitting someone, they will tell you, ‘It feels like my hands and arms are like feathers. I have no feeling in my hands. I don’t feel as though I’m doing anything.’”

In formulating a theory for the etiology of domestic violence, Dr. George reasoned that threats trigger a conditioned fear response in perpetrators that is out of proportion to the stimulus, which may result in fear-induced aggression. “This misinterpretation arises from the abnormality in structures and pathways that mediate fear-induced aggression,” he said.

In a study using PET (18FDG) imaging to examine the neural structures and pathways involved in fear conditioning and fear-induced aggression, Dr. George’s group found that mean CMRglc in the right hypothalamus was significantly lower in perpetrators with alcohol dependence, compared with nonviolent alcoholics and healthy controls. “At rest, when you compare the activities in the left amygdala with various cortical and subcortical structures like the thalamus and cingulate, you see a strong correlation in the nonviolent alcoholics between these structures and the amygdala, whereas in the perpetrators, you had decreased correlations,” said Dr. George. “We are interpreting this to mean that the ability of the cortex to modulate the amygdala in these people is reduced. Similarly, we compared perpetrators with healthy controls. We found the same kind of finding here, decreased correlations [with the left and right amygdala]. And the nonviolent alcoholics had an increased correlation between the left thalamus and left posterior orbitofrontal cortex.”

Such findings may indicate different motivations to drink alcohol for nonviolent alcoholics and alcoholic perpetrators. “Basically, we arrived at two different possibilities,” Dr. George said. “The increased correlation found in nonviolent alcoholics maybe makes them more susceptible to environmental cues that trigger drinking. Whereas, I think alcoholic perpetrators are more prone, at least in the initial stages of the disease, to drink in order to decrease anxiety.”

In another study, Dr. George and colleagues performed lumbar puncture in the left lateral decubitus position in alcoholic perpetrators of domestic violence, nonalcoholic perpetrators, and healthy controls. The researchers found that the nonalcoholic violent group had lower 5-HIAA [5-hydroxyindoleacetic acid] concentrations than did the other two groups, which was “not particularly surprising, given the huge literature that’s out there saying that 5-HIAA is involved with impulsive types of aggression,” noted Dr. George. “It is unclear as to why the alcoholics didn’t have it. We then looked at testosterone, and there we found that [alcoholic perpetrators] did have higher levels of testosterone. So we have at least two neurotransmitter systems that theoretically could be involved, that could be modulating the way they process sensory information. We are looking at a number of other transmitter systems at this time.”

CAN DOMESTIC VIOLENCE BE TREATED?

Dr. George’s current research is focusing on fMRI, genotyping, and potential treatments. To date, he emphasized, “Treatments for domestic violence are often ineffective.” In one ongoing trial, he has been comparing fluoxetine with placebo regarding their effect on measures of aggression, anxiety, and depression in those who commit acts of domestic violence. “What is really interesting is when you look at what serotonin does, it modulates sensory information,” noted Dr. George.

Dr. George believes that it is possible to piece together some of these findings to understand domestic violence on the basis of a biological pathway. “This is such a primitive pathway,” he commented. “Defensive aggression is present throughout the whole animal kingdom and promotes survival. With reduced cortical connection to the amygdala, perpetrators process sensory information very quickly. Based on fMRI studies, this processing of sensory information by the amygdala is out of the conscious awareness. I think that’s why therapy has been so ineffective in these individuals. They are responding so quickly to sensory information that they don’t even have time to think about it.”

Ultimately, Dr. George believes that further studies linking conditioned fear and fear avoidance with behaviors and psychiatric diagnoses will help change the way researchers and clinicians perceive and treat perpetrators of domestic violence.           

—Colby Stong

Suggested Reading
Fils-Aime ML, Eckardt MJ, George DT, et al. Early-onset alcoholics have lower cerebrospinal fluid 5-hydroxyindoleacetic acid levels than late-onset alcoholics. Arch Gen Psychiatry. 1996;53:211-216.
George DT, Phillips MJ, Doty L, et al. A model linking biology, behavior and psychiatric diagnoses in perpetrators of domestic violence. Med Hypotheses. 2006;67:345-353.
George DT, Umhau JC, Phillips MJ, et al. Serotonin, testosterone and alcohol in the etiology of domestic violence. Psychiatry Res. 2001;104:27-37.
Umhau JC, Petrulis SG, Diaz R, Rawlings R, George DT. Blood glucose is correlated with cerebrospinal fluid neurotransmitter metabolites. Neuroendocrinology. 2003;78:339-343.

Filed under: Violence, , , , , ,

Smoking and Schizophrenia: Self-medication?

Recently on a Difficult, Disturbing and Dangerous Behaviour course I was asked about a comment I made regarding the self-medicating aspects of smoking among patients suffering from schizophrenia. I thought that the following from:

http://www.mentalhealthcare.org.uk/research/expanded/index.php?id=21

may be of interest.

Happy reading

Iain Bourne (impact@dangerousbehaviour.com)

www.dangerousbehaiour.com

Smoking in schizophrenia – an attempt to self medicate?

3rd November 2005 | schizophrenia and psychosis

Just over one quarter of the UK population are smokers. In people with schizophrenia the rate of smoking is thought to be between two and four times higher. In addition, smokers with schizophrenia smoke more cigarettes per day and smoke stronger brands than other smokers.

Various theories have been put forward as to why so many people with schizophrenia smoke. It is thought that nicotine acts as a form of ‘self-medication’ for people with schizophrenia, producing a number of beneficial effects despite the negative impact of smoking on long term health.

Dr Veena Kumari and colleagues from the Institute of Psychiatry investigated the self-medication theory, examining evidence from previous research studies. Their findings are described below.

Symptom reduction

Many smokers with schizophrenia report that smoking helps to reduce their symptoms. This has been confirmed by studies showing that smoking is related to a reduction in the negative symptoms of schizophrenia, such as lack of motivation and social withdrawal. It is thought that this effect is caused by nicotine’s ability to raise dopamine levels in areas of the brain involved in attention and engaging with one’s surroundings. Atypical antipsychotic drugs that produce a reduction in negative symptoms, including Clozapine, are thought to act in a similar way.

However, there is no evidence that nicotine has any effect on the positive symptoms of schizophrenia such as hallucinations and delusions and if nicotine is withdrawn from smokers with schizophrenia there is no increase in these symptoms.

Reduction of medication side effects

There is also evidence that smoking may reduce the unpleasant side effects of antipsychotic medication including stiffness and rigidity of movement. Again, this effect is though to be produced by the action of nicotine stimulating dopamine release in the brain.

Nicotine has also been found to counteract the adverse side-effects of certain antipsychotics on some kinds of mental function. A study of patients taking the drug haloperidol who were given nicotine skin patches found them to be less affected by side effects such as the slowing of thought and reduction of attention span.

Improvements in attention and working memory

The areas of the brain thought to be involved in working memory, attention span and motivation have large numbers of receptors for the nicotine molecule. Experiments have shown that nicotine improves these functions both in smokers with schizophrenia and non smoking people with no mental illness. However, in general, people with schizophrenia show greater improvements than the general population. This suggests that there may be genetic differences that determine the extent to which a person will be affected by the effects of nicotine.

Given the negative effects of smoking on health, including greatly increased risk of heart disease and cancer, Dr Kumari believes there is an urgent need for treatments that provide the benefits of nicotine without the risks to long term health. Drugs are being developed that have a similar action to nicotine but these have not yet been tested on people with schizophrenia. Dr Kumari predicts that when these new treatments are available they will not only provide a valuable new way of treating the illness but also offer an alternative for the many people with schizophrenia who put their health at risk by smoking.

Filed under: Impact Training, psychosis, , ,

Difficult, Disturbing and Dangerous Behaviour Courses in Brighton

Individual places are available on the Difficult, Disturbing and Dangerous Behaviour course facilitated by Dr Iain Bourne on the following dates:

11 June 2008

6 November 2008

28 April 2009

 These courses are being organised by ROCC (www.rocc.org.uk). Enquiries should go to training@rocc.org.uk or you can download an application form at http://www.rocc.org.uk/static/documents/TrainingBookingForm.pdf. If you are interested in commissioning this course for your organisation or group please contact Iain Bourne (impact@dangerousbehaviour.com) or visit www.dangerousbehaviour.com

Filed under: Impact Training, Violence, , , , , , , , ,

Difficult, Disturbing and Dangerous Behaviour Courses in Southampton

Individual places are available on the Difficult, Disturbing and Dangerous Behaviour course facilitated by Dr Iain Bourne on the following dates:

21 May 2008

2 October 2008

23 April 2009

 These courses are being organised by ROCC (www.rocc.org.uk). Enquiries should go to training@rocc.org.uk or you can download an application form at http://www.rocc.org.uk/static/documents/TrainingBookingForm.pdf. If you are interested in commissioning this course for your organisation or group please contact Iain Bourne (impact@dangerousbehaviour.com) or visit www.dangerousbehaviour.com  

Filed under: Impact Training, Violence, , , , , ,

Werther Effect and Bridgend Suicides

By Jeremy Laurance, Health Editor, Independent Newspaper
Wednesday, 20 February 2008

One question considered by the special task force of police, health and social services set up in Bridgend to review the spate of suicides is whether they are examples of the “Werther effect”, the name given to suicide clusters after the title of a novel by Goethe.

The Sorrow of Young Werther is the story of a young artist who shoots himself after an ill-fated love affair. Following its publication in 1774 there was a series of reports of young men who took their own lives in the same way, which led to the book being banned.

The copycat element in suicide is a well recognised phenomenon. The victims tend to come from similar backgrounds and are at greatest risk if they know other victims. In Bridgend, the Werther effect is thought to have been amplified by messages posted on internet sites such as Bebo, intended as tributes to the victims but which have instead romanticised the manner of their deaths.

Professor David Gunnell, an expert on suicide at Bristol University, said: “Young people are more likely to see and read items concerning suicide on the internet than in the newspapers… A medium like Bebo will have an impact on suicidal behaviour.”

In some countries, such as Norway, reporting of suicide is virtually banned – its journalism code says it should “in general never be given any mention”. In the UK, the Press Complaints Commission amended its guidance in 2006 to editors to avoid “excessive detail about the method”.

The Samaritans, which provides support to people with suicidal feelings, says that to reduce the risk of copycat deaths, suicides should not be romanticised, permanent memorials should be discouraged, suicide notes should not be disclosed and excessive detail should be avoided.

Filed under: Suicide, , , ,

The Dangerous Behaviour Masterclass 3 – Mapping Violence

Sorry for the delay. In the last Masterclass a distinction was made between Difficult and Dangerous behaviour. We have to go into this in greater depth, but at this point in the Masterclass we are simply in the process of mapping out the terrain and identifying important processes and principles. In this mapping process, one dimension can be “dangerousness” while another might be “form.” There are some others, but at this stage let’s just think one step ahead. “Form” describes the type of behaviours involved.

Typically on training courses participants express a concern about a form of behaviour or type of person(s). “What if they are drunk”, “I deal with addicts”, ” I’m really concerned about a stalker”, “Well that’s okay, but what if you’re surrounded by a gang of thugs”, “I can deal with most situations, but what if they are completely crazy?”, “What if someone is completely on a mission to do you some harm?” – and then the additional concern “What if I lose it (panic, freeze, react inappropriately, lose control of myself)?”

All these situations, and more will be dealt with in this Masterclass. Here we will briefly consider “Form” or the perceived type of behaviour with which we might be confronted. I say “perceived” because there is an extremely complex interplay between what goes on in the minds of the protagonists during a conflictual situation – again an issue to which we return.

If Difficult-Dangerous is the “depth” dimension, then what is the breadth? This is the more common arena for academics and there are many formulations to choose from. I choose to go my own way, not out of arrogance but because I arrive at the situation from a different position. I want to know what to do when confronted with all these frightening situations not just to explain them.

For this reason, I see violence as something in motion, and therefore something must be pushing it forward. What could be these “forces?” None of us would worry if they were were static – I could be supremely confident if I knew the person in front of me wouldn’t hit me. The next question, obviously, is then what pushes the behaviour into violence. I have thought about this – motives, drivers, incentives, urges, impulses – actually, in most cases we will never know.

None-the-less, in-practice, it turns out to be very helpful to be able to assess what is driving the aggressor’s behaviour – but a different language is necessary. Here I am suggesting that we label aberrant behaviour as either: Dysphoric, Psychotic or Psychopathic. These are not mutually exclusive – obviously someone could, for example, be impassioned through a delusional belief system. The important practical question is – what is is driving the behaviour? If, somehow, we could remove the driving force, perhaps the behaviour would lessen?

These driving forces, I have briefly described below (their intricacies we will explore later)

DYSPHORIC BEHAVIOUR
This is the most common form most people will encounter. It is fueled or driven by emotion (usually unpleasant and several). It happens because the principal prontagonistics are overcomed by anger, frustration, humiliation, annoyance, irritation, euphoria, etc – and these overide thoughts or other considerations.
PSYCHOTIC BEHAVIOUR
Mental health issues affect one in four of us. It is important to notice also that 80% of violent crime is perpetrated by people with no psychiatric history – alcohol is by far the best predictor of violence. Most psychiatric patients are more worried about what others may do to them than what they may do to others. None-the-less, violence does occur when people become disturbed though drugs, severe intoxication or florid psychosis – and here it is often the fear of the unknown rather than the actual danger that fuels our concerns. The driving factors are confusion, delirium, delusions, hallucinations. Each may be associated by terrifying and potentially violent outcomes, but the question we have to ask is “what is the driving force?” For example, what would be most effective – dealing with the “voices” or reducing the anxiety?
PSYCHOPATHIC BEHAVIOUR
This is behaviour primarily driven by a goal which in the perpetrator’s mind supercedes all other consequences. Often professional criminal activity is ascribed to this grouping. It is important to understand that we are not talking categories of people here, only of behaviour. I don’t suspect that Wayne Rooney considers the feelings of the opposition’s goalie as he slams the ball into the net! This behaviour is primarily predatory but could equally apply to white collar business people and not involve any interpersonal violence.

There is still much more to know! In the next Masterclass we will explore the relation between Dissociation and Violence, and then following that Violence, Dissociation and the Brain. Then we can begin to put the whole picture together again and describe, in detail, good effective practice in violent dyadic situations. From there we will consider issues such as gang/group/ violence, bullying, crisis teamwork skills, personal control issues, post-incident reactions and support – interspersed with with anything interesting and relevant I can throw at you!

Hasta la vista!
Dr Iain Bourne
IMPACT Training & Consultation Ltd
E-mail: impact@dangerousbehaviour.com
Web: http://www.dangerousbehaviour.com

Filed under: Impact Training, psychosis, Uncategorized, Violence, , , , , , , , , , , , ,

(Interview) The Neurobiology of Suicide, by Dr. John Mann of Austral

For those interested in the whole interview, there is a link to the whole transcript at the end.

 

Iain Bourne

www.dangerousbehaviour.com

E: impact@dangerousbehaviour.com

Natasha Mitchell: You’re with ABC Radio National across Australia. This is All in the mind, I’m Natasha Mitchell, going global on Radio Australia and as podcast.

So let’s come back to Professor John Mann and his efforts to unravel why some deeply depressed souls take their lives, and yet others hold back. Your individual circumstances, social supports, sense of self, are all obviously crucial factors but do clues lie in our neurobiology as well?

. Natasha Mitchell: You’ve been focused on this area for perhaps 20 years now, and I imagine that looking at the biological underpinnings of suicide would have been a sort of novel way to approach the problem of suicide at the time.

– John Mann: Suicide was traditionally regarded very much as a kind of consequence of social factors. Émile Durkheim in France, in fact many others before him, had noticed the relationship of suicide to social changes involving people having been alienated from society and isolated and so on. But relatively recently it became more apparent that suicide was in fact related to major psychiatric disorders.

This was done through psychological autopsies: that is, interviewing the families of people who had been unfortunate enough to die by suicide. It turned out that over 90 per cent of all suicides had a psychiatric disorder.

There was a spate of youth suicide that began in the United States in the 1980s and a little later began to appear in other countries, including Australia, where it became the leading cause of death amongst young people.

And, at first, one had the impression that these were well adjusted, popular young individuals who had everything to look forward to in life and their suicide was a complete mystery. One had a sense that this was a shock to everybody.

But in fact a careful interview by a professional revealed that in fact over 90 per cent of these young people had a psychiatric illness that antedated the suicide. It was almost certainly the principle cause of their suicide, and most of them are not treated at the time when they’re committing suicide.

. Natasha Mitchell: Key to this, John Mann, though, is that we don’t see all people who experience major depression committing suicide.

– John Mann: Yes, that’s been an enormous challenge to clinicians and society. Most people who have these mood disorders never attempt suicide, let alone commit suicide. So the big challenge is trying to—

. Natasha Mitchell: They might think about it, but they may not actually carry through.

– John Mann: That’s true. They may have suicidal ideation—
they have thoughts that life is not worth living—but only a proportion of them have some kind of predisposition which causes them to be more likely to act on those feelings.

. Natasha Mitchell: In order to really get into the neurobiology of suicide—that underpins suicide potentially—you’ve had to do post-mortem biopsies of brains of people who have died. That’s pretty grisly work. What do the families say when you’re requesting permission pretty soon after a person’s taken their own life?

– John Mann: Well the autopsy’s going to be done anyway, in order to determine the cause of death. And obviously we never request permission from anybody’s family to have some brain tissue unless the coroner or the medical examiner is going to do an autopsy anyway.

Even when they’re asked, as we have to ask them, the organ has to be as fresh and as intact as possible, but these families in the height of their distress deserve an enormous amount of credit because they are very altruistic and they see it right away.

. Natasha Mitchell: Let’s climb into the brain of someone who has committed suicide. And it feels quite strange to do this, in a sense, to think of suicide from a chemical point of view, but a key neurotransmitter or brain chemical that you’ve focused your attention on is serotonin. People will be familiar with serotonin because it’s also targeted by anti-depressants.

– John Mann: Yes, it really isn’t as mysterious as it sounds. Every time we have a thought, or a good idea, or a feeling, or an impulse, the brain is involved. The brain is the machinery, and feeling suicidal is just a very sad and terrible feeling that’s most commonly associated with being depressed or having a depressive illness.

Serotonin actually plays a role in many aspects of our lives and functioning. It forms part of the chemical transmission mechanism of the brain, how one neurone talks to another neurone. It’s involved in the modulation of mood, but it also has important functions in memory, anxiety, sexual drive, appetite, sleep.

It also has been shown to be abnormal in many psychiatric disorders, including depression, bipolar disorder, anxiety disorders, schizophrenia, Alzheimer’s disease. How can it do so many different things in those different psychiatric disorders?

Well, they don’t all involve the same part of the brain and so the serotonin input to those different areas is important. Now, suicidal behaviour actually involves a very small part of the brain in the prefrontal cortex, which is at the front of the brain—

. Natasha Mitchell: Which is our sort of executive brain, it kind of co-ordinates our decisions and our actions?

– John Mann: It is where we make executive decisions, but also [has] other decision making components. So, whether or not to act on powerful feelings, to act impulsively, these are all determined by parts of the prefrontal cortex.

The predisposition to suicide involves a very focal abnormality in the serotonin system, which is located in the decision-making part of the brain; the part of the brain that is involved in determining how impulsive or how deliberate we are about decisions. There’s a casino right next door to this convention centre where this conference is taking place and there are a lot of people there who have trouble with impulse control.

. Natasha Mitchell: Low serotonin?

– John Mann: Low serotonin in the wrong place.

. Natasha Mitchell: And a compounding factor for struggling teenagers could well be that this prefrontal cortex, so key in impulse control, is really only fully developed by our early twenties, it turns out.

Might this contribute to suicide rates amongst young people? For all of us, John Mann’s suggestion is that impulse control lies at the heart of a person’s decision to take their own life.

– John Mann: The story with suicidal behaviour is that, in a particular area of the brain, this decision making area of the brain, they’ve got low serotonin function. So that if they get depressed and they feel suicidal, or if they get angry and they want to hit somebody, they are more likely to do it.

. Natasha Mitchell: You have found interesting linkages in this whole discussion between aggression, suicide and serotonin haven’t you?

– John Mann: Yes, we’ve actually found that lifetime aggressive behaviours are proportional in their severity to how low the serotonin system is as a kind of background biochemical trait. You can predict future aggression as well.

The same with suicidal behaviour—the more lethal the suicidal behaviour, the lower the background serotonin biochemical trait. And you can also predict future suicide by this biochemical trait. We’ve done two types of studies.

One is involved in interviewing the families of people who have died of suicide and getting a lot of information from those families. We’ve also been studying live people. We examine the brain directly using brain scans and we examine serotonin function somewhat indirectly by looking at spinal fluid levels.

And when it’s low, it increases the risk of future suicide in people who have a mood disorder of some sort. That actually has proven to be one of the best predictors of future risk. We eventually think that’ll be replaced by the brain scans. When you just measure a single biochemical sample in the spinal fluid, you’ve got no idea where in the brain is the origin of an altered level.

. Natasha Mitchell: John Mann, what you’re talking about is incredibly powerful science, socially powerful science here. Because if you’re talking about developing a genetic and biochemical picture of a brain from birth that predicts that someone might be at greater risk of major depression and, even more significantly, at greater risk of suicide at some later stage in their life, it’s a very powerful sort of set of conclusions to make about someone and their biology.

– John Mann: Well what it really boils down to is that we know that mood disorders are transmitted familially and that suicidal behaviour, its predisposition, is transmitted familially.

People don’t commit suicide when they’re not ill; they do it when they’re ill. So knowing who is at risk is potentially powerful and valuable, because there may be ways of preventing the development or manifestation of the mood disorder.

. Natasha Mitchell: This conversation, though, about preventing the manifestation of, say, a major depression or suicidal thoughts from a very early stage, even before they’ve ever first appeared in a person, that has some fairly complicated dimensions.

What do you do? Do you sort of ascertain whether a child is at risk and then intervene before they’ve had the opportunity to feel depressed?

– John Mann: Well obviously we’re not doing that. And this comes up in the clinic, in a clinical situation all the time. The patient comes to see you and they’ve got a parent, and maybe a grandparent, that’s committed suicide.

And they’ve felt very suicidal and they have a severe mood disorder and you treat them and they get better. The next thing you know is that their teenage child is worrying them, because a teenage child is talking about feeling suicidal and depressed.

So they then want to know, have they transmitted the predisposition for suicidal behaviour and the mood disorder to their child? You know, ‘Doctor, can you see my kid and make an evaluation?’ So we are already clinically confronted with these types of challenges.

No-one is going as far as actually treating perfectly normal-looking kids and trying to make evaluations. But what we’re doing is we are keeping a lookout for the early manifestation that may indicate that these kids are at risk and warrant intervention.

You have to remember that bipolar disorder on average takes about 9 or 10 years to be diagnosed for a lot of people, and on average, people who are going to commit suicide with a bipolar disorder do so 8 years after the illness starts—which explains why most people kill themselves before they get any treatment.

We’re certainly not talking about, at this point, starting before a person gets sick. But we can do a better job in the early phase of the illness when things look more ambiguous.

Natasha Mitchell: Professor John Mann, who’s vice-chairman for research in psychiatry at Columbia University and

http://www.abc.net.au/rn/allinthemind/stories/2008/2096877.htm#transcript

Filed under: Suicide, ,

Suicide rates for young men fall

By Jeremy Laurance, Health Editor
Friday, 15 February 2008

Suicide rates in young men have fallen to their lowest level since the 1970s, marking the end of a three-decade long rise.

In young women, suicide rates have been in steady decline for the past 40 years and are now at their lowest level since 1968.

The overall downward trajectory stands in defiance of claims that young people are suffering intolerable levels of stress from the pressures of modern life.

It suggests that those aged 15 to 34 are either happier than previous generations, or better equipped to withstand the pressures – despite increasing drink and drug use, rising obesity, higher levels of sexually transmitted disease and a more competitive, acquisitive and celebrity-obsessed culture. Or it may be they have found it harder to kill themselves, because new measures have put some suicide methods beyond reach.

During the 1980s, Britain experienced an “epidemic” rise of suicide in young men, coinciding with a huge increase in unemployment under the government of Margaret Thatcher. Male school leavers who found themselves jobless faced a bleak future which pushed some to the wall.

At the same time, rising divorce rates took a heavy toll on some men who found themselves homeless after splitting from partners. During the 1990s, suicide rates in males aged 15 to 24 reached an all-time high and the rate among those aged 25 to 34 reached its highest level since the 1920s.

All industrial nations experienced a similar rise in suicides among young men over the same period, which still remains at least partly unexplained. Although young women were more likely to attempt suicide, usually by overdosing on pills, men were more likely to succeed.

A new analysis of the figures, by scientists at the University of Bristol, shows the trend was rightly called an “epidemic” because, by the 1990s, suicide accounted for a fifth of all deaths in young men – and men aged 25 to 34 had the highest suicide rate of all age groups in both sexes. “Such trends have led to suicide becoming a major contributor to premature mortality and are thought to indicate deteriorating mental health in younger people,” the authors say in the British Medical Journal.

Since the 1990s, the rates have come down dramatically – by half among 15- to 34-year-olds, from a rate of 16.6 per 100,000 in 1990 to 8.5 per 100,000 in 2005. Among men aged 25 to 34, the rate declined from 22.2 per 100,000 to 15.7 over the same period. Removing access to a method is one of the most effective ways of reducing suicide because the act is often impulsive. The introduction of catalytic converters, which were made mandatory for new vehicles in 1992, has almost eliminated one of the most popular suicide methods. Motor gas deaths, in which a hose is run from the exhaust into the car, fell from 508 in 1979 to 219 in 2005.

Other measures that have helped cut the rate include reducing pack sizes of paractamol for sale in supermarkets to a maximum of 16, which has reduced deliberate overdoses, and the deployment of volunteer patrols and safety gear such as nets and barriers at suicide hot spots such as the Clifton suspension bridge in Bristol and Beachy Head, Sussex.

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Difficult, Disturbing and Dangerous Behaviour Course in Brighton

ROCC are organising a “Difficult, Disrturbing and Dangerous Behaviour” course led by Dr Iain Bourne in Brighton on 11thh June 2008. If you are interested attending please contact Helen Brafield (helen.brafield@rocc.org.uk) or go to their website www.rocc.org.uk.  

www.dangerousbehaviour.com

Filed under: Impact Training, Violence, , , , , ,