RICHARD CAMMARATA called his mother in the middle of the night and said he wanted to die.

He was 22 years old, a graduate of Longwood High School, a music student at Suffolk Community College. He had been diagnosed with manic-depression years earlier and had been in and out of hospitals for almost a decade.

On this night in April 2000, he said the pain inside his mind was so great that he couldn't take it any longer.

His mother, Kathleen, tried to get him help. She made an appointment with the psychiatrist Richard had been seeing for several years, and Richard kept the appointment.

But three days later he purchased a handgun. And, sitting in the rear parking lot of a Dunkin' Donuts in New Jersey, blocks away from his sister's house where he'd been visiting, he aimed it at his head and ended his life.

Richard's suicide is one of an estimated 30,000 in this country every year, almost 5,000 of them last year, according to the U.S. Centers for Disease Control and Prevention, committed by teens and young adults aged 15 to 24. Some experts consider those totals an underestimate. About half a million more attempt suicide. It's a public health problem that became the target of a campaign launched last year by Surgeon General David Satcher. "Many suicides are preventable," Satcher said last week. "One of the major prevention strategies is to have better access to mental health care."

Suicide has psychological and biological underpinnings that the psychiatric profession is still trying to understand.

Predicting who will attempt or complete suicide has been the work of many scientists, and new findings suggest that there may be ways to detect susceptibility and then develop ways to circumvent these tragic events. Indeed, researchers at Columbia University College of Physicians and Surgeons, including suicide experts Dr. David Shafer and psychologist Madelyn Gould, have gone beyond their laboratories and into the schools with intriguing tools to identify and deliver treatment to young people considered at risk.

And studies conducted on elderly people who commit suicide - an estimated 6,000 people over 65 a year - suggest a physiological condition in their brains may play a role. Autopsy studies show more evidence of what are known as neurofibillary tangles in the region called the hippocampus - twice the amount found in people who died of natural illness.

In still other studies, investigators have learned that about 20 percent of teenagers say they have thought about ending their life, according to surveys conducted by the CDC. These same surveys found that 10 percent of teens make an attempt, from doubling an aspirin dose to slashing wrists. Shafer said he believes suicide could be prevented if vulnerable children could be be identified and provided with the right therapy. It was with this goal in mind that the Columbia group created Teen Screen.

The screening program gives teenagers a short test that identifies signs of depression or anxiety. When the answers suggest a problem, a student fills out a more extensive questionnaire that helps the doctors assess how high the suicide risk is. Parents are then notified and, with their consent, psychiatric or medical treatment begins.

During the screening last year, they identified one boy who had swallowed a powdered drain cleaner and almost died of liver damage. Another teen was depressed but showed no outward clues. Leslie Craft, director of the Columbia program, said she recently received an e-mail from one teenager who received treatment. "I would not be alive today if not for your program," the e-mail said.

Gould also has been collaborating with the medical examiner's offices in Suffolk and Westchester counties in an effort to administer the screening tests to more students. In the past few years, the Columbia University researchers accumulated "psychological autopsies" on 50 Long Island teenagers, and the team has been allowed into a handful of schools to interview teens and administer the screening.

Gould and her colleagues also are conducting a nationwide study of suicide clusters, in which more than one death occurs at a school within a few months. And a number of studies are under way to evaluate prevention and treatment programs. While it is clear that reducing symptoms of emotional illness or distress reduces the risk of suicide, scientists don't know just how successful various treatments are.

"There are a thousand roads to suicide," said Kay Redfield Jamison, an authority on manic-depression and author of the book "Night Falls Fast: Understanding Suicide." She says 95 percent of people who commit suicide suffer from a serious mental illness that, if treated, could significantly reduce the risk of death.

"If we were aggressive enough to treat mental illness, we could have a real impact on lowering the suicide rate," she said in a recent interview. Indeed, this rate overlaps with the first signs of the most severe forms of mental illness, which generally strike in the late teens and young adulthood, Jamison added.

Interestingly, one of the problems in understanding suicide has been that until now there's been little research into the effects of treatment on this at-risk population. In testing new medicines designed to treat severe mental illness, for example, pharmaceutical companies have generally avoided using patients actually considered at risk for suicide.

But in one recent drug trial, of an antipsychotic medicine called Clozaril, people were enlisted who had expressed suicidal thoughts. Clozaril had been used to treat schizophrenia, and Vanderbilt University's Dr. Herbert Meltzer had noticed that his patients had fewer thoughts of suicide. He thought the drug might have unique effects on the brains of at-risk people.

So in recent years scientists at 40 medical centers have enrolled 900 schizophrenic patients who have shown a tendency to suicidal thoughts or acts. Clozaril was given to one group of patients, and another antipsychotic was given to the second. Novartis, which makes Clozaril, is currently analyzing results to submit to the FDA.

"It's a novel strategy," said Jane Pearson, chairman of the National Institute of Mental Health's suicide research consortium. "These are trials that need to be done."

To date, "nothing has been scientifically proven to prevent suicide," Pearson added. Jamison said that lithium, a treatment for patients with manic-depression, does seem to lower their risk of suicide significantly.

One recent study examined FDA files to see whether mentally ill patients enrolled in a clinical test of three popular antipsychotic drugs were at an increased risk of suicide.

In the study, published this month in the American Journal of Psychiatry, Dr. Arif Kahn, director of the Northwest Clinical Research Center in Bellevue, Wash., found no difference in the suicide rate between those on medicines and those on a placebo, but the incidence of suicide among these mentally ill patients during the study periods was 60 to 70 times higher than federal suicide statistics have previously suggested for the general population.

Of 10,000 patients whose records were studied, 26 committed suicide: 22 while receiving a new antipsychotic, three on a traditional antipsychotic and one on a placebo. There were also 51 suicide attempts, including one by a person in the placebo group.

Those numbers were surprisingly high, Kahn said.

The CDC estimates that 11 people per 100,000 kill themselves. Kahn said these studies lasted six weeks on average; projecting their suicide rates over a year would mean 680 per 100,000. Suicide attempts were also 10 times higher than expected. Suicide is "unusally high" in central nervous system drug trials of the mentally ill, Kahn said, adding that the FDA has recently hired a research scientist to analyze the findings.

Researchers are also convinced that genetics plays a role in suicide. Several are measuring levels of serotonin, the brain chemical that regulates mood and behavior, in family members after Columbia researchers found that men who died of violent suicide had low levels of a c serotonin metabolite called 5-HIAA. Studies in Dr. J. John Mann's Columbia lab have revealed that serotonin gene expression was down 40 to 50 percent in those who committed suicide. Some researchers have suggested that people who kill themselves are more impulsive, a result of the lowered serotonin. Mann said he believes that people who commit suicide are missing key serotonin receptors.

Newer studies suggest that the key isn't necessarily impulsivity but more likely hostility and aggression, also regulated by serotonin, according to Dr. Alec Roy, a staff psychiatrist at the University of Medicine and Dentistry-New Jersey Medical School. Roy has studied twins and adoptees who have attempted or completed suicide and concluded that suicide is the result of many forces.

"There are genes that predispose, childhood trauma, personality and stress that come together into the final act of self-destruction," he said in an interview. In last month's American Journal of Psychiatry, he outlined his theory and the ways scientists are trying to put these puzzle pieces together to make better predictions on who is at risk.

Statistics suggest that people over 65 are even more vulnerable to suicide than teenagers. Dr. Yeates Conwell, a professor of psychiatry and co-director of the University of Rochester Center for the Study and Prevention of Suicide, is trying to tailor interventions to older Americans. Dealing with the stress brought on by medical illnesses can increase the risk of suicide, Conwell said. He is working to train doctors, pharmacists and even postal workers and bank tellers to identify risk factors for depression in elderly people they encounter.

Conwell's studies have shown that 75 percent of older people saw a primary-care physician in the month before they killed themselves. If doctors were aware of the signs, they would be in the best position to identify and treat depression, Conwell said.

Scientists are working to assess what the evidence of plaque buildup in the brains of elderly people who kill themselves means. Are these elderly people experiencing a degenerative change that alters mood and behavior? Were they suffering from undiagnosed Alzheimer's disease? Were there other signs that could have predicted suicide?

"Finally, science is helping to determine what works and what doesn't," said Iris Bolton, executive director of LINK Counseling Center in Atlanta. The organization recently created a national resource center for prevention and counseling. Bolton lost her 20-year-old son to suicide in 1977. "This [scientific] focus," she said, "has never been there before."

Trở về đầu trang - Thơ bạn đọc - Ảnh đẹp bạn đọc - Vui cười