Dr. Alan Swann -Temporal Architecture of Suicidal Behavior and Risk

Alan C. Swann M.D.
Professor, Department of Psychiatry and Behavioral Sciences
Baylor College of Medicine, and Michael E. DeBakey VAMC
Abstract: The regulation of action requires interactions between immediate regulation of action and long-term behavioral adaptation. These interactions can result in apparently complex, chaotic patterns of behavior. We will discuss the manner in which this is related to suicidal behavior. Suicide is the most common cause of fatal trauma. People who have made medically severe suicide attempts have increased suicide and non-suicide mortality regardless of diagnosis. However, we cannot rely on past suicide attempts to predict risk because most suicides were first attempts. Many characteristics associated with long-term suicide risk have been identified, but the actual behavior is notoriously difficult to predict. We will discuss interactions between long-term mechanisms of behavioral sensitization and the immediate, pre-attentive regulation of action in suicidal behavior. The resulting characteristics cross clinical diagnoses. There may be a transdiagnostic condition characterized by impaired control of action associated with sensitization to stress- or reward-related stimuli. The expression of this behavior may be difficult to predict, but identification of mechanistic and diagnostic properties could generate effective preventive strategies. We will focus on practical approaches to these questions.