Magazine article Clinical Psychiatry News

Fetal Alcohol Spectrum Disorders and Suicidality

Magazine article Clinical Psychiatry News

Fetal Alcohol Spectrum Disorders and Suicidality

Article excerpt

As psychiatrists, we understand that behavior is complex and determined by multiple factors. However, despite our understanding that behavior is cultural, sociological, psychological, and biological, we often lose sight of the biological perspective because the brain is such a complex organ and because we are inundated with psychological theories of behavior. As I have said before, we cannot abdicate our role of being biologists in the reflection of mental health and wellness.

Accordingly, I feel it is my duty to bring our attention to a biologic etiology of suicidal behavior. I came across an article on the life expectancy of individuals afflicted with fetal alcohol syndrome in the Journal of Population Therapeutics and Clinical Pharmacology (2016;23[1]:e53-9). The findings were astonishing. As it turns out, the life expectancy of people with fetal alcohol syndrome is 34 years of age on average, and the leading causes of death were "external causes," which accounted for 44% of the deaths. Suicide was responsible for 15% of those deaths, accidents for 14%, poisoning by illegal drugs or alcohol for 7%, and other external causes for another 7%, according to the article.

Anyone who has been following my commentaries in Clinical Psychiatry News will know that I have become interested in an invisible public health problem of fetal alcohol spectrum disorders, which are being proposed as a new diagnosis of neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) in the DSM-5. My interest has been spurred by the problem of affect dysregulation that these patients exhibit. My analysis of this dynamic is that affect dysregulation causes these patients to engage in a plethora of risky behaviors that cause morbidity and mortality, including drug use, violence, and unsafe sex. Now, the research by N.X. Thanh and E. Jonsson mentioned above is leading me to add suicide attempts to that list.

While working in a general hospital in a low-income African American environment where there are high rates of fetal alcohol exposure, I see at least three to four suicide attempts a week on the medical-surgical/psychiatric inpatient units where I serve.

I am always looking for patients who have ND-PAE because determining such a diagnosis is critical to those patients' medical-surgical care. For example, there was one woman with ND-PAE who had operable breast carcinoma but did not come in for a return visit until after her carcinoma had become inoperable (she forgot how important it was to get timely treatment). There was a patient who always had out-of-control diabetes because he did not know how to use his glucometer. …

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