Predicting Suicide: Doctors' New Assessment Tool

June 16, 2011— -- The breakfast-induced suicide happened two decades ago but still haunts Dr. Igor Galynker.

He had finished medical school and was working as a resident at a New York clinic when one of the patients had a fight with her mother over whether she would get scrambled eggs or eggs sunnyside up. Directly afterward, she jumped to her death off the balcony of her 20th floor apartment.

Her doctors were surprised. Although the woman was mentally ill with schizoaffective disorder, a condition that causes mood problems and psychosis, Galynker said, the patient was seen routinely and wasn't considered acutely suicidal.

It was a wakeup call, Galynker said, for "how trivial the triggers may be and how helpless we are in predicting suicide."

But his latest research might change that. Galynker, who is the associate chairman of the Department of Psychiatry and Behavioral Sciences at Beth Israel Medical Center in New York, and who also directs the Family Center for Bipolar Disorder, is developing a series of questions that could help doctors care for suicidal patients. If his team is successful, they will have created the first tool available to help doctors predict imminent suicide attempts.

It's often assumed that patients who are planning to kill themselves are depressed, talk about killing themselves and eventually formulate a plan. In reality, doctors say, patients aren't usually so forthcoming, and their behavior isn't always premeditated; it's often impulsive.

One recent example is reality-TV star Amber Portwood, who became famous on MTV's "Teen Mom."

She reportedly fought with her daughter's father prior to being hospitalized Tuesday morning. Police in Anderson, Ind., said she was threatening to take her life.

Portwood's ex-fiance Gary Shirley called 911.

"She said, 'Call the police so they can find my body in the garage,'" he told the 911 dispatcher in an audio recording obtained by TMZ.

Star Magazine reported when paramedics arrived they found Portwood drifting in and out of consciousness and had to remove a rope from around her neck. The magazine also claimed she had admitted to taking pills.

Research indicates that the average time between thinking about suicide and actually attempting it is about 10 minutes, Galynker said.

Pathological Mental State Can Predict Suicide Attempts, Doctor Says

But Galynker says people who commit suicide do have something in common: a certain pathological state of mind that fluctuates in intensity. Defining and recognizing that mental state has been one of the great challenges faced by psychiatrists in the past 15 years, according to Dr. Tim Lineberry, chair of the inpatient Mayo Clinic psychiatry division and board chairman of the American Association of Suicidology.

"We know that psychological illness is associated with suicide but we see suicidal behavior as being something that is kind of unique to the individual and has a number of other factors," Lineberry said.

In Galynker's research, he hypothesizes that this state of mind precedes the urge to act, describing it as "really severe anxiety ... like being sucked through vortex."

Patients "try to come out, but they can't," he said.

There are three things, he says, that happen in that state: an endless cycle of hopeless thinking that cannot be controlled, the frantic sensation of being trapped and physical sensations that aren't based in reality.