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Biomedical subjects

W Victor R Vieweg

Publications and source records attributed to W Victor R Vieweg.

At least 19 recordsLinked to original sources
PubMed2006

Posttraumatic stress disorder and body mass index in military veterans. Preliminary findings.

INTRODUCTION: Current management of posttraumatic stress disorder (PTSD) focuses on the psychiatric parameters of this condition. Little has been written about co-morbid overweight and obesity in PTSD. METHODS: We used the database of the recently constituted PTSD program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia to assess and better understand the prevalence and severity of overweight and obesity among military veterans with PTSD. Variables assessed included age, decade of life, height, weight, sex, race, and severity and chronicity of PTSD. We used PTSD CheckList-Military Version (PCL-M) to assess current complaints and service-connected disability (SCD) to estimate the long-term severity of PTSD. RESULTS: Of the 221 male veterans extracted from our PTSD database for purposes of this study, 144 (65.2%) were in the age range of 50 to 59 years consistent with Vietnam veterans dominating our study population. Their mean body mass index (BMI) was 30.2+/-5.8 kg/m(2) placing the typical veteran in the obese range. Far exceeding the current US population rate of 64.5%, 82.8% of our study population was either overweight or obese. Our sample had BMI measurements greater than those reported for non-PTSD veterans and also BMI measurements reported in the literature for veterans with PTSD. Current (PCL-M) and long-term (SCD) markers of PTSD did not relate to obesity. CONCLUSIONS: The prevalence of overweight and obesity among our veterans with PTSD far exceeded current US population findings and those of other veteran groups with and without PTSD. PTSD symptoms, whether assessed acutely or chronically, did not explain our findings. Prospective studies of PTSD and comorbidity are needed using larger study populations to better understand the relationships among PTSD, stress, and obesity.

Aged↗
PubMed2006

Posttraumatic stress disorder: clinical features, pathophysiology, and treatment.

Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.

Cognitive Behavioral Therapy↗
PubMed2006

Treatment of depression in patients with coronary heart disease.

Depression and coronary heart disease are common conditions that often occur together. Evidence shows that the co-occurrence of these illnesses is not random but driven by depression as a risk factor for the occurrence and progression of coronary heart disease. This link is due, in part, to the impact that depression has on neuroendocrine pathways leading to increased platelet activation, cortisol and catecholamine excess, and altered autonomic nervous system function that influence the pathogenesis and progression of coronary atherosclerosis and subsequent heart disease. We know that treating depression in patients with coronary heart disease improves the symptoms and signs of depression. Evidence is less compelling that treating depression improves the morbidity and mortality of coronary heart disease. However, early findings suggest that some antidepressants may improve the course of coronary heart disease and improve patient compliance with various cardiac interventions. We outline a practical approach to the treatment of depression in patients with coronary heart disease. This approach includes education, counseling, antidepressant drugs, and referral when appropriate.

Antidepressive Agents↗
PubMed2006

Posttraumatic stress disorder in male military veterans with comorbid overweight and obesity: psychotropic, antihypertensive, and metabolic medications.

UNLABELLED: Posttraumatic stress disorder (PTSD) is an important syndrome among military veterans. Little has been written about comorbid medical conditions of PTSD, particularly overweight and obesity. We focus on psychotropic and non-psychotropic drugs, their interactions, and metabolic issues most relevant to primary care physicians. METHOD: Data from the recently constituted PTSD program at the Department of Veterans Affairs Medical Center in Richmond, Va., were retrospectively reviewed to assess the prevalence and severity of comorbid overweight and obesity in male veterans with PTSD. Also, our database allowed us to correlate various drugs used to treat hypertension, diabetes mellitus, and dyslipidemia with body mass index (BMI). RESULTS: The mean BMI of 157 veterans with PTSD (DSM-IV criteria) in this sample was in the obese range (30.3 ± 5.6 kg/m²). The number of drugs a given patient was taking for treatment of hypertension, diabetes mellitus, and dyslipidemia correlated with BMI. Psychotropic drugs associated with weight gain did not explain our findings. CONCLUSIONS: Overweight and obesity among our male veterans with PTSD strikingly exceeded national findings. The administration of psychotropic drugs associated with weight gain did not explain these findings. The number of medications used to treat hypertension, diabetes mellitus, and dyslipidemia correlated significantly with BMI. Rather than these medications explaining the high prevalence of overweight and obesity in our study population, obesity probably worsened these components of the metabolic syndrome, necessitating more aggressive treatment reflected in the high number of drugs prescribed.

Journal Article↗
PubMed2006

Toxicology findings in child and adolescent suicides in virginia: 1987-2003.

OBJECTIVE: In a follow-up report of child and adolescent suicides in Virginia, we describe postmortem toxicology findings in a subset of these youths. METHOD: We analyzed "unnatural" deaths from Virginia's Office of the Chief Medical Examiner for 1987 to 2003. There were 2818 unnatural deaths in children and adolescents. We grouped unnatural deaths as accidents, homicides, and suicides. Toxicology records were available for 753 cases, of which 732 were black or white youths. RESULTS: There were no age differences among suicide victims and accident or homicide victims. Whites were more likely than blacks to die by accident and suicide. White females were more likely than black females to commit suicide. Black males were more likely than white males to suffer homicide. For all unexpected deaths, antidepressants were more commonly found among whites than blacks. Suicide by poisoning occurred more commonly among whites. Recreational drugs were more commonly found among blacks than whites. Suicide by gun occurred more commonly among blacks. Antidepressants were found in 39 black and white suicide victims. Anti-depressants (all tricyclic antidepressants) were causally related in 17 cases of suicide by poisoning. No other antidepressants were found in lethal levels in suicide by poisoning. Selective serotonin reuptake inhibitors (SSRIs)/venlafaxine appeared more commonly in the suicides (p < .0001) than in accidents or homicides. For suicides, SSRIs appeared no more commonly in poisoning than in gun or hanging deaths (p = .695). CONCLUSIONS: Antidepressants appeared more commonly among youths committing suicide than those dying by accident or homicide. SSRIs did not appear more commonly among youths committing suicide by poisoning than those committing suicide by gun or hanging. Because our data are descriptive, they are subject to over-interpretation. Cause-effect inferences should not be drawn.

Journal Article↗
PubMed2006

Body mass index relates to males with posttraumatic stress disorder.

INTRODUCTION: We looked at the relationships among posttraumatic stress disorder (PTSD), body mass index (BMI) and socioeconomic status (SES) in a newly formed PTSD program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, VA. METHODS: We reviewed 265 records and then selected only black and white male veterans (n=252) for study. Variables were: 1) age, 2) decade of life, 3) height, 4) weight, 5) sex, 6) race, and 7) SES (estimated using priority group status). Low income is an important variable determining priority group status. RESULTS: About two-thirds of the veterans were in the age range of 50-59 years (Vietnam veterans). Their mean BMI was 30.2 +/- 5.6 kg/m2, and this value did not separate by race. Far exceeding national numbers, 84.1% of our veterans were either overweight or obese. Veterans in the lower priority groups had greater (p=0.029) BMIs than their counterparts in higher priority groups. CONCLUSIONS: The pervasiveness of overweight and obesity in our PTSD population was profound. Our observations suggest that low SES is a likely contributor to veterans in lower priority groups having greater BMIs than veterans in higher priority groups.

Adult↗
PubMed2005

Body mass index (BMI) in newly admitted child and adolescent psychiatric inpatients.

INTRODUCTION: Obesity is a major problem among children and adolescents suffering from chronic mental illness. State-of-the-art measures such as body mass index (BMI) and growth-related weight charts are now readily available to clinicians and investigators interested in psychotropic drug-associated weight gain in the pediatric population. However, no reports that utilize such measures in large series of children and adolescents with psychiatric disorders are available. METHODS: The authors employed the Nutstat module of the Centers for Disease Control and Prevention (CDC) Epi Info software to assess BMI in a psychiatry inpatient child and adolescent population in Central Virginia. The authors also developed a scoring system to relate psychotropic administration to BMI. RESULTS: Children and adolescents with chronic mental illness had greater BMI measurements than the general pediatric population. Our scoring system found a relationship between antipsychotic drug administration and increased BMI that almost reached a level of significance (p=0.062). CONCLUSIONS: The present methodology using absolute weight to assess psychotropic drug-associated increase in body weight for children and adolescents is unsatisfactory. The authors offer a new and convenient methodology to correct this problem.

Adolescent↗
PubMed2005

Switching depot antipsychotic drug responders to oral olanzapine.

In an open-label study, 13 patients taking depot antipsychotic medication for greater than 3 years were switched to oral olanzapine. The first 3-month experience has been previously reported. We now describe a second 3-month experience and integrate our observations into a cumulative 6-month report. Monthly, we assessed patients using clinical ratings [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Mini-Mental State Exam (MMSE), and Clinical Global Improvement Scale (CGI)] and side effect parameters [Abnormal Involuntary Movement Scale (AIMS), Association for Methodology and Documentation in Psychiatry psychotropic side effect rating scale (AMDP-5), and weights]. Olanzapine patients showed statistically significant improvement (baseline to endpoint sixth month) in GAF (p=0.015), MMSE (p=0.022), CGI improvement, and AIMS (p=0.038). There was no statistically significant change in PANSS, CGI severity, or AMDP-5 overall side effects. Weight gain over 6 months averaged 8.9 lb. All patients completed the study. Compliance was estimated at 90%, and 81% of patients chose to continue on the oral olanzapine. One patient was hospitalized at the conclusion of the study. Our findings suggest that clinicians may consider oral olanzapine as a viable alternative to depot antipsychotic medications, balancing clinical improvement in some clinical measures with lack of improvement in other clinical measures; and balancing improvement in abnormal involuntary movements with weight gain and its sequelae.

Adult↗
PubMed2005

Direct-care staff body mass index in a state mental hospital: staff obesity may impair role modeling for patients.

INTRODUCTION: Direct-care staff at institutions providing long-term care serve as both caretakers and role models for their patients. The authors report a second study showing that major portions of such direct-care staff have significant problems themselves with overweight and obesity. This may be another changeable factor in the complex dynamics governing overweight and obesity among patients with chronic mental illness. METHOD: The authors recorded age, sex, and race, and measured height and weight during a typical 8-h shift among 50 direct-care staff at a long-term care psychiatric institution. Direct-care staff were defined as those members of the nursing staff who spent at least 4 h of their 8-h shift in direct contact with their patients. RESULTS: Of the 50 direct-care staff, 44 were black females. The authors focused on this subgroup in our report. These 44 black female direct-care staff had a mean body mass index (BMI) of 33.8+/-8.3 kg/m(2) and 27 (61.4%) were obese. Six of them (13.6%) were morbidly obese. CONCLUSIONS: Overweight and obesity may be a greater problem for staff providing care for patients with chronic mental illness than for the patients themselves. The authors believe studies are needed to test the hypothesis that staff obesity may impair staff ability to help obese patients lose weight. In our two studies to date, black women functioning as direct-care staff were highly vulnerable to overweight and obesity.

Adult↗
PubMed2005

Child and adolescent suicides in Virginia: 1987 to 2003.

OBJECTIVES: The aim of this study was to better understand suicides in children and adolescents using records from the Office of the Medical Examiner of Virginia from 1987 to 2003. MAIN FINDINGS, KEY DATA, AND STATISTICS: Suicide accounted for 16.8% of unnatural deaths. Suicide rates were highest for Caucasians. Guns were the most common method of death for suicides, followed by hanging and poisoning. Poisoning other than carbon monoxide accounted for 7.8% of suicides, with tricyclic antidepressants (TCAs) the most identifiable poison. Female youths were 10 times more likely to die from TCAs than male youths, after adjusting for race and age. CONCLUSIONS: Guns and hanging were the principal methods of suicide. Among the antidepressants, TCAs have been the most common poisons used in suicide. Increasing age was a powerful determinant of suicide. Some patients may have stockpiled their TCAs for a while before their TCA overdose. Other suicide victims may have used TCA supplies from family members. Hence, some of the suicide victims may not have taken TCAs on a regular basis before committing suicide. Further exploration of TCA-induced suicidal thoughts is needed. Conclusions cannot be made at the time about the precise role that TCAs played in TCA-induced suicide reported in our study.

Adolescent↗
PubMed2005

Invited comment.

Explore the source record for details and available documents.

Antipsychotic Agents↗
PubMed2005

Body image and attitude toward obesity in an historically black university.

INTRODUCTION: The obesity epidemic is a major problem in the United States, particularly among black women. Body image and attitudes toward obesity are important areas to understand and address in any comprehensive approach to this epidemic. METHODS: From an initial evaluation of 200 college students (25 male and 25 female freshmen, sophomores, juniors and seniors each) attending an historically black university, we selected those students who identified themselves as black for data analysis (n = 191). All students underwent height and weight measurement from which body mass index (BMI) was calculated. Each student answered two questions related to nine silhouettes for each sex that progressively moved from extreme thinness to extreme obesity. Also, each student answered 20 questions describing attitudes about obesity. RESULTS: Black college students placed between the 62nd and 72nd percentiles of national BMI data for adolescents. Black female students were more likely than their black male counterparts to be obese. BMI did not vary by sex or grade level. Students of both sexes generally preferred "trim" silhouettes with the caveat that students with BMIs <25 kg/m2 preferred smaller silhouettes than did students with BMIs > or =25 kg/m2. BMI and sex did not favor any particular set of attitudes toward obesity. CONCLUSION: Black male and female college students from an historically black university were largely in the "normal" range of BMI percentiles for sex and age. Our black female students were more likely to be obese than our black male students. Our findings suggest that young black women are tolerant of a variety of body sizes. Based on findings from our Attitudes Toward Obese Persons scale, body size sense of self and sex do not influence attitudes toward obese persons. Further studies are needed.

Adolescent↗
PubMed2004

Application of body mass index principles in a model elementary school: implications for overweight and obese children.

The first model elementary school in Richmond, VA formed the study site for this project. Changes in this model will lay the groundwork for changes throughout the Richmond Public School System. Of the 283 students in grades one through five, 66 students (23.3%) were randomly selected. Of the 66 students, 54 (81.8%) were black. Each student underwent height and weight measurement. Using the Nutstat module of the Centers for Disease Control (CDC) Epi Info software program available at no cost on the Internet, we identified Body Mass Index (BMI), BMI percentile for sex and age, and z-score for each student. Z-score measurements placed the 19 black male children at the 98.08th percentile for BMI (fewer than 2% of U.S. male children were larger). Similarly, the 35 black female children's BMI was at the 95.35th percentile (fewer than 5% of U.S. female children were larger). Based on data in the literature, the typical black male and female elementary child included in our study can expect a significant reduction in life expectancy compared with their nonobese counterparts.

Black or African American↗
PubMed2003

Lifespan of male attorneys: preliminary findings.

BACKGROUND: Our objective was to test the hypotheses that trial attorneys have shorter lifespans than other attorneys, and that attorneys in general have a shortened lifespan compared with the general population. METHODS: Using obituaries from the Annual Report of the Virginia State Bar, we compared the lifespans of male trial attorneys with those of male non-trial attorneys. We also compared these findings with the lifespans of males in the general population. RESULTS: For white male attorneys in Virginia, the mean +/- SD age at death was 66.2 +/- 12.6 years for 250 trial attorneys and 65.0 +/- 12.5 years for 598 non-trial attorneys. This was not statistically significant. The lifespans of both trial and non-trial attorneys exceeded those of the general population. CONCLUSION: This small preliminary study showed that the occupation of male trial attorneys does not shorten their lives, and that male attorneys, in general, do not have shortened lifespans compared with the general population.

Aged↗
PubMed2002

Mechanisms and risks of electrocardiographic QT interval prolongation when using antipsychotic drugs.

This article reviews cardiac electrophysiology, with a focus on the assessment of the electrocardiographically determined corrected QT (QTc) interval and its role as a marker for potentially life-threatening cardiac arrhythmias such as torsades de pointes. Presently, using the QTc interval as a surrogate for polymorphic ventricular tachycardia is handicapped, in part, by the limitations of currently available group-derived formulas to estimate the QTc interval. Regulatory agencies have sharpened their interest in this arena. Substantial progress almost certainly awaits the application of individual rather than group-derived formulas to estimate the QTc interval. Until this refinement arrives, clinicians are advised to exercise caution when administering antipsychotic drugs with the potential to significantly prolong the QT interval. Caution is particularly urged in patients with cardiovascular disease or risk factors for cardiovascular disease.

Age Factors↗