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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.

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.

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.

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.

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.

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.

The development of an active collaboration between the department of behavioral medicine and psychiatry of the University of Virginia School of Medicine and Western State Hospital is described. The collaboration includes clinical research and opportunities for training residents and medical students. University faculty provide clinical and administrative leadership at all levels of the hospital's organization. The hospital's clinical functioning has improved through direct involvement of university faculty in patient care, and its recruitment of physicians and psychologists has increased due to expansion of academic opportunities and program improvements. The authors use examples from the collaboration experience to illustrate key issues, such as strong leadership, sufficient resources, and an understanding of systems factors, that are necessary to overcome resistance to change.

We surveyed 1528 first-year students at the University of Virginia, 1 month after their arrival on campus, who had used alcohol at some time in their lives. Our survey was designed to identify alcohol and cocaine use, and related psychosocial patterns. Men drank more and more often than women. Our data suggest that body weight should be considered in defining those who drink heavily and often. We define 'frequent heavy drinking' as five or more drinks in a row each week for men and three to four drinks or more in a row each week for women. Frequent heavy drinkers, cocaine users, and students with psychosocial problems appeared disproportionately among students planning to join fraternities and sororities. Although first-year students used cocaine infrequently, its users followed the patterns of frequent heavy drinkers. We believe efforts to correct alcohol and cocaine misuse by college students should be directed, in part, at social organizations such as Greek-letter societies. Also, we must attend to psychosocial features that predispose to alcohol and cocaine misuse.

We surveyed 1703 first-year students at the University of Virginia one month after arrival who used alcohol at some time in their lives. Our survey looked at drinking practices and psychosocial patterns. Men drank more and more often than women. Our data suggest that in defining frequent heavy drinkers, one should consider body weight. Now, we define frequent heavy drinking as five or more drinks in a row at least weekly for men, and for women, we use three to four drinks or more in a row at least weekly. Frequent heavy drinkers and students with psychosocial problems appeared disproportionately among students planning to join fraternities and sororities. We believe efforts to correct alcohol abuse and addiction by college students must focus, at least in part, on social organizations, especially fraternities and sororities. Also, we must attend to psychosocial features that predispose to alcohol abuse and addiction.

Review of 60 consecutive records of patients who died before the age of 53 years in a state mental hospital revealed that 27 of those patients (45%) had a schizophrenic disorder. Of those 27 patients, five (18.5%) died of the complications of self-induced water intoxication and schizophrenic disorders (SIWIS). Clinical, laboratory, and autopsy features of those five SIWIS patients and of an additional five SIWIS cases obtained from the literature include psychosis, polydipsia, polyuria, severe hyposthenuria (specific gravity 1.003 or less), hyponatremia, seizures, coma, and cerebral and visceral edema. SIWIS characteristically develops during Arieti's third or "preterminal" stage (5 to 15 years after onset of psychosis) of schizophrenic disorders and it must be included in the differential diagnosis of unexplained death among psychiatric patients. As there are no pathognomonic SIWIS tissue changes, the pathologist must carefully integrate clinical, laboratory, and autopsy findings to arrive at the proper diagnosis. When premortem findings of polydipsia and hyponatremia are not available, evidence of antecedent severe hyposthenuria and postmortem vitreous humor hyponatremia of less than 120 mEq/1 are strongly supportive of the diagnosis of death due to SIWIS.

Thirty-six chronically psychotic patients (nine men and 27 women, mean age 56.7 +/- S.D. 13.4 years) were found to have elevated thyroid stimulating hormone (TSH) levels during review of thyroid function screening tests of 1150 patients over a 15 month period in a 700 bed state mental hospital. This study population of 36 patients was more likely to be female and older than the general hospital population. The spectrum and frequency of psychiatric diagnoses included dementia (3); schizoaffective disorder (12); bipolar disorder (6); schizophrenic disorder (4); organic affective disorder (7); major depression (3); and mental retardation (1). Only nine of these 36 patients failed to receive the goitrogens lithium (LI), carbamazepine (CBZ) and/or phenytoin (PTN) and five of those nine patients had a history of thyroid disease. Sex did not predict age, thyroxine (T4) level, triiodothyronine (T3) uptake, or TSH. The distribution of psychiatric diagnoses were the same for both sexes. Expectedly, there was an inverse relationship between TSH and T4 and T3 uptake. Using T4 to separate grades 1 and 2 hypothyroidism revealed that six (17%) patients had grade 1 disease. Men were more likely to have a seizure disorder and receive LI, CBZ, and PTN. Women were more likely to have a history of thyroid disease. The goitrogenic effects of LI + CBZ seemed additive compared with patients receiving LI alone. While T4, T3 uptake, and LI levels were the same for the two groups, patients receiving LI + CBZ had higher TSH values (p = 0.028) than did patients receiving LI alone.(ABSTRACT TRUNCATED AT 250 WORDS)