Antony Fernandez

Correlation between high risk obesity groups and low socioeconomic status in school children

Objective: Obesity is a major health problem among children and adolescents which is potentially affected by socioeconomic status (SES). The high risk group (HRG) comprises those youths with a body mass index (BMI) between the 85th and 95th percentile (at risk for overweight) and ≥95th percentile (overweight). We sought a potential link between the HRG and SES. Methods: Public schools in Chesterfield County, Virginia measured BMI among students in kindergarten and third, seventh, and tenth grades. We assessed SES based on eligibility for the National School Lunch Program and the percentage of the school-age population living in poverty based on per capita income from the 2000 Census. Results: From 28 to 38% of children and adolescents were in the high risk group. Low SES had robust and highly significant correlations with HRG status with r-values ranging from 0.565 to 0.842, P < 0.0001. Conclusions: Low SES appears to be an important factor in childhood and adolescent obesity.

Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications.

Individuals with major mental illness are a high-risk group for cardio-metabolic derangements due to genetic predisposition, developmental and environmental stressors, and lifestyle. This risk is compounded when they receive antipsychotic medications. Guidelines for screening, monitoring, and managing these patients for metabolic problems have been in place for several years. Despite this, recent reports document that this population continues to receive poor care in this regard. In this article, we review the metabolic profile of atypical antipsychotic medications and offer guidelines to reduce the metabolic complications of these agents.

Posttraumatic stress disorder as a risk factor for obesity among male military veterans

Objective:  Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition.

Pharmacological management of psychosis in elderly patients with parkinsonism.

Parkinsonism is a characteristic feature of Parkinsons disease and dementia with Lewy bodies and is commonly seen in Alzheimers disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors.

The risk of overweight in children and adolescents with major mental illness.

Objectives: To survey the charts of youths with major mental illness who may constitute a high-risk group (HRG) for overweight. Methods: We reviewed the charts of youths admitted to a public sector psychiatric hospital. For the 795 cases of patients 6 to 18 years old identified as the study cohort, we derived body mass index percentiles using the Centers for Disease Control Epi Info software. We defined a HRG as those youths who were “overweight” and “at risk for overweight” and compared them with national measurements. We also determined the frequency of psychiatric diagnoses and psychotropic drugs use. Results: A total of 51.8% were in the HRG compared with the national average of 35.2% for the 6 to 19 years age group of the latest available National Health and Nutrition Examination Survey. We noted an increase in the prevalence of mood disorders and psychosis with increasing age. Many (45.3%) were discharged on medications that can potentially cause moderate-to-severe weight gain. Conclusions: Youths with major psychiatric illnesses constitute a HRG for overweight.

Charles Bonnet syndrome with peripheral and central findings

The Charles Bonnet syndrome comprises complex vivid visual hallucinations without significant psychopathology or disturbed consciousness and has been known for several hundred years. A consensus is lacking whether eye and brain disease are necessary or exclusionary criteria for this syndrome. We describe the recent onset of complex and vivid visual hallucinations in a 73‐year‐old man with macular degeneration and a history of recurrent major depression. We discuss ophthalmologic and radiographic findings in the context of syndrome cause.

Posttraumatic Stress Disorder and Body Mass Index in Military Veterans: The Richmond Experience

ABSTRACT Military veterans suffering from Posttraumatic Stress Disorder (PTSD) often have comorbid conditions including obesity. They may become disabled either from these comorbid conditions or from PTSD (or from both). Service-connected disability (SCD) is a concept employed by both the Department of Defense and the Department of Veterans Affairs to identify and compensate military veterans with such disabilities. SCD could serve as a measure of the functional impact of PTSD and comorbid obesity and other medical conditions. We reviewed the database of the recently constituted PTSD program at Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia. Variables assessed included 1) age, 2) decade of life, 3) height, 4) weight, 5) sex, 6) race, 7) employment status, 8) presence or absence of comorbid psychiatric conditions, 9) presence or absence of comorbid medical conditions, and 10) degree of disability. From the height and weight measurements, we calculated body mass index (BMI). We used SCD to estimate degree of disability in terms of total disability (total SCD) and disability ascribed to PTSD (PTSD-SCD). Results indicated that the mean BMI of the study population was 30.3±5.7 kg/m2. This value was consistent with the current definition of obesity. 83.8% of our study population was either overweight or obese. This rate exceeded the US general population level of 64.5%. SCD and comorbid medical conditions had statistically significant relationships with obesity. Race was almost a statistically significant predictor of obesity. Decade of life, employment status and presence/absence of comorbid psychiatric condition did not separate the obese veteran from the non-obese veteran. Analysis of variance (ANOVA) revealed statistical significant differences in BMI (df = 4, F = 2.921, p = 0.022)among various levels of SCD suggesting a threshold effect. PTSD-related SCD, however, did not have a significant relationship with BMI. The prevalence of overweight and obesity among our sample of veterans with PTSD exceeded current U.S. population rates. Comorbid medical conditions may predispose veterans with PTSD to obesity. SCD had a significant relationship with BMI in that there was a threshold effect in which 30% or greater SCD identified veterans with obesity. The cross-sectional nature of the study and the absence of control populations limit the conclusions that may be drawn from our study. Clearly, more definitive studies are needed with much larger study populations.

Selective serotonin reuptake inhibitors and torsade de pointes

Objective: In the light of the recent United States Food and Drug Administration (FDA) warning to clinicians on using previously approved doses of citalopram because of the purported higher risk of torsade de pointes (TdP), we pursued the broader question: are selective serotonin reuptake inhibitor (SSRI) antidepressant agents as a group unsafe because they might induce QTc interval prolongation and TdP? Method: We reviewed the literature and found only 15 case reports (6 of fluoxetine, 1 of sertraline and 8 of citalopram) of SSRI-associated QTc interval prolongation linking to TdP. Results: A total of 13 cases contained sufficient information for analysis. In the setting of TdP, QTc interval prolongation does not clearly relate to SSRI dose. Conclusion: Applying conventional statistics as the FDA does may not be the best tool to study this phenomenon because SSRI-associated TdP is a very rare event and hence best understood as an ‘extreme outlier’. Despite the limitations inherent in case report material, case reports on drug-associated QTc interval prolongation and TdP provide valuable information that should be considered along with other sources of information for clinical guidance.