Second stage of a genome scan of schizophrenia: study of five positive regions in an expanded sample.

In a previous genome scan of 43 schizophrenia pedigrees, nonparametric linkage (NPL) scores with empirically derived pointwise P-values less than 0.01 were observed in two regions (chromosomes 2q12-13 and 10q23) and less than 0.05 in three regions (4q22-23, 9q22, and 11q21). Markers with a mean spacing of about 5 cM were typed in these regions in an expanded sample of 71 pedigrees, and NPL analyses carried out. No region produced significant genomewide evidence for linkage. On chromosome 10q, the empirical P-value remained at less than 0.01 for the entire sample (D10S168), evidence in the original 43 pedigrees was slightly increased, and a broad peak of positive results was observed. P-values less than 0.05 were observed on chromosomes 2q (D2S436) and 4q (D4S2623), but not on chromosomes 9q or 11q. It is concluded that this sample is most supportive of linkage on chromosome 10q, with less consistent support on chromosomes 2q and 4q. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:864-869, 2000.

Quality of life: expanding the scope of clinical significance.

Clinical researchers have turned their attention to quality of life assessment as a means of broadening the evaluation of treatment outcomes. This article examines conceptual and methodological issues related to the use of quality of life measures in mental health. These include the lack of a good operational definition of the construct, the use of subjective versus objective quality of life indicators, and the nature of the relationship between symptoms and quality of life judgments. Of special concern is the ability of quality of life measures to detect treatment-related changes. The authors review the application of quality of life assessment across diverse patient groups and therapies and provide recommendations for developing comprehensive, psychometrically sophisticated quality of life measures.

Behavioral treatment of obese binge eaters: do they need different care?

This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.

A comparison of two approaches to the assessment of binge eating in obesity.

OBJECTIVE: To compare two different methods of assessing binge eating in a sample of 128 obese women enrolled in a weight loss protocol. METHOD: Prior to treatment, participants completed the Binge Eating Scale (BES) and the Questionnaire on Eating and Weight Patterns (QEWP), as well as measures of other relevant constructs. They were then classified as bingers and nonbingers by each method and chance-corrected agreement was calculated. RESULTS: The BES and QEWP identified a small and nearly equal number of subjects as having significant binge eating, but there was only modest overlap between the two groups (kappa of .45). Subgroup comparisons revealed fundamental differences between the BES and QEWP in the assessment of the critical and associated features of binge eating. DISCUSSION: The relative merits of these two approaches to classifying binge eaters and implications for the design of new methods are discussed.

Restrained eating among adolescents: dieters are not always bingers and bingers are not always dieters.

This study examined individual differences in the relationships among 3 constructs relevant to restrained eating theory-cognitive restraint (dieting), disinhibition (binging), and hunger. Participants were 421 adolescents (158 male, 255 female, and 8 not indicated). Comparisons among subgroups based on scores on the 3 constructs indicated that there were (a) 2 types of frequent dieters-those who follow theoretical predictions and become disinhibited and those who maintain their restraint; (b) 2 types of bingers-those who engage in dieting-induced binging and those who are hungry and disinhibited; and (c) 2 types of low-hunger eaters-those who suppress their hunger and those who eat before they experience much hunger. Implications of the results for restrained eating theory are discussed.

Delusions in schizophrenia spectrum disorders: diagnostic issues.

Family studies of schizophrenia frequently include relatives of schizophrenia probands with diagnoses falling within the schizophrenia spectrum. As part of an ongoing genetic linkage study of schizophrenia, the authors examined case material from 50 relatives (of schizophrenia probands) who received a DSM-III-R diagnosis of a nonaffective psychotic disorder or schizotypal or paranoid personality disorder. Eleven exhibited episodic or chronic delusions that resulted in diagnostic dilemmas, often arising from issues pertaining to the classification of delusional phenomena. Four of these cases are presented here. Unusual beliefs were often difficult to classify as odd beliefs versus full delusions, brief/transient versus persistent delusions, bizarre versus non-bizarre delusions. It is suggested that these might be considered continuous rather than dichotomous dimensions. Several possible implications for genetic studies of schizophrenia are discussed.

Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter.

Using data from a cross-sectional survey of 531 predominantly black and Hispanic 10th graders in two New York City schools, the explanatory power of predictors of intentions to engage in sexual intercourse, to have multiple intercourse partners, and to use condoms was compared. Theoretically derived predictor variables (i.e., susceptibility, severity, benefits, barriers, self-efficacy, values, norms) were derived from the health belief model, social cognitive theory, and a model of social influence. One half of sampled students definitely intended to have sexual intercourse in the next year, one tenth definitely intended to have multiple partners, and two thirds definitely intended to use condoms. In multivariate analyses, variables derived from the model of social influence and from social cognitive theory were most strongly associated with the three investigated behavioral intentions; however, certain background and health belief variables also contributed to the explained variance in intercourse and multiple partner intentions.

Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter.

BACKGROUND: A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. METHODS: A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. RESULTS: Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. CONCLUSIONS: These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents.

High school students' perceptions of AIDS risk: realistic appraisal or motivated denial?

We examined perceptions of risk for acquired immunodeficiency syndrome (AIDS) in 296 high school students living in or near a major urban center. We hypothesized that students with a dispositional tendency to deny threat would be more likely to misperceive their risk of contracting AIDS. Results indicated that study participants, overall, used their behaviors as a basis for assessing personal risk in the sense that they perceived higher risk when their behavior was in fact riskier. However, this relation did not hold for those students classified as repressors on a repression-sensitization scale; repressors' perceptions of absolute (but not comparative) risk were negatively correlated with degree of behavioral risk. In a secondary analysis, perceived absolute risk was found to be a significant predictor of intention to change AIDS-risk behaviors. This study provides support for a motivational interpretation of perceived invulnerability and has implications for the development of models of health behavior change.

Premenstrual exacerbation of binge eating in bulimia.

Several studies have suggested an association between the premenstrual phase of the menstrual cycle and changes in appetite and eating behavior. This study examined the relation between phase of menstrual cycle and frequency of binge eating in 15 normal-weight women with bulimia whose eating behavior had been unaffected by placebo treatment during a medication study. There was a modest but statistically significant premenstrual exacerbation of binge eating.