No abstract

Background: In December 2018, Michigan became the 10th state to legalize marijuana for adults. Since this law took effect, increased availability and use of cannabis in Michigan have led to increased emergency department (ED) visits associated with the drug's psychiatric effects.Objectives: To describe cannabis-induced anxiety disorder's prevalence, clinical features, and disposition in a community-based study.Methods: This was a retrospective cohort analysis of consecutive patients diagnosed with acute toxicity related to cannabis use (ICD-10 code F12). Patients were seen at seven EDs over a 24-month study period. Data collected included demographics, clinical features, and treatment outcomes in ED patients who met the criteria for cannabis-induced anxiety disorder. This group was compared to a cohort experiencing other forms of acute cannabis toxicity. Chi-squared and t-tests were used to compare these two groups across key demographic and outcome variables.Results: During the study period, 1135 patients were evaluated for acute cannabis toxicity. A total of 196 patients (17.3%) had a chief complaint of anxiety, and 939 (82.7%) experienced other forms of acute cannabis toxicity, predominantly symptoms of intoxication or cannabis hyperemesis syndrome. Patients with anxiety symptoms had panic attacks (11.7%), aggression or manic behavior (9.2%), and hallucinations (6.1%). Compared to patients presenting with other forms of cannabis toxicity, those with anxiety were likelier to be younger, ingested edible cannabis, had psychiatric comorbidities, or had a history of polysubstance abuse.Conclusions: Cannabis-induced anxiety occurred in 17.3% of ED patients in this community-based study. Clinicians must be adept in recognizing, evaluating, managing, and counseling these patients following cannabis exposure.

Oral supplements are commonly used by patients to enhance skin health for aesthetic purposes and in response to cutaneous disorders. Currently, the Food and Drug Administration (FDA) is not authorized to approve the efficacy or safety of dietary supplements prior to public marketing. Therefore, evidence-based medicine is needed for dermatologists to better counsel patients regarding oral supplementation. Physicians must take this into consideration while treating patients with chronic conditions, such as atopic dermatitis (AD). AD is the most common cutaneous inflammatory disease affecting individuals from infancy through adulthood. Prevention and management are focused on avoiding environmental triggers, daily skin care with emollients and/or topical steroids, and decreasing systemic inflammation. Patients with AD use various treatment options and over-the-counter supplements throughout their lifetime. Interestingly, omega-3 fatty acids (O3FA) are marketed for their anti-inflammatory effects and have been widely studied to understand health benefits. To our knowledge, the effects of oral supplementation of O3FA (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) for AD are not summarized in the literature. Thus, this study was conducted to examine O3FA’s impact on AD and ultimately, to determine if supplementation is an effective therapy for the prevention and/or treatment of AD. A comprehensive electronic search with EPA and DHA for atopic dermatitis in PubMed/MEDLINE, Cochrane Central, Embase, and Google Scholar yielded 45 articles. Duplicate, non-English articles and irrelevant articles were excluded. These parameters resulted in 38 articles being excluded as they did not meet study qualifications. Therefore, seven articles are included in this review. Of the included articles, 2/7 studies discussed an improvement in skin inflammation with O3FA supplementation, while 5/7 did not find a significant difference in the prevention of allergic disease. On the other hand, one trial resulted in a significant decline in the prevalence of eczema and another indicated significant clinical improvement compared to baseline, but not in comparison to the placebo. O3FA supplementation is not effective in preventing allergic symptoms, but may decrease the prevalence of AD and provide clinical improvement. Further evaluation is needed to characterize the efficacy of O3FA supplementation in the prevention and treatment of AD.