A Case of Panic Attacks Developing After 10 Years of Chronic Cannabis Use in a Patient With No Prior Psychiatric History

Cannabis use for medical and recreational purposes is increasing. Inhibitory activity of cannabinoids (CB) at the CB1 and CB2 receptors centrally and peripherally mediate the therapeutic effects that are wielded for palliation of pain, anxiety, inflammation, and nausea in indicated conditions. Cannabis dependence is also associated with anxiety; however, the direction of causality is unknown, such as whether anxiety disorders lead to cannabis use, or whether cannabis contributes to the development of anxiety disorder. The evidence hints that both may have validity. Here we present a case of cannabis-associated panic attacks following 10 years of chronic cannabis dependence in an individual with no prior psychiatric history. The patient is a 32-year-old male with no significant past medical history who presented complaining of five-minute episodes of palpitations, dyspnea, upper extremity paresthesia, subjective tachycardia, and cold diaphoresis occurring in a variety of circumstances for the past two years. His social history was significant for 10 years of smoking marijuana multiple times daily, which he had quit over two years ago. The patient denied past psychiatric history or known anxiety problems. Symptoms were unrelated to activity and only relieved with deep breathing. The episodes were not associated with chest pain, syncope, headache, or emotional triggers. The patient had no family history of cardiac disease or sudden death. The episodes were refractory to the elimination of caffeine, alcohol, or other sugary beverages. The patient had already stopped smoking marijuana when the episodes began. Due to the unpredictable nature of the episodes, the patient reported a growing fear of being in public. On laboratory workup, metabolic and blood panels were within normal limits, as well as thyroid studies. Electrocardiogram showed normal sinus rhythm, and continuous cardiac monitoring revealed no arrhythmias or abnormalities despite the patient indicating multiple triggered events within the duration of monitoring. Echocardiography also showed no abnormalities. With organic cardiac causes of the subjective palpitation episodes ruled out, a psychogenic etiology of the episodes was presumed, and the patient was referred to behavioral health services. In conclusion, cannabis-induced anxiety or panic disorders should be considered in patients with no prior psychiatric history presenting with anxiety-like attacks following a period of cannabis dependence or current use. These patients should be advised to cease cannabis use and referred to behavioral medicine.

Carbimazole-Induced Agranulocytosis in a Previously Stable Patient: A Case Report and Literature Review

Carbimazole-induced agranulocytosis is a rare condition. A 48-year-old female patient with a history of hyperthyroidism for several years presented with generalized fatigue and chest pain associated with palpitations; the patient was stable on carbimazole therapy. She was previously on carbimazole 15 mg once daily (OD) and, three months later, was reduced to 10 mg OD as symptoms were controlled. She was taking propranolol, and it was stopped as she was not having any palpitations. This time, however, she presented mainly with palpitations at night associated with chest pain and generalized fatigue ongoing for the last one week. Her laboratory results showed agranulocytosis with reduced white cell count and neutrophil count in the absence of any evidence of infection. Her carbimazole was stopped, and the patient was referred to ear, nose, and throat surgeons for consideration of thyroidectomy. The patient underwent subtotal thyroidectomy, and her symptoms resolved following surgery.

An Evaluation Method of Safe Driving for Senior Adults Using ECG Signals

The elderly are more susceptible to stress than younger people. In particular, heart palpitations are one of the causes of heart failure, which can lead to serious accidents. To prevent heart palpitations, we have devised the Safe Driving Intensity (SDI) and Cardiac Reaction Time (CRT) as new methods of estimating the correlations between effects on the driver's heart and the movement of a vehicle. In SDI measurement, recommended acceleration value of vehicle for safe driving is inferred from the suggested correlation algorithm using machine learning. A higher SDI value than other people means less pressure on the heart. CRT is an estimated value of the occurring time of heart palpitations caused by stressful driving. In particular, it is proved by SDI that elderly subjects tend to overestimate their driving abilities in personal assessment questionnaires. Furthermore, we validated our SDI using other general statistical methods. When comparing the results using a t-test, we obtained reliable results for the equivalent variance. Our results can be used as a basis for evaluating elderly people's driving ability, as well as allowing for the implementation of a personalized safe driving system for the elderly.