The prevalence and significance of gestational cannabis use at an Australian tertiary hospital.

BACKGROUND: Cannabis is one of the most common non-prescribed psychoactive substances used in pregnancy. The prevalence of gestational cannabis use is increasing. AIM: The aim was to examine the prevalence of gestational cannabis use and associated pregnancy and neonate outcomes. MATERIALS AND METHODS: A retrospective observational study involving pregnant women delivering in 2019 was conducted at a tertiary hospital in Perth, Western Australia. Gestational cannabis and other substance use records were based on maternal self-report. Pregnancy outcomes included neonatal gestational age, birthweight, birth length, head circumference, resuscitation measures, special care nursery admission, 5-min Apgar score and initial neonatal feeding method. RESULTS: Among 3104 pregnant women (mean age: 31 years), gestational cannabis use was reported by 1.6% (n = 50). Cannabis users were younger, more likely to use other substances and experience mental illness or domestic violence compared with non-users. Neonates born to cannabis users had a lower mean gestational age, birthweight and birth length compared to those born to non-cannabis users. Gestational cannabis use (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-6.7) and tobacco smoking (OR 2.2, 95% CI 1.5-3.6) were associated with increased odds of a low-birthweight neonate. Combined cannabis and tobacco use during pregnancy further increased the likelihood of low birthweight (LBW, adjusted OR 3.9, 95% CI 1.6-9.3). Multivariate logistic regression analysis adjusted for maternal sociodemographical characteristics, mental illness, alcohol, tobacco and other substance use demonstrated gestational cannabis use to be independently associated with LBW (OR 2.3, 95% CI 1.1-5.2). CONCLUSION: Gestational cannabis use was independently associated with low birthweight, synergistically affected by tobacco smoking.

Distress, desperation and despair: anxiety, depression and suicidality among rural South African youth.

Common mental disorders (CMDs) affect millions of people worldwide and impose a high cost to individuals and society. Youth are disproportionately affected, as has also been confirmed in South Africa. Mental disorders and substance use disorders often occur as concurrent disorders. Although youth in rural South Africa grow up in difficult social and economic conditions, the study of mental disorders in South Africa has focussed primarily on urban populations. One such rural area in South Africa is the Harry Gwala District, where rates of interpersonal violence and self-inflicted injuries among 15-24-year-old men, are extraordinarily high. Suicide is an important proxy measure of severe emotional distress, predominantly depression and hopelessness. This study reports on rates of fatal self-harm among 15-24-year-old men in the Harry Gwala District. We determined the rates and severity of CMDs and their correlates among 355 young males ranging in age from 14 to 24 years in the Harry Gwala District community. High rates of depression, anxiety, hopelessness and worthlessness were reported. One in four of the young men and boys reported current suicidal thoughts associated with depression, anxiety, feelings of worthlessness and binge drinking. Reports of alcohol use were high, as were those of daily cannabis use. Our findings show high rates of CMDs and alcohol use, and highlight the impact of collective dysphoria on the mental well-being of rural youth in South Africa, who are likely coping through drug and alcohol use.

The salience and symbolism of numbers across cultural beliefs and practice.

Numbers are ubiquitous to modern existence and have evolved with humanity over millenia. They structure, record and quantify human behaviour, spiritual belief systems and the evolution of innovation across all spheres of life. Furthermore, cultural identities and interpersonal expression often have numerical components to them for instance rites of passage, population demography and fiscal measures. The salience of numbers in both historical and contemporary cultural life arguably plays a role in individual psyches and the experience of distress or wellness. This paper illustrates the cultural relativism of numbers through superstition and foreboding to auspiciousness in different societies. As a short hand for the quantification of multiple phenomena in low literacy to high technology populations, rural and urban societies as well as traditional and evolving societies, numbers have and will continue to be core to all cultures as they have from prehistoric to contemporary times.

Cannabis and psychosis: revisiting a nineteenth century study of 'Indian Hemp and Insanity' in Colonial British India.

BACKGROUND: In nineteenth-century British India, concern regarding large numbers of asylum patients with 'Indian Hemp Insanity' led to establishment of the Indian Hemp Drugs Commission. The exotic cannabis plant was widely used in pharmacopeia and a source of government revenue. The Commission was tasked with determining the public health risks of cannabis use, particularly mental illness. This analysis of the Commission report seeks to highlight the status of 1892 cannabis research and compare it with current evidence for medical and recreational cannabis use. METHODS: Detailed historiographic review of the Indian Hemp Drugs Commission Report (1892). RESULTS: In 1892, heavy cannabis use was considered to have been associated with severe mental illness (7.3% of asylum patients; 12.6% of patients with diagnoses). About two-thirds were children and young adults with higher relapse rates. Risk increased with early cannabis use and a family history of mental illness. Cannabis psychosis was found to have a shorter trajectory and better prognosis than other mental illnesses in the asylums. Different cannabis potency and modes of consumption had different effects. Occasional cannabis use was felt to have medicinal benefits for some. Appendices provided symptoms and demographic characteristics of cannabis-induced mental illness. CONCLUSION: This important nineteenth-century study observed frequency and dose-related effects of cannabis on mental health, particularly psychotic symptoms in young people with a previous or hereditary risk of mental illness. Pathophysiological observations were consistent with current knowledge. As one of the most systematic and detailed studies of the effects of cannabis of the time it foreshadowed contemporary cannabis issues.

'Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain.

The relationship between mental exhaustion and somatic sensations has been described across cultures for millennia, including the contextual relationship with studying and learning. In 19th century Britain, concern regarding the impact of 'excessive' study ('overstudy') and the mental impact on 'brainworkers' led to the coining of the term 'Brain Fag' in 1850. Anxiety became heightened following the promulgation of the Education Acts from 1870 with compulsory child education. This was felt to be a public health crisis with social class distinctions. Brain fag anxiety subsequently transmitted across the British colonies while declining in Britain. Over a century later, this linguistic and colonial residue was observed in British West Africa where it was described as a culture bound syndrome.

Bowel patterns, gastrointestinal symptoms, and emotional well-being in adolescents: A cohort study.

BACKGROUND AND AIM: Bowel patterns are varied in the general population. Gastrointestinal symptoms are common reasons for clinical visits. We aimed to examine the usual bowel pattern and the prevalence and significance of gastrointestinal symptoms in a population-based cohort of Australian adolescents. METHODS: Seventeen-year-old adolescents (n = 1279) in the Western Australian Pregnancy Cohort (Raine) Study participated in a cross-sectional assessment, involving health questionnaires. Questions included medical history, diet, bowel patterns, and gastrointestinal symptoms. Data were analyzed to identify patterns of bowel motions, gastrointestinal symptoms, and factors associated with these in adolescents. Multivariate logistic regression analysis was used to determine predictors of poorer self-rated health status. RESULTS: The dominant pattern of bowel motions was passage of stool that was "not too hard and not too soft" (Bristol stool types 3 and 4) in 90% and occurring between three and seven times per week in 74%. The most prevalent gastrointestinal symptoms included abdominal bloating (72%), abdominal pain (36%), nausea (25%), and constipation (20%). A "Western" dietary pattern was associated with abdominal bloating, constipation, and nausea (P < 0.05). Apart from diarrhea, gastrointestinal symptoms were more prevalent in female adolescents than male adolescents (P < 0.05 for all). Female sex (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.16-3.02, P = 0.01), nausea (OR 3.18, 95% CI 2.03-4.98, P < 0.001), and depression (OR 6.68, 95% CI 3.65-12.22, P = 0.03) were independently associated with poorer self-rated health status, after adjusting for other gastrointestinal symptoms. CONCLUSIONS: In adolescents, bowel patterns and gastrointestinal symptoms are diverse and show sex differences. Nausea, depression, and female sex are significant factors for poorer self-rated health.

Mental distress and substance use among rural Black South African youth who are not in employment, education or training (NEET).

BACKGROUND: South Africa (SA) has one of the highest rates of youth unemployment and youth who are not in employment, education or training (NEET), even higher among Black South Africans. SA's NEET rates are 3 times those of UK; 5.4 times of Germany; 1.3 times of Brazil; and 2.5 times of Malaysia. Given that youths between 15 and 24 years of age make up 24% of the total population, these are significant challenges for the economy and further fuel the cyclical, pervasive and enduring nature of poverty. We hypothesised that rural youth who are NEET would have a greater prevalence of mental disorders and higher rates of substance use compared to their non-NEET counterparts. The objective of the study is to determine the differences in rates of psychological distress and substance use between NEET and non-NEET rural African 14- to 24-year-old young men. METHODS: The study took place in a remote and rural district municipality in KwaZulu-Natal, South Africa. We divided the district's five sub-municipalities into two clusters (large and small) and randomly selected one from each cluster for inclusion in the study. We further randomly selected wards from each sub-municipality and then rural settlements from each ward, for inclusion in the study. We recruited young men as part of a larger study to explore sociocultural factors important in gender-based violence in rural SA. We compared 15- to 19-year old and 20- to 24-year old youth NEET and non-NEET on rates of psychological distress symptoms (depression, anxiety, suicidal thoughts, hopelessness and worthlessness) and substance misuse (including alcohol, cannabis, other recreational drugs) using a Multivariate Analysis of Variance (MANOVA) statistics at p < .005 level of significance level. RESULTS: About 23% of the 355 male participants were NEET. There were no statistically significant differences in psychological distress or substance use between youth NEET and non-NEET, controlling for age. CONCLUSION: The study highlights difficult transitions to post-secondary education and work for Black youth in rural SA where opportunities for employment are limited. Education, training and employment appear to offer limited benefit.

Association between gestational cannabis exposure and maternal, perinatal, placental, and childhood outcomes.

Globally, the availability and formulations for the administration of cannabis are changing with decriminalization or legalization of recreational use in some jurisdictions, and the prescription of cannabis also occurring. These changes are likely to affect the prevalence of use, including by women of childbearing age. The effects of in utero and infant alcohol and tobacco exposure are well-documented, but the outcomes of cannabis exposure are less certain. The content of delta-9-tetrahydrocannabinol (THC), the psychoactive component of cannabis has progressively increased over several decades. This review explores the limited knowledge surrounding the epidemiology of gestational and postnatal cannabis exposure and implications for the mother-placenta-fetus/neonate triad. We examine cannabis' effects from antenatal and lactation exposure on (a) pregnancy and perinatal outcomes, (b) placental health, and (c) longer term cardiometabolic and neurodevelopmental risks and outcomes. Though definitive outcomes are lacking, gestational cannabis has been associated with increased risk of other substance use during pregnancy; impaired placental blood flow; increased risk of small for gestational age births; and associated complications. Childhood and adolescent outcomes are sparsely assessed, with suggested outcomes including increased risk of depression and attention-deficit hyperactivity disorder. Cardiometabolic implications of gestational cannabis use may include maternal fatty liver, obesity, insulin resistance, and increased risk of gestational diabetes mellitus (GDM), with potential consequences for the fetus. Clinical implications for pediatric practice were explored in a bid to understand any potential risk or impact on child health and development.

The relationship between abdominal pain and emotional wellbeing in children and adolescents in the Raine Study.

Abdominal pain is a common reason for medical visits. We examined the prevalence, gastrointestinal, and emotional significance of abdominal pain in a population-based cohort serially followed up from birth to 17 years. Children and adolescents from Generation 2 of the Raine Study participated in comprehensive cross-sectional assessments at ages 2, 5, 8, 10, 14 and 17 years. At 17 years, medical history, general health, gastrointestinal symptoms, medications, health practitioner attendance, and self-rated unhappiness were recorded. Longitudinal data regarding abdominal pain or unhappiness, from serial questionnaires, were analysed to identify factors associated with abdominal pain and adverse emotional health at age 17 years. Females experienced more abdominal pain than males at all ages (p < 0.05). Seventeen-year-old adolescents with abdominal pain reported a higher prevalence of depression, anxiety, being bullied at school, and poorer health status than those without abdominal pain (p < 0.05 for all). Abdominal pain and unhappiness during childhood and mid-adolescence were prospectively associated with recurrent abdominal pain, anxiety, depression and unhappiness during late adolescence (p < 0.05 for all). In conclusion, abdominal pain in children and adolescents associates with depression, anxiety, being bullied, unhappiness and reduced overall health-rating during adolescence. Awareness of these factors may guide management decisions.

Brain fag syndrome: a culture-bound syndrome that may be approaching extinction.

Aims and method To explore the current salience of 'brain fag' as a nosological, diagnostic and clinical construct in modern West African psychiatry. A semi-structured questionnaire and vignette based on classical symptoms of brain fag syndrome were used to explore current knowledge, explanatory models and practice among Nigerian psychiatrists. Results Of 102 psychiatrists who responded, 98% recognised the term 'brain fag syndrome' and most recognised the scenario presented. However, only 22% made a diagnosis of brain fag syndrome in their practice preferring diagnoses of anxiety, affective and somatic disorders. Clinical implications A decreasing number of Nigerian psychiatrists are making a diagnosis of 'brain fag syndrome'. We found strong evidence of nosological and diagnostic decline in the syndrome in its place of birth. This may signal the early extinction of this disorder or nosological metamorphosis from a 'culture-bound' syndrome in West African psychiatric practice.