[e-drug] Khat use as risk factor for psychotic disorders

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E-DRUG: Khat use as risk factor for psychotic disorders 
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Research article

Khat use as risk factor for psychotic disorders: A cross-sectional and
case-control study in Somalia Michael Odenwald1, 2 , Frank Neuner1, 2, 3
, Maggie Schauer1, 2 , Thomas Elbert1, 2, 3 , Claudia Catani2 , Birke
Lingenfelder1 , Harald Hinkel4 , Heinz Hdfner5  and Brigitte Rockstroh1,
2, 3 1Department of Psychology, University of Konstanz, Fach D25,
D-78476 Konstanz, Germany 2Outpatient Clinic for Refugees, University of
Konstanz, Feursteinstr. 55, Haus 22, D-78479 Reichenau, Germany 3Ctr.
for Psychiatry Reichenau (ZPR), Feursteinstr.55, D-78479 Reichenau,
Germany 4Worldbank, Multi-Country Demobilization and Reintegration
Program in the greater Great Lakes Region of Africa, Goma, Democratic
Republic of Congo 5AG Schizophrenieforschung, Zentralinstitut f|r
Seelische Gesundheit, J5, D-68159 Mannheim, Germany

BMC Medicine 2005, 3:5 doi:10.1186/1741-7015-3-5
Published 2 February 2005

Abstract

Background
Little is known about the prevalence of khat-induced psychotic disorders
in East African countries, where the chewing of khat leaves is common.
Its main psycho-active component cathinone produces effects similar to
those of amphetamine. We aimed to explore the prevalence of psychotic
disorders among the general population and the association between khat
use and psychotic symptoms.

Methods
In an epidemiological household assessment in the city of Hargeisa,
North-West Somalia, trained local interviewers screened 4,854 randomly
selected persons from among the general population for disability due to
severe mental problems. The identified cases were interviewed based on a
structured interview and compared to healthy matched controls. Psychotic
symptoms were assessed using the items of the WHO Composite
International Diagnostic Interview and quantified with the Positive and
Negative Symptoms Scale. Statistical testing included Student's t-test
and ANOVA.

Results
Local interviewers found that rates of severe disability due to mental
disorders were 8.4% among males (above the age of 12) and differed
according to war experiences (no war experience: 3.2%; civilian war
survivors: 8.0%; ex-combatants: 15.9%). The clinical interview verified that in 83% of positive screening cases psychotic symptoms were the most prominent manifestations of psychiatric illness. On average, cases with psychotic symptoms had started to use khat earlier in life than matched controls and had been using khat 8.6 years before positive symptoms emerged. In most cases with psychotic symptoms, a pattern of binge use (> two 'bundles' per day) preceded the onset of psychotic symptoms, in contrast to controls of the same age. We found significant correlations between variables of khat consumption and clinical scales (0.35 to 0.50; p < 0.05), and between the age of onset of khat chewing and symptom onset (0.70; p <0.001).

Conclusion
Evidence indicates a relationship between the consumption of khat and
the onset of psychotic symptoms among the male population, whereby not
the khat intake per se but rather early onset and excessive khat chewing
seemed to be related to psychotic symptoms. The khat problem must be
addressed by means other than prohibition, given the widespread use and
its role in Somali culture.