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Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects and a description of psychosis attributed to khat chewing

Published online by Cambridge University Press:  09 July 2009

Christos Pantelis ,
Charles G. Hindler  and
John C. Taylor
Christos Pantelis*
Affiliation:
Department of Psychiatry, Royal Free and Friern Hospitals, London
Charles G. Hindler
Affiliation:
Department of Psychiatry, Royal Free and Friern Hospitals, London
John C. Taylor
Affiliation:
Department of Psychiatry, Royal Free and Friern Hospitals, London
*
1Address for correspondence: Dr Christos Pantelis, Academic Unit, Horton Hospital, Long Grove Rd., Epsom, Surrey KT19 8PZ.
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Synopsis

There have been relatively few reported cases of psychosis due to khat usage despite its heavy consumption in certain East African and Arabian countries. Four cases have been reported in the UK. We report here on three further cases of psychotic reactions to this substance in Somalian males, and emphasize the need to be aware of khat as a potential substance of abuse, with both medical and psychiatric complications. The features of khat psychoses are described and the relationship to amphetamine and ephedrine psychoses is discussed. The forensic aspects of two of the cases which involved homicide and combined homicide and suicide are highlighted, as is the possible role of social dislocation from the culture of origin.

Type
Original Articles
Information
Psychological Medicine , Volume 19 , Issue 3 , August 1989 , pp. 657 - 668
Copyright
Copyright © Cambridge University Press 1989

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References

Ahmed, A. M., Anania, M. C. & Nencini, P. (1983). Long lasting analgesic effect of cathinone.In International Conference On Khat The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 144–147. International Council on Alcohol and Addictions: Madagascar.Google Scholar
Al-Thani, I. M. (1983). Development: the Saudi solution for the problem of khat.In International Conference On Khat – The Health and Socioeonomic Aspects of Khat Use,January 17–21, pp. 181–194. International Council on Alcohol and Addictions: Madagascar.Google Scholar
Baasher, T. A. (1980). The use of khat: a stimulant with regional distribution. In Drug Problems in the Sociocultural Context – A Basis for Policies and Programme Planning (ed. Edwards, G. & Arif, A.), pp. 86–93. World Health Organization: Geneva.Google Scholar
Baasher, T. A. & Sadoun, R. (1983). The epidemiology of khat.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 161–177. International Council on Alcohol and Addictions: Madagascar.Google Scholar
Braenden, O. (1979). Research on the chemical composition of khat. In Problems of Drug Dependence. NIDA Research Monograph,. 27, 320–321. US Government Printing Office: Washington.Google Scholar
Busby, A. (1987). On sale: leaf drug that led to death. The Observer 18 10 p. 5.Google Scholar
Carothers, J. C. (1945). Miraa as a cause of insanity. The East African Medical Journal 22, 4–6.Google Scholar
Chapple, P. A. L. (1965). New drugs of addiction. British Medical Journal ii, 108.CrossRefGoogle Scholar
Connell, P. H. (1958). Amphetamine Psychosis. Institute of Psychiatry, Maudsley Monographs No. 5. Oxford University Press: Oxford.Google Scholar
Critchlow, S. & Seifert, R. (1987). Khat-induced paranoid psychosis. British Journal of Psychiatry 150, 247–249.Google Scholar
Hondt, H. A., Fahmy, A. M. & Abdelbaset, S. A. (1984). Chromosomal and biochemical studies on the effect of kat extract on laboratory rats. Environmental Mutagenesis 6, 851–860.Google Scholar
Dhadphale, M. & Arap Mengech, H. N. K. (1987). Khat-induced paranoid psychosis. British Journal of Psychiatry 150, 876.CrossRefGoogle Scholar
Dhadphale, M., Arap Mengech, H. N. K & Chege, S. W. (1981). Miraa (Catha edulis) as a cause of psychosis. The East African Medical Journal 58, 130–135.Google Scholar
D'Orbán, P. T. (1986). The consequences and effectiveness of drugs legislation. Family Law 16, 221–225.Google Scholar
Dougherty, R. J. (1982). Pseudo-speed, look-alikes or pea-shooters. New York State Journal of Medicine 82, 74–75.Google Scholar
Eddy, N. B., Halbach, H., Isbell, H. & Seevers, M. H. (1965). Drug dependence: its significance and characteristics. Bulletin of World Health Organization 32, 721–733.Google Scholar
El-Guindy, M. K. (1971). Effects of Catha edulis (khat) chewing on the human body. Journal of the Egyptian Medical Association 54, 230–234.Google Scholar
Ellinwood, E. H. Jr., (1969). Amphetamine psychosis: a multidimensional process. Seminars In Psychiatry 1, 208–226Google Scholar
Ellinwood, E. H. Jr., (1971). Assault and homicide associated with amphetamine abuse. American Journal of Psychiatry 127, 1170–1175.CrossRefGoogle ScholarPubMed
Elmi, A. S. (1983 a). The chewing of khat in Somalia. Journal of Ethnopharmacology 8, 163–176.Google Scholar
Elmi, A. S. (1983 b). Khat consumption and problems in Somalia.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 78–86. International Council on Alcohol and Addictions: Madagascar.Google Scholar
Elmi, A. S. (1983 c). Effect of khat on resting and fatigued subjects.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 153–158.Google Scholar
Gendron, Y., Ardouin, Ch. & Martine, J. (1977). Accidents cardiovasculaires aigus déclenchés par le khat. Médecine Tropicale 37, 69–72.Google Scholar
Giannini, A. J. & Castellani, S. (1982). A manic-like psychosis due to khal. Journal of Toxicology 19, 455–459.Google Scholar
Giannini, A. J., Burge, H., Shaheen, J. M. & Price, W. A. (1986). Khat: another drug of abuse? Journal of Psychoactive Drugs 18, 155–158.CrossRefGoogle ScholarPubMed
Gold, M. S. & Bowers, M. B. Jr. (1978). Neurobiological vulnerability to low-dose amphetamine psychosis American Journal of Psychiatry 135, 1546–1548.Google Scholar
Gough, S. P. & Cookson, I. B. (1984). Khat-induced schizophreniform psychosis in UK. The Lancet i, 455.Google Scholar
Gough, S. P. & Cookson, I. B. (1987). Khat-induced paranoid psychosis. British Journal of Psychiatry 150, 875–876.CrossRefGoogle Scholar
Halbach, H. (1972). Medical aspects of the chewing of khat leaves. Bulletin of World Health Organization 47, 21–29.Google Scholar
Halbach, H. (1979). Khat - the problem today.In Problems of Drug Dependence, Proceedings of the 41st Annual Scientific Meeting, pp. 318–319. National Institute of Drug Abuse, US Government Printing Office, Washington DC. Research Monograph No. 27.Google Scholar
Hodgkinson, R. (1962). A study of the clinical effects of Catha edulis (khat, miraa) in Kenya. The Medical Journal of Australia 49, 884–886.CrossRefGoogle Scholar
Hogg, A. & Rogers, H. (1985). Arab danger drug on sale legally in Britain. The Sunday Times, 20 January, pp. 1–2.Google Scholar
Jaffe, J. H. (1980). Commonalities and diversity among drug-use patterns in different countries. In Drug Problems In the Sociocultural Context.– A Basis for Policies and Programme Planning (ed. Edwards, G. & Arif, A.), pp. 94–102World Health Organization: Geneva.Google Scholar
Kalix, P. (1980). Hyperthermic response to (–) cathinone, an alkaloid of Catha edulis (khat). Journal of Pharmacy and Pharmacology 32, 662–663.Google Scholar
Kalix, P. (1983 a). Mechanism of action of (–) cathinone, a new alkaloid from khat leaves. Alcohol and Alcoholism 18, 301–303.Google Scholar
Kalix, P. (1983 b). The pharmacology of khat and of the khat alkaloid cathinone.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 140–143. International Council on Alcohol and Addictions, Madagascar.Google Scholar
Kalix, P. (1984 a). The pharmacology of khat. General Pharmacology 15, 179–187.Google Scholar
Kalix, P. (1984 b). Amphetamine psychosis due to khat leaves. The Lancet i, 46Google Scholar
Kalix, P. (1987). Khat: scientific knowledge and policy issues. British Journal of Addiction 82, 47–53.Google Scholar
Kalix, P. & Braenden, O. (1985). Pharmacological aspects of the chewing of khat leaves. Pharmacological Reviews 37, 149–164.Google ScholarPubMed
Kennedy, J. G., Teague, J. & Fairbanks, L. (1980). Qat use in North Yemen and the problem of addiction: a study in medical anthropology Culture, Medicine and Psychiatry 4, 311–344.CrossRefGoogle ScholarPubMed
Kennedy, J. G., Teague, J., Rokaw, W. & Cooney, E. (1983). A medical evaluation of the use of qat in North Yemen. Society Science and Medicine 17, 783–793.Google Scholar
Kennedy, J. G. (1987). The Flower of Paradise.– The Institutionalized Use of the Drug Qat In North Yemen. D. Reidel: Dordrecht.Google Scholar
Knoll, J. (1979). Studies on the central effects of (–) cathinone.Problems of Drug Dependence-Proceedings of the 41st Annual Scientific Meeting, pp. 322–323. National Institute of Drug Abuse, US Government Printing Office: Washington, DC. Research Monograph No. 27.Google Scholar
Krikorian, A. D. (1984). Kat and its use: an historical perspective. Journal of Ethnopharmacology 12, 115–178.CrossRefGoogle ScholarPubMed
Laurent, J. M. (1962 a). Consequences médicales de la toxicomanie au cath. Medecine Tropicale 23, 477–483.Google Scholar
Laurent, J. M. (1962 b), Toxique et toxicomanie peu connus, ‘Le cath’ Annales Medecine Psychiatrie, 12, 649–657.Google Scholar
Luqman, W. & Danowski, T. S. (1976). The use of khat (Catha edulis) in Yemen. Social and medical observations. Annals of Internal Medicine 85, 246–249.CrossRefGoogle ScholarPubMed
McKee, C. M. (1987). Medical and social aspects of qat in Yemen: a review. Journal of the Royal Society of Medicine 80, 762–765.CrossRefGoogle ScholarPubMed
McLaren, P., (1987). Khat psychosis. British Journal of Psychiatry 150,712–713.CrossRefGoogle ScholarPubMed
Mancioli, M. & Parrinello, A. (1967). Il qat (Catha edulis). La Clinica Terapeutica 43, 103–172.Google Scholar
Margetts, E. L. (1967). Miraa and myrrh in East Africa – clinical notes about Catha edulis. Economic Botany 21, 358–362.Google Scholar
Mayberry, J, Morgan, G. & Perkin, E. (1984). Khat-induced schizophreniform psychosis in UK. The Lancet i, 455.Google Scholar
Murad, F. (1983). Social effects of khat.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 211–214. International Council on Alcohol and Addictions: Madagascar.Google Scholar
Nencini, P., Anania, M. C., Abdullahi, M. A., Amiconi, G. & Elmi, A. S. (1983). Physiological and neuroendocrine effects of khat in man.In International Conference On Khat – The Health and Socioeconomic Aspects of Khat Use,January 17–21, pp. 148–152. International Council of Alcohol and Addictions: Madagascar.Google Scholar
Nencini, P., Abdullahi, M. A., Amiconi, G., Elmi, A. S. (1984 a). Tolerance develops to sympathetic effects of khat in humans. Pharmacology 28, 150–154.Google Scholar
Nencini, P., Abdullahi, M. A., Anania, M. C., Moscucci, M. &Paroli, E. (1984 b). Prolonged analgesia induced by cathinone. The role of stress and opioid and nonopioid mechanisms. Pharmacology 29, 269–281.Google Scholar
Nencini, P., Amiconi, G., Befani, O., Abdullahi, M. A. & Anania, M. C. (1984 c). Possible involvement of amine oxidase inhibition in the sympathetic activation induced by khat (Calha edulis) chewing in humans. Journal of Ethnopharmacology 11, 79–86.Google Scholar
Omolo, O. E & Dhadphale, M. (1987 a). Prevalence of khat chewers among primary health clinic attenders in Kenya. Acta Psychiatrica Scandinavica 75, 318–320.CrossRefGoogle ScholarPubMed
Omolo, O. E. & Dhadphale, M. (1987 b). Alcohol use among khat (Catha) chewers in Kenya. British Journal of Addiction 82, 97–99.Google Scholar
Rosecrans, J. A., Campbell, O. L., Dewey, W. L. & Harris, L. S. (1979). Discriminative stimulus and neurochemical mechanism of cathinone: a preliminary study.In Problems of Drug Dependence, Proceedings of the 41st Annual Scientific Meeting, pp. 328–329 National Institute of Drug Abuse, US Government Printing Office: Washington, DC. Research Monograph No. 27.Google Scholar
Schorno, X. & Steinegger, E. (1979). CNS-active phenylpropylamines of Calha edulis of Kenyan origin. Experientia 35, 572–574.Google Scholar
Schuster, C. R. & Johanson, C. E. (1979). Behavioural studies of cathinone in monkeys and rats.In The Problems of Drug Dependence, Proceedings of the 41st Annual Scientific Meeting, pp. 324–325. National Institute of Drug Abuse, US Government Printing Office: Washington, DC. Research MonographNo.27.Google Scholar
Shanhandeh, B., Geadah, R., Tongue, A., Tongue, E. & Rolli, J. (1983). The health and socioeconomic aspects of khat use.In Proceedings, First International Conference on Khat. International Council on Alcohol and Addictions: Lausanne.Google Scholar
Siegel, R. K. (1980). Cocaine substitutes. The New England Journal of Medicine 302, 817–818.Google Scholar
Snyder, S. H. (1973). Amphetamine psychosis: a model schizophrenia mediated by catecholamines. American Journal of Psychiatry 130, 61–67.Google Scholar
Szendrei, K. (1980). The chemistry of khat. Bulletin of Narcotics 32, 5–36.Google ScholarPubMed
United Nations Document MNAR/11,. (1975). Etudes sur la composition chimique du khat; récherches sur la fraction phenylalkylamine.Google Scholar
Weir, S. (1985). Qat in Yemen – Consumption and Social Change. British Museums Publications: London.Google Scholar
Whitehouse, A. M. (1987). Should sympathomimetics be available over the counter? British Medical Journal 294, 1308.Google Scholar
Whitehouse, A. M. & Duncan, J. M. (1987). Ephedrine psychosis rediscovered. British Journal of Psychiatry 150, 258–261.CrossRefGoogle ScholarPubMed
WHO Expert Committee on Drug Dependence (1973). Nineteenth Report, World Health Organization Technical Report Series,.No. 526.Google Scholar
WHO Advisory Group (1980). Review of the pharmacology of khat. Bulletin on Narcotics 32, 83–93.Google Scholar
WHO Expert Committee on Drug Dependence (1985). Twentysecond Report, World Health Organization Technical Report Series, No. 729.Google Scholar
Yanagita, T. (1979). Sympathomimetic effects of khat. In Problems of Drug Dependence (ed. Harris, L. S.), pp. 326–327. National Institute of Drug Abuse, Research Monograph Series, 27: Rockville, Maryland.Google Scholar
Zelger, J. L., Schorno, Hj. X. & Carlini, E. A. (1980). Behavioural effects of cathinone, an amine obtained from Catha edulis Forsk.: comparisons with amphetamine, norpseudoephedrine, apomorphine and nomifensine Bulletin on Narcotics, Vol. XXXII, No. 3, 67–81.Google Scholar