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Olani AB, Gerbaba M, Getnet M, Soboka M, Decorte T. Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base. Subst Abuse Treat Prev Policy 2023; 18:39. [PMID: 37370160 DOI: 10.1186/s13011-023-00545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research. METHODS We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings. RESULTS 7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration. CONCLUSION Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.
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Affiliation(s)
- Amanti Baru Olani
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, Ghent, 9000, Belgium.
- Department of Sociology, Jimma University, Jimma, P.O.Box 378, Ethiopia.
| | - Mulusew Gerbaba
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Matiwos Soboka
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Tom Decorte
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, Ghent, 9000, Belgium
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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Schalinski I, Ndetei D, Odenwald M. Reducing Khat use among Somalis living in Kenya: a controlled pilot study on the modified ASSIST-linked brief intervention delivered in the community. BMC Public Health 2022; 22:2271. [PMID: 36471268 PMCID: PMC9721075 DOI: 10.1186/s12889-022-14681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During recent decades, the consumption of the stimulant khat (catha edulis) has profoundly changed in countries around the Horn of Africa, and excessive use patterns have emerged-especially evident among displaced Somalis. This is related to the development of severe somatic and psychiatric disorders. There are currently no preventive or interventional studies targeting khat use. This study's aim was to test screening and brief intervention (SBI) to reduce khat use among urban Somali refugees living in Kenya with limited access to public healthcare. METHODS In this controlled study, 330 male Somali khat users from the community were either assigned to SBI (161) or an assessment-only control condition (AC; 169); due to field conditions a rigorous experimental design could not be implemented. The World Health Organization's (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-linked brief intervention was adapted to khat and Somali culture. Trained local counselors administered the intervention. The amount and frequency of khat use was assessed using the time-line-follow-back method. We compared the month before the intervention (t1) to the two months after it (t2, t3). Baseline differences in khat use frequency were corrected by partial matching and mixed effect models used to evaluate intervention effects. RESULTS SBI was well accepted and feasible for khat users. Over the complete observation period and from t1 to t2, khat use amount and frequency decreased (p < .001) and the intervention group showed a greater reduction (group x time effects with p ≤ .030). From t2 to t3, no further reduction and no group differences emerged. CONCLUSION The results provide preliminary evidence that khat use amount and frequency can be reduced in community settings by SBI, requiring little resources. Thorough assessment alone might have intervention-like effects. The non-treatment-seeking community sample and the non-professional counselors are distinct from SBI studies with other substances in other countries, but support the feasibility of this approach in khat use countries and especially in Somali populations with limited access to healthcare. Future studies that employ rigorous experimental design are needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589 . First participant 16/09/2014.
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Affiliation(s)
- Marina Widmann
- grid.9811.10000 0001 0658 7699University of Konstanz, Feursteinstrasse 55, 78479 Konstanz, Germany ,vivo international e.V, Konstanz, Germany
| | - Bernice Apondi
- Voices of Community Action & Leadership, Beverly Court, Marcus Garvey Rd, Nairobi, Kenya
| | - Abednego Musau
- grid.4830.f0000 0004 0407 1981University of Groningen, PO Box 72, 9700 Groningen, AB Netherlands ,grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - Inga Schalinski
- vivo international e.V, Konstanz, Germany ,grid.7752.70000 0000 8801 1556Universität der Bundeswehr München, München, Germany
| | - David Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya ,grid.10604.330000 0001 2019 0495University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- grid.9811.10000 0001 0658 7699University of Konstanz, Feursteinstrasse 55, 78479 Konstanz, Germany ,vivo international e.V, Konstanz, Germany
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Im H, George N, Swan LE. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [DOI: https:/doi.org/10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/18/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E.T. Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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Im H, George N, Swan LET. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [PMID: 35923097 DOI: 10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support.
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Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E T Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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Edwards B, Atkins N. Exploring the association between khat use and psychiatric symptoms: a systematic review. BMJ Open 2022; 12:e061865. [PMID: 35879018 PMCID: PMC9328084 DOI: 10.1136/bmjopen-2022-061865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Consumption of the drug khat is high across East Africa and the South-Western Arabian Peninsula despite evidence for its adverse psychiatric effects. This systematic review aims to explore cross-sectional research in the field to determine the strength of the association between khat use and psychiatric symptoms METHODS: Six databases were searched in October 2021-Ovid Medline, Embase, APA PsycINFO, CINAHL, Scopus and Proquest-using the following search terms: "khat" OR "qat" OR "qaad" OR "catha" OR "miraa" OR "mairungi" AND "depression" OR "anxiety" OR "mania" OR "psych*" OR "schiz*" OR "mental" OR "hallucinations" OR "delusions" OR "bipolar". Eligible studies were cross-sectional studies of any population or setting comparing the prevalence of psychiatric symptoms in long term or dependent khat users with non-users. The quality of each study was appraised by the Newcastle-Ottawa scale. A meta-analysis was planned using a random effects model to produce an OR with 95% CIs-using the Mantel-Haenszel method-alongside an I2 statistic to represent heterogeneity. The quality of this meta-analysis was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) scoring system. RESULTS 35 studies were eligible for inclusion (total participants=31 893), spanning 5 countries (Ethiopia, Somalia, Kenya, Saudi Arabia, UK). Meta-analysis suggests that khat use is associated with an 122% increased prevalence of psychiatric symptoms (OR 2.22, 95% CIs 1.76 to 2.79, p<0.00001, GRADE score: 'very low'). CONCLUSIONS The high heterogeneity of the meta-analysis is likely due to the wide variation between the studies within the evidence base. To perform a more accurate systematic review, further primary studies are needed with standardised measurements of variables, particularly khat consumption. PROSPERO REGISTRATION NUMBER CRD42020224510.
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Affiliation(s)
- Betsy Edwards
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naomi Atkins
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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“It hurts so much to live for nothing”: Lived Experiences of Substance Use Among Refugee Youth in Displacement. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mesa-Vieira C, Haas AD, Buitrago-Garcia D, Roa-Diaz ZM, Minder B, Gamba M, Salvador D, Gomez D, Lewis M, Gonzalez-Jaramillo WC, Pahud de Mortanges A, Buttia C, Muka T, Trujillo N, Franco OH. Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis. THE LANCET PUBLIC HEALTH 2022; 7:e469-e481. [DOI: 10.1016/s2468-2667(22)00061-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 01/08/2023] Open
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Im H, Swan LET, Warsame AH, Isse MM. Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. Int J Soc Psychiatry 2022; 68:134-146. [DOI: https:/doi.org/10.1177/0020764020978685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. Aims: This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. Methods: We used snowball sampling to recruit Somali youth aged 15 to 35years( N = 250, n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. Results: Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. Conclusions: These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, USA
| | - Laura ET Swan
- School of Social Work, Virginia Commonwealth University, Richmond, USA
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Im H, Swan LE, Warsame AH, Isse MM. Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. Int J Soc Psychiatry 2022; 68:134-146. [PMID: 33300411 DOI: 10.1177/0020764020978685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. AIMS This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. METHODS We used snowball sampling to recruit Somali youth aged 15 to 35years(N = 250,n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. RESULTS Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. CONCLUSIONS These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, USA
| | - Laura Et Swan
- School of Social Work, Virginia Commonwealth University, Richmond, USA
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Wolde A, Dessalegn N. Posttraumatic Stress Disorder, Suicidal Behavior, Substance Use, and Sexual Victimization Among Adolescent Girls Aged 10-19 Years Living Under Ethnic-Based Civil War in Ethiopia. Neuropsychiatr Dis Treat 2022; 18:2239-2250. [PMID: 36254143 PMCID: PMC9569158 DOI: 10.2147/ndt.s381461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a chronic, impairing mental disorder that develops after exposure to a traumatic event. Despite many factors putting adolescent girls at risk of PTSD, little is known about the prevalence and how adolescent girls cope with the PTSD burden. So, this study aimed to investigate the prevalence of PTSD and associated factors among adolescent girls in three selected towns in Southwest Ethiopia. METHODS A community-based cross-sectional study was conducted among 397 adolescent girls from May 27 to July 27, 2021. The participants were selected by a systematic random sampling method. PTSD and substance use disorder were assessed by DSM V criteria for mental disorders. The data was entered into Epi Data Manager Version 4.0.2 before being exported to SPSS Version 25 for analysis. A logistic regression model was used, and variables with a p-value less than 0.05 in the final fitting model were stated as independent predictors of PTSD. RESULTS The prevalence of PTSD among the adolescent girls was 22%, and about three in four (72.7%) of the adolescent girls developed PTSD after exposure to sexual violence. Furthermore, PTSD was associated with Khat use disorder (AOR, 95% CI: 2.79 (1.47-5.30), alcohol use disorder (AOR, 95% CI: 5.27 (2.21-12.60), and suicidal behavior (AOR, 95% CI: 2.12 (1.20-3.74)). CONCLUSION The prevalence of PTSD was high among adolescent girls, and suicidal ideation or attempt, khat use disorder, and alcohol use disorder were risk factors for PTSD. Therefore, early screening for PTSD and comorbid risk factors among this particular age group and managing accordingly is warranted.
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Affiliation(s)
- Asrat Wolde
- Department of Psychiatry, School of Medicine, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Nigatu Dessalegn
- Department of Pediatric Health Nursing, Mizan Tepi University, Mizan Aman, Ethiopia
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Nakajima M, Haji A, Sero A, Taha S, Habte H, Jama S, Hodges J, Mohamud S, Ahmed O, Hassan O, al'Absi M. Psychosocial Correlates of Experience and Intention to Receive Colorectal Cancer Screening: A Cross-Sectional Study Among East African Men in the U.S. J Prim Prev 2021; 42:603-623. [PMID: 34654996 DOI: 10.1007/s10935-021-00648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 12/16/2022]
Abstract
Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.
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Affiliation(s)
- Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, USA.
| | | | - Abdul Sero
- University of Minnesota Medical School, Duluth, USA
| | - Sartu Taha
- University of Minnesota Medical School, Duluth, USA
| | | | - Shamso Jama
- University of Minnesota Medical School, Duluth, USA
| | - James Hodges
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, USA
| | | | | | - Obsa Hassan
- Mercy Hospital, Allina Health, Coon Rapids, USA
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, USA
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Hassen MT, Soboka M, Widmann M, Keller L, Zeller AC, Büchele N, Barnewitz E, Yitayih Y, Schiller S, Senger J, Adorjan K, Odenwald M. Khat Use Patterns, Associated Features, and Psychological Problems in a Khat-Treatment-Seeking Student Sample of Jimma University, Southwestern Ethiopia. Front Public Health 2021; 9:645980. [PMID: 34490174 PMCID: PMC8416611 DOI: 10.3389/fpubh.2021.645980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Khat (Catha edulis) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance. Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use. Results: The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance. Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems.
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Affiliation(s)
| | - Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Marina Widmann
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Lucas Keller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Anja C Zeller
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Natascha Büchele
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eva Barnewitz
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Yimenu Yitayih
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Sabine Schiller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Jael Senger
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Center for International Health (CIHLMU), Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael Odenwald
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
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Soares J, Costa VM, Bastos MDL, Carvalho F, Capela JP. An updated review on synthetic cathinones. Arch Toxicol 2021; 95:2895-2940. [PMID: 34100120 DOI: 10.1007/s00204-021-03083-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Cathinone, the main psychoactive compound found in the plant Catha edulis Forsk. (khat), is a β-keto analogue of amphetamine, sharing not only the phenethylamine structure, but also the amphetamine-like stimulant effects. Synthetic cathinones are derivatives of the naturally occurring cathinone that largely entered the recreational drug market at the end of 2000s. The former "legal status", impressive marketing strategies and their commercial availability, either in the so-called "smartshops" or via the Internet, prompted their large spread, contributing to their increasing popularity in the following years. As their popularity increased, the risks posed for public health became clear, with several reports of intoxications and deaths involving these substances appearing both in the social media and scientific literature. The regulatory measures introduced thereafter to halt these trending drugs of abuse have proved to be of low impact, as a continuous emergence of new non-controlled derivatives keep appearing to replace those prohibited. Users resort to synthetic cathinones due to their psychostimulant properties but are often unaware of the dangers they may incur when using these substances. Therefore, studies aimed at unveiling the pharmacological and toxicological properties of these substances are imperative, as they will provide increased expertise to the clinicians that face this problem on a daily basis. The present work provides a comprehensive review on history and legal status, chemistry, pharmacokinetics, pharmacodynamics, adverse effects and lethality in humans, as well as on the current knowledge of the neurotoxic mechanisms of synthetic cathinones.
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Affiliation(s)
- Jorge Soares
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Maria de Lourdes Bastos
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Félix Carvalho
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - João Paulo Capela
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
- FP-ENAS (Fernando Pessoa Energy, Environment and Health Research Unit), CEBIMED (Biomedical Research Centre), Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal.
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Yitayih Y, van Os J. Prevalence and determinants of chewing khat among women in Ethiopia: data from Ethiopian demographic and health survey 2016. BMC Psychiatry 2021; 21:127. [PMID: 33663452 PMCID: PMC7934259 DOI: 10.1186/s12888-021-03136-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In Ethiopia and other countries in eastern Africa, khat abuse is an increasing public health problem. Levels of use appear to be increasing in women, who are more vulnerable to khat-related problems. However, population-based data are lacking as studies have been small and related to specific settings. This study aimed to contribute to current knowledge on the prevalence of chewing khat and associated factors among women in Ethiopia, using data from the 2016 Ethiopian national demographic and health survey. METHODS The 2016 EDHS used a two-stage stratified sampling design to select households. A total of 645 enumeration areas (202 urban and 443 rural) were selected, based on the 2007 Ethiopia Population and Housing Census. In these, 18,008 households were considered, from which 15,683 women were included from individual households. The women were interviewed by trained lay interviewers. Data were tabulated and logistic regression was used to examine mutually adjusted associations, expressed as adjusted odds ratios. RESULTS The lifetime prevalence of chewing khat among women was 9.9%. Current khat use was 8.4%, with a mean of 14.2 days of use in the last month. Khat use increased with increasing age, remaining constant after age 35 years, having one child, lower educational level, being Muslim by religion and not pertaining to the lowest wealth index category. Not being in a marital relationship with the most recent sex partner and Protestant religion were protective factors. CONCLUSION Lifetime prevalence of chewing khat among women in Ethiopia is substantial and associated with specific sociodemographic risks. These can be used in targeted public health efforts to control the use of khat and reduce the associated health and economic burden.
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Affiliation(s)
- Yimenu Yitayih
- Department of Psychiatry, College of Medical faculty, Jimma University, Jimma, Ethiopia.
| | - Jim van Os
- grid.5477.10000000120346234Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Wolde A. The Relationship Between Khat Use Disorder and Post-Traumatic Stress Disorder Among Prisoners with Life Time Trauma Exposure in Ethiopia: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2021; 17:3669-3681. [PMID: 34934320 PMCID: PMC8684415 DOI: 10.2147/ndt.s336877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Problematic khat use is an emerging health problem worldwide. Trauma experience, crime, and substance misuse is closely related. However, there is lack of evidence whether post-traumatic stress disorder (PTSD) and life time trauma exposure has a relationship with problematic khat use among prisoners in our country Ethiopia, or elsewhere. Therefore, this study assessed the relationship between PTSD and life time trauma exposure with khat use disorder among newly admitted prisoners in Bench Shako and West Omo zone correctional institution, Mizan Aman, Ethiopia. METHODS A cross-sectional study was conducted among 411 (N=422) prisoners from April 20 to July 19, 2019, by using a consecutive sampling technique. Trauma exposure and post-traumatic stress disorder were assessed with a life event check list and Post-traumatic stress disorder - civilian version (PCL-C), respectively. The WHO ASSIST tool was used to assess khat, alcohol, and tobacco use disorder. Antisocial personality disorder, criminal, and clinical history were also assessed. The data were entered into Epi-data version 3.1 and then exported to Statistical Package for Social Science version 21. A logistic regression model was used and variables with a p-value less than 0.05 in the final fitting model were stated as independent predictors of PTSD. RESULTS Nearly one out of four prisoners exposed to life time trauma exposure developed PTSD, and the prevalence of khat use disorder among prisoners with life time trauma exposure and PTSD was 45% and 85%, respectively. Prisoners with khat use disorder had more than 5 times higher odds of association with PTSD than their counterparts (AOR=5.3, 95% CI=2.4-11.8). In addition, antisocial personality disorder (AOR=2.8, 95% CI=1.6-5.5), criminal recidivism (AOR=2.5, 95% CI=1.5-4.3), and being a driver (AOR=2, 95% CI=1.2-3.3) were positively associated with PTSD. CONCLUSION Khat use disorder was higher among prisoners with life time trauma exposure and PTSD, and khat use disorder was positively associated with PTSD.
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Affiliation(s)
- Asrat Wolde
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
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Mihretu A, Fekadu A, Habtamu K, Nhunzvi C, Norton S, Teferra S. Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study. BMJ Open 2020; 10:e037907. [PMID: 33046468 PMCID: PMC7552831 DOI: 10.1136/bmjopen-2020-037907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to explore how problematic khat use is characterised in the Gurage community in South Central Ethiopia. DESIGN Qualitative study. SETTING Gurage community in South Central Ethiopia. PARTICIPANTS We conducted indepth interviews with 14 khat users and 5 non-khat users, and three focus group discussions with khat users. METHODS All participants were selected purposively based on their exposure to khat or khat use. We used an interview guide to explore the perceptions of participants about khat use and problematic khat use. We analysed the data thematically using OpenCode V.4.03 software. We used iterative data collection and analysis, triangulation of methods, and respondent validation to ensure scientific rigour. FINDINGS We identified three major themes: sociocultural khat use, khat suse (khat addiction) and negative consequences of khat use. Sociocultural khat use included a broad range of contexts and patterns, including use of khat for functional, social, cultural and religious reasons. Khat addiction was mainly explained in terms of associated khat withdrawal experiences, including harara/craving and inability to quit. We identified mental health, sexual life, physical health, social and financial negative consequences of khat use. The local idiom jezba was used to label a subgroup of individuals with khat suse (khat addiction). CONCLUSION The study has identified what constitutes normative and problematic khat use in the Gurage community in South Central Ethiopia. Problematic khat use is a broad concept which includes frequency, reasons, contexts, negative consequences and addiction to khat. Insights generated can be used to inform future studies on the development of tools to measure problematic khat use.
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Affiliation(s)
- Awoke Mihretu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Social Sciences, College of Natural and Social Sciences, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clement Nhunzvi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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17
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Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey. BMC Psychiatry 2019; 19:137. [PMID: 31064338 PMCID: PMC6505064 DOI: 10.1186/s12888-019-2118-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. METHODS For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. RESULTS The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13-5.34) and hallucination (OR, 2.08; 95% C.I, 1.06-4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). CONCLUSIONS Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality.
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Adorjan K, Mulugeta S, Odenwald M, Ndetei DM, Osman AH, Hautzinger M, Wolf S, Othman M, Kizilhan JI, Pogarell O, Schulze TG. [Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. DER NERVENARZT 2019. [PMID: 28646248 DOI: 10.1007/s00115-017-0365-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).
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Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig Maximilians Universität München, München, Deutschland.
| | - S Mulugeta
- International Medical Corps, Mental Health and Psychosocial Support Program, (UNHCR and ARRA) Dolo Ado Refugee Camps, Dolo Ado, Äthiopien
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - D M Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenia
| | - A H Osman
- Department of Psychiatry, University of Khartoum, Khartoum, Sudan
| | - M Hautzinger
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - S Wolf
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - M Othman
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak
| | - J I Kizilhan
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak.,Fakultät für Sozialwesen, Duale Hochschule Baden Württemberg, Villingen-Schwenningen, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
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Compean E, Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:265-275. [PMID: 30092241 PMCID: PMC6459196 DOI: 10.1016/j.pnpbp.2018.08.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/13/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.
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Affiliation(s)
- Ebele Compean
- Medical University of South Carolina (MUSC) 169 Ashley Ave, RM 202 MUH MSC 333 Charleston SC 29425,Ralph H. Johnson VA Medical Center Department of Veterans Affairs 109 Bee Street Charleston, SC 29401-5799
| | - Mark Hamner
- Medical University of South Carolina (MUSC), 169 Ashley Ave, RM 202 MUH MSC 333, Charleston, SC 29425, United States; Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, 109 Bee Street Charleston, SC 29401-5799, United States.
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20
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Effects of Khat (Catha edulis) use on catalytic activities of major drug-metabolizing cytochrome P450 enzymes and implication of pharmacogenetic variations. Sci Rep 2018; 8:12726. [PMID: 30143732 PMCID: PMC6109098 DOI: 10.1038/s41598-018-31191-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
In a one-way cross-over study, we investigated the effect of Khat, a natural amphetamine-like psychostimulant plant, on catalytic activities of five major drug-metabolizing cytochrome P450 (CYP) enzymes. After a one-week Khat abstinence, 63 Ethiopian male volunteers were phenotyped using cocktail probe drugs (caffeine, losartan, dextromethorphan, omeprazole). Phenotyping was repeated after a one-week daily use of 400 g fresh Khat leaves. Genotyping for CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A5 were done. Urinary cathinone and phenylpropanolamine, and plasma probe drugs and metabolites concentrations were quantified using LC-MS/MS. Effect of Khat on enzyme activities was evaluated by comparing caffeine/paraxanthine (CYP1A2), losartan/losartan carboxylic acid (CYP2C9), omeprazole/5-hydroxyomeprazole (CYP2C19), dextromethorphan/dextrorphan (CYP2D6) and dextromethorphan/3-methoxymorphinan (CYP3A4) metabolic ratios (MR) before and after Khat use. Wilcoxon-matched-pair-test indicated a significant increase in median CYP2D6 MR (41%, p < 0.0001), and a marginal increase in CYP3A4 and CYP2C19 MR by Khat. Repeated measure ANOVA indicated the impact of CYP1A2 and CYP2C19 genotype on Khat-CYP enzyme interactions. The median MR increased by 35% in CYP1A2*1/*1 (p = 0.07) and by 40% in carriers of defective CYP2C19 alleles (p = 0.03). Urinary log cathinone/phenylpropanolamine ratios significantly correlated with CYP2D6 genotype (p = 0.004) and CYP2D6 MR (P = 0.025). Khat significantly inhibits CYP2D6, marginally inhibits CYP3A4, and genotype-dependently inhibit CYP2C19 and CYP1A2 enzyme activities.
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21
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Kiburi SK, Molebatsi K, Obondo A, Kuria MW. Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya. BMC Psychiatry 2018; 18:197. [PMID: 29914409 PMCID: PMC6007077 DOI: 10.1186/s12888-018-1780-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/07/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Substance use disorders are a major cause of health and social problems worldwide. Research evidence shows a strong graded relationship of adverse childhood experiences and substance use in adulthood. This study aimed at determining the prevalence of adverse childhood experiences and their association with substance use among patients with substance use disorders. METHOD The study used a descriptive cross-sectional design. A total of 134 patients aged 18 years and above receiving inpatient treatment for substance use disorders were recruited into the study. A mental state exam was done to rule out active psychopathology. Data on socio demographic variables, adverse childhood experiences (ACEs) and substance use was collected using Adverse Childhood Experiences International Questionnaire and The Alcohol, Smoking and Substance Involvement Screening Test respectively. Data was analysed using statistical package for social sciences (SPSS) version 20 for windows. RESULTS Males accounted for the majority of the study participants (n = 118, 88.1%). Only 43.3% (n = 58) of the participants had a family history of substance use disorder. The most frequently used substance was alcohol which was reported by 82.1% of the participants. Nearly 93% of the respondents had experienced at least one ACE and the most prevalent ACE was one or no parent which was reported by half of the respondents. The adverse childhood experiences significantly associated with current problematic substance use were; emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect. Emotional abuse significantly predicted tobacco (A.O.R = 5.3 (1.2-23.9)) and sedative (A.O.R = 4.1 (1.2-14.2)) use. Childhood exposure to physical abuse was associated with cannabis use [A.O.R = 2.9 (1.0-7.9)]. Experiencing five or more ACEs was associated with increased risk of using sedatives. CONCLUSION There is a high prevalence of adverse childhood experiences among patients with substance use disorders. Experiencing emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect in childhood are risk factors of substance use disorders. ACEs screening and management should be incorporated in substance abuse prevention programs and policies.
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Affiliation(s)
- Sarah Kanana Kiburi
- Department of Psychiatry, Mbagathi Hospital, Nairobi County, Nairobi, P.O. BOX 20725-00202, Kenya.
| | - Keneilwe Molebatsi
- 0000 0004 0635 5486grid.7621.2Department of Psychiatry, University of Botswana, Private Bag, 00713 Gaborone, Botswana
| | - Anne Obondo
- 0000 0001 2019 0495grid.10604.33Department of Psychiatry, University of Nairobi, Nairobi, P.O. BOX 19676-00202 Kenya
| | - Mary W. Kuria
- 0000 0001 2019 0495grid.10604.33Department of Psychiatry, University of Nairobi, Nairobi, P.O. BOX 19676-00202 Kenya
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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Ndetei D, Odenwald M. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1425-1434. [PMID: 28321455 DOI: 10.1007/s00127-017-1368-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention. METHODS In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning. RESULTS We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024). CONCLUSION Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.
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Affiliation(s)
- Marina Widmann
- University of Konstanz, Box 23, 78457, Konstanz, Germany.,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany
| | - Bernice Apondi
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - David Ndetei
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- University of Konstanz, Box 23, 78457, Konstanz, Germany. .,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany.
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Ibrahim H, Hassan CQ. Post-traumatic Stress Disorder Symptoms Resulting from Torture and Other Traumatic Events among Syrian Kurdish Refugees in Kurdistan Region, Iraq. Front Psychol 2017; 8:241. [PMID: 28265252 PMCID: PMC5316552 DOI: 10.3389/fpsyg.2017.00241] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/07/2017] [Indexed: 12/27/2022] Open
Abstract
Political violence is known to cause psychological distress. There is a large body of empirical studies drawing correlations between war trauma, torture, and post-traumatic stress disorder (PTSD). However, there are few studies on the effects of war-related trauma among Syrian refugees after events following the ‘Arab Spring’ uprisings between 2010 and 2012. This study examines the association of PTSD symptoms with torture and other traumatic events among Syrian Kurdish refugees living in Kurdistan Region, Iraq. The experiences and PTSD symptoms among 91 Syrian Kurdish refugees in the Arbat camp in the Sulaymaniyah Governorate of the Kurdistan Region of Iraq were assessed using the Harvard Trauma Questionnaire, sections I, IV, and V. Results showed that the estimated levels of PTSD symptoms were high: between 35 and 38%. There were no significant gender differences in the occurrence of PTSD symptoms. However, men reported more general traumatic experiences than women. There were significant positive correlations between PTSD symptoms with traumatic events and torture (r = 0.500, r = 0.366, respectively). Examining the mental health impact of torture and other traumatic events among refugees has possible implications for organizations managing rehabilitation programs for individuals who have been exposed to traumatic events.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld UniversityBielefeld, Germany; Department of Clinical Psychology, Koya UniversityKoya, Iraq
| | - Chiya Q Hassan
- Department of Clinical Psychology, Koya University Koya, Iraq
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Bogale T, Engidawork E, Yisma E. Subchronic oral administration of crude khat extract (Catha edulis forsk) induces schizophernic-like symptoms in mice. Altern Ther Health Med 2016; 16:153. [PMID: 27245332 PMCID: PMC4896131 DOI: 10.1186/s12906-016-1145-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 05/27/2016] [Indexed: 11/24/2022]
Abstract
Background Chewing fresh leaves of the khat plant (Catha edulis forsk) is a deep rooted and widespread habit in East Africa and the Middle East. Although a body of knowledge exists about the adverse effects of khat on health, data are sparse with regard to the consequences of long-term khat chewing in resulting schizophrenic like symptoms. Methods A crude extract of khat at different doses (100 mg/kg (K (khat)100), 200 mg/kg (K200) and 400 mg/kg (K400)) were administered for experimental group of mice whereas standard (ketamine (KT) 10 mg/kg- positive controls (KT10)) and vehicle (2 % v/v Tween-80 in distilled water – negative control groups (CON)) were administered for control groups of mice daily for two months to evaluate subchronic oral administration of crude khat extract to induce schizophrenic-like symptoms in mice. Mice were subjected to a battery of behavioural tests and parameters like locomotor activity, total time spent in social interaction and level of cognition among different groups of mice were measured and analyzed. Results Khat at all doses significantly increased (p < 0.001) the mean locomotor activity score of mice compared to CON. However, the mean locomotor activity score of mice treated with khat was significantly lower (p < 0.001) compared to the mean locomotor activity score of KT10 mice (p < 0.001). The mean total time score (in seconds) spent in social interaction, mean total time score (in seconds) spent in sniffing and following the partner was significantly higher (p < 0.001) in CON groups of mice compared to khat and ketamine treated groups. Moreover, in spatial memory task, the mean latency score (in seconds) to find the platform of khat and ketamine treated mice was significantly higher (p < 0.05) when compared to CON. Conclusions Subchronic oral administration of khat showed an enhanced locomotor activity, reduced social interaction and impaired cognitive function, which demonstrated that long-term use of khat is associated with schizophernic-like symptoms.
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Abstract
The use of khat (Catha edulis) while on medication may alter treatment outcome. In particular, the influence of khat on the metabolic activities of drug-metabolizing enzymes is not known. We performed a comparative 1-way crossover study to evaluate the effect of khat on cytochrome P450 (CYP)2D6 and CYP3A4 enzyme activity. After 1 week of khat abstinence, baseline CYP2D6 and CYP3A4 metabolic activities were determined in 40 Ethiopian male volunteers using 30 mg dextromethorphan (DM) as a probe drug and then repeated after 1 week of daily use of 400 g fresh khat leaves. Urinary concentrations of cathinone and cathine were determined to monitor the subjects' compliance to the study protocol. Genotyping for CYP2D6*3 and CYP2D6*4 was done. Plasma DM, dextrorphan and 3-methoxymorphinan concentrations were quantified. CYP2D6 and CYP3A4 enzyme activities were assessed by comparing plasma log DM/dextrorphan and log DM/methoxymorphinan metabolic ratio (MR) respectively in the presence and absence of khat. Cytochrome 2D6 MR was significantly increased from baseline by concurrent khat use (paired t test, P = 0.003; geometric mean ratio, 1.38; 95% confidence interval [95% CI], 1.12-1.53). Moreover, the inhibition of CYP2D6 activity by khat was more pronounced in CYP2D6*1/*1 compared with CYP2D6*1/*4 genotypes (P = 0.01). A marginal inhibition of CYP3A4 activity in the presence of khat was observed (P = 0.24). The mean percentage increase of CYP2D6 and CYP3A4 MR from baseline by khat use was 46% (95% CI, 20-72) and 31% (95% CI, 8-54), respectively. This is the first report linking khat use with significant inhibition of CYP2D6 metabolic activity in humans.
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Kassim S, Dalsania A, Nordgren J, Klein A, Hulbert J. Before the ban--an exploratory study of a local khat market in East London, U.K. Harm Reduct J 2015; 12:19. [PMID: 26066043 PMCID: PMC4465728 DOI: 10.1186/s12954-015-0048-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Khat is a green leaf with amphetamine-like effects. It is primarily used among people in Africa, the Middle East and in the diaspora communities from these countries. Prior to the prohibition of khat in the UK on 24 June 2014, there was almost no information available on key aspects of the local khat market. METHODS A cross-sectional study was conducted in 2012 using snowball sampling, Privileged Access Interviewing and area mapping in order to identify khat sale establishments. Data was collected via face-to-face interviews using mixed methods for data collection. This included information about the establishments selling khat, khat pricing and its use among different ethnic minority groups, in addition to the potential sale of khat to children and risk assessment (e.g., use of pesticides on khat). RESULTS Five out of seven sellers identified agreed to participate. Sellers described their khat sale establishments as 'community centres' which included, for example, a restaurant basement. The sellers' history of selling khat ranged between 1-15 years and khat's sale took place between 2pm-10pm. Miraa (e.g., Lara) from Kenya was the most popularly used khat variety, sold in pre-wrapped bundles of approximately 250 g costing £3 each and delivered four days a week. Harari (e.g., Owdi) from Ethiopia was sold in 200 g, 400 g and 1 kg bundles, priced between £5 and £20 and delivered two days a week. The primary benefit of khat use was reported to be social interaction. The customers were predominantly adult males of Somali origin. Most sellers claimed a self-imposed ban on sales to children under 18 years old. Khat bundles had no labelling describing variety or weight and sellers had no knowledge of the use of pesticides on khat and did not advertise the risks associated with khat use. CONCLUSIONS Khat selling establishments were businesses that did not adhere to trade standards regulations (e.g., labelling khat bundles). They claimed to provide a community service (facilitating social interaction) to their predominately Somali customers. Without a better understanding of the dynamics of the khat market there is a risk that both health and social needs of the vulnerable populations involved in the market continue to go unaddressed. Future research should track changes in the now illicit khat market in order to evaluate the social and public health implications following the recent changes to the current U.K. regulatory environment regarding khat.
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Affiliation(s)
- Saba Kassim
- Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - Asha Dalsania
- Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | - Johan Nordgren
- Department of Social Work, Malmö University, Malmö, Sweden.
| | - Axel Klein
- Project Office with Egmont, Institute for International Relations, Brussels, Belgium.
| | - Josh Hulbert
- Drugscience, the Independent Scientific Committee on Drugs, London, UK.
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Patel NB. "Natural Amphetamine" Khat: A Cultural Tradition or a Drug of Abuse? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 120:235-55. [PMID: 26070760 DOI: 10.1016/bs.irn.2015.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Khat, Catha edulis Forsk, is among the most widely used plant-based psychoactive substance in the world. Grown in Eastern Africa, Horn of Africa, and southwestern part of the Arabian Peninsula, its fresh young leaves and twigs are used daily by over 20 million people for the psychostimulatory effects it produces in the user, a practice deeply rooted in the history, tradition, and culture of the indigenous population. Once hardly known outside the regions where it is grown and used, khat use has now spread to other countries. This review will cover the, phytochemistry, pharmacokinetics of the active ingredients-cathinone, cathine, norephedrine, neurochemistry, effects on cognitive and executive functions as well as its ability to produce dependency in the user. Whether it is an innocuous cultural practice or a drug of abuse is debatable as the preclinical and clinical data needed to arrive at an authoritative conclusion is lacking.
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Affiliation(s)
- Nilesh B Patel
- Department of Medical Physiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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28
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Astatkie A, Demissie M, Berhane Y, Worku A. Prevalence of and factors associated with regular khat chewing among university students in Ethiopia. Subst Abuse Rehabil 2015; 6:41-50. [PMID: 25750551 PMCID: PMC4348121 DOI: 10.2147/sar.s78773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose Khat (Catha edulis) is commonly chewed for its psychostimulant and euphorigenic effects in Africa and the Arabian Peninsula. Students use it to help them study for long hours especially during the period of examination. However, how regularly khat is chewed among university students and its associated factors are not well documented. In this article we report on the prevalence of and factors associated with regular khat chewing among university students in Ethiopia. Methods We did a cross-sectional study from May 20, 2014 to June 23, 2014 on a sample of 1,255 regular students recruited from all campuses of Hawassa University, southern Ethiopia. The data were collected using self-administered questionnaires. We analyzed the data to identify factors associated with current regular khat chewing using complex sample adjusted logistic regression analysis. Results The prevalence of current regular khat chewing was 10.5% (95% confidence interval [CI]: 6.1%–14.9%). After controlling for sex, religion, year of study, having a father who chews khat, cigarette smoking and alcohol drinking in the adjusted logistic regression model, living off-campus in rented houses as compared to living in the university dormitory (adjusted odds ratio [95% CI] =8.09 [1.56–42.01]), and having friends who chew khat (adjusted odds ratio [95% CI] =4.62 [1.98–10.74]) were found to significantly increase the odds of current regular khat use. Conclusion Students living outside the university campus in rented houses compared to those living in dormitory and those with khat chewing peers are more likely to use khat. A multipronged prevention approach involving students, the university officials, the surrounding community, and regulatory bodies is required.
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Affiliation(s)
- Ayalew Astatkie
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia ; School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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