title: Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychology, University of Konstanz, Fach D25, D-78476 Konstanz, Germany. michael.odenwald@uni-konstanz.de
authors.forename: Michael
authors.initials: M
authors.lastname: Odenwald
authors.forename: Frank
authors.initials: F
authors.lastname: Neuner
authors.forename: Maggie
authors.initials: M
authors.lastname: Schauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
authors.forename: Claudia
authors.initials: C
authors.lastname: Catani
authors.forename: Birke
authors.initials: B
authors.lastname: Lingenfelder
authors.forename: Harald
authors.initials: H
authors.lastname: Hinkel
authors.forename: Heinz
authors.initials: H
authors.lastname: Häfner
authors.forename: Brigitte
authors.initials: B
authors.lastname: Rockstroh
mesh_terms: D000293:Adolescent; D000328:Adult; D000470:Alkaloids / Q000009:adverse effects*; D016022:Case-Control Studies; D029754:Catha / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010936:Plant Extracts / Q000009:adverse effects*; D011605:Psychoses, Substance-Induced / Q000453:epidemiology* / Q000209:etiology; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012149:Restraint, Physical; D012307:Risk Factors; D017678:Sex Distribution; D012998:Somalia / Q000453:epidemiology; D040921:Stress Disorders, Traumatic / Q000453:epidemiology
chemical_list: D000470:Alkaloids; D010936:Plant Extracts; D011619:Psychotropic Drugs; C023665:cathinone