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LETTERS TO EDITOR  
Year : 2017  |  Volume : 59  |  Issue : 1  |  Page : 126-127
Leaf it or not: A case of khat dependence from India


1 Department of Psychiatry, 166 Military Hospital, Jammu, Jammu and Kashmir, India
2 Department of Mental and Behavioural Sciences, Fortis Healthcare groups of Hospitals, Mumbai, Maharashtra, India
3 Department of Psychiatry, Peoples College of Medical Sciences, Bhopal, Madhya Pradesh, India
4 Assistant Professor, Central Institue of Psychiatry, Ranchi, Jharkhand, India

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Date of Web Publication12-Apr-2017
 

How to cite this article:
Gupta S, Dutta ES, Raju M, Kumar A. Leaf it or not: A case of khat dependence from India. Indian J Psychiatry 2017;59:126-7

How to cite this URL:
Gupta S, Dutta ES, Raju M, Kumar A. Leaf it or not: A case of khat dependence from India. Indian J Psychiatry [serial online] 2017 [cited 2019 Jul 16];59:126-7. Available from: http://www.indianjpsychiatry.org/text.asp?2017/59/1/126/204439


Sir,

Khat (Catha edulis) is an evergreen shrub mainly cultivated in East Africa and South Yemen. Its fresh leaves tops are chewed or dried and consumed as tea. Other famous names are Mirra, Qat, Gat, or Arabian tea.[1] Chewing of the leaves helps achieve a state of euphoria and stimulation, which in recent years has left an impact on the health and social aspects of African countries.[2] We present the first case of Khat dependence reported in India.

Mr. X, a 25-year-old Kenyan national of Indian origin, belonging to higher socioeconomic status, came to visit India for treatment. He appeared obese, unshaven, made poor eye contact, and was guarded. He complained that he “thinks too much” and had lost interest in work, sex, and interaction with others for nearly 2 years. No family and past history of psychiatric illness were reported. Anamnesis revealed that he was a gregarious person.

In the company of friends, he began chewing Miraa leaves at the age of 10. He had been chewing Miraa excessively for the last 15 years. Initially, his consumption was in tune of half to one bundle occasionally, which gradually increased to about 4 kg daily (12–15 bundles/day) to get the desired effect. He would remain dull and worrisome whenever he would not chew leaves and would get a “good feeling” on chewing leaves. He was not able to stop chewing leaves once he started consuming it. He lost interest in almost everything and was housebound chewing leaves. The last intake was before boarding aircraft for India.

Physical examination revealed digital tremors, cold and clammy hands, and pulse-88/minute. Mental status: the patient had doubts (if he had given something to somebody, whether he locked the car or tap or not, if he accidentally had dropped his keys). He sought clarifications repeatedly from spouse about his doubts (checking compulsions). He would often go into long internal dialogs (obsessive ruminations). He reported a feeling that he was at neighbor's house when in fact was at his own house (derealization). He reported no delusions and hallucinations. Magnetic resonance imaging brain revealed small, white matter hyperintensities in the frontal region. Rorschach test revealed an extratensive personality with obsessive features. No seizure activity or slowing was noted on electroencephalography.

A dual diagnosis of mental and behavioral disorders due to use of stimulants- dependence syndrome currently abstinent (F15.20) with obsessive–compulsive disorder (F42.0) – was made according to the International Classification of Diseases, 10th Revision. He was treated with fluvoxamine 200 mg/day, buspirone 30 mg/day, clonazepam 0.5 mg/day, and melatonin 3 mg at night with adjunct cognitive behavioral therapy sessions. His spouse was suggested to avoid clarifying his doubts. The patient reported improvement over the next month as he started going out, regained interest in sexual activities, and reported an increase in confidence. Before departure, he was advised strict abstinence. Currently, he is being followed up through video conferences. His spouse states that the patient is abstinent, working, socializing, and better.

Khat dependence and its ill effects are indigenous to parts of the African Peninsula. In 2002, it came under a critical scanner due to its dependence-producing ability. Khat contains more than 40 alkaloids, glycosides, tannins, amino acids, vitamins, and minerals.[3] Most of the sympathomimetic effect of chewing khat such as palpitations, tremors is thought to come from two phenylalkylamines, namely, cathinone and cathine – they are structurally related to amphetamine.[4],[5] Other central nervous system effects can lead to hyperthermia and anorexia. Limited literature exists regarding treatment of khat-induced psychiatric illness. Khat-induced psychosis (usually schizophrenia such as psychosis and mania) has been widely described, which may sometimes resolve spontaneously upon stopping consumption.[6] Obsessive–compulsive features linked to use of khat have not been reported earlier. As psychiatrists, we need to open our minds to dependence forms that are rare to our country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Hassan NA, Gunaid AA, Murray-Lyon IM. Khat (Catha edulis): Health aspects of khat chewing. East Mediterr Health J 2007;13:706-18.  Back to cited text no. 1
    
2.
Al-Mugahed L. Khat chewing in Yemen: Turning over a new leaf: Khat chewing is on the rise in Yemen, raising concerns about the health and social consequences. Bull World Health Organ 2008;86:741-2.  Back to cited text no. 2
    
3.
Halbach H. Medical aspects of the chewing of khat leaves. Bull World Health Organ 1972;47:21-9.  Back to cited text no. 3
    
4.
Cox G. Adverse effects of khat: A review. Adv Psychiatr Treat 2003;9:456-63.  Back to cited text no. 4
    
5.
Al-Motarreb A. Effect of khat on the heart and blood vessels. Heart 2004;3:54-7.  Back to cited text no. 5
    
6.
Al-Motarreb A, Baker K, Broadley KJ. Khat: Pharmacological and medical aspects and its social use in Yemen. Phytother Res 2002;16:403-13.  Back to cited text no. 6
    

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Correspondence Address:
Era S Dutta
Department of Mental and Behavioural Sciences, Fortis Healthcare groups of Hospitals, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_276_15

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