Khat use and occurrence of psychotic symptoms in the general male population in Southwestern Ethiopia: evidence for sensitization by traumatic experiences

Abstract

Khat trees are native to East Africa and the Arabian peninsula. Their leaves contain amphetamine-like alkaloids such as cathinone, cathine and norephedrine, and are chewed for their stimulating and euphorigenic effects 1 . Khat use varies by season: in the dry season, there is limited availability and market prices are high; in the rainy season, the opposite is true. Excessive use is associated with dependence and khat-induced psychosis 2 .In collaboration with the Gilgel Gibe Field Research Center of Jimma University, in Southwestern Ethiopia, we studied khat use and khat-induced psychotic symptoms in 1,100 men aged 18 to 40 years (mean 28.4 6 6.6), randomly selected from the center's population registry.Trained raters interviewed participants at two subsequent time points, i.e. during the dry season (T1; N5853) and during the rainy season, nine months later (T2; N5695). They explored khat use during the past 7 days using the Timeline Followback Method Assessment. Psychotic symptoms experienced during the past 6 months were assessed by four items from the Composite International Diagnostic Interview (CIDI) selected on the basis of previous studies 3 . Khat-induced psychotic symptoms were defined as being present during or up to 6 hours after consumption and assessed with supplementary questions 3 . Potentially traumatic experiences (e.g., assault or life-threatening injury) during the period up to T1 or since T1 were explored by an adapted version of the Life Events Checklist for DSM-5 (LEC-5) 4 . A cut-off of four experiences was fixed by median split.Urine samples were collected to analyze khat alkaloids through immunoassay tests for amphetamine.Khat use in the past 7 days was reported by 599 individuals (70.2%) at T1, and 565 (81.3%) at T2. The 6-month prevalence of khat-induced psychotic symptoms was 7.9% at T1 and 12.8% at T2.At T2, we found 225 individuals with a positive immunoassay test. In these subjects, the rate of khat-induced psychotic symptoms was 26.6% among those with a history of four or more past traumatic experiences (N5124) and 14.0% among those with a history of less than four of those experiences (N5121) (p50.015). This result could not be explained by higher khat use among the high trauma group (p>0.081 for all use indicators in the last 7 days among people with high vs. low trauma load).We also observed that recent trauma exposure was associated with elevated presence of khat-induced psychotic symptoms in individuals with low trauma exposure during the period up to T1 (with recent trauma: 28%; without recent trauma: 12%; p50.009). Among individuals with high trauma exposure during that period, additional recent trauma did not have this effect (with recent trauma: 25%; without recent trauma: 26%; p50.933).Our findings suggest that, in the general male population of an African country, traumatic experiences can sensitize to the effects of a psychomimetic substance. This is in line with the behavioral sensitization paradigm, which suggests that repeated administration of amphetamines or ...

Factors affecting current khat chewing among male adults 15–59 years in Ethiopia, 2016: a multi-level analysis from Ethiopian Demographic Health Survey

“…In addition, it has two city administrations, Addis Ababa and Dire-Dawa. More than 82% of the country's total population lives in the regional states of Amhara, Oromia, and SNNPR [11].…”

“…Regular khat chewing: causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems [4][5][6][7]. A study from Ethiopia suggests that khat chewing resulted in poor lung function and oxygen saturation [8], risky sexual behavior [9,10], and psychosis [11]. In addition, concurrent use of khat with alcohol and cigarette smoking was highly associated with sleep disturbance [12].…”

Trauma exposure and alcohol use disorder among prisoners in Jimma Zone correctional institution, Southwest Ethiopia: a cross-sectional study

“…In addition, alcoholic patients with a high trauma load often functionally consume alcohol to cope with sleep issues, depression, or intrusive memories [10]. According to the behavioral sensitization paradigm, repeated administration of substances or exposure to stress can cause sensitization of dopamine neurons, resulting in a higher dopamine release in response to subsequent stress and substance abuse [11].…”

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“…Miraa use has been associated with being male, Muslim, and having multiple sexual partners, [4][5][6][7][8]. Miraa has been reported to have lots of mental health effects on humans that include inducing psychotic symptoms, depression, dependence increase sleep and negative mood disturbances, higher levels of distress to likely induce memory deficits, and cognitive flexibility, " [9][10][11][12][13][14]". In addition, miraa use has been seen to increase physical health problems that include gastrointestinal disorders, high blood pressure, heart failure, autoimmune hepatitis, poor health among those living with HIV/AIDS, poor physical health problems, low birth weight among pregnant women, H. pylori infection, and under nutrition,. "…”