Psychopharmacological aspects of catha edulis (khat) and consequences of long term use: a review

Yıl 2011, , 187 - 94, 01.04.2011

Nasir Tajure Wabel

https://doi.org/10.5455/jmood.20111217095840

Öz

Catha edulis (khat) is a plant grown commonly in the horn of Africa. Its leaves are chewed by the local people for their stimulant action. The purpose of this review was to summarize the psychopharmacologic aspects of Catha edulis (khat) and consequences of long term use. I collected data from scientific journals. The databases such as Pubmed, Medline, Hinary, Google search, Cochrane, and Embase were searched for literature on the different aspects of Catha edulis (khat) including central nervous system effects, pharmacological effects and long term consequences of khat use. Different research findings from various sources showed that Catha edulis (khat) causes schizophreniform psychotic illness, mania, and more rarely, depression and also has negative impact on health and socio-economic conditions. Most of the effects of chewing khat come from two phenylalkylamines; cathinone and cathine which are structurally related to amphetamine. On occasion these presentations are associated with episodes of self-harm or harm to others. Owing to the mode of consumption, the dose of khat tends to be self-limiting, unlike amphetamines. Therefore toxic psychosis as a result of excessive use is much less frequent with khat than with amphetamines. Frequent khat chewing is responsible for different disorders including psychotic illness and has harmful socioeconomic consequences. It is important for clinicians to increase awareness of their patients and the general public about the harmful effects of khat-chewing.

Anahtar Kelimeler

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Catha edulis (gat)’ın psikofarmakolojik yönleri ve uzun dönem kullanımının sonuçları: Bir gözden geçirme

Öz

Catha edulis (gat) Afrika boynuzunda yaygın olarak yetiştirilen bir bitkidir. Yaprakları yerli halk tarafından uyarıcı etkisi sebebi ile çiğnenmektedir. Bu gözden geçirmenin amacı birçok bilimsel makaleden elde edilen bilgiler ışığında gat’ın psikofarmakolojik yönlerini ve uzun dönem kullanımın sonuçlarını özetlemektir. Ben, pek çok bilimsel dergiden veri topladım. Pubmed, Medline, Hinary, Google arama, Cochrane ve EMBASE gibi veritabanlarından Catha edulis (gat)’in merkezi sinir sistemine etkileri, farmakolojik etkisi ve uzun dönem kullanımının sonuçları da dahil olmak üzere farklı yönleriyle ilgili literatür tarandı. Farklı kaynaklardan farklı araştırma sonuçları gat’ın şizofreniform bozukluğa, maniye ve daha az sıklıkla depresyona sebep olduğu ve sağlık ve sosyoekonomik koşullar üzerinde olumsuz etkileri olduğu gösterilmiştir. Gat’ın çiğnenirken ortaya çıkan etkilerinin çoğu yapısal olarak amfetamine benzer olan fenilalkilaminler; katinon ve katinden kaynaklanmaktadır. Bu temsiller hemen her defasında kendine zarar veya diğerlerine zarar ile ilişkilidir. Gatın tüketimde doz amfetaminlere zıt olarak kişiyle sınırlıdır. Bu nedenle gatın aşırı kullanımı sonucu ortaya çıkan toksik psikoz amfetaminden daha az sıklıkla görülür. Gatın fazlaca kullanılması psikotik bozukluk ve sosyoekonomik zararlı sonuçlar gibi değişik bozuklukların ortaya çıkmasında sorumludur. Klinisyenlerin, hastalarının ve genel halkın gat çiğnemenin zararlı etkileri hakkında farkındalığı arttırmaları önemlidir.

Anahtar Kelimeler

gat, catha edulis, farmakolojik etki, kation, psikolojik sekel, psikoz

Kaynakça

• Lqman W, Donaldson T. The use of Khat (Catha edulis) in Yemen. Social and Medical Observations. Ann Intern Med 1976; 85:246-9.
• Hussein M. Ageely, prevalence of khat chewing in college and secondary (high) school students of Jazan region Saudi Arabia. Harm Reduct J 2009; 6:11.
• Luqman W, Danowski TS. The use of khat (Catha edulis) in Yemen: social and medical observations. Annals of Internal Medicine 1976; 85:246-249.
• Numan N. Exploration of adverse psychological symptoms in Yemeni khat users by the Symptoms Checklist-90 (SCL 90). Addiction 2004; 99:61-5
• Hassan NA, Gunaid AA, Abdo-Rabbo AA, et al. The effect of khat chewing on blood pressure and heart rate in healthy volunteers. Trop Doct 2000; 30:107-108.
• George Y, Zahid H, Tim L. Khat chewing as a cause of psychosis. British Journal of Hospital Medicine 1995; 54:322-326.
• Pantelis C, Hindler CG, Taylor JC. Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects and a description of psychosis attributed to khat chewing. Pharmacological Medicine 1989; 19:657-668.
• Kalix P, Braenden O. Pharmacological aspects of the chewing of khat leaves. Pharmacological Reviews 1985; 37:149-164.
• Dhadphale M, Omolo OE. Psychiatric morbidity among khat chewers. East African Medical Journal 1988; 65:355-359.
• Al-Motarreb AL, Broadley KJ. Coronary and aortic vasoconstriction by cathinone, the active constituent of khat. Auton Autacoid Pharmacol 2004; 23:319-326.
• Al-Motarreb A, Al-Kebsi M, Al-Adhi B, Broadley KJ: Khat chewing and acute myocardial infarction. Heart 2002; 87:279-80.
• Al-Motarreb S, Briancon N, Al-Jaber B, Al-Adhi F, Al-Jailani MS, Salek KJ. Broadley Khat chewing is a risk factor for acute myocardial infarction: a case-control study. Br J Clin Pharmacol 2004; 59:574-581.
• Benson PB, Mcdermott W, editors: Cecil-Loeb Textbook of Medicine. 13th edition. Philadelphia, W. B. Saunders Co 1971:107-149.
• Al-Hadrani AM. Khat induced Haemorrhoidal disease in Yemen. Saudi Medical Journal 2000; 21:475-7.
• Ageely HM. Health and Socioeconomic Hazards associated with Khat consumptions. Journal of Family & Community Medicine 2008; 15:95-101
• Nencini P, Ahmed AM, Aminconi G, et al. Tolerance develops to sympathetic effects of khat in humans. Pharmacology 1984; 28:150-154.
• Kalix P. Khat: a plant with amphetamine effects. Journal of Substance Abuse and Treatment 1988; 5:163-169.
• Kennedy JG, Teague J, Rokaw W, et al. A medical evaluation of the use of qat in North Yemen. Social Science and Medicine 1983; 17:783-793.
• Elmi AS. The chewing of khat in Somalia. Journal of Ethnopharmacology 1983; 8:163-176.
• Alem A, Kebedae D, Kullgren G. The prevalence and sociodemographic correlates of khat chewing in Butajira, Ethiopia. Acta Psychiatrica Scandinavica Supplementum 1999; 100:84-91.
• Geisshusler S, Brenneisen R. The content of psychoactive phenylpropyl and phenylpentenyl khatamines in Catha edulis Forsk. of different origin. J Ethnopharmacol 1987; 19:269-277.
• Al Motarreb A, Baker K, Broadley KJ. Khat: pharmacological and medical aspects and its social use in Yemen. Phytother Res 2002;16:403-413.
• Halbach H. Medical aspects of the chewing of khat leaves. Bulletin of the World Health Organization. 1972; 47:21-29.
• Giannini AJ, Burge H, Shaheen JM, et al. Khat: another drug of abuse? Journal of Psychoactive Drugs 1986; 18:155-158.
• Kite GC, Ismail M, Simmonds MS, Houghton PJ. Use of doubly protonated molecules in the analysis of cathedulins in crude extracts of khat (Catha edulis) by liquid chromatography/serial mass spectrometry. Rapid Commun Mass Spectrom 2003;17:1553-1564.
• Brenneisen R, Geisshusler S. Psychotropic drugs. III. Analytical and chemical aspects of Catha edulis Forsk. Pharm Acta Helv 1985; 60:290-301.
• Drake PH. Khat-chewing in the Near East (letter). Lancet, i, 1988:532-533.
• Halket JM, Karasu Z, Murray-Lyon IM. Plasma cathinone levels following chewing khat leaves (Catha edulis Forsk.). J Ethnopharmacol 1995; 49:111-113.
• Widler P, Mathys K, Brenneisen R, Kalix P, Fisch HU. Pharmacodynamics and pharmacokinetics of khat: a controlled study. Clin Pharmacol Ther 1994; 55:556-562.
• Brenneisen R, Fisch HU, Koelbing U, Geisshusler S, Kalix P. Amphetamine-like effects in humans of the khat alkaloid cathinone. Br J Clin Pharmacol 1990; 30:825-828.
• Brenneisen R, Geisshusler S, Schorno X. Metabolism of cathinone to (-)-norephedrine and (-)-norpseudoephedrine. J Pharm Pharmacol 1986; 38:298-300.
• Maitai CK, Mugera GM. Excretion of the active principle of of Catha edulis (Miraa) in human urine. J Pharm Sci 1975; 64:702-703.
• Toennes SW, Harder S, Schramm M, Niess C, Kauert GF. Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves. Br J Clin Pharmacol 2003; 56:125-130.
• Heymann TD, Bhupulan A, Zureikat NE, Bomanji J, Drinkwater C, Giles P, Murray-Lyon IM. Khat chewing delays gastric emptying of a semi-solid meal. Aliment Pharmacol Ther 1995; 9:81-83.
• Alkadi HO, Noman MA, Al Thobhani AK, Al Mekhlafi FS, Raja’a YA. Clinical and experimental evaluation of the effect of Khat-induced myocardial infarction. Saudi Med J 2002; 23:1195-1198.
• Kuczkowski KM. Herbal ecstasy: cardiovascular complications of khat chewing in pregnancy. Acta Anaesthesiol Belg 2005; 56:19-21.
• Yousef G, Huq Z, Lambert T. Khat chewing as a cause of psychosis. British Journal of Hospital Medicine 1995; 54:322-326.
• Kalix P, Khan I. Khat: an amphetamine-like plant material. Bulletin of the World Health Organization 1984; 62:681-686.
• Critchlow S, Seifert R. Khat-induced paranoid psychosis. British Journal of Psychiatry 1987; 150:247-249.
• Alem A, Shibre T. Khat induced psychosis and its medico-legal implication: a case report. Ethiopian Medical Journal 1997; 35:137-141.
• Giannini AJ,Castellani S. A manic-like psychosis due to khat (Catha edulis Forsk). Journal of Clinical Toxicology 1982; 19:455-459.
• McLaren P. Khat psychosis (letter). British Journal of Psychiatry 1987; 150, 712-713.
• Khattab NY, Amer G. Undetected neuropsychophysiological sequelae of khat chewing in standard aviation medical examination. Aviat Space Environ Med 1995; 66:739-744.
• Morrish PK, Nicolaou N, Brakkenberg P, Smith PE. Leukoencephalopathy associated with khat misuse. J Neurol Neurosurg Psychiatry 1999; 67:556.