Leaf It or Not: A Case of Khat Dependence from India

By Gupta, Sriniwas; Dutta, Era et al. | Indian Journal of Psychiatry, January-March 2017 | Go to article overview

Leaf It or Not: A Case of Khat Dependence from India


Gupta, Sriniwas, Dutta, Era, Raju, M. S. V. K., Kumar, Abhishek, Indian Journal of Psychiatry


Byline: Sriniwas. Gupta, Era. Dutta, M. S. V. K. Raju, Abhishek. Kumar

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.[sup][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.[sup][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. …

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