KOPS - Das Institutionelle Repositorium der Universität Konstanz

The use of the stimulant khat, war-related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace

The use of the stimulant khat, war-related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace

Zitieren

Dateien zu dieser Ressource

Prüfsumme: MD5:ae1d2a06332262ff77db049f162cd51f

ODENWALD, Michael, 2006. The use of the stimulant khat, war-related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace

@phdthesis{Odenwald2006stimu-10991, title={The use of the stimulant khat, war-related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace}, year={2006}, author={Odenwald, Michael}, address={Konstanz}, school={Universität Konstanz} }

The use of the stimulant khat, war-related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace deu application/pdf The production and consumption of khat leaves, a traditional stimulant drug originating from the countries around the Horn of Africa and the Arab Peninsula, has been growing enormously during the last century, especially fast after 1970. Since then, modern means of transport were available for the distribution of the perishable good to markets outside the regions of its production. Today, khat is an important cash crop and economic factor for several national economies. Millions of people economically depend on khat. At the same time, the understanding of newly developed consumption patterns, distinct from the former traditional use, and their health consequences are neither well studied nor understood.<br />In Chapter 2, the currently available literature concerning the association between khat use and psychosis is reviewed and critically discussed. Most studies had severe methodological shortcomings and did not address important research questions, e.g. the direction of relationship. There is sufficient evidence to say that excessive khat use can induce short-lived psychotic states, which remit normally within two weeks upon cessation. Whether khat use is in any way related to schizophrenia spectrum disorders, e.g. by exacerbating symptoms, triggering single episodes or increasing the vulnerability, has not been topic of any scientific study.<br />In Chapter 3, a study is presented targeting this very issue. In a cross-sectional household survey in Hargeisa, the capital of Somaliland (North-Western Somalia) we identified 169 cases with long-lasting functioning impairment due to mental disorders among our sample of 4.854 subjects. The prevalence of this condition was highest among the former combatants (5% of the total sample), with about 16%, compared to civilian war survivors (8%) and others without any war experiences (3%). We randomly selected 54 of these cases, assessed their mental health using a structured clinical interview and compared them to healthy matched controls. Our results show that 83% (43) of these cases suffered from a long-lasting psychotic disorder of the schizophrenia spectrum. The rest of them was diagnosed with stroke, traumatic brain injury, dementia and mental retardation. In a following case-control study with the 43 psychotic patients we found that their khat use at the time of psychosis onset was significantly higher than the consumption of the matched controls at the same age. Excessive khat use preceded the onset of the disorder in 78% of the psychotic cases in comparison to 4% at the same age among the controls. Additionally, psychotic patients had started to use khat four years earlier in their lives as the healthy controls, on mean at the age of 17. Based on these results we concluded that early onset and excessive use of khat might be risk factors for the development of psychotic disorders of the schizophrenia spectrum.<br />In Chapter 4, a case study of one patient with a long-lasting psychotic disorder and a comorbid khat abuse is presented. His symptoms worsened while he, in parallel, increased his khat intake; in the course of deterioration of paranoid delusions he finally committed a murder and was imprisoned. This case probably illustrates the most neglected side of the psychiatric problems related to khat: this is not the striking picture of a khat-induced psychosis but the effect of khat chewing on pre-existing disorders. This case study also provides insight into the local juridical practice: he was treated as a normal prisoner as if there was no psychiatric condition involved.<br />In Chapter 5, a study is reported, which aimed at the development of a reliable and valid psycho-diagnostic instrument to assess Posttraumatic Stress Disorder (PTSD) in Somali language and which can be applied by trained, local interviewers. A Somali version of the Posttraumatic Stress Diagnostic Scale (Foa, 1995) was developed. It showed good reliability and validity in a sample of 135 randomly chosen ex-combatants. We found that ex-combatants with PTSD reported a longer average duration of khat sessions in the previous week. They also exhibited more frequently productive psychotic symptoms. Important in this context, we confirmed our previous hypothesis that attempts to self-medicate posttraumatic symptoms promote khat use and might in this way - contribute to the development of khat-induced psychotic symptoms.<br />The previously reported work served as preparatory study for a large epidemiological assessment of more than 8.000 active and former combatants, as described in Chapter 6. This study was conducted in the context of a preparatory project for an international disarmament, demobilization and reintegration program. Drug use patterns markedly differed between northern and southern Somalia: the one-week prevalence as well as the amount of khat use and the estimated use of five other drugs (hashish, psychoactive tablets, alcohol, solvents and hemp seeds) were clearly higher in southern Somalia. This study illustrates that the reintegration of former combatants will be a challenge, as a large number of participants will have drug-related problems.<br />In Chapter 7, a model for the assumed relationship between khat use and schizophrenia spectrum disorders is presented. Central in this model are three consecutive processes: the early onset in life, the increase of khat consumption and the development of acquired vulnerability to schizophrenia through multiple khat-induced psychotic states. Schizophrenia as such can be triggered through continuous khat use after this stage has been reached. 2011-03-25T09:24:32Z 2006 Odenwald, Michael deposit-license Odenwald, Michael 2011-03-25T09:24:32Z

Dateiabrufe seit 01.10.2014 (Informationen über die Zugriffsstatistik)

Odenwald_Diss.pdf 494

Das Dokument erscheint in:

KOPS Suche


Stöbern

Mein Benutzerkonto