The leaves of the tree Catha edulis, or khat (also qat and kat) are chewed by a large proportion of the adult population of the Yemen, and throughout Saharan and sub-Saharan Africa. The leaves are also chewed by members of the Yemeni and Somali community in the United Kingdom.1 The psychoactive constituents of khat are cathin (d-norisoephedrine), cathidine, and cathinone (an alkaloid with a structure resembling ephedrine and amphetamine) and users report a mild euphoria similar to that of amphetamine.1 Khat is acknowledged as a precipitant of psychosis and has also been reported to cause cognitive impairment.2 We report a case in which khat chewing has been associated with a severe and disabling neurological illness.

A 56 year old Somali living in the United Kingdom for the past 18 years was admitted to a psychiatric hospital with a 5 week history of progressive confusion and agitation. His family reported that he had been chewing …