الفهرس 
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Abstract
Adherence to medication regimens has been monitored since the time of Hippocrates and is generally defined as “the extent to which patients take medications as prescribed by their health care providers”. Adherence tends to be poor in patients on long-term drug therapy (including psychiatric patients). Non-adherence to psychotropic medications leads to undermine treatment effectiveness, increase risk of relapse and poor treatment outcomes.
In developed countries, adherence to long-term therapies -including psychotropic medications- in the general population is around 50%, and much lower in developing countries. Poor adherence to psychotropic medications has been found to associate with various factors such as disease related characteristics, socioeconomic factors, illiteracy, and substance addiction. Khat is considered by the National Institute of Drug Abuse as one of the addictive substances that leads to persistent psychological dependence, and thus may have a negative effect on patients’ adherence to psychotropic medications. Unfortunately, few studies have tackled this association between khat chewing and psychiatric patients’ non-adherence to psychotropic medications
Khat, Catha edulis, is a flowering shrub which contain the naturally cathinone and cathine that are active amphetamine-like stimulants. It has been widely used since the thirteenth century as a recreational drug by the indigenous people of East Africa and the Arabian Peninsula. Daily use of khat in Yemen is estimated as 27.6% of the general population. The prevalence has been estimated at 80% for males and 50% for females in the capital Sana’a at age fifteen and above.
Those working with Yemenis psychiatric patients who chew khat (among which are nurses), need to have a significant role in supporting psychotropic medication adherence in psychiatric patients who are khat chewers and psychoeducating them in relation to this problem.
The current study aimed to explore the beliefs of Yemenis patients with psychiatric disorders about khat chewing and investigate the relation between khat chewing, beliefs about it and adherence to psychotropic medications among patients with psychiatric disorders in Yemen.
The study followed a descriptive correlational design. It was conducted at the psychiatric outpatient clinic of Al-Amal Psychiatric Hospital in Sana’a governorate Yemen.
The study subjects comprised 200 Yemenis patients with psychiatric disorders (100 Khat chewers and 100 non-khat chewers).
The data of this study were collected using the following tools:
Tool I: A Socio-Demographic and Clinical characteristics Structured Interview Schedule that was developed by the researcher.
Tool II: Medication Adherence Rating Scale (MARS) that was developed by Thompson et al. (2000) to measure the adherence of psychiatric patients to psychotropic medications.
Tool III: Beliefs about Khat Chewing Questionnaire that was developed by Wedegaertner et al. (2010) to probe people’s beliefs about khat and its impacts in general through 57 items .
Tools II and III were translated into the Arabic language and were tested for content validity by five Yemenis experts in the field of psychiatric medicine and both tools proved to be valid.
A pilot study was carried out on 20 adult Yemenis outpatients with psychiatric disorders using the three tools. Few corrections were done and tools were found to be clear and applicable.
Reliabilities of tools II and III were tested on 20 adult Yemenis psychiatric patients using the Cronbach’s alpha and both tools proved to be reliable (0.72, and 0.95 respectively).
Actual study:
Each patient was interviewed on an individual basis to fill in the study tools (taking into account the ethical considerations). Data were collected over a period of three months from November 2016 to end of January 2017.
The following are the main results yielded by this study:
• Male patients constituted the majority of the studied subjects(83.0%). Subjects’ age ranged between 18 and 60 years, (χ= 31.32±9.419 years). The majority of the subjects were having either secondary school certificate (38.5%) or were less educated. Having 46.0% of subjects being single and 59.5% living in urban areas. The subjects monthly income was perceived as not enough by 35.0% or partially enough by 47.5%.
• No statistical significant differences were detected between khat chewers and non-khat chewers in almost all items of sociodemographic items.
• Nearly half of the studied subjects (42.5%) were schizophrenic patients, followed by anxiety disorder (21.0%), with 34.5% having a duration of illness ranging from one year to less than 3 years, 41.5% being previously hospitalized, out of them 34.9% were previously admitted for only one time. In addition, 34.0% of the studied subjects had positive family history.
• No statistical significant differences were detected in all clinical characteristic items between khat and non khat chewers.
• As for the pattern of khat chewing 66.0% were using it for more than five years, 51.0% chewing it 7 times per week, 49.0% chewed it for more than 6 hours per day, and 68.0% consumed a medium to large amount of khat. Also, 64.0% of khat chewers used another substance with khat. Smoking (nicotine, shisha, madaa) were the most frequently used substances followed by soda as reported by 68.7% and 25.0% respectively.
• Concerning causes for khat chewing, making them more social came first (53.0%), followed by energizing them in work (50.0%), improving concentration & problem solving (48.0%), imitating their friends and family (43.0%), and escaping from psychological stress (42.0%).
• Concerning the differences between khat chewers and non khat chewers regarding their beliefs about khat chewing, there were statistically significant differences in 36 out of 57 belief items, where P value ≤ 0.05.
• Khat chewers were significantly scoring less than non khat chewers on the following negative belief items: Q1 The partner’s ability to take care of the family is impaired by consuming khat, Q3 Consuming khat leads to a loss of esteem in the family, Q4 Khat leads to an unhealthy complexion, Q9 Khat consumption causes agitation and anxiousness, Q13 Khat consumption is the cause of social problems, Q14 Khat consumption is a bad habit and should be eliminated, Q15 Women should not consume khat, because this is especially bad for the family, Q16 Khat consumers have a poor physical appearance,Q17 Khat causes partners to fall out with each other, Q18 Khat is addictive, Q20 Khat consumption leads to loss of valuable work time,Q21 Children of khat consuming parents do worse in school, Q22 Khat causes poverty and squalor in Yemeni society, Q23 Khat consumption is a factor in divorces, Q24 Khat consumption is harmful to people’s esteem and sophistication, Q25 Khat consumption impairs the relationships between parents and their children, Q26 Khat causes constant aggression between spouses, Q27 Khat consumption causes lack of food in the family, Q30 Khat is a reason for most family problems, Q33 Khat consumption causes a higher crime rate, Q35 Khat causes depression, Q40 Khat causes loss of appetite, Q44 Khat consumption impairs the function of the jaw muscles, Q49 Khat causes impaired mood, Q55 Khat causes panic attacks, and Q56 Khat causes loneliness.
• Khat chewers were significantly scoring higher than the non khat chewers on the following positive belief items: Q2 Consuming khat leads to relief of social and mental stress, Q5 Khat rituals are the best way to spend one’s time, Q10 Khat is stimulating, Q19 Khat improves the experience during sexual intercourse, Q29 Khat consumption improves relationships in our society, Q32 Khat rituals solve many social problems, Q45 Khat improves memory retentiveness and concentration, Q50 You feel well and relaxed while consuming khat, and Q53 Khat causes low blood sugar.
• Both groups (khat chewers and non khat chewers) agreed on a number of beliefs with no statistical significant differences as: Q12 The family as a whole suffers financially if khat is consumed by the adults, Q39 Khat causes constipation, Q41 Khat consumers are undernourished, Q47 Khat consumption is bad for one’s health, and Q48 Khat worsens oral hygiene.