PHYSIOLOGICAL EFFECTS
Long term addicts become thin, their skin darkens, particularly in the face on both cheeks which gives an appearance similar to a hepatic face. Dryness in the mouth is common as well as frequent micturition and often constipation. Some mention that the faeces are black and tend to be small in shape similar to goat faeces (Norakarnphadung, 1968). Withdrawal symptoms include, for example, hostility, aggression, flow of tears, wet nose, inability to work, aching in the muscles and bones, jerky movement of the limbs. These are all typical symptoms of kratom addicts.
KRATOM PSYCHOSIS
There were five cases of kratom addiction revealing psychotic symptoms; these had been seen by the author in the last year (1974) in the outpatient department. Initially three cases were suspected of having kratom psychosis on the basis of their history of addiction and their general appearance and on psychiatric examination.
Case 1: A 55-year old Thai subject had begun eating kratom at the age of 20. His complaints were convulsions and mental confusion over the past few weeks. He was thin, his skin had become dark, particularly in the face on both cheeks, and it had an appearance similar to a hepatic face. Clouding of consciousness, experiencing of delusions and hallucinations were clearly evident.
Case 2: This 32-year old Thai was a labourer. He had begun using the kratom leaf daily at the age of 22 and had combined his kratom addiction with alcohol consumption for the past two years. He was confused and experienced persecutory ideation. He was admitted for two weeks; the result of the treatment was satisfactory.
Case 3: This 31-year old Thai was a married labourer who had begun eating kratom when he was 14. He complained of dizziness and headaches. He experienced hallucinations, delusion and confusion.
Only case 2 was admitted to the hospital, where major tranquillizers and supportive treatment were given. Cases 1 and 3 were out-patients, treated with major tranquillizers.
Cases 4 and 5 were psychotic patients. They had been multiple addicts, combining the use of kratom with alcohol, amphetamines and heroin. There were two cases of schizophrenia who had a history of kratom addiction and who were still users. While they were limited in social activity, they were good workers. None of them has relapsed during the past 10 years.