Caffeine-Related
Disorders
For Psychiatry students
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Caffeine cont...
Caffeine is the most widely consumed
psychoactive substance in the world.
Caffeine is found in more than 60 species of
plants
In US, 87% of children and adults consume
foods and beverages containing caffeine
Caffeine affects various neurobiological
and physiological systems and
produces significant psychological
effects
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Caffeine cont...
Caffeine is not associated with any life-
threatening illnesses, but its use can result
in psychiatric symptoms and disorders.
Hence, it is important for clinicians to be
familiar with the effects, and problems that
can be associated with caffeine use.
Caffeine use is associated with five
disorders:
◦ caffeine use disorder, caffeine intoxication,
caffeine withdrawal
◦ caffeine-induced anxiety disorder, and
caffeine induced sleep disorder
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EPIDEMIOLOGY
Caffeine is contained in drinks, foods,
prescription medicines
20 to 30% of all adults in US consume more
than 500 mg caffeine per day
A cup of coffee generally contains 100 to
150 mg of caffeine
A cup of tea contains about 30 to 100mg of
caffeine
Cocoa, chocolate, and soft drinks also
contain significant amounts of caffeine.
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COMORBIDITY
Persons with caffeine-related disorders are
more likely to have additional substance
related disorders than are those without
diagnoses of caffeine-related disorders.
◦ About two thirds of those who consume
large amounts of caffeine daily also use
sedative-hypnotic drugs.
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ETIOLOGY
After exposure to caffeine, continued
caffeine consumption can be influenced by
several different factors, such as
◦ the pharmacological effects of
caffeine
caffeine’s reinforcing effects
◦ genetic predispositions to caffeine
use
◦ personal attributes of the consumer
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Neuropharmacology
half-life of caffeine in the human body is 3 to 10
hours, and the time of peak concentration is 30 to
60 minutes.
Caffeine readily crosses the blood–brain barrier
Caffeine primarily antagonize the adenosine
receptors.
Adenosine receptors activate an inhibitory G
protein (Gi) and, thus, inhibit the formation of the
second-messenger cyclic adenosine
monophosphate (cAMP).
Caffeine intake, therefore, results in an increase in
intraneuronal cAMP concentrations in neurons with
adenosine receptors.
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Neuropharmacology
Several experiments indicate that caffeine
can affect dopamine and noradrenergic
neurons.
Specifically, dopamine activity may be
enhanced by caffeine,
◦ caffeine intake associate with an exacerbation of
psychotic symptoms in patients with schizophrenia.
Activation of noradrenergic neurons has
been hypothesized to be involved in the
mediation of some symptoms of caffeine
withdrawal.
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Subjective Effects of caffeine
Single low to moderate doses of caffeine
(i.e., 20 to 200 mg) can produce and
results:-
◦ pleasurable effects
◦ well-being, energy and concentration
◦ motivation to work
◦ Decreases sleepy or tiredness
Doses range of 300 to 800 mg produce
effects that are often rated as
◦ being unpleasant,
◦ anxiety and nervousness
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Special Populations
Cigarette smokers
◦ consume more caffeine than nonsmokers
◦ have increased rates of caffeine elimination
alcohol dependence
◦ heavy use and clinical dependence on caffeine as
well.
psychiatric patient
◦ have shown use of high daily amounts of caffeine
(5 or more cups of coffee each day)
Prisoners
◦ has been noted high daily caffeine consumption
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DIAGNOSIS
The diagnosis of caffeine intoxication or
other caffeine-related disorders depends
primarily on
◦ a comprehensive history of a patient’s intake of
caffeine-containing products
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DIAGNOSIS
The differential diagnosis:
◦ generalized anxiety disorder,
◦ panic disorder with or without
agoraphobia,
◦ bipolar II disorder,
◦ attention-deficit/hyperactivity
disorder (ADHD)
◦ sleep disorders
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Caffeine Intoxication
DSM-5 diagnostic criteria for caffeine
intoxication includes
◦ the recent consumption of caffeine, usually in
excess of 250 mg
◦ The common symptoms include
anxiety, psychomotor agitation,
restlessness, irritability, and
psychophysiological complaints such as
muscle twitching, flushed face, nausea,
diuresis, gastrointestinal distress,
excessive perspiration, tingling in the
fingers and toes, and insomnia.
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Caffeine Withdrawal
withdrawal symptoms
◦ The most common symptoms are
headache and fatigue
◦ other symptoms include
anxiety, irritability, mild depressive
symptoms
impaired psychomotor
performance
nausea, vomiting
craving for caffeine
muscle pain and stiffness
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Caffeine Withdrawal
The number and severity of withdrawal
symptoms are correlated with
◦ the amount of caffeine ingested and
◦ the abruptness of the withdrawal.
Caffeine withdrawal symptoms
◦ have their onset 12 to 24 hours after
the last dose;
◦ the symptoms peak in 24 to 48 hours
◦ But resolve within 1 week
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Caffeine-Induced Anxiety
Disorder
anxiety related to caffeine use can resemble
that of generalized anxiety disorder.
Patients are perceived as
◦ “wired,” overly talkative, and irritable;
◦ they complain of not sleeping well and of
having energy
Caffeine can induce and exacerbate
◦ panic attacks in persons with a panic
disorder
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Caffeine-Induced Sleep
Disorder
Caffeine is associated with
◦ delay in falling asleep
◦ inability to remain asleep, and
◦ early morning awakening
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Caffeine Use and
Nonpsychiatric Illnesses
caffeine results
◦ in cerebral vasoconstriction
◦ decrease cerebral blood flow (CBF)
◦ can cause constriction in coronary arteries
the modest ability of caffeine to increase blood
pressure
◦ caffeine and coffee use have an association to
cardiovascular disease
mild association between higher daily caffeine
use in women and delayed conception and
slightly lower birth weight
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TREATMENT
Analgesics
Rarely benzodiazepines
If benzodiazepines are used for this
purpose, they should be used in small
dosages for a brief time
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TREATMENT
How to reduce or eliminate caffeine use
1. patients determine daily caffeine
consumption
2. patient must recognize all sources of
caffeine in the diet, including forms of
caffeine and accurately record the amount
consumed
3. determine the average daily caffeine
dose in milligrams with their clinician
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Any Question?
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