Caffeine - Nursing Research (Chapter 2 of 5)

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Stratland (1976), based on her study, caffeine can accumulate in severe liver disease when its half-life can increase to 96 hours. If these patients drink coffee, they should be closely monitored. Caffeine is known to interact with other drugs resulting in a modified effect. For example, caffeine administered with nardil (an MAO inhibitor) caused headaches and high blood pressure (Pakes, 1979). This potentially dangerous interaction was first noted by Berkowitz et al., (1971) and implicated serotonin in the mechanism.

Stratland (1976) stated that caffeine and barbitol are antagonistic, with caffeine (in coffee) reducing the sleeping time induced by barbitol. Decaffeinated coffee had no effect. In another study, caffeine resulted in reduced sleeping time which was counteracted by pentobarbitol in hospitalized patients as what Forrest and her co-researher found in 1972.

Because of the wide spread use of caffeine and their known potent physiological effect, caffeine has been the subject of research in psychological related studies. This work has been stimulated by personal experiences and observations as well as by efforts to understand its action and mechanism.

Habituation and Tolerance: Ritchie (1975) and Kozlowski (1976) cited in their study that caffeine ingestion and coffee drinking have been investigated with regard to the degree that this habit results in tolerance and withdrawal effects. These studies look beyond the obvious social implications and psychic dependence of coffee consumption which may be related to the “first cup of coffee to wake me up” or “the coffee break” or to its association with smoking. In the latter case, it is of interest that coffee drinkers were shown to take more nicotine when deprived of coffee.

Stephenson (1977) considered caffeine as not only a habit forming, but also addicting. Others considered morphinism and caffeinism to be similar, with caffeine causing loss of self-control, spells of agitation and depression as well as psychotic behavior . Ritchie mentioned a report by Colton that tolerance can develop for the diuretic, salivary stimulation and sleep disturbance effects of caffeine.

Diamond and Pfifferling (1974) Cola consumed in amounts of 48 to 111 ounces per day (144 to 333 mg of caffeine per day) was reported to have caused physical effects on withdrawal. The resultant effects were depression, nervousness, decreased alertness,, sleeping difficulty, frequent mood changes, and various other behavioral difficulties which were attributed to caffeine withdrawal.

Kozlowski (1976) illustrated in his study that the dependence of coffee drinkers on caffeine in which coffee drinkers drank more coffee if the caffeine content was lowered. Abrams (1977) said “There is no doubt that a certain degree of psychic dependence, that is habituation, develops from the use of xanthine beverages”.

Goldstein (1969) did a survey using questionnaire completed by more than 200 young housewives showed that the perceived effects of caffeine depended on previous use. The heavy coffee drinkers had few sleep disturbances and less evidence of nervousness after their morning coffee as compared to nondrinkers. if the morning coffee was stopped, the habitual coffee drinkers experienced nervousness, headache and irritation. The non-coffee drinkers reacted negatively to coffee, experiencing effects opposite to the coffee drinkers. An experiment was devised to verify the results of the questionnaire involving 18 housewives, non-coffee drinkers, and 38 who drank five or more cups per day. The results confirmed those obtained from the questionnaire previously administered.This experiment was double-blind and placebo controlled and caffeine was administered in coffee at 0, 150 and 300 mg. Coffee drinkers showed a dose-response effect whereas non-coffee drinkers showed signs such as nervousness, jitters and upset stomachs at all doses of caffeine but not on placebo.

Ritchie (1975) says that tolerance and psychological dependence to caffeine beverages does occur to some extent but he feels that this does-not present a problem. He says that coffee or tea drinking are socially acceptable and are apparently not harmful when practiced in moderation. However, it does appear that at least in some persons excess consumption of caffeine can result in severe psychological dependence and withdrawal effects and is a problem to be reckoned with.

Behavioral Effects: Caffeine’s stimulating activity on the central nervous system as well as other body organs results in certain physiological effects which may be considered to be behavior oriented. Caffeine produces more rapid, clearer flow of thought, allays drowsiness and fatigue, and increases the capability of a greater sustained intellectual effort and more perfect association of ideas. It also causes a keener appreciation of sensory stimuli, and reaction time is diminished. Motor activity is increased; typists, for example, work faster with fewer errors. Tasks requiring delicate muscular coordination and accurate timing may, however, be adversely affected. All of this occurs at doses of 150 to 250 mg of caffeine (approximately two cups of coffee) according to Ritchie (1975).

In 1912, Hollingsworth who was a psychologist reported caffeine’s effect on mental and motor efficiency in a study sponsored by Coca-Cola. In nine double-blind tests, he found beneficial effects for both mental and motor performance at doses of 65 to 130 mg of caffeine. At a dose of 300 mg, caffeine caused tremors, poor motor performance and insomnia. These results have withstood the test of time.     Goldstein (1965) showed no effect of caffeine on objective measures of performance although most subjects “felt” more alert and physically active. However, some subjects felt nervous. Mitchell, Ross and Hurst showed caffeine to prevent attention lapses in a visual monitoring test which simulated night driving. The effect persisted for the two to three hour experiment on Stephenson’s study in 1977.

Smith et al. (1977) conducted a study using a 200 mg dose of caffeine which resulted in decreased decision time scores and improved motor time scores in volunteers. Hand steadiness, however, was impaired. After a caffeine intake of 200 mg, introverts performed less well on a verbal ability test as compared to extroverts when time pressure was applied.

Wayner et al. (1976) reported on the effects of caffeine on schedule dependent and schedule induced behavior in mice. Caffeine, (3.125, 6.25, 12.5, 25, 50 and 100 mg/kg) was tested on lever pressing, schedule induced licking and water consumption of mice. The effect on mice at 80 percent of body weight was different than when mice were allowed to recover the lost weight. At the lower weight, caffeine had little effect except at the highest dose (equivalent to 100 cups of coffee given at once). At their ordinary weight, the mice were more sensitive to caffeine, with all measures enhanced, even at the lowest dose (equivalent to approximately three cups of coffee). At high doses, all measures decreased; the mice became tolerant.

Castellano (1976) studied mice behavior under two sets of conditions. One involved a natural preference (swimming towards a light-”L” ) and the other involved an acquired behavior pattern (swimming toward the dark-”D”). A facilitation of learning and consolidation after caffeine dosing was noted in naive mice after the -D” procedure. Natural tendencies were also enhanced by caffeine as noted by improved performance in the “L” procedure. Animals pretained in the “D” procedure exhibited behavioral disruption after treatment. Animals pretrained in the natural -U procedure needed very high doses to cause disruption. Caffeine decreases five HT turnover in rat brain. Amphetamines do not show the results as demonstrated in this paper, whereas other drugs such as hallucinogens show a similar effect. The implication is that the mechanism of caffeine’s action may be similar to hallucinogenic drugs.

Effect on Sleep: Caffeine is known to cause insomnia because of its central nervous system stimulating activity. In fact, its major therapeutic use is to allay sleep and drowsiness, being the only OTC stimulant approved by the FDA. Several studies investigating this action in some detail have been published.

Karacan (1976) found that caffeine given half an hour before sleep adversely affected the sleeping process in normal sublects. The effect is dose related. Caffeine’s effect simulates clinical insomnia and gave the same response as coffee containing an equivalent amount of caffeine. Decaffeinated coffee showed no effect on sleep.

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