Caffeine - Nursing Research (Chapter 2 of 5)

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Dr. Greden considers caffeine to be a psychotropic drug and 25 percent of the population may take more than 500 mg per day, a large physiologically active dose. He describes three cases in which caffeinism may be misdiagnosed as an anxiety syndrome.

Dr. Greden concludes that caffeine is found among a fairly large percentage of hospitalized patients with psychiatric symptoms. Caffeine should not be used as part of psychiatric treatment routines, e.g., to reduce drowsiness from psychotropic medications as has been occasionally suggested.

Dr. John Neil and associates (1978) reported on the possible complication of caffeinism in diagnosing psychiatric patients. He suggests that self-medication may confound behaviors of patients. Caffeine has been considered the most popular “psychotropic” drug in North America and coffee and tea drinking are not usually in the records of psychiatric patients. In this experiment, hypersomnic patients with various diagnoses and caffeine consumption participated. The authors conclude that “self medication with large doses of caffeine is a likely response to the anergia and hypersomnia experienced during certain types of depression”. This may lead to diagnostic confusion and a complicated course of therapy. Mixed depressive states may be caused by excess caffeine consumption and they suggest, also, that unipolar 11 depressives may use more caffeine as they become depressed.

Caffeine, in these patients, provides only transitory relief as it is not a true antidepressant. Caffeine also may render anxiolytic and antipsychotic medications less effective.

Mikkelsen (1978) noted caffeine’s involvement in schizophrenic-like states similar to that observed by Greden in anxiety/neurosis symptoms of patients who consumed large quantities of caffeine (coffee). One case cited was of a white male in a catatonic state who threatened his mother after having gone on a coffee jag over injustices caused to him by his mother. He developed paranoid delusions which he felt were, at least in part, due to the coffee. A 30 year old white single female exhibited paranoid and auditory hallucinations. An anxiety state had resulted in increased coffee consumption. in the hospital she noted the correlation of these strange feelings with coffee consumption. Other examples of psychotic behavior as noted in the literature are described in this paper. Forty years ago a case of psychosis was reported in which a 24 year old female took 60 g (about four g) of caffeine. Manic symptoms developed. He theorizes that adenyl cyclase which is increased by caffeine may be a receptor for dopamine. If this system is abnormal in schizophrenics, caffeine may further sensitize the patient. Certainly, coffee should be considered as a factor in this disease.

Reimann (1967) noted that symptoms of a psychoneurotic woman disappeared when coffee was reduced. She presented with an irregular fever, insomnia, anorexia and irritability, having consumed large amounts of coffee.

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