Caffeine-related disorders
All answers are from DSM-IV-TR and First
and Tasman [pages 440-464] unless
otherwise indicated. This edition was done on
1Sep08.
Action of caffeine
Q. What is the cellular site of action of
caffeine?
Action of caffeine
Ans. Adenosine receptor antagonist. By
antagonizing adenosine, caffeine
increases dopamine activity.
Role of adenosine
Q. What physiological effects does
adenosine produce?
Role of adenosine
Ans.
In general, adenosine is a suppressant of
brain activity. Also an antidiuretic, inhibits
rennin release, inhibits gastric secretion,
and inhibits lipolysis.
[If asked and don’t remember, remember
that it is the opposite of what a cup of
coffee does, so can guess some of the
answer.]
Caffeine in coffee
Q. How much caffeine in a six oz of coffee?
Caffeine in coffee
Ans. About 100 mg. Remembering this will
get you in the ballpark of how much in
other drinks.
Other sources of caffeine
Q. What other drinks or foods have
caffeine?
Other sources of caffeine
Ans.
Soft drinks
Tea
Chocolate
[also, might say that some analgesics
contain caffeine]
Average intake
• Q. In the US, what is the average caffeine
intake per day?
Average intake
Ans. 200 mg/d
Drink caffeine
Q. What percentage of Americans drink
caffeine drinks?
Caffeine drinks
Ans. About 85%.
> 500 mg/d
What percentage of US people consume
more than > 500 mg/d?
> 500 mg/d
Ans. 30%
Caffeine half-life
Q. What is the half-life of caffeine?
Caffeine half-life
Ans. 3 – 6 hours.
Caffeine-related disorders
Q. What are the DSM-IV caffeine-related
disorders?
Caffeine-related disorders
Ans.
Caffeine intoxication
Caffeine-related anxiety disorder
Caffeine-related sleep disorder
Caffeine disorder, NOS
[Note, no “abuse” or “dependence” because DSM
authors thought that evidence for such was
insufficient, but if you think the evidence is
overwhelming in a pt, can use NOS.]
Caffeine intoxication
Q. DSM-IV lists 12 signs and expects at
least 5 for the dx of caffeine intoxication.
See how many of the 12 you can name?
[There is a lot of overlap among the 12, so
don’t expect to get all.]
Caffeine intoxication -1
Ans.
1. Restlessness
2. Nervousness
3. Excitement
4. Insomnia
5. Flushed face
6. Diuresis
[see next screen]
Caffeine intoxication - 2
7. GI complaints
8. Muscle twitching
9. Rambling speech
10. Tachycardia or arrhythmia
11. Periods of inexhaustibility
12. Agitation
Differential dx
Q. Differential dx of caffeine intoxication?
Differential dx
Ans.
-- other substance-induced stimulant intoxications
-- other substance-induced sedative withdrawal
-- mania
-- panic disorder
-- generalized anxiety disorder
-- sleep disorder
-- medication side effect, especially those that
have akathisia
Tolerance
Q. Do people develop tolerance to caffeine?
Tolerance
Ans. Yes, very much so, even though DSMIV doesn’t recognize dependence.
Treatment of caffeine intoxication
Q. What is the treatment of caffeine
intoxication?
Treatment of caffeine intoxication
Ans. Supportive. First and Tasman focus on
educating the pt about the dangers of
caffeine – i.e., prevention, not focus on the
episode itself.
Caffeine withdrawal
Q. Signs of caffeine withdrawal are what?
Caffeine withdrawal
Ans.
Headache,
Sluggishness
Drowsiness
Dysphoria
Irritability
Nausea
Muscle soreness or stiffness
Caffeine withdrawal course
Q. What is the typical course of caffeine
withdrawal
Caffeine withdrawal course
Ans.
Onset between 12 and 24 hours of last
ingestion of caffeine, signs get worse for
the next day or two, and last 2 to 7 days.
Treatment of caffeine withdrawal
Q. What is the treatment of caffeine
withdrawal?
Caffeine withdrawal treatment
Ans. Give caffeine and taper.
Caffeine-induced anxiety disorder
Q. How does caffeine-induced anxiety
disorder differ from caffeine intoxication or
withdrawal?
Caffeine-induced anxiety disorder
Ans. The signs of anxiety are more severe
than those seen in intoxication or in
withdrawal
Caffeine-induced sleep disorder,
definition
Q. Definition of caffeine-induced sleep
disorder?
Caffeine-induced sleep disorder,
definition
Ans. Insomnia, hypersomnia [rare], or
parasomnia [rare].