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. Restlessness2. Nervousness3. Excitement4. Insomnia5. Flushed face6. 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 DSM-IV 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,SluggishnessDrowsinessDysphoriaIrritabilityNauseaMuscle 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].