Caffeine-related disorders
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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.
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Action of caffeine
Q. What is the cellular site of action of caffeine?
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Action of caffeine
Ans. Adenosine receptor antagonist. By antagonizing adenosine, caffeine increases dopamine activity.
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Role of adenosine
Q. What physiological effects does adenosine produce?
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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.]
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Caffeine in coffee
Q. How much caffeine in a six oz of coffee?
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Caffeine in coffee
Ans. About 100 mg. Remembering this will get you in the ballpark of how much in other drinks.
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Other sources of caffeine
Q. What other drinks or foods have caffeine?
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Other sources of caffeine
Ans. Soft drinksTea Chocolate[also, might say that some analgesics
contain caffeine]
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Average intake
• Q. In the US, what is the average caffeine intake per day?
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Average intake
Ans. 200 mg/d
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Drink caffeine
Q. What percentage of Americans drink caffeine drinks?
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Caffeine drinks
Ans. About 85%.
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> 500 mg/d
What percentage of US people consume more than > 500 mg/d?
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> 500 mg/d
Ans. 30%
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Caffeine half-life
Q. What is the half-life of caffeine?
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Caffeine half-life
Ans. 3 – 6 hours.
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Caffeine-related disorders
Q. What are the DSM-IV caffeine-related disorders?
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Caffeine-related disorders
Ans.Caffeine intoxicationCaffeine-related anxiety disorderCaffeine-related sleep disorderCaffeine 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.]
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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.]
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Caffeine intoxication -1
Ans.1. Restlessness2. Nervousness3. Excitement4. Insomnia5. Flushed face6. Diuresis[see next screen]
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Caffeine intoxication - 2
7. GI complaints8. Muscle twitching9. Rambling speech10. Tachycardia or arrhythmia11. Periods of inexhaustibility12. Agitation
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Differential dx
Q. Differential dx of caffeine intoxication?
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Differential dxAns. -- 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
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Tolerance
Q. Do people develop tolerance to caffeine?
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Tolerance
Ans. Yes, very much so, even though DSM-IV doesn’t recognize dependence.
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Treatment of caffeine intoxication
Q. What is the treatment of caffeine intoxication?
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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.
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Caffeine withdrawal
Q. Signs of caffeine withdrawal are what?
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Caffeine withdrawal
Ans. Headache,SluggishnessDrowsinessDysphoriaIrritabilityNauseaMuscle soreness or stiffness
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Caffeine withdrawal course
Q. What is the typical course of caffeine withdrawal
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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.
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Treatment of caffeine withdrawal
Q. What is the treatment of caffeine withdrawal?
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Caffeine withdrawal treatment
Ans. Give caffeine and taper.
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Caffeine-induced anxiety disorder
Q. How does caffeine-induced anxiety disorder differ from caffeine intoxication or withdrawal?
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Caffeine-induced anxiety disorder
Ans. The signs of anxiety are more severe than those seen in intoxication or in withdrawal
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Caffeine-induced sleep disorder, definition
Q. Definition of caffeine-induced sleep disorder?
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Caffeine-induced sleep disorder, definition
Ans. Insomnia, hypersomnia [rare], or parasomnia [rare].