196 Caffeine Intoxication (305.9)

DSM-IV-TR criteria

A. Recent consumption of caffeine, usually in excess of 250mg (e.g. more than 2-3 cups of brewed coffee).

B. Five or more of the following signs, developing during, or shortly after, caffeine use:

1. restlessness
2. nervousness
3. excitement
4. insomnia
5. flushed face
6. diuresis
7. gastrointestinal disturbance
8. muscle twitching
9. rambling flow of thought and speech
10. tachycardia or cardiac arrhythmia
11. periods of inexhaustibility
12. psychomotor agitation

C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. (e.g. Anxiety Disorder)

• Tolerance to caffeine may be developed, so Caffeine Intoxication may not occur in certain individuals.

DSM-IV-TR criteria for caffeine-induced anxiety disorder

• Prominent anxiety predominates in the clinical picture.
• There is evidence from the history, physical examination, or laboratory finding suggesting that the anxiety developed within 1 month of caffeine intoxication or withdrawal or that medications containing caffeine are etiologically related to the disturbance.
• The disturbance is not bettr accounted for by an anxiety disorder that is not substance-induced.
• The disturbance does not occur exclusively during the course of a dlirium.
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functiong.

DSM-IV-TR criteria for caffeine-induced sleep disorder

• A prominent disturbance in sleep occurs that is sufficiently severe to warrant independent clinical attention.
• There is evidence from the history, physical examination, or laboratory findings that the sleep disturbance is the direct physiological consequence of caffeine consumption.
• The disturbance is not better accounted for by another mental disorder.
• The disturbance does not occur exclusively during the course of a delirium.
• The disturbance does not meet the criteria for breathing-related sleep disorder or narcolepsy.
• The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM-IV-TR criteria for caffeine-related disorder NOS

• This includes any caffeine disorder other than those previously listed.
• Symptoms of caffeine withdrawal that are not currently an officially recognized diagnosis are present.

Mental Status Examination

• Many of the effects of caffeine consumption are expressed in behavioral manifestations. The most common is anxiety, with its associated fidgetiness, distractibility, poor eye contact, hesitating speech, and prolonged bursts of energy.
• Caffeine’s effecton mood is complicated and not fully understood. Although initially it may promote some improvement in mood, notably identified by some slight euphoria or focused attention, this pattern may give way to a chronic dysphoria. This mildly depressed state may be a consequence of withidrawal.
• Any complaint of sleep difficulty should include a careful assessment of beverage consumption.
• Caffeine would not produce perceptual problems such as hallucinations.
• Caffeine consumption does not produce alterations in thinking, such as delusions.
• Caffeine consumption does not cause disorientation, memory problems, mental confusion, impairment in judgment, or problems with abstract thinking.

Causes

• The means by which caffeine exerts its pharmacologic effects remains a subject of active research.
• A leading theory suggests that caffeine is an adenosine receptor antagonist that blocks two major types of adenosine receptors, A1AR and A2AAR.
• Adenosine is an inhibitory neuromodulator affecting norepinephrine, dopamine, and serotonin activity.
• Caffeine’s putative antagonism of adenosine would increase those neurotransmitters promotting psychostimulation.
• The same neurotransmitter systems are implicated in the pathophysiology of several psychiatric.