Am
J Psychiatry
135:8,
August
BRIEF
1978
State Department of Mental Health, 1975 6. Howells JG: Modern Perspectives in the Psychiatric Aspects Surgery. New York, Brunner/Mazel, 1976, pp 408-409 7. Oken D: What to tell cancer patients. JAMA 175:1120-1128,
REFERENCES 1 . Parsons effect
JA, in
Webster
the
3. 4.
Dowd
treatment
56:129-140, Aug 2.
JH,
of
JE:
Evaluation
radiation
sickness.
5.
Mental Spitzer tionnaire
Biometrics
Research,
and
Psychiatric
AND
Acta
Radiol
New
York
Hosp
care of patients 1965
Record. Department
State
Depression
New of
Associated
F. GREDEN,
CAFFEINISM
M.D.,
PATRICIA M.D.
CHAMBERLIN,
FONTAINE,
CAN
and
BE pharmacologically
consequent
actions
defined
as the
doses
of cal-
of high
at the 130th annual meeting of the American Toronto, Ont. , Canada, May 2-6, 1977.
Psychiatric
Truth
and
the
physician.
Bull
NY
Acad
Med
45:59-
patients
suffering
from
neoplastic
disease.
Am
I Psycho-
ther 12:723-734, 1958
Caffeinism
; and
Dr.
Chief, Open Psychiatric Ann Arbor, Mich.
Chamberlin
Unit,
is
Veterans
Instructor
in
Psychiatry
M.D.,
MARTIN
feine,
counter
Among
and
Administration
Hospital,
0002-953X178/0008-0963$0.45
©
LUBETSKY,
whether
from
substances,
coffee,
tea,
cola
drinks,
on prescription
over-the-
medications.
Cal-
feine’s profound impact on various physiological systems has been firmly documented (1, 2), but whether high doses of the substance can produce a definitive psychiatric syndrome with predictable onset, symptoms, course, and outcome has not yet been determined.
There widely
is no doubt used
that
caffeine
is one
psychotropic drugs in the (3-5). Comparisons ofcaffeine
of the United
most States
and Canada study to study have been 20%-30% of respondents
intake from difficult, but approximately in all surveys reported consuming more than 500-600 mg of caffeine pen day. Pharmacologically, symptoms of caffeinism would be quite likely to occur above this point (6). Thus, as much as one-quarter of the population would seem to be at high risk for caffeinism. Despite widespread caffeine intake and its confirmed pharmacological potency, clinical reports of caffeinism
Dr. Greden is Associate Professor of Psychiatry and Inpatient Mcdical Director, Clinical Studies Unit, University of Michigan Medical Center, Ann Arbor, Mich. 48109. Dr. Fontaine is a resident in family practice, University of Minnesota, Minneapolis, Minn. ; Mr. Lubetsky is a first-year medical student, Wayne State University, DcMich.
with
with
,
troit,
EC: 1969
9. Shands H, Finesinger JE, Cobb 5, et al: Psychological mechanisms in patients with cancer. Cancer 4:1159-1170, 1951 10. What shall we tell the cancer patient? (symposium). Proceedings, Staff Meetings of the Mayo Clinic 35:239, 1960 11. LeShan L, Gassman M: Some observations on psychotherapy
QuesYork
Among 83 hospitalized adultpsychiatricpatients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms,felt that theirphysical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels inhibits phosphodiesterase breakdown ofcyclic AMP, and sensitizes receptor sites, association ofcaffeinism with both anxiety and depressive symptoms is possible.
Presented Association,
1961 Meyer
of
Inpatients
KENNETH
ingestion
8.
Top
71,
Health, 1975 RL, Endicott JE: Study of Affective Disorders (SADS). New York, Biometrics Research, New
Anxiety
BY JOHN
placebo
1961
Yonke G: Emotional response to radiotherapy. 45:107-108, Sept 1967 Feder SL: Psychological considerations in the with cancer. Ann NY Acad Sci 125:1020-1030, Spitzer RL, Endicott JE: Social Background
York,
of the
COMMUNICATIONS
have
been
infrequent.
In
1974,
Greden
(6)
described three cases in which caffeinism was misdiagnosed as an anxiety syndrome; clinicians from several other settings confirmed this finding (7, 8). However, until recently few investigators have reported caffeine intake in larger samples of psychiatric patients. In 1976, Winstead (9) studied 135 psychiatric patients and found that 25% were high coffee users 1978 American
Psychiatric
Association
963
BRIEF
COMMUNICATIONS
Am
during their hospitalization, consuming more than five cups pen day. Of greaten interest was his observation that heaviest users scored significantly higher on the State-Trait Anxiety Index (STAI) (10) and that significantly more were diagnosed as psychotic. Winstead’s findings have not been replicated, howeven, and he did not attempt to assess typical prevailing caffeine intake among psychiatric patients before hospitalization or to compile a symptom profile associated with caffeinism. Indeed, there have been few published reports of a clinical
profile
for
patients
who
develop
caffeinism.
To further assess this issue we studied average calfeine intake among a sample of psychiatric patients and related this to psychiatric symptoms and rating scales. Our working hypothesis was that there would not be a relationship between total caffeine intake and reported clinical symptoms on rating scones. This paper reports the findings from that study.
Twenty-two nc
During
July,
August,
and
September
a 26-page questionnaire sequentially hospitalized
units at the (N=45) and
University the Ann
of Arbor
1976
we admin-
to 83 psychiatric inon three general
Michigan Veterans
Medical Center Administration
Hospital (N=38). We had previously pilot-tested the questionnaire by interviewing 30 subjects to confirm its
validity.
The
questionnaire
contained
an
informed
consent statement, which was signed by all subjects, and 190 key-punchable items, which included three rating scales: the Beck Depression Scale, the StateTrait Anxiety Index (STAI) (10), and the Michigan Alcohol Screening Test (MAST) (11). Because of the lack of similar diagnostic techniques in the three clinical
units,
havion basis
we
and
primarily
elected
of traditional
not
emphasized
symptoms
to compare
respondents
nomenclature.
We
strongly
and
be-
on the empha-
sized to all respondents that we were assessing average patterns of caffeine consumption that prevailed before hospitalization. A unique feature of our methodology was that we assessed total caffeine intake. This contrasts
with
most
studies,
which
have
reported
only
“cups of coffee,” “cups of tea,” “ounces of cola,” etc., without compiling total intake of caffeine. Our technique for determining total average caffeine ingestion was to inquire about use of coffee, tea, cola drinks, and 25 medications that contain caffeine. We then multiplied average caffeine content for each source (6, p. 1090) by the daily amounts consumed and, with a computer, summed caffeine intake from all sources to obtain daily figures. After determining total caffeine intake, we arbitrarily subdivided the 83 subjects into 3 subgroups:
I) low
consumers
(0-249
mg caffeine
per
day), 2) moderate consumers (250-749 mg per day), and 3) high consumers (750 mg or more per day). For the purpose of testing our hypothesis, we assumed that the high consumers would be most likely to report symptoms of caffeinism if such a syndrome exists. 964
percent
patients
were
Forty-two 36%
percent
were
low
of these
identified
August
1978
hospitalized
as high
were
psychiat-
caffeine
moderate
consumers.
consumers,
and
consumers.
on tea
consumption
cantly
more
When asked whether coffee was a ‘habit’ for them, signifimoderate and high groups respond‘
of the
‘
ed affirmatively (p
J Psychiatry
135:8,
August
BRIEF
1978
State Department of Mental Health, 1975 6. Howells JG: Modern Perspectives in the Psychiatric Aspects Surgery. New York, Brunner/Mazel, 1976, pp 408-409 7. Oken D: What to tell cancer patients. JAMA 175:1120-1128,
REFERENCES 1 . Parsons effect
JA, in
Webster
the
3. 4.
Dowd
treatment
56:129-140, Aug 2.
JH,
of
JE:
Evaluation
radiation
sickness.
5.
Mental Spitzer tionnaire
Biometrics
Research,
and
Psychiatric
AND
Acta
Radiol
New
York
Hosp
care of patients 1965
Record. Department
State
Depression
New of
Associated
F. GREDEN,
CAFFEINISM
M.D.,
PATRICIA M.D.
CHAMBERLIN,
FONTAINE,
CAN
and
BE pharmacologically
consequent
actions
defined
as the
doses
of cal-
of high
at the 130th annual meeting of the American Toronto, Ont. , Canada, May 2-6, 1977.
Psychiatric
Truth
and
the
physician.
Bull
NY
Acad
Med
45:59-
patients
suffering
from
neoplastic
disease.
Am
I Psycho-
ther 12:723-734, 1958
Caffeinism
; and
Dr.
Chief, Open Psychiatric Ann Arbor, Mich.
Chamberlin
Unit,
is
Veterans
Instructor
in
Psychiatry
M.D.,
MARTIN
feine,
counter
Among
and
Administration
Hospital,
0002-953X178/0008-0963$0.45
©
LUBETSKY,
whether
from
substances,
coffee,
tea,
cola
drinks,
on prescription
over-the-
medications.
Cal-
feine’s profound impact on various physiological systems has been firmly documented (1, 2), but whether high doses of the substance can produce a definitive psychiatric syndrome with predictable onset, symptoms, course, and outcome has not yet been determined.
There widely
is no doubt used
that
caffeine
is one
psychotropic drugs in the (3-5). Comparisons ofcaffeine
of the United
most States
and Canada study to study have been 20%-30% of respondents
intake from difficult, but approximately in all surveys reported consuming more than 500-600 mg of caffeine pen day. Pharmacologically, symptoms of caffeinism would be quite likely to occur above this point (6). Thus, as much as one-quarter of the population would seem to be at high risk for caffeinism. Despite widespread caffeine intake and its confirmed pharmacological potency, clinical reports of caffeinism
Dr. Greden is Associate Professor of Psychiatry and Inpatient Mcdical Director, Clinical Studies Unit, University of Michigan Medical Center, Ann Arbor, Mich. 48109. Dr. Fontaine is a resident in family practice, University of Minnesota, Minneapolis, Minn. ; Mr. Lubetsky is a first-year medical student, Wayne State University, DcMich.
with
with
,
troit,
EC: 1969
9. Shands H, Finesinger JE, Cobb 5, et al: Psychological mechanisms in patients with cancer. Cancer 4:1159-1170, 1951 10. What shall we tell the cancer patient? (symposium). Proceedings, Staff Meetings of the Mayo Clinic 35:239, 1960 11. LeShan L, Gassman M: Some observations on psychotherapy
QuesYork
Among 83 hospitalized adultpsychiatricpatients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms,felt that theirphysical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels inhibits phosphodiesterase breakdown ofcyclic AMP, and sensitizes receptor sites, association ofcaffeinism with both anxiety and depressive symptoms is possible.
Presented Association,
1961 Meyer
of
Inpatients
KENNETH
ingestion
8.
Top
71,
Health, 1975 RL, Endicott JE: Study of Affective Disorders (SADS). New York, Biometrics Research, New
Anxiety
BY JOHN
placebo
1961
Yonke G: Emotional response to radiotherapy. 45:107-108, Sept 1967 Feder SL: Psychological considerations in the with cancer. Ann NY Acad Sci 125:1020-1030, Spitzer RL, Endicott JE: Social Background
York,
of the
COMMUNICATIONS
have
been
infrequent.
In
1974,
Greden
(6)
described three cases in which caffeinism was misdiagnosed as an anxiety syndrome; clinicians from several other settings confirmed this finding (7, 8). However, until recently few investigators have reported caffeine intake in larger samples of psychiatric patients. In 1976, Winstead (9) studied 135 psychiatric patients and found that 25% were high coffee users 1978 American
Psychiatric
Association
963
BRIEF
COMMUNICATIONS
Am
during their hospitalization, consuming more than five cups pen day. Of greaten interest was his observation that heaviest users scored significantly higher on the State-Trait Anxiety Index (STAI) (10) and that significantly more were diagnosed as psychotic. Winstead’s findings have not been replicated, howeven, and he did not attempt to assess typical prevailing caffeine intake among psychiatric patients before hospitalization or to compile a symptom profile associated with caffeinism. Indeed, there have been few published reports of a clinical
profile
for
patients
who
develop
caffeinism.
To further assess this issue we studied average calfeine intake among a sample of psychiatric patients and related this to psychiatric symptoms and rating scales. Our working hypothesis was that there would not be a relationship between total caffeine intake and reported clinical symptoms on rating scones. This paper reports the findings from that study.
Twenty-two nc
During
July,
August,
and
September
a 26-page questionnaire sequentially hospitalized
units at the (N=45) and
University the Ann
of Arbor
1976
we admin-
to 83 psychiatric inon three general
Michigan Veterans
Medical Center Administration
Hospital (N=38). We had previously pilot-tested the questionnaire by interviewing 30 subjects to confirm its
validity.
The
questionnaire
contained
an
informed
consent statement, which was signed by all subjects, and 190 key-punchable items, which included three rating scales: the Beck Depression Scale, the StateTrait Anxiety Index (STAI) (10), and the Michigan Alcohol Screening Test (MAST) (11). Because of the lack of similar diagnostic techniques in the three clinical
units,
havion basis
we
and
primarily
elected
of traditional
not
emphasized
symptoms
to compare
respondents
nomenclature.
We
strongly
and
be-
on the empha-
sized to all respondents that we were assessing average patterns of caffeine consumption that prevailed before hospitalization. A unique feature of our methodology was that we assessed total caffeine intake. This contrasts
with
most
studies,
which
have
reported
only
“cups of coffee,” “cups of tea,” “ounces of cola,” etc., without compiling total intake of caffeine. Our technique for determining total average caffeine ingestion was to inquire about use of coffee, tea, cola drinks, and 25 medications that contain caffeine. We then multiplied average caffeine content for each source (6, p. 1090) by the daily amounts consumed and, with a computer, summed caffeine intake from all sources to obtain daily figures. After determining total caffeine intake, we arbitrarily subdivided the 83 subjects into 3 subgroups:
I) low
consumers
(0-249
mg caffeine
per
day), 2) moderate consumers (250-749 mg per day), and 3) high consumers (750 mg or more per day). For the purpose of testing our hypothesis, we assumed that the high consumers would be most likely to report symptoms of caffeinism if such a syndrome exists. 964
percent
patients
were
Forty-two 36%
percent
were
low
of these
identified
August
1978
hospitalized
as high
were
psychiat-
caffeine
moderate
consumers.
consumers,
and
consumers.
on tea
consumption
cantly
more
When asked whether coffee was a ‘habit’ for them, signifimoderate and high groups respond‘
of the
‘
ed affirmatively (p
