BRIEF

The RDC (as well as the working draft of DSM-III) employs duration of illness as one classification axis, and we considered the possibility that our two groups might have differed on this variable. The mean duration

of

illness

for

the

index

episode

was

REFERENCES I.

Spitzer teria

RL,

tute, 2. 3.

4.

DISCUSSION

are no generally

accepted

specific

criteria

Some

investigators

schizo-affective nomenological

even, drome

group criterion.

would by

certainly

adding one Few would

that patients with a prominent plus FRS ought to be prime

broaden

the

on another disagree,

phehow-

affective examples

synof any

schizo-affective grouping. Using these straightforward criteria, we are unable to differentiate mania from schizo-affective disorder, manic type, using a group of variables that we believe

are critical in the validation of psychiatric disorders. We present these data in the hope that others will be prompted to do similar analyses, eventually providing a data base adequate nosis of schizo-affective

Coffee

to assess the disorder.

Consumption

BY DANIEL

K. WINSTEAD,

validity

of the



E:

Research

Diagnostic

Cri-

Group of Functional Disorders, Research, NY State Psychiatric

SM, Allen MG. Pollin W, et al: Relationship

6. Welner

2nd Insti-

to manic depressive in 15,909 veteran pairs.

A, Croughan

JL, Robins

of schizo-

psychosis and schizoArch Gen Psychiatry

E: The group of schizo-affec-

tive and related psychoses-critique, record, follow-up, and family studies. I. A persistent enigma. Arch Gen Psychiatry 31: 628-631, 1974 7. Croughan JL, Weiner A, Robins E: The group of schizo-affective and related psychoses-critique, record, follow-up, and family studies. II. Record studies. Arch Gen Psychiatry 31:632-637, 1974 8. Sovner RD. McHugh P: Bipolar course in schizo-affective illness. Biol Psychiatry I I : 195-204, 1976 9. American Psychiatric Association: Diagnostic and Statistical Manual ofMental Disorders, 2nd ed. Washington, DC, 1968

10. Spitzer

RL, Endicott

J, Robins

E: Clinical

criteria

for psychiat-

ric diagnosis andDSM-JII. Am J Psychiatry 132: 1 187-1 192, 1975 I I . American Psychiatric Association Task Force on Nomenclature

and Statistics: Presented Classification

at

Critically 12.

diag-

Progress

Report

the Conference and Terminology:

Examine

of DSM-IJJ.

Improvements in Psychiatric A Working Conference to in Midstream, St Louis, Mo, June

DSM-III

10-Il, 1976 Abrams R, Taylor MA, and paranoid schizophrenia:

on the Preparation on

Gaztanaga P: Manic-depressive illness a phenomenologic, family history, study. Arch Gen Psychiatry 31:640-642,

and treatment-response 1974

Among

Psychiatric

Inpatients

M.D.

0f135 patients on an acute psychiatric ward, 34 were ‘high users’ ofcoffee. The high users tended to be older, single, and have diagnoses ofpsychosis. They showed significantly more state anxiety than other patients, but there were no differences in trait anxiety or MMPJ scores. Further research is suggested to determine whether high caffeine consumption among inpatients may be related to staff coffee-drinking behavior and/or treatment with anticholinergic drugs. ‘

Robins

1975

affective psychosis phrenia: findings 26:539-546, 1972

for

schizo-affective disorder, manic type, and no two studies have used exactly the same criteria. We chose FRS to separate schizo-affective disorder from manic disorder as these abnormal experiences can be rated neliably, are considered by many to be diagnostic for schizophrenia, and figure prominently in the RDC for schizo-affective disorder.

J,

Kasanin J: The acute schizoaffective psychoses. Am J Psychiatry 13:97-126, 1933 Clayton PJ, Rodin L, Winokur G: Family history studies: III. Schizo-affective disorder, clinical and genetic factors including a one- to two-year follow-up. Compr Psychiatry 9:31-49, 1968 Post F: Schizo-affective symptomatology in late life. Br J Psychiatry 118:437-445, 1971

5. Cohen

There

Endicott

(RDC) for a Selected ed. New York, Biometrics

somewhat

longer for the schizo-affective (15.12 weeks) than for the manic group (10.79 weeks), but this difference was not statistically significant (t= .66)

COMMUNICATIONS

is the

CAFFEINE

tem

stimulant.

$1.2

billion

When

this

try Service, New Orleans.

The author ber, U.S.

widely

1972,

was

done,

Nuremberg,

used

pounds Dr.

Winstead

Am J Psychiatry

was

He

Hospital,

to acknowledge

Mr. Harry Megaw, and the Army Hospital. Nuremberg.

the assistance nursing West

133:12,

nervous

sys-

more

than

spent ofcoffee-mone

West Germany.

Veterans Administration La. 70146.

wishes

central

Americans

for 2.8 billion work

my Hospital,

most

In

Major, is now 1601

than MC, Chief, Perdido

of Ms. Sharon

staff of Ward Germany.

December

U.S. ArPsychiaStreet,

1976

4-Main

Barof the

1447

BRIEF

COMMUNICATIONS

150 billion

cups

of coffee.

This

represents

consumption of 14.3 pounds (I). of caffeine produces dependence, drawal symptoms (2), the general luctant to classify caffeine drug’s “domestication,” our daily life in such rituals

coffee club (3). In a recent article, side

effects

mented

of

,

Greden

(4) reported

caffeine

misdiagnosis

to both

disorders, the

then,

the

and only two.

symptoms

To

drinking

services,” further

a careful

of caffeine

[ofi

no

on

drugwith reas anal-

gesics. These studies revealed a correlation between individual anxiety levels and the extent of use of such drugs when made freely available. During these studies, it became evident that there was another drug

available

caffeine, cessive

to all of these

in the amounts

The

refilled

The would anxiety

large

with

present

quantify nc setting

wand-

beer

mugs

was

was

6 a.m.

they

RESU

undertaken

contin-

that

in an attempt

in an inpatient the high user

high

coffee

be closely correlated with and diagnoses of alcoholism.

both

to

psychiatof caffeine.

consumption high

their

given

first 5-7

the

levels

of

were

Minnesota Multiphasic and a questionnaire

and

10 p.m.

collected were

On an average

daily

and

subsequently

the accuracy

of their

mately

1 : 1 , with

psychiatrists patients.

Am

also treats dependents, military personnel. Eight

a 5: 1 ratio

admitted J Psychiatry

the

for each

Army hosis approxi-

of the shifts.

responsibility

to the unit were 133:12,

most to 10

by patients in a 4The remainder of facility; chronic

evacuated to a larger The patient/staff ratio

share

All patients 1448

generally states.

December

for

initially /976

15 gallons

of

by

the

in an

daily

staff. attempt

records.

LTS

longer

and they hospital

higher

were than

incidence

of

more the

Five these

includ-

likely other

psychosis

to be evacuated subjects.

in the

Given

high-user

group, it is not surprising that they were treated with phenothiazines or antidepressants more often than the other patients. Patients in the high-user group had a significantly higher level of state (current) anxiety than the other group (mean scones=5l.7 and 49.6, nespectively, p.OS). Scones on the trait (personality) anxiety scale were almost equal. It is of particular interest that

of the high

users

was given

The results of the questionnaire ed in table 2. The high-user group

patients are pital in the

day,

reviewed

ny. Although patients are

occupied program. treatment

drugs. Coffee the hours of

interviewed

The study was conducted on the 27-bed psychiatric unit ofthe U.S. Army Hospital in Nurembeng, Germa-

of the beds are generally week alcohol rehabilitation the ward is an acute

Personality examined

by patients and staff. All to record each cup of coffee the day, and these records

neurosis. Interestingly, less psychopathology though there were ences between the

facility duty

of hospitalAnxiety In-

that

use of coffee, tea, and other available on the ward between

to a stateside

none METHOD

this active

days

State-Trait

During the 3-month period, a total of 188 patients were admitted for varying intervals. The data are based on the 135 patients for whom psychological testing could be completed before discharge. The majority of patients not included were hospitalized 4 days on less. Thirty-four of the 135 patients tested (25%) were identified as “high users” of coffee, defined as drinking S or more cups of coffee on 2 or more days during their hospitalization. This cut-off point of 5 cups represents a minimum of 500 mg of caffeine, a large dose (4, 5). Table 1 presents demographic data for high users compared to the other patients in our sample. The high users were olden and more often single, divorced, or separated. In addition, they had a higher incidence of psychosis and a lower incidence of depressive neurosis. Therefore their hospital stays

the

consumption thus to identify

hypothesis

which

coffee.

study

coffee and

on the

form ofcoffee. Many patients drank exof coffee, but those with a diagnosis seemed to be particular offenders. Many

of alcoholism patients purchased ually

patients

prior freely

were

also

suggested incidence

of caffeinism. In previous reports (8, 9) I have evaluated seeking behavior among psychiatric inpatients spect to the use of minor tranquilizers as well

freely

their was

to determine

psychiatric He and

(10), the (MMPI),

Patients

fur-

can

inpatient

ventory Inventory

were

with nervousness, the most common noted “chronic

supporting data. of the prevalence

During

they

histo-

matters

withdrawal

state, being Greden

patients

he gave investigations

dietary

complicate

mimic those of an anxiety restlessness, and headache complaints (5-7). Although

coffee

com-

neuno-

symptoms of irritability, restlessness, disturbed and diarrhea are com-

,

ry distinguishes

and

ofanxiety

study.

ization,

coffee were consumed patients were instructed that they drank throughout

the multiple

ingestion

sis in cases ofcaffeinism. The nervousness palpitations , sleep, gastrointestinal irritation,

mon

ed in the

capita

as a drug. This reflects the i.e. its incorporation into as the coffee break and the

excess

on the frequent

a pen

Although heavy use tolerance, and withpublic has been ne-

the coffee on 9 of the no statistically groups.

a diagnosis

of anxiety

consumers revealed 13 MMPI scales, alsignificant differ-

survey reported

are presentan average

daily intake of 6.7 cups of coffee compared with 3.2 cups in the other group. Both groups reported a rather high incidence of nervousness from overindulgence in coffee, and a substantial percentage also reported physical symptoms when they drank less coffee than usual. There were, however, significantly more reports of anxiety symptoms on withdrawal from calfeine in the high-user group. Patients in the two groups reported similar patterns

BRIEF

TABLE 1 Demographic

22-year-old Data for High Users of Caffeine and Other Patients

Item

Other Patients (N= 101)

Significance*

Meanage(years)

29.2

25.6

p.OS

91 21 20.9

83 44 14.2

p.OS p.O5 p.OS

41 24 32 3

43 39 13 5

n.s. p

Coffee consumption among psychiatric inpatients.

BRIEF The RDC (as well as the working draft of DSM-III) employs duration of illness as one classification axis, and we considered the possibility tha...
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