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