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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.
Action of caffeine
Ans. Adenosine receptor antagonist. By antagonizing adenosine, caffeine increases dopamine activity.
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.]
Caffeine in coffee
Ans. About 100 mg. Remembering this will get you in the ballpark of how much in other drinks.
Other sources of caffeine
Ans.
Soft drinks
Tea
Chocolate
[also, might say that some analgesics contain caffeine]
Caffeine-related disorders
Ans.
Caffeine intoxication
Caffeine-related anxiety disorder
Caffeine-related sleep disorder
Caffeine 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.]
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.]
Caffeine intoxication -1
Ans.1. Restlessness2. Nervousness3. Excitement4. Insomnia5. Flushed face6. Diuresis[see next screen]
Caffeine intoxication - 2
7. GI complaints
8. Muscle twitching
9. Rambling speech
10. Tachycardia or arrhythmia
11. Periods of inexhaustibility
12. Agitation
Differential dx
Ans. -- 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
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.
Caffeine withdrawal
Ans. Headache,SluggishnessDrowsinessDysphoriaIrritabilityNauseaMuscle soreness or stiffness
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.
Caffeine-induced anxiety disorder
Q. How does caffeine-induced anxiety disorder differ from caffeine intoxication or withdrawal?
Caffeine-induced anxiety disorder
Ans. The signs of anxiety are more severe than those seen in intoxication or in withdrawal