Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. [1] It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. [2] [3] This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited. [1] [4] [5]
Psychosis is a symptom of psychotic disorders like schizophrenia and severe mood disorders like depression or bipolar disorder. Simply put, psychosis affects the human brain in ways that alter the person's ability to perceive reality. During a psychotic episode, a person may misinterpret and struggle to understand their own thoughts, and additionally "they may have difficulty recognizing what is real and what is not." [6] In order to spot an individual who could be experiencing Psychosis, look for these symptoms:
If a person has any one of these symptoms, they are most likely prone to experience Psychosis.
Consuming excessive amounts of caffeine and combining this with psychotic and mood disorders can impact the severity of the disorders, but excessive consumption can severely affect people who are schizophrenic. 85% of the population of the United States ingests caffeine in some form every day. The most common ways people ingest caffeine is through freshly brewed coffee, instant coffee, tea, soda, and chocolate.
Average caffeine levels are:
A majority of the population ingests roughly 210 mg of caffeine every day, while people who have higher tolerances/consume more excessive amounts ingest more than 500 mg of caffeine daily.
80% of people with schizophrenia smoke daily and are heavy smokers. Smoking tends to deplete much of ingested caffeine, so the majority of users with schizophrenia have to consume much more caffeine than others to regulate their caffeine levels.
Many people with schizophrenia use caffeine to combat boredom or to fight the sedating effects of antipsychotic medications. Additionally people with schizophrenia may have polydipsia (causes someone to feel an immense amount of thirst, despite already drinking plenty of hydrating fluids), [9] so people with this disorder may try to consume more caffeine than normal. A lot of antipsychotic medications contain ingredients that make the mouth more prone to dryness, which would also increase the amount of coffee (containing caffeine) one may uptake.
"Caffeine use can cause restlessness, nervousness, insomnia, rambling speech, and agitation" [10] worsening the symptoms of schizophrenia. "Caffeine is metabolized by the CYP1A2 enzyme and also acts as a competitive inhibitor of this enzyme. Thus, caffeine can interact with a wide range of psychiatric medications, including antidepressant agents, antipsychotic agents, antimanic agents, antianxiety agents, and sedative agents." [11] So when caffeine interacts with these specific medications, it can complicate the side effects of the disorder and possibly the medication. To lessen the side effects, people with schizophrenia should consume lower amounts of caffeine.
A consumption of less than 250 mg of caffeine a day has been seen to give better results in better performances on cognitive tasks in people with schizophrenia. Although, more research still needs to be done to determine if the same amount of caffeine that is safe to consume by schizophrenics (> 250 mg/a day) matches up with the general population of people without schizophrenia. [12]
Chronic caffeine-induced psychosis has been reported in a 47-year-old man with high caffeine intake. The psychosis resolved within seven weeks after lowering caffeine intake, without the use of anti-psychotic medication. [1]
For schizophrenic people that have an addiction to caffeine, the best way to treat caffeine-induced psychosis is to gradually consume smaller amounts of it over a period of time. Withdrawal to certain drugs may worsen side effects of any psychotic or mood disorders, so it is best for people that have an addiction to slowly drop their levels of caffeine over time instead of completely restricting their consumption of caffeine.
For people who consume excessive amounts of caffeine and don't already have a psychotic disorder, a doctor may prescribe antipsychotics to help stop the effects of psychosis. [13] For people with a psychotic disorder, it is best to slowly limit caffeine intake and continue taking antipsychotics.
Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.
Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes. Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention. Also, the depressive episodes will be approximately 2 weeks long.
Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived as a "mirror image" to depression, the heightened mood can be either euphoric or dysphoric. As the mania intensifies, irritability can be more pronounced and result in anxiety or anger.
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, such as bipolar disorder and the bipolar type of schizoaffective disorder.
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.
Olanzapine, sold under the brand name Zyprexa among others, is an atypical antipsychotic primarily used to treat schizophrenia and bipolar disorder. For schizophrenia, it can be used for both new-onset disease and long-term maintenance. It is taken by mouth or by injection into a muscle.
Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.
A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."
Caffeinism is a state of intoxication caused by excessive consumption of caffeine. This intoxication covers a variety of unpleasant physical and mental symptoms associated with the consumption of excessive amounts of caffeine.
Stimulant psychosis is a mental disorder characterized by psychotic symptoms. It involves and typically occurs following an overdose or several day binge on psychostimulants; however, one study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for some time.
Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions. In more severe cases, the motions may become harmful to the individual, and may involve things such as ripping, tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe hyponatremia. The middle-aged and the elderly are more at risk to express it.
The emphasis of the treatment of bipolar disorder is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques.
Psychoneuroendocrinology is the clinical study of hormone fluctuations and their relationship to human behavior. It may be viewed from the perspective of psychiatry, where in certain mood disorders, there are associated neuroendocrine or hormonal changes affecting the brain. It may also be viewed from the perspective of endocrinology, where certain endocrine disorders can be associated with negative health outcomes and psychiatric illness. Brain dysfunctions associated with the hypothalamus-pituitary-adrenal axis HPA axis can affect the endocrine system, which in turn can result in physiological and psychological symptoms. This complex blend of psychiatry, psychology, neurology, biochemistry, and endocrinology is needed to comprehensively understand and treat symptoms related to the brain, endocrine system (hormones), and psychological health..
In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. More specifically, it refers to the period between the first recognition of a disease's symptom until it reaches its more severe form. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.
Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).
Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.
Postpartum psychosis (PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is a condition currently represented under "Brief Psychotic Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V). Symptoms may include delusions, hallucinations, disorganized speech, and/or abnormal motor behavior. Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders, as well as cognitive features such as consciousness that comes and goes or disorientation.
Schizophrenia is a primary psychotic disorder, whereas, bipolar disorder is a primary mood disorder which can also involve psychosis. Both schizophrenia and bipolar disorder are characterized as critical psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). However, because of some similar symptoms, differentiating between the two can sometimes be difficult; indeed, there is an intermediate diagnosis termed schizoaffective disorder.
The following outline is provided as an overview of and topical guide to bipolar disorder:
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