Effects of caffeine on behavior of schizophrenic inpatients

From bean to brain: Coffee, gray matter, and neuroprotection in neurological disorders spectrum

Coffee is a popular drink enjoyed around the world, and scientists are very interested in studying how it affects the human brain. This chapter looks at lots of different studies to understand how drinking coffee might change the brain and help protect it from neurodegenerative disorders especially like schizophrenia. With the help of available literature a link between the coffee mechanism and neurodegenerative disorders is established in this chapter. Researchers have found that drinking coffee can change the size of certain parts of the brain that control things like thinking and mood. Scientists also study how coffee's ingredients, especially caffeine, can change how the brain works. They think these changes could help protect the brain from diseases. This chapter focuses on how coffee might affect people with schizophrenia as hallucination is caused during and after excess consumption of caffeine. There's still a lot we don't know, but researchers are learning more by studying how different people's brains respond to coffee over time. Overall, this chapter shows that studying coffee and the brain could lead to new ways to help people with brain disorders. This study also draws ideas for future research and ways to help people stay healthy.

Impact of a Caffeine Restriction Policy on Inpatients With Schizophrenia: A Pre-Post Comparison Using Electronic Health Records

BACKGROUND/PURPOSE

Caffeine is the most commonly used psychostimulant worldwide. Although its large intake is suspected to worsen psychotic symptoms because of increasing dopamine neurotransmission, schizophrenic patients are heavier caffeine consumers than the general population. This study aims to assess the impact of a caffeine restriction policy in a psychiatric hospital on patient psychopathology, hospitalization characteristics, and psychotropic prescribing patterns.

METHODS

It is a retrospective cross-sectional study based on electronic health records of a psychiatric hospital in the French-speaking area of Belgium. Two different periods were compared, the first (n = 142), in 2017, when caffeine was available in the institution and the second (n = 119), between November 2018 and November 2019 after the restriction of access to caffeine was implemented. Adult inpatients with schizophrenia or schizoaffective disorder admitted for an acute hospitalization were included. Antipsychotic exposure, benzodiazepine daily dose, Global Assessment of Functioning scores, length of hospital stay, and some other factors were tested for their potential association with the decaffeinated period.

RESULTS

After adjusting for potential confounders, reduced caffeine availability inside the hospital was significantly associated with higher Global Assessment of Functioning scores at discharge (adjusted odds ratio [aOR] = 2.86, 95% confidence interval [CI] = 1.77-4.62) and shorter hospital stays (aOR = 0.68, 95% CI = 0.47-0.99) but was not associated with change in antipsychotic exposure at discharge (aOR = 1.04, 95% CI = 0.64-1.7) or benzodiazepine daily dose (aOR = 0.89, 95% CI = 0.61-1.29).

CONCLUSIONS

Limiting access to caffeine in psychiatric hospitals is a simple and inexpensive intervention that should be promoted, especially for patients with schizophrenia.

Stress, caffeine and psychosis-like experiences-A double-blind, placebo-controlled experiment

OBJECTIVE

Psychosis-like perceptual distortions can occur in the general population, and both stress and caffeine can enhance the proneness to psychosis-like experiences, such as hallucinations. The current study aims to explore the effects of acute caffeine intake and acute stress on perceptual distortions in a double-blind, placebo-controlled experiment.

METHODS

Regular caffeine consumers (n = 92) and non/low consumers (n = 89) were assigned to 100 mg caffeine/placebo and stress/no stress conditions. The White Christmas Paradigm (WCP) was used to measure hallucination-like symptoms, and bias towards threat-related words was used as an indicator of persecutory ideation. Participants reported their daily caffeine intake, and completed the State-Trait Anxiety Inventory, the Launay-Slade Hallucination Scale, the Persecutory Ideation Questionnaire and the Marlow-Crowne Social Desirability Scale.

RESULTS

Acute stress slightly increased hallucination-like experiences, but not recall bias, while the small amount of caffeine had a time-dependent effect on recall bias. Proneness to persecutory ideation was positively and social desirability was negatively correlated with recall bias towards threat-related words, while proneness to hallucinations positively correlated with hallucination-like experiences.

CONCLUSIONS

Our results indicate that psychosocial stress-in line with the diathesis-stress model-can lead to the enhancement of hallucination-like experiences.

Caffeine Restrictions in Inpatient Psychiatric Settings: Precipitating Withdrawal?

: Caffeine is often restricted in locked inpatient psychiatric facilities based on concern that it may exacerbate clinical symptoms. However, psychiatric inpatients may be at particularly high risk of caffeine withdrawal during psychiatric hospitalization, which may cause undue discomfort or distress, limit their engagement in inpatient treatment, and confound the management of psychiatric illness. Psychiatric patients who regularly consume caffeine also possess a degree of caffeine tolerance which may reduce the risk of adverse effects associated with continued inpatient caffeine intake. For these reasons, it appears reasonable to allow caffeine in inpatient psychiatric settings.

Neuropsychiatric effects of caffeine

Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.

Higher serum caffeine in smokers with schizophrenia compared to smoking controls

Previous studies of high dietary caffeine intake in individuals with schizophrenia have not demonstrated biological evidence of higher intake or controlled smoking behavior. This study aimed to examine differences in serum caffeine levels in 104 smokers with schizophrenia/schizoaffective disorder (SCZ/SA) and compare them to 63 smokers without any mental illness (CON). Since we were interested in measuring caffeine levels, we excluded all non-caffeine users from the study. Blood draws were standardized to occur at mid-day on a usual smoking day. The mean serum caffeine level was significantly higher for SCZ/SA group compared to CON (2722 ng/mL vs. 1122 ng/mL; p<0.001). This trend persisted in subsets of smokers who smoked less than 20 cigarettes per day (CPD; 2052 ng/mL vs. 587 ng/mL; p<0.05), 20-30 CPD (2743 ng/mL vs. 1170 ng/mL; p<0.001) or more than 30 CPD (3430 ng/mL vs. 1834 ng/mL; NSS). Linear backward stepwise regression analyses including demographic and smoking variables revealed that having a diagnosis of SCZ/SA (compared to CON) significantly predicted serum caffeine level (B=1528.2; p<0.001). In addition, SCZ/SA group had two times greater serum caffeine levels as compared to CON with similar smoking behavior. Clinical effects of smoking and caffeine intake are important and may complicate the interpretation of schizophrenia symptoms and antipsychotic medication side effects, thus warranting further research.

Acute risperidone treatment did not increase daily cigarette consumption or plasma levels of cotinine and caffeine: a pilot study

Excessive cigarette smoking and caffeine intake are often seen in schizophrenic patients being treated with antipsychotic drugs, particularly typical antipsychotic drugs. Using nicotine and caffeine sometimes influences psychotic symptoms in these patients. Clozapine is the only antipsychotic drug reported to reduce the amount of cigarette smoking, however, still remains controversial of its efficacy. In the present study, we examined the effect of acute risperidone treatment on the amount of cigarette smoking and plasma levels of cotinine and caffeine in schizophrenic patients. Treatment with risperidone for 4 weeks did not increase daily cigarette consumption or plasma levels of cotinine and caffeine. The results suggest that acute risperidone treatment does not promote the intake of nicotine and caffeine at least by 4 weeks in schizophrenic patients.

Systemic administration of the adenosine A(2A) agonist CGS 21680 induces sedation at doses that suppress lever pressing and food intake

Adenosine A(2A) receptors are involved in the regulation of several behavioral functions. Adenosine A(2A) antagonists exert antiparkinsonian effects in animal models, and adenosine A(2A) agonists suppress locomotion and impair various aspects of motor control. The present experiments were conducted to study the effects of low doses of the adenosine A(2A) agonist CGS 21680 on lever pressing, specific parameters of food intake, and sedation. In the first experiment, the effects of CGS 21680 on fixed ratio 5 lever pressing were assessed. In the second experiment, rats were tested in 30 min feeding sessions, and also were observed for drug-induced sedation using a sedation rating scale. CGS 21680 (0.025, 0.05, 0.1 mg/kg IP) produced a dose related suppression of lever pressing, and also reduced the amount of food consumed. The feeding effect was largely dependent upon a slowing of the rate of feeding, and there was only a modest suppression of time spent feeding. Doses of CGS 21680 that suppressed lever pressing and feeding also were associated with sedation/drowsiness. In conjunction with other studies, the present results suggest that sedative effects may play an important role in some of the behavioral effects produced by systemic administration of adenosine A(2A) agonists.

Increased caffeine and nicotine consumption in community-dwelling patients with schizophrenia

INTRODUCTION

It is known that people with schizophrenia make poor dietary choices and smoke at alarmingly high rates. There is also anecdotal evidence that they may ingest large amounts of caffeine. However, while smoking habits in this population have been examined, no recent study has quantified caffeine consumption taking into account various dietary caffeine sources unrelated to coffee including convenience foods such as candy bars, chocolate or soft drinks, and compared results to US population data.

METHODS

We employed 24-h diet recalls to assess dietary habits in a sample of outpatients suffering from schizophrenia or schizoaffective disorder. Caloric intake and caffeine consumption were quantified and the relationship to various sociodemographic variables including body mass index (BMI) and dietary quality was examined.

RESULTS

146 patients were recruited. Mean BMI in the sample was 32.7+/-7.9. Patients ingested 3,057+/-1,132 cal on average. Patients smoked at higher rates (59.6% vs. 23.4%, p< or =0.001), higher numbers of cigarettes/day (24+/-14.4 vs. 13.5+/-11.3, t=8.549, p<0.001) and ingested more caffeine (471.6+/-584.6 mg vs. 254.2+/-384.9 mg, t=6.664, p<0.001) than US population comparisons. Caffeine consumption was correlated to the number of cigarettes smoked daily (r=0.299, p< or =0.001), but not to BMI (r=0.134, p=0.107) or dietary parameters such as caloric intake (r=0.105, p=0.207).

CONCLUSION

Community-dwelling schizophrenia patients consume significantly more caffeine and nicotine than US population comparisons. Clinicians should be aware that while a significant proportion of patients are overweight and have poor dietary quality - which merits lifestyle counseling on its own - there is a lack of correlation between those factors and smoking and caffeine intake. Thus, lifestyle modification counseling in all patients should address smoking and caffeine intake concurrently.

Effects of smoking during antipsychotic withdrawal in patients with chronic schizophrenia

A number of studies have shown that patients with schizophrenia smoke more than other psychiatric patients and more than the general population. Also, medicated schizophrenics who smoke present more positive symptoms of schizophrenia than non-smokers. The objective of the present study was to assess the effect of smoking on ratings of psychopathology for 30 days following discontinuation of antipsychotic medication. The subjects were 101 treatment-resistant patients with schizophrenia who had been admitted to the inpatient service of Neuroscience Research Hospital (NRH), National Institute of Mental Health, between 1982 and 1994 to undergo studies involving discontinuation of antipsychotic medication. Patients were rated independently on a daily basis on the 22-item Psychiatric Symptom Assessment Scale (PSAS), an extended version of the Brief Psychiatric Rating Scale (BPRS). At baseline, ratings for Verbal Positive, Paranoia and Loss of Function were higher in smokers (n=65) than non-smokers (n=36), but a statistically significant difference was observed only for the Verbal Positive cluster. Analysis by gender revealed that male non-smokers had the lowest psychopathology ratings at baseline. There were no differences in Anxiety/depression, Behavior Positive, Deficit Symptoms or Mannerisms (a measure for abnormal involuntary movements). Following medication discontinuation, repeated-measure analysis demonstrated a 'time' effect for all the variables studied and a 'group' (smokers vs. non-smokers) effect for Verbal Positive, Paranoia, and Loss of Function. Post-hoc comparisons at individual time points showed significantly higher ratings for smokers at week 1 for Paranoia. No differences were observed at later time points. In conclusion, at baseline, smokers had more positive symptoms and were apparently more functionally impaired than non-smokers. This difference was no longer evident after a 30 day medication discontinuation period.

Indirect modulation of dopamine D2 receptors as potential pharmacotherapy for schizophrenia: I. Adenosine agonists

OBJECTIVE

To review preclinical and clinical information related to pharmacologic modulation of dopamine D2 receptors as potential novel antipsychotic therapy. Specifically, to summarize the data that suggest a modulatory action of adenosine A2A receptors on dopamine D2 receptors and, therefore, a possible rational role of adenosine A2A agonists as novel antipsychotic agents.

DATA SOURCES

Primary and review articles were identified by MEDLINE search (from 1966 to May 1998) and through secondary sources.

STUDY SELECTION AND DATA EXTRACTION

All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review.

DATA SYNTHESIS

For all of the older and many of the newer antipsychotic agents, there is a strong correlation between clinical antipsychotic activity and affinity for dopamine D2 receptors. Unfortunately, dopamine D2 receptors are believed to also be involved in the adverse effect profile of these agents. The indirect modulation of dopamine D2 receptors, rather than direct block, might produce antipsychotic effects without the usual adverse reactions. Several lines of evidence from animal studies suggest that the use of selective A2A agonists might represent a novel approach to the treatment of psychoses.

CONCLUSIONS

Dopamine receptor modulation might represent a novel antipsychotic approach or adjunct therapy. The data regarding adenosine agonists (particularly selective A2A receptor agonists) are inconclusive at the present time. Direct clinical demonstration of effectiveness is required.

Chronic psychiatric patients' use of caffeine: pharmacological effects and mechanisms

The uses and effects of caffeine as a psychoactive drug in chronic psychiatric inpatient groups are described. Caffeine use and abuse is linked etiologically to diverse psychiatric disorders; its mechanisms of action are examined in relation to anxiety, anxiety neuroses, psychosis, schizophrenia, and caffeine intoxication and dependence. It is postulated that deleterious effects may result from the interaction of caffeine with commonly prescribed psychotropic drugs. A possible model of caffeine abuse is discussed. Increased public education about potential health problems related to caffeine consumption is suggested, and further controls of caffeine in psychiatric settings are recommended.

Caffeine and its effect on persons with mental disorders

Whereas caffeine is widely accepted for use in society, it can be physically and psychologically harmful, especially to those with a mental illness. The effects of caffeine on specific mental illnesses and the medications used to treat them will be discussed. A review of addiction to caffeine and withdrawal from caffeine will also be presented. An assessment tool used to determine potential caffeine abuse is provided.

Medical disorders in the schizophrenic patient

OBJECTIVE

The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject.

METHOD

The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center.

RESULTS

The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists.

CONCLUSIONS

Schizophrenia and its protean manifestations confound the care of the medical patient. The psychosis of schizophrenia may impair the patient's capacity to recognize or articulate emerging medical illness, or to respond to therapeutic interventions. The psychiatrist caring for and consulting on patients with medical illnesses bears major responsibility for understanding the complex interface of schizophrenia and medical illnesses. Psychiatrists need to educate our medical and surgical colleagues how schizophrenia alters the usual presentation, clinical course, and response to treatment of common medical and surgical illnesses.

Caffeine: use and effects in long-stay psychiatric patients

In a double-blind crossover study of 26 long-stay schizophrenic patients, no correlation was found between caffeine consumption and levels of anxiety and depression. No significant changes in patients' behaviour or levels of anxiety and depression occurred when the wards changed to decaffeinated products. Serum caffeine levels confirmed compliance. No evidence was found to support a removal of caffeinated products from this group of patients.

An update on research with coffee/caffeine (1989-1990)

The interest in research with coffee has been increasing in recent years, and this has resulted in a surge of publications dealing with a variety of pharmaco-physiological effects of coffee/caffeine. This review attempts to update the information on the research with coffee/caffeine, including epidemiological studies, laboratory investigations and tests with volunteers, published in 1989 and 1990. It groups published articles according to observed or investigated biological effects. The most significant findings and differences between studies are pointed out with brief commentaries on the results. The overall assessment for the safety of drinking coffee and the effect of coffee on human health, based on the literature published in 1989 and 1990, indicates that certain controversial issues are still unresolved.

Regional cerebral blood flow in schizophrenia: repeated studies during a psychotic episode

Regional cerebral blood flow (rCBF) measurements and clinical ratings were performed on 17 schizophrenic patients and a subgroup of 10 medication-free patients before and after treatment. While clinically exacerbated patients had normal blood flow, patients in remission showed a redistribution of flow with lower values in frontal areas. Anteroposterior ratios correlated with the degree of behavioral disturbances, suggesting that the level of frontal lobe activity in schizophrenia may be a function of the patient's clinical state at the time of study.