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Chapter 1

THE PROBLEM & ITS BACKGROUND


Introduction
Caffeine is among the most widely used drugs because of its ubiquitous occurrence in
commonly consumed beverages such as coffee, tea and cola. Many drugs contain
caffeine and are readily accessible to the public in the form of OTC stimulants and
combination analgesics. Clearly caffeine is an important drug-food substance in our
society which deserves attention.
To begin to have a new consciousness about caffeine so that we can become aware of
how this drug can affect our physiology and psychology is a problem. The reasons for
this are certainly complicated, but we can start by considering a factor dominating all of
our lives, our habits. When we become aware of and take responsibility to change
habits, we are taking a first step in the process of awakening. The result must not be
only an improvement in the quality of our lives but the world itself will be changed for the
better.
The use and abuse of caffeine is a major public “habit’ and may be as important a factor
as heredity and environment in the etiology of physiological and psychological disorders.
To recognize this, we must know that we are creatures of habit. Most people are caffeine
consumers because from birth this food-drug is set before us, if not offered directly,
along with orange juice, cereal, dessert and cigarettes.
Caffeine is a potent central nervous system stimulant and much of its “psychological”
activity may be related to this action of the drug. Its effects on the nervous system are
obviously adverse at high doses. it may not be obvious that at lower doses when used in
moderation, it may have beneficial effects. For example, its possible therapeutic use in
hyperkinetic children certainly would seem advantageous when compared to the current
treatment with more powerful stimulants which have concomitant adverse reactions.
Also, with the intense day to day pressures imposed on and accepted by many of us, is
there any harm in “relaxing” with a hot cup of coffee? On the other hand, caffeine is a
drug which is subject to abuse. The fact that it is a drug with a potentially powerful
physiological effect escapes most of us who think of coffee as a relatively harmless
beverage. Recently published studies and reports of personal observations have shown
without doubt that caffeine abuse (caffeinism) may result in a syndrome which
resembles and may be confused or confounded with true psychotic states. This may
lead to misdiagnosis and mistreatment. A question arises from the varied reports of
caffeine consumption in psychiatric populations: Does caffeine stimulate psychosis or
does psychosis stimulate caffeine consumption?
These are not trivial findings because of the ready availability of caffeine and the
epidemic of psychological problems which we are experiencing in this era. This study
reviews some of the knowledge of caffeine’s effects with the hope that we will all be
more educated and more careful in the use of this commonly ingested drug.
Theoretical Framework
The respondents in this study are the thirty (30) 3rd year Nursing students of Perpetual
Help College of Manila. Their age ranges from 18-25 years old, 15 are male and the
other half are female. The procedure of this study is to know the common habits &
attitudes of the profile in terms of their practice in drinking such beverages. The
physiological and psychological effects of caffeine in the profile are tested. The variables
to be considered in this study are the following: body mass index (BMI), 24-hour diet
recall, vices other than caffeine intake, rest and sleep pattern, elimination pattern and
environment.
The following are theories regarding caffeine which can be a guide in answering the
question on what are the physiological and psychological effects of caffeine in the
human system.
The prevailing theory of why caffeine increases alertness took shape only in the early
1970s. The theory holds that caffeine interferes with the depressant effects of
adenosine, which is one of the chemicals that the body makes to control neural activity
Adenosine triggers a series of slowing effects: it depresses mood and alertness, lowers
the need to urinate and slows gastric secretion and respiration. After it is released by
nerve endings in the brain, adenosine must reach receptors on the surface of certain
brain cells in order to work. Caffeine, the theory has it, acts as an adenosine impostor.
Molecules of caffeine counterfeit molecules of adenosine, locking into the adenosine
receptors on brain cells. They fool the body into thinking that adenosine is circulating,
but they produce no depressive effect of their own.
Caffeine speeds you up, then, by not slowing you down. Its effects are the opposite of
what adenosine does: it makes you feel brighter and more alert, increases gastric
secretion, makes you urinate more and stimulates respiration.
Proponents of caffeine speak of its ability to increase vigilance and heighten the ability to
perform various tasks. Its effects are most pronounced, however, when compared with
performance levels that are low because of fatigue, boredom or caffeine abstinence.
Too, its effects seem to vary by personality type. For example, caffeine appears to help
extroverts keep performing vigilance tasks better than introverts, who can evidently plow
through such tasks unassisted.
Despite the generations of writers who have thought that coffee helped them think more
clearly, caffeine seems only to increase intellectual speed, not intellectual power.
Subjects in experiments do things like read and fill out crossword puzzles faster-but not,
unfortunately, more accurately.
Caffeine quickens reaction time and can enhance both hand-eye coordination and the
capacity of muscles to work. This boost to overall endurance has led to its use by
cyclists and runners. But caffeine also has a diuretic effect, increasing frequency of
urination. Caffeinated drinks are thus dehydrating, good for neither athletes nor flyers:
dehydration is one of the worst problems of air travel and a prime cause of jet-lag.
Caffeine speeds up the metabolism and makes you burn calories faster, although not so
much faster that it will help you lose weight. Its inclusion in over-the-counter diet pills in
place of prescription-only amphetamines (“speed”) seems to be largely ineffective.
Amphetamines, which diminish appetite, work differently than caffeine does on the brain.
This general quickening does not mean that coffee can sober you up – either black or
with milk. Your motor functions will be just as impaired by alcohol as they were minutes
before you downed that cup of coffee, and even if you feel more awake, you’re just as
dangerous as a driver. Similarly, caffeine does not counteract the effects of
Phenobarbital and other barbiturates. It does, however, help reverse the impairment of
cognitive activity caused by benzodiazepines, the compounds that are the basis of
Valium and many other tranquilizers. This reversal affects how you think as opposed to
how fast you react. If you are taking a muscle relaxant or tranquilizer that you think might
be one of these compounds, ask your doctors; he or she will probably advise you not to
defeat the effects of the drug by drinking coffee.

Chapter 2
REVIEW OF RELATED LITERATURE
This chapter is a review of some existing literature and studies on the effects
of caffeinewhich are related to the present study.
Related Literature &
Studies
Murdoch (1975) described
the pharmacological effects
of caffeine. The largest
sources of caffeine are
from the plants used to
make coffee, tea, cocoa
and kola (the basis of cola
beverages), although it is
also found in Latin America
as mate’ and
guarana. Caffeine particula
rly has a profound effect on
the central nervous system, but it also affects, to a lesser degree the heart muscle,
gastric secretion and diuresis. Interestingly, caffeine is ingested daily by a vast number
of people and is unique in that it is a potent drug, considered to be part of our normal
diet.
Leinart (1966) stated that caffeine stimulates the central nervous system first at the
higher levels, the cortex and medulla, and finally the spinal cord at higher doses. Mild
cortex stimulation appears to be beneficial resulting in more clear thinking and less
fatigue. Caffeine has been shown to improve attention in a study which simulated night
driving. The onset of the effect ofcaffeine occurs within one hour and lasts for three to
four hours.
The equivalent of one or two cups of coffee (150 to 250 mg of caffeine) is sufficient to
induce adverse effects. The occurrence of hyperesthesia, an unpleasant sensory
sensation, can be stimulated by large doses of caffeine.
Ritchie (1975) stated in his study that the medullary, respiratory, vasomotor and vagal
centers are stimulated by caffeine. This effect is due to an increased sensitization to
carbon dioxide but needs large doses to elicit this effect, 150 to 250 mg, parenterally.
The spinal cord is stimulated at higher doses and convulsions and death may result.
More than 10 g are needed for such toxicity to occur in man.
Abrams (1977) and Dowell (1965) cited that stimulation of the CNS is followed by
depression although the effect is small at low doses e.g. a single cup of coffee. After two
hours, males (but not females) showed a lower CNS stimulation compared to placebo.
The post stimulation “let down” with caffeine results in fatigue and lethargy and the
constant stimulation caused by chroniccaffeine dosing could be disastrous.
Children, because of their smaller size, are more susceptible to caffeine. One report
noted that hyperactivity and insomnia observed in children could be attributed to
excess caffeine intake from cola drinks.
According to Dr. Page, “There is no doubt that children should be kept from using coffee
and the popular caffeine containing soft drinks.” Ritchie (1975) mentioned on his study
that caffeine’s effect on the cardiovascular system is less profound than its central
nervous system action. Its direct stimulatory effect on the heart may be neutralized by its
central vagus stimulation. The direct effect predominates at very large doses with
tachycardia and, eventually, arrythmias resulting.Caffeine’s ability to potentiate cyclic
AMP can explain its ability to potentiate ionotropic responses to B-adrenergic agonists
and glucogon.
Peach (1972) and Poisner (1973) theorized that although caffeine dilates blood vessels
by a direct action, its central effect is one of constriction. At higher doses, the dilating
effect is apparent .
Similarly, because its direct and central effects are antagonistic, the resultant effect
of caffeine on blood pressure is unpredictable. The net effect is usually of less than 10
mm of Hg in blood pressure. Caffeine’s purported efficacy in hypertensive headaches
may be due to a decrease in blood flow as a result of the increased cerebral
resistance. Caffeine also stimulates releases of catecholamines from the adrenal
medulla and norepinephrine is released from nerve endings in the isolatA heart. It has
been shown that prolonged augmentation of gastric secretion results
from caffeine administration and that ulcer patient have sustained elevation of acid as
opposed to normal.
Gleason (1969) cited that although a dose of approximately 10 g or more taken orally
can be fatal, an oral (3.2 g IV) one gram dose will cause adverse effects. The toxic
effects are due to CNS and circulatory system stimulation and include some well
recognized prominent symptoms in addition to those which can result at high doses or in
hypersensitive persons: insomnia, restlessness, excitement, tinnitus, flashes of light,
quivering muscles, tachycardia, extrasystoles, and even low grade fever and mild
delirium have been observed.
Harrie (1970) described a patient whose constant headaches were due to
excessive caffeineconsumption. He states, “I suspect that the condition is much more
common than supposed and could well be one of the more frequent causes of chronic
recurrent headache.” Headaches can also be precipitated by caffeine withdrawal
especially by those who have the “habit”.
Ritchie (1975) stated that although caffeine is well absorbed when taken orally,
its absorptionmay be erratic because of its low solubility and because it may cause
gastric irritation. Caffeine is principally metabolized with only 10 percent excreted in the
urine unchanged.
Parsons and Neims (1978) also cited that caffeine has a physiological half-life of three
and a half hours to six hours (Aranda et al., 1979). Its physiological effects are observed
in less than one hour. Infants do not metabolize caffeine as well as adults and thus have
a half-life of about four days (Aranda et al., 1975). Certainly, continuous ingestion
of caffeine by infants can be dangerous. If a cup of coffee is consumed by an adult six or
seven times a day it would result in a high steady concentration of caffeine in the blood.
As little as four cups a day can result in appreciable omnipresent amounts of caffeine in
the body.

Chapter 3
METHODOLOGY AND PROCEDURE
This chapter deals with the method of research used, respondent of the study, research
toolsand instruments, procedure followed and the statistical treatment of data.
Method of Research
The type of research used in this study is the descriptive method. The term descriptive is
self-explanatory and terminology synonymous to this type of research is: describe, write
on, depict. The aim of descriptive research is to verify formulated hypotheses that refer
to the present situation in order to elucidate it. Descriptive research is thus a type of
research that is primarily concerned with describing the nature or conditions and degree
in detail of the present situation (Landman 1988: 59). The emphasis is on describing
rather than on judge or interprets. According to Klopper (1990: 64) researchers who use
this method for their research usually aim at:
• demarcating the population (representative of the universum) by means of perceiving
accurately research parameters; and
• Recording in the form of a written report of that which has been perceived.
The aim of the latter is that when the total record has been compiled, revision of the
documents can occur so that the perceptions derived at can be thoroughly investigated.
Because the total population (universum) during a specific investigation can not be
contemplated as a whole, researchers make use of the demarcation of the population or
of the selection of a representative test sample. Test sampling therefore forms an
integral part of descriptive research.
Respondent of the Study
The 3rd year Nursing students of Perpetual Help College of Manila are the respondents
chosen for this study. The age of the respondent ranges from 18 to 25 years old,
randomly from both genders. Nursing is a course that is said to be very stressful.
The hospital and school works make it impossible for a nursing student to be stress-free.
Aside from clubbing, strolling along malls, playing online games, etc., some would prefer
to remove stress while chatting with friends over a coffee and a piece of their favorite
chocolate cake or pastries not knowing that they have exceeded already the
recommended caffeine value.
Research Tools and Instruments
This research made use of a survey questionnaire as the main vehicle to gather data for
this research. The researcher used a survey questionnaire based on the statement of
the problem of this study. The questionnaire consists of two parts. The first part aims to
elicit information on the profile of the respondent in terms of age, gender, civil status,
educational background, year/ level and length of caffeine intake. Part two intends to
assess the attitude of the respondents and their beliefs with regards to caffeine and to
gather habits and practices of the respondents on their daily caffeine intake in terms of
food and beverages.
Procedure Followed
Prior to the conduct of the study, permission was sought from the research adviser in
order to conduct the study to the target respondents. The questionnaires were
personally administered and retrieved to these respondents. After the retrieval of all
accomplished questionnaires, encoding, summarizing and tabulating of the data were
proceeded for statistical interpretation and analysis.
Statistical Treatment of Data
The statistical tool and technique used to ensure a valid and systematic presentation,
analysis and interpretation of data is the percentage.
Percentage. This was used as a descriptive statistics to describe the relationship of a
part to the whole. The formula is:
P = fx 100
N
where: P = percentage
f = frequency of percentage
N = total number of respondents

Chapter 5
CONCLUSION AND RECOMMENDATION
Conclusion
Based on the significant findings of the study, the following conclusions were made:
1. The typical 3rd year nursing student respondents are female aged 20 – 21 years old;
and they have a habit of drinking caffeinated products.
2. The student respondents perceive that caffeine intake has its physiological and
psychological effects in an individual.
3. Evidently, environmental factors such as family and friends affect the habitual drinking
of caffeinated products of our respondents.
Based on the result of this study, caffeine has been widely used by almost individual and
they considered it as part of their everyday lives. It has been so popular because of its
known physiological and psychological effect on human system.
One of its popular effects is related to sleep pattern of an individual. Based on the result
of the survey, most of the respondents have overcome sleepiness by using either coffee
or soft drinks which both contain caffeine. This effect of caffeine was also observed on
the experimental research done by Mikkelsen on 1978. According to him, caffeine
inhibits deeper stages of sleep as opposed to disturbances of the REM stage which was
also been documented by Colton on his study. Non-coffee drinkers were more sensitive
to coffee’s insomnic effect whereas coffee drinkers were relatively insensitive in this
regard. Non-coffee drinkers experienced disturbed sleep patterns and delayed onset of
sleep. Mueller-Limmroth (Stephenson, 1977) showed that the quality of the first three
hours of sleep was impaired by the ingestion of coffee before retiring. This is
approximately equal to the half-life of caffeine in the body. Goldstein did also an
extensive work on the effect of coffee and showed that coffee drinkers slept more
soundly when they took placebo as opposed to caffeine in coffee. Caffeine is known
to cause insomnia because of its central nervous system stimulating activity. In fact, its
major therapeutic use is to allay sleep anddrowsiness, being the only OTC stimulant
approved by the FDA.
Using caffeine as an stimulant on endurance level of an individual has also been a
subject to several study and it was also considered in this study. According to the
respondents on this study, they feel more energetic and tend to work longer and faster.
This effect is explained on the theory which focuses on caffeine’s ability to cause the
body to burn fatter and fewer carbohydrates. Glycogen is the principle fuel for muscles,
but fat is the most abundant resource that the body uses for energy. Caffeine enters the
body and forces the working muscles to utilize as much fat as possible. This delays the
immediate depletion of glycogen. Studies show that in the first fifteen minutes of
exercise caffeine has the potential to reduce the loss of glycogen by fifty percent. When
this happens, the saved glycogen can be used for the remainder of the workout where
normally it would be entirely depleted.
Caffeine has also been associated to some issue regarding the effect on the intellectual
capacity of an individual. Based on the result of the survey done, respondents did not
feel the effect of it on their intellectual capacity. According to some study, coffee helped
them think more clearly and increase intellectual speed but not intellectual power.
Subjects in experiments do things like read and fill out crossword puzzles faster-but not,
unfortunately, more accurately.
It was also included in this study the related effect of caffeine on the hydration status of
an individual. Based on the result of the survey, almost of the respondents did feel thirsty
after taking in caffeine products but have not feel any change on skin turgor. According
to some studies done, caffeine has a diuretic effect as what has been documented by
Colton.
Based on the last theory about caffeine which we also presented on this study, caffeine
withdrawal causes headache and migraine. Caffeine’s ability to potentate severe
headache and nausea/vomiting, combined with its near-universal use, should make
caffeine the prime suspect in the hunt for the mysterious cause of migraine without aura.
Yet neither caffeine nor caffeine withdrawal is considered a major cause of headache or
migraine. Instead, the prevailing view is that caffeine is merely one among many factors
that influence primary headache.
Recommendation
1. There is no current scientific evidence that demonstrates the occasional use of
moderate doses of caffeine (100-200 mg) adversely affects the overall health of most
individuals. This drug can be effective in reducing drowsiness and prompting
mental alertness in the mild-to-moderately fatigued person.
2. However, frequent use of caffeine should be avoided. The only way to deal effectively
with fatigue is to rest. Masking the fatigue with caffeine only postpones the inevitable
and should not be viewed as a solution to the problem. In addition, if used excessively,
tolerance develops to the stimulant action of the caffeine causing the desired effects to
be diminished. If OTC stimulant products are used, consumption of caffeine-containing
beverages should be reduced to avoid ingesting toxic doses of caffeine.
3. The Respondents should be aware that coffee tea or cola are not the only caffeinated
products, but also in other food, drinks and medicines that they take.
4. The respondent should know that, caffeine act as an adenosine impostor. They fool
the body into thinking that adenosine is circulating, but they produce no depressive
effect of their own. Its effect is the opposite of what adenosine does: caffeine makes one
respondent to feel more alert, increase intellectual speed, increase gastric secretion,
makes him/her urinate more and stimulate respiration.
5. Respondent should also know that primary headache such as migraine, is due to
withdrawal to caffeine.
6. For respondent with asthma, also caffeine works as bronchodilator, widen the air
passages in the lungs and eases breathing. And also it might be something of
aphrodisiac.
7. Caffeine has the ability to burn more fats and fewer carbohydrates of one respondent.
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