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

They fool the body into thinking that adenosine is circulating. 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 prevailing theory of why caffeine increases alertness took shape only in the early 1970s. the theory has it. 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.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. 24-hour diet recall. The physiological and psychological effects of caffeine in the profile are tested. 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. . adenosine must reach receptors on the surface of certain brain cells in order to work. elimination pattern and environment. but they produce no depressive effect of their own. 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. Caffeine. rest and sleep pattern. vices other than caffeine intake. Molecules of caffeine counterfeit molecules of adenosine. After it is released by nerve endings in the brain. 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. Theoretical Framework The respondents in this study are the thirty (30) 3rd year Nursing students of Perpetual Help College of Manila. The variables to be considered in this study are the following:body mass index (BMI). acts as an adenosine impostor. locking into the adenosine receptors on brain cells. Their age ranges from 18-25 years old. 15 are male and the other half are female. This may lead to misdiagnosis and mistreatment. The theory holds that caffeine interferes with the depressant effects of adenosine.

Caffeinated drinks are thus dehydrating. makes you urinate more and stimulates respiration. Your motor functions will be just as impaired by alcohol as they were minutes before you downed that cup of coffee. Proponents of caffeine speak of its ability to increase vigilance and heighten the ability to perform various tasks. unfortunately. . This general quickening does not mean that coffee can sober you up – either black or with milk. boredom or caffeine abstinence. help reverse the impairment of cognitive activity caused by benzodiazepines. who can evidently plow through such tasks unassisted.Caffeine speeds you up. increasing frequency of urination. caffeine seems only to increase intellectual speed. by not slowing you down. then. its effects seem to vary by personality type. caffeine appears to help extroverts keep performing vigilance tasks better than introverts. Too. Its inclusion in over-the-counter diet pills in place of prescription-only amphetamines (“speed”) seems to be largely ineffective. when compared with performance levels that are low because of fatigue. It does. Similarly. however. and even if you feel more awake. work differently than caffeine does on the brain. however. which diminish appetite. 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. Caffeine speeds up the metabolism and makes you burn calories faster. you’re just as dangerous as a driver. For example. more accurately. although not so much faster that it will help you lose weight. But caffeine also has a diuretic effect. Amphetamines. increases gastric secretion. caffeine does not counteract the effects of Phenobarbital and other barbiturates. Its effects are the opposite of what adenosine does: it makes you feel brighter and more alert. the compounds that are the basis of Valium and many other tranquilizers. good for neither athletes nor flyers: dehydration is one of the worst problems of air travel and a prime cause of jet-lag. Its effects are most pronounced. Subjects in experiments do things like read and fill out crossword puzzles faster-but not. Despite the generations of writers who have thought that coffee helped them think more clearly. not intellectual power.

. the saved glycogen can be used for the remainder of the workout where normally it would be entirely depleted. ask your doctors. Yet neither caffeine nor caffeinewithdrawal is considered a major cause of headache or migraine. The last theory about caffeine is presented by Barry Spencer which states that caffeinewithdrawal causes headache and migraine. Caffeine’s ability to potentiate severe headache and nausea/vomiting. that the question is whether caffeine can help you think more clearly after you have drunk alcohol – not whether it will improve your reflexes. though. if the results of a University of Michigan study can be generally applied: the study showed that older subjects were more likely to be sexually active if they were coffee drinkers than if they were not. No one imagines that coffee can make you a safer driver after you’ve been drinking. Glycogen is the principle fuel for muscles. Besides being a self-prescribed antidepressant and alertness drug. he or she will probably advise you not to defeat the effects of the drug by drinking coffee. but fat is the most abundant resource that the body uses for energy. When this happens. Some researchers speculate that a similar restorative effect on cognitive activity might take place in the interaction between caffeine and alcohol. since it works as a bronchodilator. It might even be something of an aphrodisiac. meaning that it widens the air passages in the lungs and eases breathing. caffeine has been shown to be useful to people with asthma. Remember.This reversal affects how you think as opposed to how fast you react. should make caffeine the prime suspect in the hunt for the mysterious cause of migraine without aura. If you are taking a muscle relaxant or tranquilizer that you think might be one of these compounds. The second theory focuses on caffeine’s ability to cause the body to burn more fat and fewer carbohydrates. Studies show that in the first fifteen minutes of exercise caffeine has the potential to reduce the loss of glycogen by fifty percent. Caffeine enters the body and forces the working muscles to utilize as much fat as possible. but no one yet knows. This delays the immediate depletion of glycogen. combined with its near-universal use.

It may be subjects tend to underestimate their own caffeine intake. Many migrainers insist they ingest no caffeinewhatsoever. Caffeine is no doubt just as popular. which makes the effects of caffeine blend into the background of human existence. and some infants suffer caffeine withdrawal symptoms soon after birth. In fact more than 75 percent of infants have been exposed to caffeine in the womb. in other words. Phone survey studies. because nearly everyone uses caffeine. for example. among adults. in studies of primary headache or primary headache treatments. Many nursing infants are exposed tocaffeine in mother’s milk. no such experimental evidence exists. if not more popular. may be mistaken. primary headache has never been demonstrated to exist separately from caffeine withdrawal. however. The lack of focus on caffeine is not due to any experimental evidence that rules out caffeine as a major cause of migraine without aura. and therefore studies that depend on self-reported information about personal caffeine intake tend to underestimate the prevalence of caffeine use. In another phone survey 96 percent of subjects said they had ever used caffeine. Another error that may obscure the importance of caffeine in headache is the collective tendency to underestimate the prevalence of caffeine use. so there is plenty of anecdotal evidence that primary . for example. Many headache researchers and physicians may assume. Nearly all children are regularly exposed to caffeine: a study in which food diaries were kept for one week found 98 percent of subjects’ ages five to 15 regularly consumed caffeine. the effects of caffeine have become confounded with the condition of being human. that infants and children are generally not exposed to caffeine. The reason for this error may simply be the near-ubiquity of caffeine. The failure to focus on caffeine is due not to demonstrated evidence but to error. and 14 percent said they had ceased all caffeine intake. Those 14 percent of interviewees who believe they have ceased allcaffeine intakes.Instead. find a lower prevalence of caffeine use: in one phone survey only 61 percent of subjects said they use caffeine every day. a demonstrated cause of headache. 83 percent said they drink a caffeinecontaining beverage at least once a week. Surprisingly. the prevailing view is that caffeine is merely one among many factors that influence primary headache. One such error is the collective failure to control for caffeine withdrawal.

. This fact has important implications: it means caffeine withdrawal might cause the entire phenomenon of primary headache. For that reason it makes sense to examine the relationship between our most popular neuroactive drug and our most prevalent neurological malady. Unquestioning faith in the prevailing multiple disease theory of primary headache may be the biggest reason for the failure to focus on caffeine. and medicines. all migrainers who believe they consume no caffeine may be mistaken. cluster headache. The theory that primary headache is heterogeneous is so firmly entrenched that evidence to the contrary is ignored. each of which may have multiple causes and multiple precipitating factors. however. it is all too easy to ingest caffeine without being aware of it. Yet because caffeine is present in many foods. but this negative result may be due to the relative rarity of visual aura. According to prevailing theory. and is often occult. so testimony regarding personal caffeine intake is unreliable. migraine without aura. etc. migraine with aura. drinks. called triggers.headaches such as migraine without aura can occur separately from caffeine withdrawal.) The multiple disease theory has a possibly fatal weakness: it utterly rests and depends on the assumption that primary headache can occur in the absence of caffeine withdrawal. Such testimonial evidence. primary headache consists of multiple distinct disease entities (tension headache.). Patients who believe they have multiple distinct headache conditions may be mistaking one highly variable condition for multiple distinct conditions. (Caffeine withdrawal has not been demonstrated to cause visual aura. For example: visual aura accompanying cluster headache is not considered compelling evidence of kinship between cluster headache and migraine with aura. This suggests caffeine withdrawal and migraine might still be considered separate conditions even if caffeine withdrawal was demonstrated to cause visual aura. amounts to conclusions drawn by patients based on their interpretation of subjective symptoms. Many primary headache patients insist they can readily distinguish between their caffeinewithdrawal headaches and their migraines or other types of primary headache. Because primary headache has never been demonstrated to exist separately from caffeine withdrawal.

2 1. 2006. This study is applicable only to the thirty (30) 3rd year Nursing students of Perpetual Help College of Manila. 3. 24-hour diet recall. The variables would include the respondent’s body mass index (BMI). Caffeine has been demonstrated to have a withdrawal syndrome often featuring severe headache and nausea/vomiting.1 1. It focus on the effects of caffeine on physiological and psychological well-being of the respondents. Significance of the Study . 2. vices other than caffeine intake.3 2. rest and sleep pattern. Scope and Limitation This study is limited only to the thirty (30)3rd year Nursing students of Perpetual Help College of Manila as the respondents on the survey done on August 12. What is the profile of the Nursing student’s respondent in terms of the following variables? Age Gender Civil Status What is physiological and psychological status of nursing student’s respondent in Perpetual Help College of Manila? Hypothesis There is no significant difference between the profile variables and the physiological and psychological status of nursing students in Perpetual College of Manila. Specifically it sought to answer the following questions: 1. Caffeine is used as a medicine to relieve various primary headaches including migraine. Heavy caffeine intake is associated with migraine and cluster headache. 1. Statement of the Problem This study is intended to determine the physiological and psychological effects of caffeine in the human system of the thirty (30) 3rd year Nursing students of Perpetual Help of Manila. elimination pattern and environment. Other situation may avail of findings relevant to their needs.Caffeine is related beyond dispute to primary headache in three ways: 1.

It is hoped that the findings of this study will further enhance the knowledge of consumers and researchers on caffeine’s effect.The purpose of this study was to review the effects of caffeine on the physiological and psychological aspects of the human system. the following terms are defined below: Caffeine. In this study it is a drug that is naturally produced in the leaves and seeds of many plants Caffeinism. To know the actual findings and values of caffeine’s effectCaffeine Addicts. It also aims to show the findings and values from the corresponding method used to obtain such. Client recall of all the food & beverages consumed during a typical 24-hour period Chapter II REVIEW OF RELATED LITERATURE This chapter is a review of some existing literature and studies on the effects ofcaffeine which are related to the present study. Related Literature & Studies Murdoch (1975) described the pharmacological effects of caffeine. Caffeine abuse Body Mass Index (BMI). tea. The largest sources ofcaffeine are from the plants used to make coffee. physiological and psychological effects of Researchers. this study will benefit the following: Nursing students. Specifically. It would know the potential caffeine intake in the human system. To learn about its effect on the human body Other Individual Definition of Terms For a better understanding of the study. For supplemental referenceConsumers. cocoa and kola (the basis of cola . Indicates whether weight is appropriate for height 24-hour Diet Recall.

an unpleasant sensory sensation. considered to be part of our normal diet. Abrams (1977) and Dowell (1965) cited that stimulation of the CNS is followed by depression although the effect is small at low doses e. and finally the spinal cord at higher doses. vasomotor and vagal centers are stimulated by caffeine. gastric secretion and diuresis. the cortex and medulla. males (but not females) showed a lower CNS stimulation compared to placebo.” Ritchie (1975) mentioned on his study that caffeine’s . The post stimulation “let down” with caffeine results in fatigue and lethargy and the constant stimulation caused by chronic caffeine dosing could be disastrous. 150 to 250 mg. The onset of the effect ofcaffeine occurs within one hour and lasts for three to four hours. but it also affects. After two hours. One report noted that hyperactivity and insomnia observed in children could be attributed to excess caffeine intake from cola drinks. to a lesser degree the heart muscle. The occurrence of hyperesthesia. respiratory. Ritchie (1975) stated in his study that the medullary. Caffeine has been shown to improve attention in a study which simulated night driving. although it is also found in Latin America as mate’ and guarana. Children.beverages). The equivalent of one or two cups of coffee (150 to 250 mg of caffeine) is sufficient to induce adverse effects. a single cup of coffee. According to Dr. are more susceptible to caffeine. This effect is due to an increased sensitization to carbon dioxide but needs large doses to elicit this effect.g. More than 10 g are needed for such toxicity to occur in man. Leinart (1966) stated that caffeine stimulates the central nervous system first at the higher levels. Interestingly. The spinal cord is stimulated at higher doses and convulsions and death may result. Page. parenterally. Mild cortex stimulation appears to be beneficial resulting in more clear thinking and less fatigue. Caffeineparticularly has a profound effect on the central nervous system. because of their smaller size. “There is no doubt that children should be kept from using coffee and the popular caffeine containing soft drinks. caffeine is ingested daily by a vast number of people and is unique in that it is a potent drug. can be stimulated by large doses of caffeine.

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. restlessness. an oral (3. He states. the resultant effect of caffeineon blood pressure is unpredictable. tinnitus. Harrie (1970) described a patient whose constant headaches were due to excessive caffeineconsumption. “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”. Caffeine’s purported efficacy in hypertensive headaches may be due to a decrease in blood flow as a result of the increased cerebral resistance. flashes of light. The net effect is usually of less than 10 mm of Hg in blood pressure. extrasystoles. tachycardia. the dilating effect is apparent .effect on the cardiovascular system is less profound than its central nervous system action. Caffeine’s ability to potentiate cyclic AMP can explain its ability to potentiate ionotropic responses to B-adrenergic agonists and glucogon. because its direct and central effects are antagonistic. The direct effect predominates at very large doses with tachycardia and. excitement. Its direct stimulatory effect on the heart may be neutralized by its central vagus stimulation. . Gleason (1969) cited that although a dose of approximately 10 g or more taken orally can be fatal.2 g IV) one gram dose will cause adverse effects. Peach (1972) and Poisner (1973) theorized that although caffeine dilates blood vessels by a direct action. arrythmias resulting. and even low grade fever and mild delirium have been observed. Similarly. At higher doses. 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. quivering muscles. its central effect is one of constriction. eventually.

As little as four cups a day can result in appreciable omnipresent amounts of caffeine in the body. Its physiological effects are observed in less than one hour.. These studies look beyond the obvious social implications and psychic dependence of coffee consumption which may be related to the “first cup of coffee to wake me up” or “the coffee break” or to its association with smoking. Others considered morphinism and caffeinism to be similar. This work has been stimulated by personal experiences and observations as well as by efforts to understand its action and mechanism. .Ritchie (1975) stated that although caffeine is well absorbed when taken orally. Infants do not metabolize caffeine as well as adults and thus have a half-life of about four days (Aranda et al. Habituation and Tolerance: Ritchie (1975) and Kozlowski (1976) cited in their study that caffeineingestion and coffee drinking have been investigated with regard to the degree that this habit results in tolerance and withdrawal effects. Stratland (1976). 1975). with caffeine (in coffee) reducing the sleeping time induced by barbitol. If these patients drink coffee. For example. but also addicting. Caffeineis principally metabolized with only 10 percent excreted in the urine unchanged. Certainly. This potentially dangerous interaction was first noted by Berkowitz et al. Caffeine is known to interact with other drugs resulting in a modified effect. In another study. based on her study. Stratland (1976) stated that caffeine and barbitol are antagonistic. caffeinehas been the subject of research in psychological related studies. Decaffeinated coffee had no effect. Stephenson (1977) considered caffeine as not only a habit forming. 1979). Because of the wide spread use of caffeine and their known potent physiological effect. In the latter case. spells of agitation and depression as well as psychotic behavior . salivary stimulation and sleep disturbance effects of caffeine. continuous ingestion of caffeine by infants can be dangerous. they should be closely monitored. its absorption may be erratic because of its low solubility and because it may cause gastric irritation. it is of interest that coffee drinkers were shown to take more nicotine when deprived of coffee. caffeine administered with nardil (an MAO inhibitor) caused headaches and high blood pressure (Pakes. caffeine can accumulate in severe liver disease when its half-life can increase to 96 hours.. 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. (1971) and implicated serotonin in the mechanism.. caffeine resulted in reduced sleeping time which was counteracted by pentobarbitol in hospitalized patients as what Forrest and her co-researher found in 1972. Ritchie mentioned a report by Colton that tolerance can develop for the diuretic. 1979). with caffeine causing loss of self-control. 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.

This experiment was double-blind and placebo controlled and caffeine was administered in coffee at 0. and various other behavioral difficulties which were attributed tocaffeine withdrawal. poor motor performance and insomnia.. the habitual coffee drinkers experienced nervousness. experiencing effects opposite to the coffee drinkers. An experiment was devised to verify the results of the questionnaire involving 18 housewives. headache and irritation. These results have withstood the test of time. however. and reaction time is diminished. Behavioral Effects: Caffeine’s stimulating activity on the central nervous system as well as other body organs results in certain physiological effects which may be considered to be behavior oriented. At a dose of 300 mg. work faster with fewer errors. non-coffee drinkers. sleeping difficulty. some subjects felt nervous. typists. Tasks requiring delicate muscular coordination and accurate timing may. The resultant effects were depression. Hand . caffeine caused tremors. All of this occurs at doses of 150 to 250 mg of caffeine (approximately two cups of coffee) according to Ritchie (1975). The non-coffee drinkers reacted negatively to coffee. Coffee drinkers showed a dose-response effect whereas non-coffee drinkers showed signs such as nervousness. if the morning coffee was stopped. In 1912. Mitchell. allays drowsiness and fatigue. Smith et al. Goldstein (1969) did a survey using questionnaire completed by more than 200 young housewives showed that the perceived effects of caffeine depended on previous use. Caffeine produces more rapid. be adversely affected. 150 and 300 mg. and increases the capability of a greater sustained intellectual effort and more perfect association of ideas. for example. develops from the use of xanthine beverages”. However. frequent mood changes. (1977) conducted a study using a 200 mg dose of caffeine which resulted in decreased decision time scores and improved motor time scores in volunteers. Motor activity is increased. it does appear that at least in some persons excess consumption ofcaffeine can result in severe psychological dependence and withdrawal effects and is a problem to be reckoned with. Ross and Hurst showed caffeine to prevent attention lapses in a visual monitoring test which simulated night driving. Goldstein (1965) showed no effect of caffeine on objective measures of performance although most subjects “felt” more alert and physically active. Kozlowski (1976) illustrated in his study that the dependence of coffee drinkers on caffeine in which coffee drinkers drank more coffee if the caffeine content was lowered. jitters and upset stomachs at all doses of caffeine but not on placebo. The heavy coffee drinkers had few sleep disturbances and less evidence of nervousness after their morning coffee as compared to nondrinkers. Abrams (1977) said “There is no doubt that a certain degree of psychic dependence. nervousness. He says that coffee or tea drinking are socially acceptable and are apparently not harmful when practiced in moderation. In nine double-blind tests. that is habituation. and 38 who drank five or more cups per day.Diamond and Pfifferling (1974) Cola consumed in amounts of 48 to 111 ounces per day (144 to 333 mg of caffeine per day) was reported to have caused physical effects on withdrawal. Ritchie (1975) says that tolerance and psychological dependence to caffeine beverages does occur to some extent but he feels that this does-not present a problem. decreased alertness. Hollingsworth who was a psychologist reported caffeine’s effect on mental and motor efficiency in a study sponsored by Coca-Cola. The results confirmed those obtained from the questionnaire previously administered. clearer flow of thought. he found beneficial effects for both mental and motor performance at doses of 65 to 130 mg of caffeine. It also causes a keener appreciation of sensory stimuli. However. The effect persisted for the two to three hour experiment on Stephenson’s study in 1977.

Animals pretrained in the natural -U procedure needed very high doses to cause disruption. The implication is that the mechanism ofcaffeine’s action may be similar to hallucinogenic drugs. This was a doubleblind study in which 0. In fact. Decaffeinated coffee showed no effect on sleep.steadiness. whereas other drugs such as hallucinogens show a similar effect. A facilitation of learning and consolidation after caffeine dosing was noted in naive mice after the -D” procedure.25. even at the lowest dose (equivalent to approximately three cups of coffee). Castellano (1976) studied mice behavior under two sets of conditions. and 250 mg of caffeine was administered one hour before bedtime. The effect is dose related. 12. its major therapeutic use is to allay sleep and drowsiness. 50 and 100 mg/kg) was tested on lever pressing. Several studies investigating this action in some detail have been published. Caffeine. Other studies show contradictory evidence. Karacan (1976) found that caffeine given half an hour before sleep adversely affected the sleeping process in normal sublects.125. 60. Dorfman and Jarvick (1970) showed a dose-response effect of caffeine on the self estimation of sleep latency (which was increased) and quality (which was decreased). 6. Amphetamines do not show the results as demonstrated in this paper. Wayner et al.5. One involved a natural preference (swimming towards a light-”L” ) and the other involved an acquired behavior pattern (swimming toward the dark-”D”). the mice were more sensitive to caffeine. 25. At their ordinary weight. (3. Natural tendencies were also enhanced bycaffeine as noted by improved performance in the “L” procedure. Non-coffee drinkers were more sensitive to coffee’s insomnic effect whereas coffee drinkers were relatively insensitive in this regard. the mice became tolerant. with all measures enhanced. however. After a caffeine intake of 200 mg. At high doses. Effect on Sleep: Caffeine is known to cause insomnia because of its central nervous system stimulating activity. being the only OTC stimulant approved by the FDA. schedule induced licking and water consumption of mice. 120. REM being affected by caffeine. was impaired. (1976) reported on the effects of caffeine on schedule dependent and schedule induced behavior in mice. Caffeine decreases five HT turnover in rat brain. At the lower weight. The effect on mice at 80 percent of body weight was different than when mice were allowed to recover the lost weight. introverts performed less well on a verbal ability test as compared to extroverts when time pressure was applied. all measures decreased. leaving the situation to be resolved. caffeine had little effect except at the highest dose (equivalent to 100 cups of coffee given at once). Caffeine’s effect simulates clinical insomnia and gave the same response as coffee containing an equivalent amount of caffeine. The tolerance developed to caffeine’s effect on sleep by coffee drinkers has been documented by Colton. Mikkelsen (1978) notes that caffeine seems to inhibit deeper stages of sleep as opposed to disturbances of the REM stage. Animals pretained in the “D” procedure exhibited behavioral disruption after treatment. Non-coffee drinkers experienced disturbed .

Reichard and Elder (1977) published an article on caffeine’s effect on reaction time in hyperkinetic children. are less able to maintain attention and have a lower rate of correct . 1965). -and decreased activity. 1977) showed that the quality of the first three hours of sleep was impaired by the ingestion of coffee before retiring.. resulting in improved attention. Mueller-Limmroth (Stephenson. Test scores showed a similar improvement with coffee as compared to methylpheniclate and the annoying side effects disappeared when the children were on caffeine. anorexia. A study by Schnackenberg (1975) showed that 200 to 300 mg of caffeine was similar in effect to methylpheniclate in treating hyperkinetic impulse disorder secondary to minimal brain dysfunction syndrome. Heavy and continued use of caffeine results in tolerance so that heavy users have less sleep disturbance or need more to obtain its stimulating effect. If 150 to 200 mg of caffeine was taken before bedtime. drank coffee to calm down. he observed.sleep patterns and delayed onset of sleep. Sixteen children who had shown improvement on methylphenidate but who had annoying side effects were given one cup of coffee at breakfast and lunch. Goldstein did 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. Schnackenberg recommends 200 to 300 mg of caffeine in a time-release form. Caffeine increased the accuracy of stimulus identification and processing and decreased lapse of attention in the hyperkinetic group. Side effects are usually disturbing with the more powerful drugs and include insomnia. This is approximately equal to the half-life of caffeine in the body. there was an increased sleep latency which was less pronounced in persons who were heavy ingestors of caffeine (Goldstein et al. Some hyperkinetic children. These studies show that caffeine has a profound effect on sleep. Treatment of Hyperkinetic Children: Hyperkinetic children have been shown to respond to central nervous system stimulants. This is what might be expected based on caffeine’s known effects on such tasks in normal. weight loss and abdominal pain. concentration. nervousness. Hyperkinetic children have a slower reaction time. They tested the effect on a choice reaction time task and simple reaction time as compared to normal children.

The authors note that other studies have shown methylpheniclate was more effective than caffeine in controlling certain aspects of clinical behavior (impulsivity and hyperactivity). The use of caffeine in the treatment of hyperkinetic children remains unresolved at this time. and 20 mg methylpheniclate. 300 mg of caffeine. Further work seems warranted to ensure that if caffeine is useful in this prevalent condition that it be available as a viable alternate treatment in lieu of more powerful CNS stimulants. This was’ a carefully controlled study consisting of 17 boys and four girls. Firestone did a study comparing 300 mg of caffeine with placebo in a double-blind crossover design. In 1978. Dr. No significant improvement was noted with caffeine although some children showed a slight improvement. Caffeine significantly raised the rate of correct responses on simple reaction time in the hyperkinetic group.responses on a vigilance performance task as compared to normal children. six normal and six hyperkinetic children were compared in a double-blind design. the more severely afflicted had a larger response. In this study. Firestone and associates in a study funded by the Ontario Mental Health Foundation (1978) showed a significant improvement with methylphenidate as rated by mothers and teachers on tests of impulsivity and motor control. Similar results were found with choice reaction time. 1977). The response is a function of the initial state of the children.. Each of 21 hyperactive children received 500 mg of caffeine. Garfinkel was unable to confirm the results of caffeine’s effectiveness in controlling the behavior of children with minimal brain damage (Stephenson. in an article titled as above. The reaction time was reduced with caffeine but was not significantly less than the control period or placebo. suggest that this syndrome is primarily . A restless leg is a syndrome %vh1ch may be associated with anxious – depressed as well as other clinical states. Side effects with both drugs were minimal.e. Lutz. subjective ratings by teachers and parents as well as a reaction time task showed caffeine to be better than placebo although the difference was not statistically significant. i. In this study. Firestone concludes on the basis of the most recent study that caffeine is not a meaningful alternative as a treatment for hyperkinetic children. they are compatible. This result does not contradict those obtained in this study. Children responding to methylpheniclate did not necessarily respond to caffeine.

twitching. less legs syndrome. anxiety. In periods of stress. depression. Anxiety is not a causative factor. Also. and results in insomnia. and insomnia: and the heightened proprioceptive awareness may result in restless legs. All of these states are associated with high central nervous system arousal. in another study by . a professor of psychiatry at the University of Michigan. as has also been observed in certain psychological disorders. Symptoms of excessive caffeine consumption are similar to anxiety neurosis (Avery. This is a known effect of caffeine and all medications including caffeine have a potential for abuse and many individuals clearly ingest symptom-producing doses daily”. This manifestation consists of nervousness and movement of legs as a result of a distressing creeping sensation. says caffeinism can be found among those who have psychiatric problems”. 1980) and include nervousness. Its symptoms are most obvious at night when the patient is trying to be still. Psychological Disorders: Dr. For example. depression. The intake of caffeine (coffee. all of which were alleviated when caffeine was removed from the diet. etc. was first described in England at the time when coffee and tea first were introduced in the country.caused by caffeine. This is reflected in anxiety. diagnosis of the restless legs syndrome. rest. Caffeine stimulates the nervous system and has a direct contractile effect on striated muscle. e.) has been correlated with the degree of mental illness in psychiatric patients. Dr. Excess drinking of coffee by prisoners is not uncommon and may initiate a vicious cycle: a bored person drinking more coffee resulting in caffeinism which may result in more consumption. Lutz describes cases of this disorder in detail and cites examples. This condition has been attributed to many causes including psychiatric disturbances. The symptoms remitted after the coffee drinking stopped. recurrent headache. a prisoner with severe anxiety symptoms admitted to drinking 50 cups of coffee per day. and gastrointestinal disturbance among other symptoms. “normal” persons are also afflicted. irritability. may simply be the result of over dosage of ubiquitous caffeine. Thus. In any event. a restless leg is a frequent symptom of hysteria. John Greden. It is clear if the caffeine intake intensifies the psychiatric disorder or whether those with more severe problems tend to drink more coffee. Based on study conducted by Niolde in 1975 supports the relationship indicated above.g.

a large physiologically active dose. Catecholamines contribute to the anxiety profile and patients may drink more coffee in response to stress. Caffeine should not be used as part of psychiatric treatment routines. Dr. Greden concludes that caffeine is found among a fairly large percentage of hospitalized patients with psychiatric symptoms. He suggests that self-medication may confound behaviors of patients. in the hospital she noted the correlation of these . In this experiment. One case cited was of a white male in a catatonic state who threatened his mother after having gone on a coffee jag over injustices caused to him by his mother. that unipolar 11 depressives may use more caffeine as they become depressed. Mikkelsen (1978) noted caffeine’s involvement in schizophrenic-like states similar to that observed by Greden in anxiety/neurosis symptoms of patients who consumed large quantities ofcaffeine (coffee). sensitizing receptor sites. The high consumers had more clinical symptoms: their physical health was worse. Greden in 1978 and associates 83 hospitalized psychiatric patients were internee and showed an association of symptoms with high caffeine intake provides an explanation of some problems which have been experienced in diagnosing out-patient disorders.. Greden considers caffeine to be a psychotropic drug and 25 percent of the population may take more than 500 mg per day. Caffeine has been considered the most popular “psychotropic” drug in North America and coffee and tea drinking are not usually in the records of psychiatric patients. they used more sedatives. Mixed depressive states may be caused by excess caffeine consumption and they suggest. These patients showed a tolerance to sleep effects which could be due to a change in body kinetics or metabolism. due to the coffee. A 30 year old white single female exhibited paranoid and auditory hallucinations.g. provides only transitory relief as it is not a true antidepressant. at least in part. hypersomnic patients with various diagnoses and caffeine consumption participated. also. the association of caffeine with anxiety and depressive symptoms is indeed a possibility. Since caffeine affects catecholamine levels and inhibits phosphodiesterase breakdown of C-AMP. Eighteen of the 83 patients (22 percent) were high caffeine consumers (70 mg or more). hypnotics. This may lead to diagnostic confusion and a complicated course of therapy. He describes three cases in which caffeinism may be misdiagnosed as an anxiety syndrome. to reduce drowsiness from psychotropic medications as has been occasionally suggested. accentuating a neuro-transmitter response cycle.Dr. and minor tranquilizers. He developed paranoid delusions which he felt were. John Neil and associates (1978) reported on the possible complication of caffeinism in diagnosing psychiatric patients. An anxiety state had resulted in increased coffee consumption. e. in these patients. Caffeine. They scored significant higher on the State-Trait anxiety index and the Beck Depression Scale than lower caffeine consumers. The authors conclude that “self medication with large doses of caffeine is a likely response to the anergia and hypersomnia experienced during certain types of depression”. Dr. Dr.Caffeine also may render anxiolytic and antipsychotic medications less effective.

having consumed large amounts of coffee.strange feelings with coffee consumption. Reimann (1967) noted that symptoms of a psychoneurotic woman disappeared when coffee was reduced. . Manic symptoms developed. insomnia. Certainly. He theorizes that adenyl cyclase which is increased by caffeine may be a receptor for dopamine. anorexia and irritability. She presented with an irregular fever. Other examples of psychotic behavior as noted in the literature are described in this paper. Forty years ago a case of psychosis was reported in which a 24 year old female took 60 g (about four g) of caffeine. coffee should be considered as a factor in this disease. If this system is abnormal in schizophrenics. caffeine may further sensitize the patient.

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