“The path is smooth that leadeth on to danger”: caffeine and psychosis

Isabel Ganhao,Miguel Trigo,Afonso Paixa,Goncalo Marinho

doi:10.1192/bjo.2021.505

Abstract

AimsTo review literature on the importance of caffeine intake with regard to psychosis. The need for intervention with regard to caffeine intake hinges on effectively recognizing potential risks.BackgroundCaffeine is the most widely consumed psychoactive substance worldwide and as such is generally considered acceptable but as a competitive adenosine antagonist, it affects dopamine transmission. Patients with serious mental illness are known to have higher caffeine intakes than the general population. The hierarchy of needs for this patient population is complex, frequently leaving the intake of caffeine under the radar of clinical priorities.MethodPubMed and Google Scholar search for caffeine/coffee and psychosis/schizophreniaResultOf the 43 articles that were considered relevant for clinical practice, caffeine consumption was associated with 1) appearance of psychotic symptoms and episodes (caffeine-induced psychosis) and chronic psychosis in high intake 2) exacerbation of psychosis in schizophrenic patients even in lower intakes, 3) treatment resistance possibly due to interference with antipsychotics (ex. clozapine), 4) abuse and addiction, 5) comorbidity with tobacco smoking and other addictions. Caffeine in low doses was associated with ameliorating cognitive and extrapyramidal side-effects of medication and as a potential treatment strategy for treatment-resistant schizophrenia.ConclusionCaffeine consumption may have a greater impact on psychotic symptoms and episodes than is recognized with negative effects outweighing any potential benefits. Greater awareness of the necessity to quantify caffeine intake and implementation of interventions to curb intake may contribute to better quality of care of serious mental illness. Further research is warranted.

Highlights

Lithium monitoring clinics have been established in our CMHRS since 2017, Lithium is a high-risk medication as recognised by a National Patient Safety Alert in 2009
NICE recommends that patients on lithium have their lithium levels checked every 3 months for the first year and at least every 6 months, plus TFTs, U&Es, calcium and weight every 6 months
An audit was subsequently carried out in December 2020 to assess our patient’s compliance with the aforementioned NICE recommendations for lithium monitoring, the results of which were compared to previous annual audits

Summary

Introduction

Surrey and Borders Partnership NHS Foundation Trust *Corresponding author. The COVID-19 pandemic has presented a challenge in ensuring that routine monitoring can still be offered and occur in a safe and effective manner. Our aim was to continue the regular physical health monitoring of North East Hampshire CMHRS patients who are prescribed lithium during the COVID-19 pandemic, and to achieve above 90% compliance for the monitoring standards. Lithium monitoring clinics have been established in our CMHRS since 2017, Lithium is a high-risk medication as recognised by a National Patient Safety Alert in 2009.

Results

Conclusion