Caffeine-Related Disorders

Alcohol withdrawal symptoms can occur as soon as two hours after drinking cessation but

usually happen about 8 hours after the last drink. The symptoms tend to peak at 24-72 hours

after stopping alcohol. The symptoms include tremors, tachycardia, diaphoresis, agitation, anxiety, nausea/vomiting, seizures, and hallucinations (in severe cases). Other common

symptoms in alcohol withdrawal are fatigue, depression, mood swings, confusion, nightmares,

and irritability. The symptoms can escalate suddenly and may be life-threatening.

Risk factors include consuming alcohol for a long period of time, having a history of delirium

tremens, having intense alcohol cravings, and having been through detoxification in the past.

These will predict a longer and more severe course of alcohol withdrawal. The symptoms as noted will cause intense distress and/or impairment in function. It can be misinterpreted, with

other things in the differential diagnosis. Drug screening for other substances may need to be

done to rule out intoxication from another substance. Encephalitis, meningitis, hypoglycemia,

and delirium for other medical reasons should also be ruled out. Mental disorders like

schizophrenia can mimic alcohol withdrawal.

The goals of treatment are to keep symptoms to a low level and to prevent complications. This

can be a medical emergency, with the main treatment being a long-acting benzodiazepine. A

second-line treatment might be carbamazepine, which is less addicting. Antipsychotics might

be necessary to reduce hallucinations and resultant agitation; Clonidine can be used for

hypertension and beta blockers can be used for tachycardia. Phenytoin is used only if the

person has an underlying seizure disorder.

CAFFEINE-RELATED DISORDERS

Caffeine-related disorders include caffeine intoxication, caffeine abuse disorder, and caffeine

withdrawal. With caffeine intoxication, there can be physical, psychomotor, and emotional/mental impairments after over-consumption. Most of the time, caffeine intake

comes through coffee consumption but it can be seen in soda, energy drinks, analgesics,

chocolate, tea, and cold medicine. The goals of taking are to improve cognitive function,

alertness, concentration, and mood. It is consumed by 85 percent of adults in the US.

Intoxication is short-lived, but can be lethal.

Symptoms of caffeine intoxication can include sleep loss (the most common symptom),

nervousness, increased urination, stomach upset, hypertension, and irritability—usually when

ingesting 250 mg or more of caffeine at one time. The DSM-V diagnosis is made after ingestion

of 250 mg or more of caffeine and with five of these symptoms: nervousness, restlessness,

insomnia, flushing, diuresis, GI upset, twitching, psychomotor agitation, cardiac arrhythmia,

rambling speech, tachycardia, increased energy levels, and excitement.

Risk factors for the disorder include being an infrequent user of caffeine. It can easily mimic the

use of other substances, like nicotine and alcohol. Sleep disorders can mimic caffeine

intoxication as can mania and hypomania. Anxiety can exacerbate caffeine intoxication and

anxiety can be exacerbated by its use. Intoxication can impair motor skills in someone who

requires high precision in the workplace. Young people who use energy drinks are at risk for

intoxication as are body builders. Some people trying to lose weight can have caffeine

intoxication.

Severe caffeine intoxication can lead to a heart attack and death from overstimulation of the

nervous system. Dialysis can be used to decrease the caffeine level as can diuretics. The effects

of caffeine intoxication will wear off after a day or so. It is often treated simultaneously to

treating caffeine addiction with the addition of some psychological therapy after the physical

effects have worn off.

The diagnosis of caffeine withdrawal is new to the DSM-V. This is because it may require

psychological intervention. People who are trying to overcome caffeine addiction do so

because a doctor has recommended it or because it is for health-related reasons. Treatment of

withdrawal happens along with the treatment of addiction. It involves treatment facilities in

some cases, along with psychotherapy and behavioral therapy.

Withdrawal symptoms include irritability, anxiety, depression, fatigue, headache, and difficulty

concentrating. Relapsing happens because the patient wants to relieve the symptoms. The

most common symptom seen is headache, which happen within 12-24 hours of stopping