# Caffeine-induced psychosis

Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited.

## Understanding psychosis

Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not. This state of mind may be caused by a range of mental ilnesses (schizophrenia, bipolar disorder), physical ones (Parkinson's diesease, Alzheimers), and some substances such as stimulant drugs.

## Caffeine use & its risks

Consuming excessive amounts of caffeine and combining this with psychotic and mood disorders can impact the severity of the disorders, but excessive consumption can severely affect people who are schizophrenic. 85% of the population of the United States ingests caffeine in some form every day. The most common ways people ingest caffeine is through freshly brewed coffee, instant coffee, tea, soda, and chocolate.
Average caffeine levels are:
* Brewed coffee- 100 mg/6 oz serving
* Instant coffee- 65 mg
* Tea- 40 mg
* Soda- 35 mg
* Chocolate- 5 mg
A majority of the population ingests roughly 210 mg of caffeine every day, while people who have higher tolerances/consume more excessive amounts ingest more than 500 mg of caffeine daily.
80% of people with schizophrenia smoke daily and are heavy smokers. Smoking tends to deplete much of ingested caffeine, so the majority of users with schizophrenia have to consume much more caffeine than others to regulate their caffeine levels.
Many people with schizophrenia use caffeine to combat boredom or to fight the sedating effects of antipsychotic medications. Additionally people with schizophrenia may have polydipsia (causes someone to feel an immense amount of thirst, despite already drinking plenty of hydrating fluids), so people with this disorder may try to consume more caffeine than normal. A lot of antipsychotic medications contain ingredients that make the mouth more prone to dryness, which would also increase the amount of coffee (containing caffeine) one may uptake.
"Caffeine use can cause restlessness, nervousness, insomnia, rambling speech, and agitation" worsening the symptoms of schizophrenia. "Caffeine is metabolized by the CYP1A2 enzyme and also acts as a competitive inhibitor of this enzyme. Thus, caffeine can interact with a wide range of psychiatric medications, including antidepressant agents, antipsychotic agents, antimanic agents, antianxiety agents, and sedative agents." So when caffeine interacts with these specific medications, it can complicate the side effects of the disorder and possibly the medication. To lessen the side effects, people with schizophrenia should consume lower amounts of caffeine.
A consumption of less than 250 mg of caffeine a day has been seen to give better results in better performances on cognitive tasks in people with schizophrenia. Although, more research still needs to be done to determine if the same amount of caffeine that is safe to consume by schizophrenics (> 250 mg/a day) matches up with the general population of people without schizophrenia.

## Treatment & prevention

Chronic caffeine-induced psychosis has been reported in a 47-year-old man with high caffeine intake. The psychosis resolved within seven weeks after lowering caffeine intake, without the use of anti-psychotic medication.
For schizophrenic people that have an addiction to caffeine, the best way to treat caffeine-induced psychosis is to gradually consume smaller amounts of it over a period of time. Withdrawal to certain drugs may worsen side effects of any psychotic or mood disorders, so it is best for people that have an addiction to slowly drop their levels of caffeine over time instead of completely restricting their consumption of caffeine.
For people who consume excessive amounts of caffeine and don't already have a psychotic disorder, a doctor may prescribe antipsychotics to help stop the effects of psychosis. For people with a psychotic disorder, it is best to slowly limit caffeine intake and continue taking antipsychotics.