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Caffeine Use and Physical Health - exploring the links for people with a diagnosis of schizophrenia or schizo-affective disorder Lisa Thompson Research Officer 22nd August 2013 Neami National is a non-government mental health organisation that provides support within a recovery framework Support is provided to approximately 2500-3000 consumers across Queensland, NSW, SA, Victoria and WA Approximately 450 staff employed across 35 service sites Service delivery is guided by the Collaborative Recovery Model (CRM) – Prevention & Recovery Care Services Caffeine (primarily sourced from coffee, tea and soft drinks) is the most frequently and widely consumed central nervous system stimulant in the world Previous research has identified an association between schizophrenia and high levels of caffeine consumption, with some studies suggesting that caffeine may contribute to the symptomatology of schizophrenia – Studies have shown a significant correlation between caffeine consumption and higher doses of anti-psychotic medication required The general belief has been that many individuals with mental illness consume caffeine as a way to counteract the negative effects of psychotropic medications What are the frequencies, amounts and primary means of caffeine consumption? What are the motivations, behaviours and side effects associated with caffeine consumption? Is there a relationship between high amounts of caffeine and sugar consumption? What understanding do individuals have about the risks associated with excessive caffeine consumption? Participants recruited from 10 service sites in Melbourne All consumers with diagnosis of schizophrenia or schizo-affective disorder who were in Moderate or High Risk categories for their caffeine use according to the ASSIST were invited to participate Caffeine Use Questionnaire developed by Neami and administered by support workers Semi-structured interviews completed with sub-sample of 20 participants 59 recruited, representing overall response rate of 58% 43 (73%) schizophrenia, 16 (27%) schizo-affective 64% daily cigarette smokers, who smoke on average 13 per day Prescribed on average 3.2 different medications, most common anti-psychotics, anti-anxiolytics, anti-convulsants, sedatives, cholesterol and heart medication Number of participants
Approximate daily mg
consuming this drink on daily
caffeine consumption
(average amount)
Soft Drinks
230 (2 litres)
containing caffeine
Instant Coffee
462 (4-5 cups)
Brewed Coffee
590 (3-4 cups)
110 (3 cups)
Iced Coffee
160 (800ml)
Energy Drinks
200 (2 cans)
20% (unsure), 24% (disagreed or strongly disagreed), 56% (agreed or strongly agreed) that consuming large amounts of caffeine can have a negative impact on physical health 36% (unsure), 27% (disagreed or strongly disagreed), 37% (agreed or strongly agreed) that consuming large amounts of caffeine can have a negative impact on mental health 79% stated no one had ever told them about possible interactions between caffeine and anti-psychotic medication – 45% liked to drink caffeine when they smoke cigarettes 2 – 3 cups instant and 4 – 5 cups brewed coffee per day Motivations – combat sedatives and feel high Reported experiencing headaches, restlessness, difficulty sleeping and rapid heartbeat Unaware of potential interaction between caffeine and antipsychotic medication Consuming approx. 4000mg caffeine per day
Consumption of 500mg or over per day represents significant health risk Approximately 90% of participants stated that they have a regular GP, with 40.7% reporting they visited their GP more than ten times in the previous 12 months Analysis also revealed a moderate positive relationship between participants’ weight and the number of medications prescribed (r = 0.444, p = 0.001) 50% reported they had a physical illness or condition, with diabetes and high blood pressure the most common Common concerns expressed by participants about their health were being overweight, developing heart disease or having a heart attack Prevalence of obesity and diabetes consistent with previous research (De Hert, 2011; Robson & Gray, 2007) “I was vampirical [sic] on coffee like just drinking it like it was my life source” “I don’t miss cigarettes either, but coffee, I have to have coffee…I don’t think I could live without coffee” “I’d be lost without my Coca Cola. I couldn’t survive without it…I can’t get off to sleep without it…I need to have a certain amount each day to get me through” “When I was taking hard tabs [of antipsychotic medication], I’d have a couple of coffees to whack it down [sic] in my bloodstream…If I was taking a lot of hard tablets I would probably consume more Coca-Cola or coffee to break it down”. “If I do things like go to the gym after I’ve had some tea like I did yesterday, I start hearing voices and get a fair bit of anxiety and stuff like that.I also like the taste of Pepsi Max so much I’d like to still be able to drink it, but I’ve cut down since [realising it was contributing to psychosis] - I haven’t had any Cola for a little while.” “I was drinking it [instant coffee] all day.I just for some reason couldn’t control myself and that so eight o’clock at night would be my last coffee and then during the night I felt like I couldn’t sleep because of it…I was also drinking probably four or five 1.25 litre [bottles] a day…I ended up in hospital for five days, because the fizzy drinks blew, blew my tummy up a lot…I had a tube up my nose and back down my throat”. Self-report measures (no objective measures) Notwithstanding these limitations, study is one of the first of its kind in Australia The information gathered is used to inform harm minimisation and prevention strategies for staff to utilise when working with consumers who identify as having problematic caffeine use behaviours. Continued focus on healthy eating and exercise as part of health promotion strategy. Staff having conversations with consumers about how to incorporate safe caffeine drinking Example: “Varie-tea” group constructed in partnership with local tea business Our vision Full citizenship for all people living with a mental illness in Australian society Our mission Improving mental health and wellbeing in local communities neaminational.org.au

Source: http://www.neaminational.org.au/wp-content/uploads/2013/09/Caffeine_Use_and_Physical_Health.pdf