[Life-threatening caffeine poisoning by using coffee as a psychoactive drug]. / Lebensgefährliche Coffeinintoxikation unter Verwendung von Kaffee als Rauschmittel.

A 27 year-old deeply unconscious male patient with shallow spontaneous respiration was admitted to hospital following an epileptoid convulsion with a tentative diagnosis of cerebral trauma. On admission he was noted to have hyperpyrexia, tachycardia and hypertension. The clinical and laboratory findings pointed to intoxication. Aspiration of the stomach produced a large amount of coffee grounds, but not tablets or other poison. The plasma caffeine level was 29 micrograms/ml, which is potentially lethal. Therapy was commenced with a beta-blocker, an anticonvulsive drug and an antipyretic, and supportive symptomatic measures were undertaken. After 12 hours the patient was fully conscious, orientated and cooperative. He subsequently admitted having ingested about 500 g ground coffee with the intention of obtained a "high" state of drug intoxication, which he had successfully achieved on previous occasions with a smaller amount of coffee and without complications. The clinical picture was consistent with the expected signs of caffeine intoxication whereby the central effects of the substance remain to be clarified. This appears to be the first report of caffeine misused in this manner. In cases of intoxication with convulsions of uncertain aetiology, caffeine poisoning should be considered in the differential diagnosis.

Coffee consumption and mortality in the Chicago Western Electric Company Study.

The relations between coffee consumption and 19-year mortality from all causes, coronary heart disease, and non-coronary causes were assessed in 1,910 white males aged 40-56 years in 1957-1958 from the Chicago Western Electric Company Study. Mortality rates, adjusted for age, serum cholesterol, diastolic blood pressure, and smoking status, were compared for those consuming 0-1, 2-3, 4-5, and 6+ cups of coffee per day; coffee intake, measured at the first anniversary examination, included both caffeinated and decaffeinated intake. Mortality from all causes was greatest in the highest and lowest intake groups. The increased mortality in the 6+ cups per day group was due to coronary heart disease, while the increased mortality in the lowest intake group was due to noncoronary causes. The adjusted relative risk of coronary heart disease death for those drinking 6+ cups of coffee per day compared with those drinking less was 1.71 (95 per cent confidence limits 1.27, 2.30). This increased risk of coronary heart disease death was present in both smokers and nonsmokers, with adjusted relative risks of 1.62 and 2.21, respectively (95 per cent confidence limits 1.17, 2.24 and 1.06, 4.62). The increased mortality from non-coronary causes in the lowest intake group was due primarily to increased mortality from cancer and cardiovascular diseases other than coronary heart disease. The results of this study support the hypothesis that those who drink 6+ cups of coffee per day may be at an increased risk of death from coronary heart disease.

Case-control studies on the acute effects of coffee upon the risk of myocardial infarction: problems in the selection of a hospital control series.

In the course of evaluating the acute effect of caffeine-containing coffee on the risk of myocardial infarction (MI) among women 30-49 years of age, this study noted appreciable differences in coffee consumption among hospital patients admitted for illnesses not known to be related to coffee use. Among these potential controls, the coffee consumption of patients who had been compelled to hospital by conditions having an acute onset, such as fractures ("acute condition controls") was compared with that of patients admitted for chronic disorders ("chronic condition controls"). The proportion of drinkers of caffeine-containing coffee among 980 acute condition controls (65%) was significantly greater than that among 5835 chronic condition controls (58%) (p less than 0.01); by contrast, the proportion of drinkers of decaffeinated coffee was significantly greater among chronic condition controls (22%) than among acute condition controls (18%) (p less than 0.01). With regard to caffeine-containing coffee, other findings were that the frequency of drinking decreased with increasing contact with medical care in the year before admission; that patients who changed their consumption after discharge tended to give up coffee; and that the proportion of drinkers was greater among women in the community than among the hospital patients. These results suggest that relatively long-standing illness influences against drinking caffeine-containing coffee among women 30-49 years of age. They also suggest that there is an opportunity for overestimation of the relative risk of MI among coffee drinkers in hospital-based studies that use chronic condition controls.

Behavioral treatment of caffeinism: reducing excessive coffee drinking.

Excessive coffee drinking can have deleterious effects because of the large amounts of caffeine that are ingested. Caffeine is thought to be addicting, and prolonged and excessive use can lead to caffeinism, a condition that has serious behavioral and physiological side effects. The present study developed and evaluated a treatment program to reduce excessive daily coffee drinking to moderate and presumably safer levels. Three habitual coffee drinkers received individualized changing criterion programs that systematically and gradually reduced their daily caffeine intake. The coffee drinkers were required to self-monitor and plot their daily intake of caffeine. They received monetary prizes for not exceeding the treatment phase criteria and forfeited a portion of their pretreatment deposit when they did. Their coffee drinking decreased from almost nine cups per day (over 1100 mg of caffeine) during baseline to less than three cups per day (less than 343 mg) at the end of treatment or a reduction of 69%. The treatment effect was maintained during a 10-month follow-up, averaging a 67% reduction from baseline. The program appears to be a reasonable method of reducing and then maintaining daily caffeine intake at less harmful levels.

Caffeine and schizophrenia.

Two cases are described in which markedly increased consumption of caffeine led to an exacerbation of a schizophrenic process. The original description of this phenomenon and the clinical and basic science literature regarding the psychotropic effects of caffeine are reviewed. The cases are discussed in light of the clinical and research implications.