Caffeine use and the side effects associated with its use among adolescents of Trinidad

OBJECTIVES: To determine the prevalence of the use of products containing caffeine, the side effects associated with this use and whether there was a relationship between the development of side effects and the dose of caffeine consumed among an adolescent population in Trinidad. A threshold level of daily caffeine consumption was being sought in this population to establish when there is likely to be an increase in side effects being experienced. DESIGN AND METHODS: A cross-sectional study was done using a convenience sampling strategy. A de novo questionnaire was self-administered to adolescents 18-20 years old. Questions included a one week caffeine recall for the participants, side effects and the timing of these side effects related to the use of the caffeinated products. RESULTS: The response rate was 391/412 (94.9%). The most common source of caffeine for this population was from beverages (67.5%).Significant dose dependent relationships between the dose of weekly caffeine consumed and the frequency of occurrence of palpitations (p=0.001) and the frequency of sleep disturbances (p=0.001) were observed. Doses of weekly caffeine consumption of > 428.5mg were significantly predictors for headaches, restlessness and anxiety in this population; OR (95% CI) [1.7(1.03, 2.74), 2.3(1.3, 4.0), 1.8(1.1, 2.9)] respectively. CONCLUSION: Caffeinated products mainly from beverages were commonly consumed by adolescents. Side effects like palpitations, sleep disturbances, restlessness and headaches were significantly more often reported above a threshold of 428.5mg/week. Daily caffeine intake in this adolescent population should be recommended to be less than this threshold in an attempt to reduce the occurrence of these side effects.

The timing of side effects associated with caffeine use in adolescents: acute effects or withdrawal symptoms?

OBJECTIVES: To determine the timing of side effects related to caffeine use in adolescents. It also serves to determine adolescents’ perception as to what food product or medication they believed caused the side effects. DESIGN AND METHODS: A cross-sectional study was done using a convenience sampling strategy. A de novo questionnaire was self-administered to adolescents 18-20 years old. Questions included a one week caffeine recall for the participants, side effects, the timing of these side effects related to the use of the caffeinated products and which product the participants associated with the development of the side effects. RESULTS: The survey response rate was 391/405 (95.6%). The response rate varied from 19.5% to 45.3% for the various adverse events experienced. Headaches (68.9%), palpitations(81.4%), restlessness (67.5%), nausea/vomiting (66.7%), polyuria (84.6%), tremors (75%) and anxiety (62.5%) were reported to occur more commonly within 4 hours of consumption of caffeinated products and these symptoms were attributed to coffee, tea and chocolate beverages. Depression (66.7%) occurred more commonly between 4-24 hours after consumption and was attributed to colas and energy drinks. Sleep disturbances (55.7%) occurred within 4 hours of caffeine consumption. CONCLUSION: Side effects reported by adolescent participants: palpitations, polyuria, nausea, tremors, anxiety and restlessness were mainly due to the acute effect of caffeine. Participants attributed most of these symptoms to coffee, teas and chocolate drinks. Depression was a withdrawal symptom attributed more to colas and energy drinks by the adolescents. Sleep disturbances could have been related to both the acute and withdrawal effects of caffeine.

Substance abuse among first admissions to the psychiatric unit of a general hospital in Trinidad.

Admissions for first episode of psychiatric illness provide information on service utilization which can be used to improve service delivery. The present study reviews the use of in-patient general psychiatric services in southern Trinidad using data from first admissions in one year, specifically to determine service utilization by substance-abusing patients. Case files of all admissions to the psychiatric unit of the San Fernando General Hospital in one year were reviewed and analyzed for demographic data, substance abuse, diagnosis and associated features of the admission. Significant rates of substance abuse were found among first admissions. Of 123 new patients, 43.1% were diagnosed with a substance abuse disorder, 56.6% of whom had a comorbid psychiatric disorder. Patients with substance abuse problems tended to be young males. The substance most commonly abused was alcohol (26.8%) and alcohol abusers were more likely to be of East Indian descent. Management within this mental health catchment area needs to address identification, early intervention and prevention of substance abuse among psychiatric patients. It is proposed that both hospital and community-based substance abuse interventions should be employed in the management of acute psychiatric patients.

Substance abuse among first admissions to the psychiatric unit of a general hospital in Trinidad

Admissions for first episode of psychiatric illness provide information on service utilization which can be used to improve service delivery. The present study reviews the use of in-patient general psychiatric services in southern Trinidad using data from first admissions in one year, specifically to determine service utilization by substance-abusing patients. Case files of all admissions to the psychiatric unit of the San Fernando General Hospital in one year were reviewed and analyzed for demographic data, substance abuse, diagnosis and associated features of the admission. Significant rates of substance abuse were found among first admissions. Of 123 new patients, 43.1 were diagnosed with a substance abuse disorder, 56.6 of whom had a comorbid psychiatric disorder. Patients with substance abuse problems tended to be young males. The substance most commonly abused was alcohol (26.8) and alcohol abusers were more likely to be of East Indian descent. Management within this mental health catchment area needs to address identification, early intervention and prevention of substance abuse among psychiatric patients. It is proposed that both hospital and community-based substance abuse interventions should be employed in the management of acute psychiatric patients

Gender and ethnicity in first admissions to a psychiatric unit in Trinidad

It has been recognized that there are gender disparities in the admission rates to psychiatric units. While the community prevalence of the major non-organic psychotic mental disorders are thought to have no gender bias, non-psychotic disorders such as depression are more commonly diagnosed in women. Gender differences in admission may indicate differences in severity or in presentation to psychiatric services and would have important implications for the targeting of preventative strategies. The case notes of all admissions to the psychiatric unit at the San Fernando General Hospital were obtained for the calendar year 1999. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses and gender were analysed to determine the distribution of diagnostic categories by gender. A total of 119 patients were admitted to the unit for the first time in the period under review, 72 were male (60.5) and 47 were female (39.5). There were no significant differences in age by gender. Substance use related admissions and psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p = 0.006; p = 0.03 respectively). These differences were especially marked for those of East Indian descent. Non-psychotic illnesses were more commonly diagnosed among women (p = 0.0008). These findings suggest that a larger proportion of males are admitted to the general hospital psychiatric unit among first time admissions. This is also true for re-admissions. Men are more likely to be diagnosed with substance use and psychotic disorders, while for women, major depression and non-psychotic illnesses are the main diagnoses. Community surveys are needed to determine whether this demographic pattern of admission reflects the population prevalence of these disorders. Reduction of admission rates will require interventions that are sensitive to gender differences in diagnosis among those admitted to psychiatric units

Gender and ethnicity in first admissions to a psychiatric unit in Trinidad.

It has been recognized that there are gender disparities in the admission rates to psychiatric units. While the community prevalence of the major non-organic psychotic mental disorders are thought to have no gender bias, non-psychotic disorders such as depression are more commonly diagnosed in women. Gender differences in admission may indicate differences in severity or in presentation to psychiatric services and would have important implications for the targeting of preventative strategies. The case notes of all admissions to the psychiatric unit at the San Fernando General Hospital were obtained for the calendar year 1999. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses and gender were analysed to determine the distribution of diagnostic categories by gender. A total of 119 patients were admitted to the unit for the first time in the period under review, 72 were male (60.5%) and 47 were female (39.5%). There were no significant differences in age by gender. Substance use related admissions and psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p = 0.006; p = 0.03 respectively). These differences were especially marked for those of East Indian descent. Non-psychotic illnesses were more commonly diagnosed among women (p = 0.0008). These findings suggest that a larger proportion of males are admitted to the general hospital psychiatric unit among first time admissions. This is also true for re-admissions. Men are more likely to be diagnosed with substance use and psychotic disorders, while for women, major depression and non-psychotic illnesses are the main diagnoses. Community surveys are needed to determine whether this demographic pattern of admission reflects the population prevalence of these disorders. Reduction of admission rates will require interventions that are sensitive to gender differences in diagnosis among those admitted to psychiatric units.