Caffeinism in Chronic Schizophrenic Patients

I would like to report the use of high amount of tea (15-20 cups per day) by patients with chronic schizophrenia. In 3 years of clinical practice in psychiatry I have come across 11 patients where excessive tea consumption was one of the presenting complaints. 7 were male and 4 were female patients. Mean period of illness was 4.5 years. Family members reported that if these patients were not given tea they became more irritable and aggressive and would forcibly demand for it. Some refused to do any work but would actively prepare tea for themselves. The attendants complained , "He has lust for tea", "Tea makes her feel better", "Even if you do not give him any food he would prefer to survive on tea alone", "He has become a tea addict". Increased tea consumption was reported in 5 patients during active phase of psy-chosis. 6 patients reported that they had inner urge to take tea and felt better after taking it. Two paients said that tea decreased sedation due to drugs. 3 patients could not specify and reason. After an average follow up period of six and half months of treatment tea consumption had reduced to 2-3 cups a day in 6 patients and the rest 5 continued to the consume same quantity. During their first contact, all but two patients were already taking psychotropic drugs. In 6 patients where the consumption reduced during treatment period it could also be correlated with dose of neuroleptic in term of chlorpromazine equivalent of 2400 mg being reduced 600 mg a day. There are a few reports on excessive consumption of tea and coffee in psychiatric disorders. Greden and associates (1978) reported intake of large amounts of coffee in psychiatric inpatients and concluded that caffeinism probably could be found among a fairly large percentage of hospitalized patients with psychiatric symptoms, especially those presenting with anxiety/depres-sion profile. It has been reported by Freitas et al (1978) in their study on chronic psychiatric patients that prolonged use of coffee increased certain psychotic features and general improvement was obtained in patients whose caffeine was reduced. It was suggested by the same workers that some patients may use caffeine and nicotine to reverse the sedative effects of major tranquilizers and thus institute a cycle of increased anxiety and initiates irritability, which may lead to increased medication dosages. Present findings suggest that in some patients the …