Addressing Caffeine-induced Psychosis: A Clinical Perspective

Introduction: Caffeine-induced psychosis is a rare entity with just 6 cases published in the medical literature. According to these cases, massive caffeine intake can precipitate psychosis. Objectives: Authors reviewed the medical literature on caffeine-induced psychosis and its proposed neurobiological pathways. Methods: We performed a review on caffeine-induced psychosis using MEDLINE, Pubmed, and OVID with different word combinations including: "caffeine,'' "psychosis,'' "delusions,'' "agitation,'' "intoxication.'' In addition, we present a case of a previously healthy 29-year-old man who developed an abrupt onset of paranoid delusions, thought disorganization, and bizarre behavior after increasing his caffeine intake to > 1500mg per day over a period of 2 days. During the psychotic episode, the patient accidentally shot himself in the chest and was rushed to the hospital. Thyroid tests, toxicology, blood, and urine work-up excluded other conditions that could have triggered the psychosis. There is no personal or family history of psychiatric illness or substance use. Furthermore, the patient and family denied any suicidal intention or psychiatric symptoms before this episode. Results: Our case supports the existing data on psychosis precipitated by excessive amounts of caffeine intake. Conclusions: Caffeine-induced psychiatric disorders should be included in the differential diagnoses for patients presenting with psychotic symptoms. Overuse of coffee or other caffeine-containing beverages such as energy drinks should be investigated in these patients.