“Clozapine makes me quite drowsy, so when I wake up in the morning those first cups of coffee are really handy”: an exploratory qualitative study of excessive caffeine consumption among individuals with schizophrenia

Abstract

BackgroundResearch has shown that individuals with schizophrenia use caffeine at higher rates than the general population; however, no qualitative research has been undertaken investigating problematic caffeine use and its effects on this population. This article explores the role of caffeine consumption in the lives of people with schizophrenia through a narrative analysis of the attitudes and beliefs associated with this practice, and how these, in turn, influence caffeine consumption.MethodsA qualitative study was undertaken with individuals who had previously scored in either a ‘moderate’ or ‘high’ risk category for caffeine use on the Alcohol, Smoking and Substance Involvement Screening Tool (ASSIST). In-depth interviews were undertaken with 20 individuals, and transcripts were analysed thematically to identify prominent perspectives.ResultsConsistent with previous literature, participants’ caffeine consumption was driven largely by its stimulating properties; however, participants also identified ‘cravings’ as an important motivating factor. Participants’ behaviours related to caffeine consumption seemed to be tempered by their previous experiences of consumption; if participants had experienced positive effects such as alertness or relaxation in the past, their use was maintained at a similar level or increased. Conversely, participants who anticipated negative consequences often altered their patterns of caffeine consumption; for example, by substituting caffeinated drinks that minimised or ceased their experience of negative side effects for those that directly caused such impacts. Overall, participants largely identified caffeine consumption as a highly meaningful activity, which provided structure to their day and facilitated opportunities for social interaction.ConclusionsThe inconsistencies between individuals’ beliefs about their health and the actual risk of harm associated with health-related behaviours present significant and ongoing challenges for the implementation of relevant and effective strategies for health promotion among individuals diagnosed with mental illness. As a starting point, it would be worthwhile for services engaging with people diagnosed with mental illness, and in particular schizophrenia, to consider implementing caffeine-related health literacy strategies to educate consumers about the risk of excessive caffeine consumption and the interactions between caffeine and antipsychotic medications.

Educational needs and psychoeducation interventions in clozapine users: a narrative review

“…Most studies were carried out in psychiatric hospitals ( n = 9) (25,32‐39). Other mental health settings were community mental health structures ( n = 4) (40‐43) and clozapine out‐patient clinics (n = 3) (26,31,44). One study was carried out in members of a users' association (27), and one used data collected in an epidemiological survey (45).…”

“…All other studies included chronic clozapine users: a minimal duration of clozapine treatment (3–12 months) was required in four studies; the mean duration of use (16 months to 13 years) was specified in five studies. A study carried out in patients using clozapine but also olanzapine or paliperidone was included in the review as it was focused on knowledge about caffeine consumption, an issue not addressed elsewhere (42).…”

“…With a few exceptions (23), the current literature on clozapine psychoeducation does not explicitly address situations where clozapine dosage may need to be adapted because of potentially dramatic changes in blood clozapine concentrations. A study investigating knowledge of antipsychotic users about caffeine (42) showed that their beliefs were at odds with the actual pharmacological effects. Indeed, caffeine was consumed to counterbalance the sedative effects of antipsychotics, while high caffeine intake has inhibitory effects on clozapine clearance because of the competing metabolism by CYP1A2 (59,60).…”

“…Studies exploring users' knowledge about clozapine showed poor level of knowledge about the rationale for blood testing (31,36,39,40), clozapine dose (32), adverse effects (36) or interaction with caffeine (42). Knowledge about the risks associated with clozapine discontinuation was good in users (32,43) but poor in their relatives (36).…”

Fusing Sensor Paradigms to Acquire Chemical Information: An Integrative Role for Smart Biopolymeric Hydrogels

“…Also, the patient's health can affect clozapine's metabolism (e.g., inflammation suppresses metabolism). Further a patient's lifestyle can alter metabolism as cigarette smoking induces metabolism and coffee drinking may inhibit metabolism . Potentially, serum contains information on these factors and accessing this information could better guide decisions of clozapine dosing, however accessing this information from a serum sample will require more than a single sensor measurement.…”