Spectrum of caffeine‑induced conditions

• Caffeine Intoxication — nervousness, tremor, tachycardia, gastrointestinal upset.
• Caffeine‑Induced Anxiety Disorder — panic attacks or persistent anxiety following high intake.
• Caffeine‑Induced Sleep Disorder — insomnia or fragmented sleep due to timing/amount of caffeine.
• Caffeine‑Induced Cardiac Arrhythmia — palpitations, supraventricular tachycardia in susceptible individuals.
• Caffeine‑Related Neurocognitive Effects — concentration difficulties or exacerbation of underlying disorders.

Recognition — history & examination

1. Quantify caffeine intake: source (coffee, tea, energy drinks, supplements), amount, timing and recent changes.
2. Symptoms temporal to intake: onset within hours of large doses supports caffeine role.
3. Examine for tremor, diaphoresis, tachycardia, hypertension and anxiety signs.
4. Consider ECG for palpitations, syncope or cardiac history.

Diagnostic criteria highlights

DSM‑5 criteria for caffeine intoxication include recent consumption (usually >250 mg), clinically significant distress/impairment and at least five characteristic symptoms (restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, arrhythmia, agitation, etc.).

Management — general principles

• Reassure and provide a calm setting for mild intoxication; observe until symptoms abate.
• For severe anxiety or panic, short‑acting benzodiazepines may be used cautiously.
• Treat palpitations/arrhythmias per cardiology guidance — beta‑blockers can be considered for symptomatic tachycardia in absence of contraindications.
• Encourage reduction/tapering of intake; discuss safer timing (avoid caffeine 6–8 hours before sleep).
• Address coexisting conditions (anxiety disorders, insomnia, cardiac disease) which may increase sensitivity to caffeine.

Specific management scenarios

Caffeine intoxication

• Mild: rest, hydration, symptomatic care; monitor vitals.
• Moderate‑severe: benzodiazepine for severe agitation; check electrolytes and ECG if arrhythmia suspected.
• Massive overdose (rare): may require activated charcoal if early ingestion, cardiac monitoring, and ICU care for seizures or refractory arrhythmia.

Caffeine‑induced anxiety/panic

• Advise immediate reduction of intake, brief supportive therapy, breathing techniques, and consider short benzodiazepine for acute panic; refer for CBT if persistent anxiety.

Caffeine‑induced sleep disorder

• Sleep hygiene, reduce evening caffeine, consider melatonin short‑term and CBT‑I for chronic insomnia.

Caffeine‑related palpitations/arrhythmia

• ECG assessment, rule out electrolyte disturbances, review medications and consider cardiology referral for persistent arrhythmia.

Prevention & patient education

• Educate about caffeine content in beverages and supplements (energy drinks, pre‑workout, OTC stimulants).
• Encourage moderation (≤200–300 mg/day for most adults) and avoidance in pregnancy, children, and those with anxiety or cardiac disease.
• Recommend spacing doses earlier in the day and avoid mixing with other stimulants or alcohol.

Key takeaways

• Caffeine disorders range from mild intoxication to severe anxiety and cardiac effects; assessment focuses on dose, timing and medical history.
• Treatment is mainly supportive; benzodiazepines or beta‑blockers are used selectively for symptoms under supervision.
• Educate patients about sources of caffeine and safe intake limits; refer for specialist care when red flags present.