Presentation of Caffeine Intoxication in an Active Duty Service Member Originally Believed to Have a Psychotic Disorder

Caffeine has the highest use of any psychoactive substance worldwide and is highly appealing to military personnel who are required to work the long, grueling hours necessary to complete a mission. However, published reports of caffeine intoxication in the medical literature are rare. Individuals undergoing military training experience long work hours in a stressful environment. These conditions can make various caffeine supplements enticing. However, most energy drinks contain multiple serving sizes, and supplements are often packaged in large containers, increasing individuals’ risk of caffeine overconsumption and intoxication. Additionally, young adults in stressful environments are the classic demographic in which the first presentation of a psychiatric illness, such as psychotic disorder, occurs. Interestingly, many of the presenting signs and symptoms, including agitation, restlessness, insomnia, tremors, tachycardia, and psychomotor agitation, are the same in both diagnoses. This stresses the importance of differentiating caffeine intoxication from a psychotic disorder. We present a novel case of an active-duty Service member who presented to the emergency room with symptoms concerning the psychotic disorder. After a more detailed history was acquired, caffeine intoxication became more likely and was ultimately treated. We discuss the overlap in presentation and thus difficulty in differentiating caffeine intoxication from a psychotic disorder.