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• W2074027497 abstract "Back to table of contents Previous article Next article Letter to the EditorFull AccessPsychosis Associated With Modafinil and Shift WorkJOHN J. MARIANI, M.D., and CARL L. HART, Ph.D., JOHN J. MARIANISearch for more papers by this author, M.D., and CARL L. HARTSearch for more papers by this author, Ph.D., New York, N.Y.Published Online:1 Oct 2005https://doi.org/10.1176/appi.ajp.162.10.1983AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Modafinil is indicated to improve wakefulness in patients with excessive daytime sleepiness associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and sleep disorders associated with shift work. It is chemically and pharmacologically distinct from other psychostimulants.Ms. A was a 38-year-old research volunteer who developed mood and psychotic symptoms while taking modafinil as part of a double-blind inpatient laboratory study that was approved by an institutional review board. The purpose of the 23-day study was to examine the effects of modafinil on sleep, cognitive performance, and mood during simulated shift work. Ms. A received a single oral dose of modafinil (0 mg, 200 mg, or 400 mg) 1 hour after waking in 3-day blocks, and each dosing condition was separated by a day during which placebo was administered. Ms. A was studied under two shift conditions: day and night. The shifts alternated three times during the study.Ms. A had no known history of any psychiatric disorder, and a medical and psychiatric evaluation produced unremarkable results. She was without complaints until day 19 of the study, when she reported anxiety about her family’s well-being. It should be noted that Ms. A had received modafinil (400 mg) on days 17–19; her sleep was progressively disrupted over this period. On day 20, Ms. A began to focus increasingly on her children’s well-being and expressed guilt about being an inadequate parent.On day 21, she became markedly disorganized and was internally preoccupied, mumbling prayers and gesturing in a bizarre manner. She did not respond coherently to questioning and was transferred to the psychiatric emergency service. Her psychotic symptoms resolved spontaneously over 24 hours, and she was discharged. Over the next 2 days, she became increasingly depressed and was admitted to a psychiatric hospital. She was treated with risperidone and paroxetine and was discharged after 1 week.The history and clinical course of this patient suggest that the study procedures, i.e., sleep-cycle manipulations in combination with modafinil, likely precipitated her mood and psychotic symptoms. The patient’s family confirmed that she had no history of any psychiatric disorder, and there was no known family history of psychiatric disorders. Although we found no published reports of modafinil causing psychosis in individuals without a psychiatric illness, there is one published case report of modafinil worsening psychotic symptoms in a patient with schizophrenia receiving clozapine (1). The prescribing information for modafinil (2) notes, “There have been reports of psychotic episodes associated with Provigil use” and describes the case of a healthy normal volunteer who developed psychosis after multiple daily doses of 600 mg and sleep deprivation, which resolved 36 hours after discontinuation of the drug. Although the potential risk of modafinil precipitating psychosis in patients with no known psychiatric history is low, clinicians should be aware that the risk may increase when individuals are subjected to sleep disruptions and stress such as that caused by abrupt changes in work schedules.References1. Narendran R, Young CM, Valenti AM, Nickolova MK, Pristach CA: Is psychosis exacerbated by modafinil? Arch Gen Psychiatry 2002; 59:292–293Crossref, Medline, Google Scholar2. Package insert for Provigil. Cephalon Inc., West Chester, PaGoogle Scholar FiguresReferencesCited byDetailsCited byEthical Issues in Neuropsychopharmacotherapy: US Perspective5 November 2022Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future PerspectivesNeural Plasticity, Vol. 2021Comorbidity of Narcolepsy and Psychotic Disorders: A Nationwide Population-Based Study in Taiwan25 March 2020 | Frontiers in Psychiatry, Vol. 11Ethical Issues in Neuropsychopharmacotherapy: US Perspective9 October 2020Case Reports in Psychiatry, Vol. 2018ModafinilProgress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 70Case Reports in Cardiology, Vol. 2016High-Dose, Self-Administered Modafinil–Related PsychosisJournal of Clinical Psychopharmacology, Vol. 33, No. 4Drug Safety, Vol. 36, No. 4Agitation and Psychosis Associated With Dementia With Lewy Bodies Exacerbated by Modafinil Use14 August 2012 | American Journal of Alzheimer's Disease & Other Dementiasr, Vol. 27, No. 7Psychopharmacology, Vol. 220, No. 3AJOB Neuroscience, Vol. 3, No. 2Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, Vol. 22, No. 1Circadian Disorders24 September 2011Reining in the Pharmacological Enhancement Train: We Should Remain Vigilant about Regulatory Standards for Prescribing Controlled Substances1 January 2021 | Journal of Law, Medicine & Ethics, Vol. 39, No. 2Modafinil-Associated Vivid Visual Hallucination in a Patient With Kleine-Levin SyndromeJournal of Clinical Psychopharmacology, Vol. 30, No. 3Hallucinations Associated With Modafinil Treatment for NarcolepsyJournal of Clinical Psychopharmacology, Vol. 29, No. 4Internal Medicine Journal, Vol. 38, No. 8Drugs, Vol. 68, No. 13Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie, Vol. 57, No. 1FMC - Formación Médica Continuada en Atención Primaria, Vol. 14, No. 5Pharmacoepidemiology and Drug Safety, Vol. 15, No. 4Expert Review of Neurotherapeutics, Vol. 6, No. 4 Volume 162Issue 10 October 2005Pages 1983-1983 Metrics PDF download History Published online 1 October 2005 Published in print 1 October 2005" @default.
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