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Effects of modafinil on cognitive functions in first episode psychosis

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Abstract

Rationale

Cognitive impairments are important determinants of functional outcome in psychosis, which are inadequately treated by antipsychotic medication. Modafinil is a wake-promoting drug that has been shown to improve attention, memory and executive function in the healthy population and in patients with schizophrenia.

Objectives

We aimed to establish modafinil’s role in the adjunctive treatment of cognitive impairments in the first episode of psychosis, a time when symptoms may be more malleable than at chronic stages of the disease.

Methods

Forty patients with a first episode of psychosis participated in a randomised, double-blind, placebo-controlled crossover design study assessing the effects of a single dose of 200 mg modafinil on measures of executive functioning, memory, learning, impulsivity and attention.

Results

Modafinil improved verbal working memory (d = 0.24, p = 0.04), spatial working memory errors (d = 0.30, p = 0.0004) and strategy use (d = 0.23, p = 0.03). It also reduced discrimination errors in a task testing impulsivity. Modafinil showed no effect on impulsivity measures, sustained attention, attentional set-shifting, learning or fluency.

Conclusions

Modafinil selectively enhances working memory in first episode psychosis patients, which could have downstream effects on patients’ social and occupational functioning.

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Acknowledgements

We would like to thank the patients for their participation in the present study and our financial support from the Stanley Medical Research Institute and the Pinsent Darwin Fund of Cambridge University. Prof. Jones has received research support from the Wellcome Trust, NIHR and GSK. Prof. Sahakian has received consulting fees from Cambridge Cognition Ltd., GSK, Novartis, Shire, Lilly, and Boehringer-Ingelheim and has received honoraria from the Journal of Psychological Medicine, Grand Rounds in Psychiatry and the International Conference on Cognitive Dysfunction in Schizophrenia and Mood Disorders. Dr. Barnett is an employee of Cambridge Cognition Ltd and a co-inventor on patent PCT/GB2005/003279 (methods for assessing psychotic disorders) with Profs Jones and Sahakian. Dr. Soma and Dr. Scoriels reported no financial conflict of interests. The authors have full control of all primary data and agree to allow the journal to review this data if requested.

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Authors and Affiliations

  1. Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK

    Linda Scoriels, Jennifer H. Barnett & Peter B. Jones

  2. North Essex Partnership NHS Foundation Trust, Essex, UK

    Praveen K. Soma

  3. Department of Psychiatry, MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK

    Barbara J. Sahakian

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  1. Linda Scoriels
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  2. Jennifer H. Barnett
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  3. Praveen K. Soma
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  4. Barbara J. Sahakian
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  5. Peter B. Jones
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Correspondence to Linda Scoriels.

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Scoriels, L., Barnett, J.H., Soma, P.K. et al. Effects of modafinil on cognitive functions in first episode psychosis. Psychopharmacology 220, 249–258 (2012). https://doi.org/10.1007/s00213-011-2472-4

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