The rising popularity of medical marijuana and its potential therapeutic uses has resulted in passionate discussions that have mainly focused on its possible benefits and applications. Although the concept itself seems promising, the multitude of presented information has noticeable ramifications—terminological chaos being one. This work aimed to synthesize and critically analyze scientific evidence on the therapeutic uses of cannabinoids in the field of psychiatry. Emphasis was placed on the anxiolytic effects of cannabis constituents and their effects on post-traumatic stress disorder, anxiety disorders, schizophrenia spectrum, and other psychotic disorders. The review was carried out from an addictological perspective. A database search of interchangeably combined keywords resulted in the identification of subject-related records. The data were then analyzed in terms of relevance, contents, methodologies, and cited papers. The results were clear in supporting one common conclusion: while most findings provide support for beneficial applications of medical marijuana in psychiatry, no certain conclusions can be drawn until larger-scaled, more methodologically rigorous, and (preferably) controlled randomized trials verify these discoveries.

Modafinil belongs to a class of wakefulness promoting agents. It is widely used in the treatment of sleep disorders. Although narcolepsy is the main indication for its use, hypersomnia from obstructive sleep apnoea and shift work sleep disorder are also indications in some countries. Due to its efficacy in the treatment of hypersomnia, the drug has also been clinically assessed in patients with mental disorders to reduce the severity of symptoms such as fatigue, hypersomnolence and cognitive impairment. The aim of this paper is to present the potential clinical applications of modafinil in the treatment of selected mental disorders. The use of modafinil in depressive disorders to enhance the treatment applied may improve mood, anhedonia and apathy, fatigue, hypersomnolence and executive cognitive impairment. In severe episodes of bipolar depression, modafinil may improve depressive symptoms, fatigue, and hypersomnia. Despite the potential risk of manic symptoms during modafinil treatment, recent studies show no increased risk of switching from depressive to manic phase. In schizophrenia, there is no evidence for the beneficial effect of modafinil on the negative symptoms, but improvement in selected cognitive functions accompanied by exacerbation of psychotic symptoms was observed in some patients. Furthermore, modafinil is used as an alternative to standard therapy in attention-deficit/hyperactivity disorder. Despite lacking evidence for the efficacy of modafinil in cocaine addiction, an analysis of selected studies indicates a potential benefit in the form of maintained abstinence. Modafinil is well tolerated and safe in most cases. The risk of dependence is lower than with other psychostimulants.

Until 2010, modafinil, which is a wakefulness promoting agent, was approved in Europe for a wider spectrum of indications, such as narcolepsy, idiopathic hypersomnia, obstructive sleep apnoea and shift work sleep disorder. Currently, it is registered by the European Medicines Agency only for the treatment of narcolepsy, and is used as an off-label therapy in other sleep disorders. This paper presents the efficacy of modafinil in selected sleep disorders. Modafinil remains first-choice treatment for narcolepsy. It reduces the frequency of bouts of inadvertent sleep and nap episodes, the duration and intensity of daytime hypersomnolence, and also significantly improves the quality of life of patients. However, it is associated with only a slight improvement in cataplexy and other symptoms. In idiopathic hypersomnia, modafinil reduces the frequency of naps and unintentional sleep episodes, as well as subjective sleepiness measured with the Epworth Sleepiness Scale. Furthermore, the drug is used to treat hypersomnia from obstructive sleep apnoea in the case of lack of improvement despite optimal positive airway pressure therapy. Modafinil is also approved by the U.S. Food and Drug Administration for the treatment of shift work sleep disorder. The drug has been shown to reduce the level of somnolence, but it has not been found to reduce unintentional sleep episodes, reported mistakes or accidents at work. Given the strong negative impact of hypersomnolence on performance at work and school, the risk of accidents and the quality of life, the risk-benefit assessment of modafinil often justifies its use in the treatment of hypersomnolence also outside the approved indications.

Introduction Sleep apnea is a prevalent disorder but it is frequently overlooked in diagnosing mental disorders. The aim of the present study was to screen for sleep apnea in a group of patients referred for diagnosing mental disorders or non-restorative sleep and to assess the accuracy with which such testing can be replaced with commonly used screening questionnaires for sleep apnea. Methods 104 patients were investigated – 58 with mental disorders (26 with affective disorders, 26 with schizophrenia spectrum disorders, 3 with anxiety disorders, 3 with neurocognitive disorders; mean age 37.5±9.5 years, 24% females, BMI 32.8±6.5 kg/m2) and 46 with non-restorative sleep (mean age 41.2±14.6, 39% females, BMI 26.3±4.8 kg/m2). The patients were screened for sleep apnea with a home sleep apnea test (HSAT) based on peripheral arterial tonometry (PAT) and were asked to fill in the Sleep Apnea Scale from Sleep Disorders Questionnaire (SDQ-SA), the STOP-BANG and the Berlin questionnaires (BQ), and the Epworth Sleepiness Scale (ESS). Results Apnea-Hypopnea Index of > 5/h was found in 57 (55%) patients: 36 (62%) patients with mental disorders and 21 (45%) patients with non-restorative sleep. An increased risk for sleep apnea was found in 45 patients (43.3%) using SDQ-SA, 64 (61.5%) using BQ, 80 (76.9%) patients using STOP-BANG with the cut-off of 3 points and 30 (28.8%) with the cut-off of 5 points. Positive predictive values were: 65.9% for SDQ-SA, 71.0% for BQ, 68.8% for STOP-BANG with the cut-off of 3 point and 75.9% with the cut-off of 5 points. Negative predictive values were 49.1%, 63.0%, 83.3% and 51.4% respectively. Diagnostic accuracy was highest for STOP-BANG with the cut-off of 3 points – 72.3% and lowest for SDQ-SA – 56.6%. Excessive Daytime Sleepiness was found in 44 (42.3%) of patients. Three patients (2.9%) refused or did not complete the HSAT. Conclusion Inclusion of HSAT in the diagnostic process revealed high prevalence of sleep apnea in patients with mental disorders. Psychiatrists should be encouraged to include HSAT in evaluation of patients. Such testing is patient-friendly and using only screening questionnaires does not provide high enough diagnostic accuracy. Support (if any)

Introduction Occupational stress is a predictor of sleep problems. Recovery from it by detaching yourself from work-related issues outside of work hours is crucial for sleep health. Shift workers, especially in healthcare, are at a higher risk of sleep problems, which may lead to fatigue and errors at work, impacting patient care. The aim of the study was to 1) verify whether overcommitment to work is a moderator of the relationship between occupational stress and insomnia symptoms, and 2) check if this moderation is impacted by an individual’s occupation – whether overcommitment impacts the relationship of occupational stress and insomnia symptoms the same way for the two biggest occupational groups in healthcare in Poland - physicians and nurses. Methods Participants provided information on their occupation and filled in the Effort-Reward Imbalance questionnaire (ERI) with the Overcommitment (OC) scale, and the Insomnia Severity Index (ISI). Using the PROCESS macro for SPSS, we conducted a moderated regression analysis to test a multiple moderation (Model 3). Results We gathered responses from 281 participants – 178 physicians and 103 nurses. The interaction of ERI and OC was not significant, but a three-way interaction (ERI*OC*occupation) was significant in predicting ISI score. The relationship between ERI and ISI was moderated by OC depending on a respondent’s occupation. For physicians as OC increased the relationship between ERI and ISI increased as well. For nurses as OC increased the relationship between ERI and ISI decreased. Conclusion This study showed that stress at work has the strongest relationship with insomnia when physicians ruminate over work problems, are easily overwhelmed with time pressure and are unable to unwind in their free time. However, when nurses obtain high scores on an overcommitment measure, they will experience sleep problems regardless of the level of occupational stress. Support (if any) This work was supported by the National Science Center in Poland under Grant 2019/33/N/HS6/02572.