Agitation and Psychosis Associated With Dementia With Lewy Bodies Exacerbated by Modafinil Use

Abstract

Dementia with Lewy bodies (DLB) is commonly associated with excessive daytime somnolence (EDS). Modafinil is a wakefulness-promoting agent that is considered to have limited interaction with the dopaminergic system. As individuals with DLB are predisposed to psychotic symptoms which might be exacerbated by dopaminergic stimulation, modafinil is considered to be an attractive option for the treatment of EDS in DLB. We describe two cases in which administration of modafinil exacerbated agitation and hallucinations in DLB, and we also review data that may explain the mechanisms underlying this effect. In both cases, psychotic symptoms emerged concomitantly with modafinil administration, and remitted following its discontinuation. Although definitive data regarding the benefits and adverse effects of modafinil for the treatment of EDS in DLB await controlled prospective randomized studies, our observations warrant caution regarding its use in this context.

Addiction to Armodafinil and Modafinil Presenting With Paranoia

“…16 The psychosis associated with this case is not unexpected, nor unusual, given the stimulant action of modafinil and armodafinil. 17,18 Though the psychosis exhibited by this patient could have been secondary to benzodiazepine withdrawal, the absence of perceptual disturbances, clouded sensorium, or autonomic hyperactivity seems to suggest another etiology. Given that the patient had a well-documented seizure during his hospital stay; it is possible that his delusions may have been representative of interictal psychosis.…”

Modafinil-Induced Psychosis: A Case Report

“…Recently, a case of a 54-year-old man who developed late onset mania after treatment with modafinil because of somatization disorder and depression was reported (1). In addition, two cases with Lewy body dementia were reported to develop agitation and psychotic symptoms after treatment with modafinil for whole day sleepiness (15).…”

Shedding Light on Manic Syndromes and Dementia

“…Physical examination showed mild bradykinesis and a kyphotic posture. Prado et al [107] presented the case of a 70-year-old man with a diagnosis of probable DLB treated with modafinil (2-[(Diphenylmethyl) sulfinyl] acetamide). The drug is currently authorized for the following indications: excessive sleepiness caused by sleep apnea, narcolepsy, or shift work sleep disorder.…”