1
|
Udal ABH, Stray LL, Pripp AH, Stray T, Egeland J. The Utility of Neuromuscular Assessment to Identify ADHD Among Patients with a Complex Symptom Picture. J Atten Disord 2024; 28:1577-1588. [PMID: 39221625 PMCID: PMC11403920 DOI: 10.1177/10870547241273102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Diagnostic assessment of ADHD is challenging due to comorbid psychopathologies and symptoms overlapping with other psychiatric disorders. In this study, we investigate if a distinct pattern of neuromuscular dysregulation previously reported in ADHD, can help identifying ADHD in psychiatric patients with diverse and complex symptoms. METHOD We explored the impact of neuromuscular dysregulation, as measured by The Motor Function Neurologic Assessment (MFNU), on the likelihood of being diagnosed with ADHD, affective disorder, anxiety disorder, or personality disorder among adults (n = 115) referred to a psychiatric outpatient clinic. RESULTS Logistic regression revealed that neuromuscular dysregulation was significantly associated with ADHD diagnosis only (OR 1.15, p < .01), and not with affective-, anxiety-, or personality disorders. Sensitivity and specificity for ADHD at different MFNU scores is provided. CONCLUSIONS A test of neuromuscular dysregulation may promote diagnostic accuracy in differentiating ADHD from other psychiatric disorders in patients with an overlapping symptom picture. This may have important implications for clinical practice. More studies are needed.
Collapse
Affiliation(s)
| | - Liv Larsen Stray
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Are Hugo Pripp
- Department of Biostatistics, Oslo University Hospital, Norway
| | - Torstein Stray
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Jens Egeland
- Department of psychology, University of Oslo, Norway
- Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
2
|
Petrie J, Kowallis LR, Kamhout S, Bills KB, Adams D, Fleming DE, Brown BL, Steffensen SC. Gender-Specific Interactions in a Visual Object Recognition Task in Persons with Opioid Use Disorder. Biomedicines 2023; 11:2460. [PMID: 37760905 PMCID: PMC10525754 DOI: 10.3390/biomedicines11092460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Opioid use disorder (OUD)-associated overdose deaths have reached epidemic proportions worldwide over the past two decades, with death rates for men reported at twice the rate for women. Using a controlled, cross-sectional, age-matched (18-56 y) design to better understand the cognitive neuroscience of OUD, we evaluated the electroencephalographic (EEG) responses of male and female participants with OUD vs. age- and gender-matched non-OUD controls during a simple visual object recognition Go/No-Go task. Overall, women had significantly slower reaction times (RTs) than men. In addition, EEG N200 and P300 event-related potential (ERP) amplitudes for non-OUD controls were significantly larger for men, while their latencies were significantly shorter than for women. However, while N200 and P300 amplitudes were not significantly affected by OUD for either men or women in this task, latencies were also affected differentially in men vs. women with OUD. Accordingly, for both N200 and P300, male OUD participants exhibited longer latencies while female OUD participants exhibited shorter ones than in non-OUD controls. Additionally, robust oscillations were found in all participants during a feedback message associated with performance in the task. Although alpha and beta power during the feedback message were significantly greater for men than women overall, both alpha and beta oscillations exhibited significantly lower power in all participants with OUD. Taken together, these findings suggest important gender by OUD differences in cognitive processing and reflection of performance in this simple visual task.
Collapse
Affiliation(s)
- JoAnn Petrie
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
| | - Logan R. Kowallis
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
| | - Sarah Kamhout
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
| | - Kyle B. Bills
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
- Department of Neuroscience, Noorda College of Osteopathic Medicine, Provo, UT 84606, USA
| | - Daniel Adams
- PhotoPharmics, Inc., 947 So, 500 E, Suite 100, American Fork, UT 84003, USA
| | - Donovan E. Fleming
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
| | - Bruce L. Brown
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
| | - Scott C. Steffensen
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (J.P.); (K.B.B.)
- Department of Neuroscience, Noorda College of Osteopathic Medicine, Provo, UT 84606, USA
| |
Collapse
|
3
|
Ghetti C, Chen XJ, Brenner AK, Hakvoort LG, Lien L, Fachner J, Gold C. Music therapy for people with substance use disorders. Cochrane Database Syst Rev 2022; 5:CD012576. [PMID: 35532044 PMCID: PMC9082681 DOI: 10.1002/14651858.cd012576.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. OBJECTIVES To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. SEARCH METHODS We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.
Collapse
Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy, University of Bergen, Bergen, Norway
| | - Xi-Jing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China
| | - Annette K Brenner
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hospital Innlandet Trust, Brumunddal, Norway
| | - Jorg Fachner
- Cambridge institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| |
Collapse
|
4
|
Roehrs T, Sibai M, Roth T. Sleep and alertness disturbance and substance use disorders: A bi-directional relation. Pharmacol Biochem Behav 2021; 203:173153. [PMID: 33582097 PMCID: PMC7996967 DOI: 10.1016/j.pbb.2021.173153] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/18/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
The majority of the literature describing the relation of sleep/alertness disturbance and substance use disorders (SUD) has focused on the disruptive effects of substances with abuse liability on sleep and alertness. Rarely have studies or literature reviews assessed or discussed how sleep/alertness disturbance affects substance use. This paper focuses on the sleep/alertness disturbance side of the relation. We argue that the relation is bi-directional and review evidence showing that sleep/alertness disturbance affects all phases of the addiction cycle, including the initiation, maintenance and relapse of SUD. We review a variety of substances across all phases of the addiction cycle and conclude sleep/alertness disturbance is a critical factor in both understanding and treating SUD.
Collapse
Affiliation(s)
- Timothy Roehrs
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychiatry & Behavioral Neuroscience, Wayne State University, SOM, Detroit, MI, United States of America; Dept of Psychology, University of Detroit Mercy, Detroit, MI, United States of America
| | - Mohammad Sibai
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychology, University of Detroit Mercy, Detroit, MI, United States of America
| | - Thomas Roth
- Sleep Medicine, Henry Ford Health System, Detroit, MI, United States of America; Dept of Psychiatry & Behavioral Neuroscience, Wayne State University, SOM, Detroit, MI, United States of America.
| |
Collapse
|
5
|
Rodriguez-Romaguera J, Ung RL, Nomura H, Otis JM, Basiri ML, Namboodiri VM, Zhu X, Robinson JE, van den Munkhof HE, McHenry JA, Eckman LE, Kosyk O, Jhou TC, Kash TL, Bruchas MR, Stuber GD. Prepronociceptin-Expressing Neurons in the Extended Amygdala Encode and Promote Rapid Arousal Responses to Motivationally Salient Stimuli. Cell Rep 2020; 33:108362. [PMID: 33176134 PMCID: PMC8136285 DOI: 10.1016/j.celrep.2020.108362] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/18/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023] Open
Abstract
Motivational states consist of cognitive, emotional, and physiological components controlled by multiple brain regions. An integral component of this neural circuitry is the bed nucleus of the stria terminalis (BNST). Here, we identify that neurons within BNST that express the gene prepronociceptin (PnocBNST) modulate rapid changes in physiological arousal that occur upon exposure to motivationally salient stimuli. Using in vivo two-photon calcium imaging, we find that PnocBNST neuronal responses directly correspond with rapid increases in pupillary size when mice are exposed to aversive and rewarding odors. Furthermore, optogenetic activation of these neurons increases pupillary size and anxiety-like behaviors but does not induce approach, avoidance, or locomotion. These findings suggest that excitatory responses in PnocBNST neurons encode rapid arousal responses that modulate anxiety states. Further histological, electrophysiological, and single-cell RNA sequencing data reveal that PnocBNST neurons are composed of genetically and anatomically identifiable subpopulations that may differentially tune rapid arousal responses to motivational stimuli.
Collapse
Affiliation(s)
- Jose Rodriguez-Romaguera
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Randall L. Ung
- Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Hiroshi Nomura
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - James M. Otis
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Marcus L. Basiri
- Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Vijay M.K. Namboodiri
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Xueqi Zhu
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - J. Elliott Robinson
- Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Hanna E. van den Munkhof
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Jenna A. McHenry
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Louisa E.H. Eckman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Oksana Kosyk
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Thomas C. Jhou
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Thomas L. Kash
- Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC 72599, USA,Bowles Center for Alcohol Studies, Department of Pharmacology, University of North Carolina, Chapel Hill, NC 72599, USA
| | - Michael R. Bruchas
- Department of Anesthesiology, Washington University Pain Center, Department of Neuroscience, Division of Biology & Biomedical Sciences; and Department of Biomedical Engineering, Washington University, St. Louis, MO 63130, USA
| | - Garret D. Stuber
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Center, University of North Carolina, Chapel Hill, NC 72599, USA,Neuroscience Curriculum, University of North Carolina, Chapel Hill, NC 72599, USA,Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC 72599, USA,Correspondence:
| |
Collapse
|
6
|
Murillo-Rodríguez E, Millán-Aldaco D, Palomero-Rivero M, Morales-Lara D, Mechoulam R, Drucker-Colín R. Cannabidiol Partially Blocks the Excessive Sleepiness in Hypocretindeficient Rats: Preliminary Data. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:705-712. [PMID: 31642794 DOI: 10.2174/1871527318666191021143300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/05/2019] [Accepted: 09/13/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Excessive daytime sleepiness and cataplexy are among the symptoms of narcolepsy, a sleep disorder caused by the loss of hypocretin/orexin (HCRT/OX) neurons placed into the Hypothalamus (LH). Several treatments for managing narcolepsy include diverse drugs to induce alertness, such as antidepressants, amphetamine, or modafinil, etc. Recent evidence has shown that cannabidiol (CBD), a non-psychotropic derived from Cannabis sativa, shows positive therapeutic effects in neurodegenerative disorders, including Parkinson´s disease. Furthermore, CBD provokes alertness and enhances wake-related neurochemicals in laboratory animals. Thus, it is plausible to hypothesize that excessive somnolence observed in narcolepsy might be blocked by CBD. OBJECTIVE Here, we determined whether the systemic injection of CBD (5mg/kg, i.p.) would block the excessive sleepiness in a narcoleptic model. METHODS To test this idea, the neurotoxin hypocretin-2-saporin (HCRT2/SAP) was bilaterally injected into the LH of rats to eliminate HCRT leading to the establishment of narcoleptic-like behavior. Since excessive somnolence in HCRT2/SAP lesioned rats has been observed during the lights-off period, CBD was administered at the beginning of the dark phase. RESULTS Hourly analysis of sleep data showed that CBD blocked the sleepiness during the lights-off period across 7h post-injection in lesioned rats. CONCLUSION Taking together, these preliminary findings suggest that CBD might prevent sleepiness in narcolepsy.
Collapse
Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, Mexico.,Intercontinental Neuroscience Research Group, Merida, Yucatán, Mexico
| | - Diana Millán-Aldaco
- Depto. de Neurociencia Cognitiva, División de Neurociencias, Instituto de Fisiología Celular. Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Marcela Palomero-Rivero
- Depto. de Neuropatología Molecular, División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Daniela Morales-Lara
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, Mexico.,Intercontinental Neuroscience Research Group, Merida, Yucatán, Mexico
| | - Raphael Mechoulam
- Institute for Drug Research, Medical Faculty, Hebrew University, Jerusalem, Israel
| | - René Drucker-Colín
- Depto. de Neuropatología Molecular, División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| |
Collapse
|
7
|
Zager A. Modulating the immune response with the wake-promoting drug modafinil: A potential therapeutic approach for inflammatory disorders. Brain Behav Immun 2020; 88:878-886. [PMID: 32311496 DOI: 10.1016/j.bbi.2020.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/16/2020] [Accepted: 04/15/2020] [Indexed: 01/03/2023] Open
Abstract
Modafinil is a psychostimulant drug approved by the FDA primarily for the treatment of sleep disorders such as narcolepsy, excessive daytime sleepiness and sleep apnea. Several documented but not yet approved uses for modafinil have been described over the last 30 years, including alleviating fatigue in neurological and neurodegenerative disorders. Recent evidence has suggested that modafinil may have an immunomodulatory effect. Here, we review the different effects of modafinil treatment in animal models of brain inflammation and peripheral immune function. We conclude that there is unequivocal evidence of an anti-inflammatory effect of modafinil in experimental animal models of brain inflammation and neurodegenerative disorders, including systemic inflammation and methamphetamine-induced neuroinflammation, Parkinson's disease, brain ischemia, and multiple sclerosis. Modafinil acts on resident glial cells and infiltrating immune cells, negatively affecting both innate and adaptive immune responses in the brain. We also review the outcomes of modafinil treatment on peripheral immune function. The results of studies on this subject are still controversial and far from conclusive, but point to a new avenue of research in relation to peripheral inflammation. The data reviewed here raise the possibility of modafinil being used as adjuvant treatment for neurological disorders in which inflammation plays an important role.
Collapse
Affiliation(s)
- Adriano Zager
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
8
|
Sousa A, Dinis-Oliveira RJ. Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects. Subst Abus 2020; 41:155-173. [PMID: 31951804 DOI: 10.1080/08897077.2019.1700584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Modafinil is a nonamphetamine nootropic drug with an increasingly therapeutic interest due to its different sites of action and behavioral effects in comparison to cocaine or amphetamine. A review of modafinil (and of its prodrug adrafinil and its R-enantiomer armodafinil) chemical, pharmacokinetic, pharmacodynamic, toxicological, clinical and forensic aspects was performed, aiming to better understand possible health problems associated to its unconscious and unruled use. Modafinil is a racemate metabolized mainly in the liver into its inactive acid and sulfone metabolites, which undergo primarily renal excretion. Although not fully clarified, major effects seem to be associated to inhibition of dopamine reuptake and modulation of several other neurochemical pathways, namely noradrenergic, serotoninergic, orexinergic, histaminergic, glutamatergic and GABAergic. Due its wake-promoting effects, modafinil is used for the treatment of daily sleepiness associated to narcolepsy, obstructive sleep apnea and shift work sleep disorder. Its psychotropic and cognitive effects are also attractive in several other pathologies and conditions that affect sleep structure, induce fatigue and lethargy, and impair cognitive abilities. Additionally, in health subjects, including students, modafinil is being used off-label to overcome sleepiness, increase concentration and improve cognitive potential. The most common adverse effects associated to modafinil intake are headache, insomnia, anxiety, diarrhea, dry mouth and raise in blood pressure and heart rate. Infrequently, severe dermatologic effects in children, including maculopapular and morbilliform rash, erythema multiforme and Stevens-Johnson Syndrome have been reported. Intoxication and dependence associated to modafinil are uncommon. Further research on effects and health implications of modafinil and its analogs is steel needed to create evidence-based policies.
Collapse
Affiliation(s)
- Ana Sousa
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| |
Collapse
|
9
|
Lopez-Rico M, Lopez-Ibor JJ, Crespo-Hervas D, Muñoz-Villa A, Jimenez-Hernandez JL. Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|