Clinical and neurocognitive changes with modafinil in obsessive–compulsive disorder : a case report

Abstract

There are limited treatment options for co-occurring sleep disorders and obsessive-compulsive disorder (OCD). We postulated that Modafinil (Provigil) [2-{(diphenylmethyl) sulfinyl acetamide}] a non-amphetamine wakefulness-promoting agent, might be of value in patients with excessive daytime sleepiness (EDS). Randomized double-blind placebo controlled depression trials have investigated the effects of modafinil co-administered with selective serotonin re-uptake inhibitors (SSRIs) and found improvement in clinical global scores and, aside from effects on sleep and mood, modafinil has exhibited cognitive enhancing effects in some subjects (Minzenberg and Carter, 2008). In a double-blind placebo-controlled crossover challenge, Turner et al. (2004) demonstrated decreased motor impulsivity as measured on laboratory tests in adult attention-deficit/hyperactivity disorder patients treated with single doses of modafinil (100 mg and 200 mg). To date, studies examining the neuropsychological effects of treatment are rare in OCD and have generally failed to show a positive effect of SSRI treatment on cognition (Nielen and den Boer 2003). In this context, we considered a new approach for treating neurocognitive impairments in treatment-resistant OCD. Modafinil’s effects on clinical symptoms and on a selected range of neurocognitive functions previously reported to be impaired in OCD (Chamberlain et al. 2005) are examined. We report the case of a patient with treatment-resistant OCD and EDS treated with adjunctive modafinil.