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[CQ-Contest] Re: keep awake drugs

Subject: [CQ-Contest] Re: keep awake drugs
From: spa@tri.net (Salina Physician Anesthesia)
Date: Sun Jan 5 16:21:30 2003
With the recent flap about one of our planes in Afganistan shooting some 
friendly Canadians while the pilots were on some performance enhancing drug 
and some past discussion of such for contesting, here are a few references 
from the medical literature of yet another drug.  Personally, a few extra 
contacts aren't worth the effort just as with my bad coronaries, Viagra 
definitely wouldn't be!  Of course, as the last line would indicate that not 
all should try this stuff...but all the contesters I know are sane, normal 
and definitely not psychotic. 


1)  Psychopharmacology (Berl) 2002 Jan;159(3):238-47. Maintaining alertness
and performance during sleep deprivation: modafinil versus caffeine.
Wesensten NJ, Belenky G, Kautz MA, Thorne DR, Reichardt RM, Balkin TJ.
Department of Neurobiology and Behaviour, Division of Neuropsychiatry,
Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver
Spring, MD 20910-7500, USA. nancy.wesensten@na.amedd.army.mil 

RATIONALE: The performance and alertness effects of modafinil were
evaluated to determine whether modafinil should replace caffeine for
restoring performance and alertness during total sleep deprivation in
otherwise healthy adults. OBJECTIVES: Study objectives were to determine
(a) the relative efficacy of three doses of modafinil versus an active
control dose of caffeine 600 mg; (b) whether modafinil effects are
dose-dependent; and (c) the extent to which both agents maintain
performance and alertness during the circadian trough. METHODS: Fifty
healthy young adults remained awake for 54.5 h (from 6:30 a.m. day 1 to
1:00 p.m. on day 3) and performance and alertness tests were administered
bi-hourly from 8:00 a.m. day 1 until 10:00 p.m. day 2. At 11:55 p.m. on day
2 (after 41.5 h awake), subjects received double blind administration of
one of five drug doses: placebo; modafinil 100, 200, or 400 mg; or caffeine
600 mg ( n=10 per group), followed by hourly testing from midnight through
12:00 p.m. on day 3. RESULTS: Performance and alertness were significantly
improved by modafinil 200 and 400 mg relative to placebo, and effects were
comparable to those obtained with caffeine 600 mg. Although a trend toward
better performance at higher modafinil doses suggested a dose-dependent
effect, differences between modafinil doses were not significant.
Performance enhancing effects were especially salient during the circadian
nadir (6:00 a.m. through 10:00 a.m.). Few instances of adverse subjective
side effects (nausea, heart pounding) were reported. CONCLUSIONS: Like
caffeine, modafinil maintained performance and alertness during the early
morning hours, when the combined effects of sleep loss and the circadian
trough of performance and alertness trough were manifest. Thus, equivalent
performance- and alertness-enhancing effects were obtained with drugs
possessing different mechanisms of action. However, modafinil does not
appear to offer advantages over caffeine (which is more readily available
and less expensive) for improving performance and alertness during sleep
loss in otherwise normal, healthy adults. 

3)  Psychopharmacology (Berl) 2002 Nov 1; [epub ahead of print] Cognitive
enhancing effects of modafinil in healthy volunteers. Turner DC, Robbins
TW, Clark L, Aron AR, Dowson J, Sahakian BJ. Department of Psychiatry,
University of Cambridge, School of Clinical Medicine, Addenbrooke's
Hospital, Hills Road, Cambridge CB2 2QQ, UK. 

RATIONALE. Modafinil, a novel wake-promoting agent, has been shown to have
a similar clinical profile to that of conventional stimulants such as
methylphenidate. We were therefore interested in assessing whether
modafinil, with its unique pharmacological mode of action, might offer
similar potential as a cognitive enhancer, without the side effects
commonly experienced with amphetamine-like drugs. OBJECTIVES. The main aim
of this study was to evaluate the cognitive enhancing potential of this
novel agent using a comprehensive battery of neuropsychological tests.
METHODS. Sixty healthy young adult male volunteers received either a single
oral dose of placebo, or 100 mg or 200 mg modafinil prior to performing a
variety of tasks designed to test memory and attention. A randomised
double-blind, between-subjects design was used. RESULTS. Modafinil
significantly enhanced performance on tests of digit span, visual pattern
recognition memory, spatial planning and stop-signal reaction time. These
performance improvements were complemented by a slowing in latency on three
tests: delayed matching to sample, a decision-making task and the spatial
planning task. Subjects reported feeling more alert, attentive and
energetic on drug. The effects were not clearly dose dependent, except for
those seen with the stop-signal paradigm. In contrast to previous findings
with methylphenidate, there were no significant effects of drug on spatial
memory span, spatial working memory, rapid visual information processing or
attentional set-shifting. Additionally, no effects on paired associates
learning were identified. CONCLUSIONS. These data indicate that modafinil
selectively improves neuropsychological task performance. This improvement
may be attributable to an enhanced ability to inhibit pre-potent responses.
This effect appears to reduce impulsive responding, suggesting that
modafinil may be of benefit in the treatment of attention deficit
hyperactivity disorder. 



6) Narendran R, Young CM, Valenti AM, Nickolova MK, Pristach CA. Is
psychosis exacerbated by modafinil? Arch Gen Psychiatry. 2002
Mar;59(3):292-3. Department of Psychiatry, School of Medicine and
Biomedical Sciences, State University of New York at Buffalo, 462 Gilder
St, Buffalo, NY 14215 schizomania@yahoo.com
<http://archpsyc.ama-assn.org/issues/v59n3/ffull/ylt0302-5.html> Letter to
the Editor 

Modafinil (Provigil; Cephalon Inc, West Chester, Pa) is indicated to
improve wakefulness in patients with excessive daytime sleepiness
associated with narcolepsy. The stimulant drug methylphenidate, which
promotes wakefulness, has been reported to be useful in treating severe and
persistent sedation associated with clozapine treatment.1 However,
controversy has surrounded the routine use of such stimulant drugs to treat
clozapine-induced sedation because of the potential risk of exacerbating
psychosis (due to the drugs' dopaminergic activity) and worsening movement
disorders.2 We herewith report on the possible exacerbation of psychosis by
modafinil in a clozapine-treated patient with schizophrenia. 

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