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Letters   |    
Modafinil for the Treatment of Antipsychotic-Induced Excessive Daytime Sedation: Does It Exacerbate Tics?
Gayatri Saraf, M.B.B.S.; Biju Viswanath, M.D.; Janardhanan C. Narayanaswamy, M.D.; Bharath Holla, M.B.B.S.; Suresh Bada Math, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E35-E36. doi:10.1176/appi.neuropsych.12100246
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Dept. of Psychiatry
National Institute of Mental Health and Neurosciences
Bangalore, India

Correspondence: Dr. Biju Viswanath; e-mail: bijuv1@gmail.com

Copyright © 2013 by the American Psychiatric Association

Extract

To the Editor: Excessive daytime sedation (EDS) is a common and disabling side effect of antipsychotics (AP). We report on a case of a 17-year-old patient with difficult-to-treat symptoms of obsessive-compulsive disorder, chronic tic disorder, and primary derealization syndrome, whose compliance was noted to be poor because of AP-induced EDS. We successfully used modafinil for the treatment of this AP-related EDS, but with initial exacerbation of tics. This report highlights the need for careful dose-titration of modafinil, especially in those with past or family history of tic disorders.

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References

Makela  EH;  Miller  K;  Cutlip  WD  2nd:  Three case reports of modafinil use in treating sedation induced by antipsychotic medications.  J Clin Psychiatry 2003; 64:485–486
[CrossRef] | [PubMed]
 
Sudhakar  TP;  Rao  GP;  Prasuna  PL:  Study of effects of modafinil add-on therapy on excessive daytime drowsiness and weight gain in patients on atypical antipsychotics.  Indian J Psychol Med. 2008; 30:24–31
[CrossRef]
 
Roessner  V;  Robatzek  M;  Knapp  G  et al:  First-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants.  Dev Med Child Neurol 2006; 48:616–621
[CrossRef] | [PubMed]
 
Price  RA;  Leckman  JF;  Pauls  DL  et al:  Gilles de la Tourette’s syndrome: tics and central nervous system stimulants in twins and non-twins.  Neurology 1986; 36:232–237
[CrossRef] | [PubMed]
 
Pidsosny  IC;  Virani  A:  Pediatric psychopharmacology update: psychostimulants and tics: past, present, and future. J Can Acad Child Adolesc Psychiatry 2006; 15:84–86
 
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