Title: Treatment of Acute Mania with Modafinil Monotherapy
Abstract: In mania, increased catecholaminergic neurotransmission associated with a state of increased arousal is hypothesized. However, hypnotics and neuroleptics may not rapidly improve manic symptoms. Furthermore, in some but not in all manic patients, rapid declines of vigilance levels and intrusion of sleep spindles occur within the first minute of electroencephalography (EEG) under resting conditions with eyes closed ( 1 Van Sweden B. Disturbed vigilance in mania. Biol Psychiatry. 1986; 21: 311-313 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 2 Small J.G. Milstein V. Malloy F.W. Medlock C.E. Klapper M.H. Clinical and quantitative EEG studies of mania. J Affect Disord. 1999; 53: 217-224 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar ). Based on this observation, one could infer that manic behavior may also reflect an autoregulatory attempt to stabilize vigilance by creating a stimulating environment ( 3 Hegerl U. Sander C. Olbrich S. Schönknecht P. Are psychostimulants a treatment option in mania?. Pharmacopsychiatry. 2009; 42: 169-174 Crossref PubMed Scopus (38) Google Scholar ). Such a mechanism could apply to the hyperactive behavior of patients with attention-deficit/hyperactivity disorder (ADHD) ( 4 Hegerl U. Himmerich H. Engmann B. Hensch T. Mania and attention-deficit/hyperactivity disorder: Common symptomatology, common pathophysiology and common treatment?. Curr Opin Psychiatry. 2010; 23: 1-7 Crossref PubMed Scopus (70) Google Scholar ), which is associated with an unstable regulation of vigilance ( 5 Carskadon M.A. Dement W.C. Sleep tendency: An objective measure of sleep loss. J Sleep Res. 1977; 6: 200 Google Scholar ). Accordingly, the seemingly paradoxical therapeutic effects of psychostimulants in ADHD could be explained by their vigilance-stabilizing properties ( 6 Pliszka S.R. Pharmacologic treatment of attention-deficit/hyperactivity disorder: Efficacy, safety and mechanisms of action. Neuropsychol Rev. 2007; 17: 61-72 Crossref PubMed Scopus (102) Google Scholar ). Positive effects of psychostimulants have been observed in children with ADHD and severe mood dysregulation ( 7 Waxmonsky J. Pelham W. Gnagy E. Cummings M. O'Connor B. Majumdar A. et al. The efficacy and tolerability of methylphenidate and behaviour modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. J Child Adolesc Psychopharmacol. 2008; 18: 573-588 Crossref PubMed Scopus (98) Google Scholar ).
Publication Year: 2010
Publication Date: 2010-06-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 38
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