Hypersexuality after Modafinil Treatment： A Case Report

Modafinil is employed for the treatment of narcolepsy and other sleep disorders like idiopathic hypersornnia. Modafinil is involved in the modulation of orexin, a hypothalamic neuropeptide that regulates wakefulness. It also indicated that the drug interferes with the activity of additional neurotransmitters like hypocretin, histamine, gamma-aminobutyricacid, glutamate and norepinephrine. Modafinil can also block the dopamine transporter by increasing brain dopamine levels. Common side effects of modafinil include headache, nausea, nervousness, anxiety and trouble sleeping. Other side effects are affective lability, hyposexuality, personality change, aggression, abnormal dreams, irritability, suicidal ideas, mania, hypomania and psychotic exacerbation. In this case report, we present a 45 year old woman with idiopathic hypersomnia which is characterized primarily excessive day time sleepiness. Before modafinil treatment ESS （Epworth Sleepiness Scale） score of patient was 13. Treatment with Modafmil 200 mg daily within two weeks produced a subjective improvement in her daytime sleepiness （ESS score after treatment is 4）. But one week after the start of modafmil treatment, her sexual desire increased. Before this treatment, her sexual intercourse frequency was 1-2 times per week and after this treatment she wanted coitus every day. She has continual thoughts about sexuality. She didn＇t have any additional medication use or medical condition that increase sexual desire. Modafinil dose was decreased 100 mg/daythen to 50 mg/day. Her ESS score was 7 and daytime sleepiness had no effect on her life. After decreasing modafinil treatment her sexual desire returned to normal. Hypersexuality has not been reported as a side effect of modafinil yet. The pathophysiological mechanism of modafinil induced hypersexuality is not clear. In conclusion, clinicians should be aware of this rare significant side effect of modafinil and should maintain treatment with the lowest possible dose.

Concomitant Othello syndrome and impulse control disorders in a patient with Parkinson’s disease:A case report

BACKGROUND Othello syndrome(OS)is characterized by delusional beliefs concerning the infidelity of a spouse or sexual partner,which may lead to extreme behaviors.Impulse control disorders refer to behaviors involving repetitive,excessive,and compulsive activities driven by an intense desire.Both OS and impulse control disorders in Parkinson’s disease(PD)may be side effects of dopamine agonists.At present,there are only a few case reports and studies related to PD with concomitant OS and impulse control disorders.CASE SUMMARY We describe a 70-year-old male patient with PD,OS,and impulse control disorders,who presented with a six-month history of the delusional belief that his wife was having an affair with someone.He began to show an obvious increase in libido presenting as frequent masturbation.He had been diagnosed with PD ten years earlier and had no past psychiatric history.In his fourth year of PD,he engaged in binge eating,which lasted approximately one year.Both OS and hypersexuality were alleviated substantially after a reduction of his pramipexole dosage and a prescription of quetiapine.CONCLUSION Given its potential for severe consequences,OS should be identified early,especially in patients undergoing treatment with dopamine agonists.