BACKGROUND: Emotional impairments are important determinants of functional 
outcome in psychosis, and current treatments are not particularly effective. 
Modafinil is a wake-promoting drug that has been shown to improve emotion 
discrimination in healthy individuals and attention and executive function in 
schizophrenia. We aimed to establish whether modafinil might have a role in the 
adjuvant treatment of emotional impairments in the first episode of psychosis, 
when therapeutic endeavor is arguably most vital.
METHODS: Forty patients with a first episode of psychosis participated in a 
randomized, double-blind, placebo-controlled crossover design study testing the 
effects of a single dose of 200 mg modafinil on neuropsychological performance. 
Emotional functions were evaluated with the emotional face recognition test, the 
affective go-no go task, and the reward and punishment learning test. Visual 
analogue scales were used throughout the study to assess subjective mood 
changes.
RESULTS: Modafinil significantly improved the recognition of sad facial 
expressions (z = 2.98, p = .003). In contrast, there was no effect of modafinil 
on subjective mood ratings, on tasks measuring emotional sensitivity to reward 
or punishment, or on interference of emotional valence on cognitive function, as 
measured by the affective go-no go task.
CONCLUSIONS: Modafinil improves the analysis of emotional face expressions. This 
might enhance social function in people with a first episode of psychosis.