We conducted a systematic review and meta-analysis of randomized controlled 
trials (RCTs) of modafinil or armodafinil (ar/mod) augmentation in 
schizophrenia. We searched PubMed, clinical trial registries, reference lists, 
and other sources for parallel group, placebo-controlled RCTs. Our primary 
outcome variable was the effect of ar/mod on negative symptom outcomes. Eight 
RCTs (pooled N = 372; median duration, 8 weeks) met our selection criteria. 
Ar/mod (200 mg/day) significantly attenuated negative symptom ratings (6 RCTs; N 
= 322; standardized mean difference [SMD], -0.26; 95% CI, -0.48 to -0.04). This 
finding remained similar in all but one sensitivity analysis - when the only RCT 
in acutely ill patients was excluded, the outcome was no longer statistically 
significant (SMD, -0.17; 95% CI, -0.51 to 0.06). The absolute advantage for 
ar/mod was small: just 0.27 points on the PANSS-N (6 RCTs). Ar/mod attenuated 
total psychopathology ratings (7 RCTs; N = 342; SMD, -0.23; 95% CI, -0.45 to 
-0.02) but did not influence positive symptom ratings (5 RCTs; N = 302; mean 
difference, -0.58; 95% CI, -1.71 to 0.55). Although data were limited, 
cognition, fatigue, daytime drowsiness, adverse events, and drop out rates did 
not differ significantly between ar/mod and placebo groups. Fixed and random 
effects models yielded similar results. There was no heterogeneity in all but 
one analysis. Publication bias could not be tested. We conclude that ar/mod (200 
mg/day) is safe and well tolerated in the short-term treatment of schizophrenia. 
Ar/mod reduces negative symptoms with a small effect size; the absolute 
advantage is also small, and the advantage disappears when chronically ill 
patients or those with high negative symptom burden are treated. Ar/mod does not 
benefit or worsen other symptom dimensions in schizophrenia.