RATIONALE: Cognitive impairments are important determinants of functional 
outcome in psychosis, which are inadequately treated by antipsychotic 
medication. Modafinil is a wake-promoting drug that has been shown to improve 
attention, memory and executive function in the healthy population and in 
patients with schizophrenia.
OBJECTIVES: We aimed to establish modafinil's role in the adjunctive treatment 
of cognitive impairments in the first episode of psychosis, a time when symptoms 
may be more malleable than at chronic stages of the disease.
METHODS: Forty patients with a first episode of psychosis participated in a 
randomised, double-blind, placebo-controlled crossover design study assessing 
the effects of a single dose of 200 mg modafinil on measures of executive 
functioning, memory, learning, impulsivity and attention.
RESULTS: Modafinil improved verbal working memory (d = 0.24, p = 0.04), spatial 
working memory errors (d = 0.30, p = 0.0004) and strategy use (d = 0.23, 
p = 0.03). It also reduced discrimination errors in a task testing impulsivity. 
Modafinil showed no effect on impulsivity measures, sustained attention, 
attentional set-shifting, learning or fluency.
CONCLUSIONS: Modafinil selectively enhances working memory in first episode 
psychosis patients, which could have downstream effects on patients' social and 
occupational functioning.