{
  "abstract": "Modafinil is a wakefulness-promoting (eugeroic) agent increasingly used off-label for cognitive enhancement. Although generally regarded as having a favorable psychiatric safety profile, it can precipitate manic or hypomanic episodes in vulnerable individuals, and the boundary between a self-limited substance-induced episode and the unmasking of an underlying mood disorder is not always clear at presentation. We report the case of a 20-year-old female law student admitted to the emergency unit after a suicide attempt by polypharmacy overdose during escalating off-label modafinil use. A notable feature was her use of an artificial intelligence (AI) conversational platform to inform about the preparation of the attempt: the AI did not generate her suicidal motivation but contributed to operationalizing an already-formed intent. The acute presentation was characterized by logorhoea, affective expansiveness, and behavioral disinhibition, initially consistent with a substance-induced manic episode. Over the three-month follow-up, however, subsyndromal hypomanic features persisted after discontinuation of modafinil and after withdrawal of a serotonergic antidepressant, while the patient was maintained on a mood stabilizer - raising the possibility that modafinil acted as a precipitant unmasking an underlying bipolar diathesis. This case illustrates modafinil's potential to precipitate affective destabilization in a high-achieving young person under sustained academic pressure, and the difficulty of distinguishing a transient substance-induced episode from an emerging bipolar-spectrum disorder without longitudinal follow-up. It also highlights an emerging risk: the role of large language models (LLMs) in operationalizing - rather than originating - suicidal intent. The case underscores the need for careful psychiatric screening before prescribing wakefulness-promoting agents, for continued longitudinal monitoring, and for attention to patients' interactions with AI platforms during crisis assessment.",
  "abstract_shown": true,
  "affiliations": [
    "Medical Psychology and Psychiatry, Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.",
    "Medical Biochemistry, Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Marinela Minodora Manea"
    },
    {
      "affs": [
        1
      ],
      "name": "Andreea Moise-Crintea"
    },
    {
      "affs": [
        0
      ],
      "name": "Paul-Andrei Singalievici"
    },
    {
      "affs": [
        0
      ],
      "name": "Madalina Iuliana Muntean"
    },
    {
      "affs": [
        0
      ],
      "name": "Horia George Coman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8tfwqg44mjpfr.bib",
  "cited_by": 0,
  "doi": "10.15386/mpr-2975",
  "fulltext_url": "https://europepmc.org/articles/PMC13743146",
  "id": "8tfwqg44mjpfr",
  "issns": [
    "2602-0807",
    "2668-0572"
  ],
  "landing_url": "https://europepmc.org/article/MED/42997657",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2738|Bipolar Disorder and Treatment"
    ]
  ],
  "openalex": "W7212634098",
  "pdf_url": "https://europepmc.org/articles/PMC13743146?pdf=render",
  "pmcid": "PMC13743146",
  "pmid": "42997657",
  "published": "2026-10-31",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/8tfwqg44mjpfr.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42997657",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42997657"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Bipolar Disorder and Treatment",
      "subfield": "psychiatry"
    }
  ],
  "title": "Digital pathways to self-harm: Modafinil-induced mania and AI-assisted operationalization of suicidal intent in a law student: a case report.",
  "title_text": "Digital pathways to self-harm: Modafinil-induced mania and AI-assisted operationalization of suicidal intent in a law student: a case report.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/8tfwqg44mjpfr",
  "venue": "Medicine and pharmacy reports",
  "versions": []
}