Digital pathways to self-harm: Modafinil-induced mania and AI-assisted operationalization of suicidal intent in a law student: a case report.
- 1Medical Psychology and Psychiatry, Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- 2Medical Biochemistry, Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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.
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BibTeX
@article{manea2026digital,
title = {{Digital pathways to self-harm: Modafinil-induced mania and AI-assisted operationalization of suicidal intent in a law student: a case report.}},
author = {Marinela Minodora Manea and Andreea Moise-Crintea and Paul-Andrei Singalievici and Madalina Iuliana Muntean and Horia George Coman},
journal = {Medicine and pharmacy reports},
year = {2026},
month = oct,
doi = {10.15386/mpr-2975},
url = {https://europepmc.org/article/MED/42997657},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Digital pathways to self-harm: Modafinil-induced mania and AI-assisted operationalization of suicidal intent in a law student: a case report.
AU - Marinela Minodora Manea
AU - Andreea Moise-Crintea
AU - Paul-Andrei Singalievici
AU - Madalina Iuliana Muntean
AU - Horia George Coman
PY - 2026
DA - 2026/10/31
JO - Medicine and pharmacy reports
DO - 10.15386/mpr-2975
UR - https://europepmc.org/article/MED/42997657
AB - 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.
SN - 2602-0807
SN - 2668-0572
ER -