Knowledge, Attitude, Self-esteem and Use of Pharmaceutical Cognitive Enhancers (PCE) Among Medical Students: Cross Sectional Study
[1]
Gayathirii a/p Sathaya, Faculty of Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.
[2]
Danoosha a/p T. S. K. Nagendra Rao, Faculty of Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.
[3]
Ang Chen En, Faculty of Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.
[4]
Jonathan Raj Gnan, Faculty of Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.
[5]
Harishankera a/l A. Mahalingam, Faculty of Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia.
Pharmaceutical cognitive enhancers, otherwise known as PCEs or ‘smart pills’, are drugs that some people use in an attempt to improve memory, increase mental alertness and concentration as well as boost energy levels and wakefulness. Some common cognitive enhancers are modafinil (Provigil), amphetamine (Adderall), and atomoxetine (Strattera). With nootropics being available over-the-counter in Western countries while being a prescribed medication in Asian countries such as Malaysia and Singapore, there is a concern over the use and misuse by students and other academics alike. The use of prescription drugs for non-medical purposes has driven some of the controversy over cognitive enhancement. An analytical cross sectional study was conducted among medical students of Melaka-Manipal Medical College (MMMC) regarding knowledge, attitude, self-esteem and its association with use of cognitive enhancers among undergraduate students. Participants of this study comprised of students who have enrolled for MBBS in MMMC in both Muar and Melaka campus in Malaysia. The study was conducted from December 2018 – January 2019. The study population were clinical phase students from Semester 6, 7, 8, 9 and 10 respectively. The sample size of this research project is 260. The sampling method chosen is purposive sampling. For data collection, the printed questionnaires were handed out to the research participants along with an attached consent form. The hypothesis tested by applying the logistic regression and correlation. People with low knowledge regarding PCEs are 0.1 times less likely to use PCEs. People with moderate knowledge are 0.7 times less likely to use PCEs. People with moderate attitude are 6.2 times more likely to use PCEs. People with poor attitude towards PCEs are 13.3 times more likely to use PCEs. People with low self-esteem are 0.1 times less-likely to use PCEs whereas people with normal self-esteem are 0.1 times less-likely to use PCEs. There is a low positive correlation between knowledge and attitude of the students. Through this study it has been determined that the knowledge, attitude and self-esteem are important factors that define the practice of PCEs. The general population with poor knowledge, poor attitude regarding Pharmaceutical Cognitive Enhancers (PCEs), and with low self-esteem would be perceived to be users of PCEs. Thus, healthcare authorities should create awareness to improve the knowledge in society regarding PCEs. More research regarding PCEs should be conducted in Malaysia or South-East Asian countries to obtain a more significant association for future reference.
Cognitive Enhancers, Medical Students, Nootropic Agents, Cognition, Pharmaceutical Preparations, Self Esteem
[1]
Hanna, L., Rainey, J., & Hall, M. (2018). A questionnaire study investigating future pharmacists’ use of, and views on cognitive enhancers [Abstract]. Pharmacy Education, 18 (1), 76-84.
[2]
Singh, I., Bard, I. and Jackson, J. (2014). Robust Resilience and Substantial Interest: A Survey of Pharmacological Cognitive Enhancement among University Students in the UK and Ireland. PLoS ONE, 9 (10), p.e105969.
[3]
Smith, M. and Farah, M. (2011). Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychological Bulletin, 137 (5), pp. 717-741.
[4]
Wilens, T., Adler, L., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R., Utzinger, L. And Fusillo, S. (2008). Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature. Journal of the American Academy of Child & Adolescent Psychiatry, 47 (1), pp. 21-31.
[5]
Desantis, A., Noar, S. and Webb, E. (2010). Speeding through the Frat House: A Qualitative Exploration of Nonmedical Adhd Stimulant Use in Fraternities. Journal of Drug Education, 40 (2), pp. 157-171.
[6]
Maier, L. and Schaub, M. (2015). The Use of Prescription Drugs and Drugs of Abuse for Neuroenhancement in Europe. European Psychologist, 20 (3), pp. 155-166.
[7]
Maslen, H., Faulmüller, N. and Savulescu, J. (2014). Pharmacological cognitive enhancement: how neuroscientific research could advance ethical debate. Frontiers in Systems Neuroscience, 8.
[8]
Sattler, S., Sauer, C., Mehlkop, G. and Graeff, P. (2013). The Rationale for Consuming Cognitive Enhancement Drugs in University Students and Teachers. PLoS ONE, 8 (7), p.e68821.
[9]
Shook, J., Galvagni, L. and Giordano, J. (2014). Cognitive enhancement kept within contexts: neuroethics and informed public policy. Frontiers in Systems Neuroscience, 8.
[10]
Schelle, K., Olthof, B., Reintjes, W., Bundt, C., Gusman-Vermeer, J. and van Mil, A. (2019). A survey of substance use for cognitive enhancement by university students in the Netherlands.
[11]
Pighi, M., Pontoni, G., Sinisi, A., Ferrari, S., Mattei, G., Pingani, L., Simoni, E. and Galeazzi, G. (2018). Use and Propensity to Use Substances as Cognitive Enhancers in Italian Medical Students. Brain Sciences, 8 (11), p. 197.
[12]
Ram, S., Hussainy, S., Henning, M., Stewart, K., Jensen, M. and Russell, B. (2017). Attitudes toward Cognitive Enhancer Use among New Zealand Tertiary Students. Substance Use & Misuse, 52 (11), pp. 1387-1392.
[13]
Bostrom, N. and Sandberg, A. (2009). Cognitive Enhancement: Methods, Ethics, Regulatory Challenges. Science and Engineering Ethics, 15 (3), pp. 311-341.
[14]
Micoulaud-Franchi JA, e. (2018). A preliminary study on cognitive enhancer consumption behaviors and motives of French Medicine and Pharmacology students. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25010616 [Accessed 27 Dec. 2018].
[15]
Dietz, P., Ulrich, R., Dalaker, R., Striegel, H., Franke, A., Lieb, K. and Simon, P. (2013). Associations between Physical and Cognitive Doping – A Cross-Sectional Study in 2.997 Triathletes. PLoS ONE, 8 (11), p.e78702.
[16]
Forlini, C. and Racine, E. (2009). Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement. BMC Medical Ethics, 10 (1).
[17]
Müller, U., Rowe, J., Rittman, T., Lewis, C., Robbins, T. and Sahakian, B. (2013). Effects of modafinil on non-verbal cognition, task enjoyment and creative thinking in healthy volunteers. Neuropharmacology, 64, pp. 490-495.
[18]
Mache, S., Eickenhorst, P., Vitzthum, K., Klapp, B. and Groneberg, D. (2012). Cognitive-enhancing substance use at German universities: frequency, reasons and gender differences. Wiener Medizinische Wochenschrift, 162 (11-12), pp. 262-271.
[19]
Bossaer, J., Gray, J., Miller, S., Enck, G., Gaddipati, V. and Enck, R. (2013). The Use and Misuse of Prescription Stimulants as “Cognitive Enhancers” by Students at One Academic Health Sciences Center. Academic Medicine, 88 (7), pp. 967-971.
[20]
de Jongh, R., Bolt, I., Schermer, M. and Olivier, B. (2008). Botox for the brain: enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience & Biobehavioral Reviews, 32 (4), pp. 760-776.
[21]
Outram, S. (2010). The use of methylphenidate among students: the future of enhancement?. Journal of Medical Ethics, 36 (4), pp. 198-202.
[22]
Lengvenyte, A., Strumila, R. and Grikiniene, J. (2016). Use of cognitive enhancers among medical students in Lithuania. Nordic Studies on Alcohol and Drugs, 33 (2), pp. 173-188.
[23]
Bailly D, Beuscart R, Dekeuwer P, Parquet Ph-J. Attitudes Et Motivations Des Étudiants En Médecine Face Aux Substances Psychotropes. Ann Psychiatrie 1988; 3: 37-46.
