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Ask the Mental Health Expert Archives 2001-2004

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Schizoaffective Disorder

Q. I would like information regarding Schizo Affective disorder and any information regarding recent research using Ultram to treat intrusive thoughts. Thank you.

A. Schizoafective Disorder (SD) is among the most difficult psychiatric disorders to explain simply--probably because it is really more than one disorder. Basically, the diagnosis of SD means that the patient must show an uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode, ALONG WITH symptoms of schizophrenia (delusions, hallucinations, disorganized speech/behavior, negative symptoms).

Furthermore, during this same period, the patient must show delusions or hallucinations for at least 2 weeks in the ABSENCE of prominent mood symptoms. Finally, the mood episode symptoms must be present for a substantial portion of the total illness (usually several weeks or longer). To help you a bit, here's an illustrative vignette of SD:

A 40 year-old mother of two presents with the complaint that "the neighbors are trying to strangle my mind", and states that "I can hear them breathing down my neck at night." She has felt this way for about a month, which time coincides with the sudden death of her husband in an automobile accident. The patient does not show prominent symptoms of mania or depression, and has no disturbance of orientation, memory, or cognition. She does show some disorganization of her thought processes.

Two weeks later, the patient begins to complain of feeling "tired and dirty--like a tramp." She begins to eat poorly, shows early morning awakening, and expresses the conviction that "I probably deserve what God is doing to me...maybe I'd be better off dead." These depressive symptoms persist, along with the fear of the neighbors and auditory hallucinations, over the next two months, then begin to remit. The patient's sleep and appetite improve, and she no longer feels "tired and dirty".

However, she remains convinced that the neighbors "are out to get me", and occasionally hears them "whispering" to her when she is alone in her bedroom. These fears persist for another month, then begin to remit. Overall, the patient's illness has lasted about five months.

For more information on this disorder, you can contact the National Alliance for Research on Schizophrenia and Depression (516-829-0091). Your second question regarding Ultram [tramadol] is harder to answer, since there is very little research on this medication for other than its FDA-labeled indication as a pain reliever. I'm not aware of any studies using tramadol to treat obsessive-compulsive disorder (OCD) or "intrusive thoughts" per se.

However, tramadol has some biochemical effects that are similar to antidepressant agents, which are used to treat OCD. For example, both venlafaxine and tramadol boost the amount of the brain chemicals norepinephrine and serotonin in the brain, which could favorably affect both depression and OCD [see Markowitz & Patrick, Medical Hypotheses August 1998]. Also, there is one report that found tramadol useful in a patient with severe Tourettes' Syndrome, a tic disorder, including reduction of some OCD features (Shapira et al, Journal of Clinical Psychiatry April, 1997).

This may relate to tramadol's effects on opiate receptors in the brain, on serotonin, or both. Still, there is no controlled evidence at this time that convincingly shows tramadol useful for OCD.

February, 2001

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