I was dx'd with bp1 in November this year.  I am taking a low dose (225 mg.) of lithium along with wellbutrin (300 mg.) and neurontin (1200 mg.) and have felt almost well.  My problem is that I'm afraid I am hallucinating and suffering from schizoaffective disorder.  For example, I felt someone tap my shoulder at a concert (people were sitting behind me, but when I looked back, they were looking ahead at the stage); the next day I thought I heard my cat meowing from behind my closed bathroom door (the cat was sleeping in the bedroom); and recently when sitting at my desk upstairs at night, I hear what sounds like muffled voices eminating from downstairs.  Do these sound like hallucinations, or do you suppose there is some actual explanation for each occurrence?  The stress of thinking I have hallucinated or am about to is causing a tremendous amount of depression and anxiety.   Thanks for your help, Katie

Hello Katie -- 
You've learned well, recognizing that some would consider "schizoaffective" disorder on the basis of symptoms like this.  However, these are rather unusual sensations you're describing.  Some but not all doc's would be triggered by these symptoms to get a brain scan (CT or MRI) because of their atypical nature.  Usually "auditory hallucinations" in psychosis are rather like one's own thoughts heard spoken by a voice, sometimes known, sometimes not.  

You're right to recognize that having such sensations when there are no mood symptoms going on at the same time is unusual in bipolar disorder, again signalling "something's unusual here".  However, I would not go so far as to invoke schizoaffective disorder now.  For one thing, we know that the typical course of recovery from a manic phase takes several months; i.e. people don't feel and act as though they're "back to their usual self" for that long, even if their symptoms that got them in the hospital, and perhaps thus into treatment, have decreased enough to leave the hospital.  

If you are sleeping just fine, then this is puzzling but I'd be inclined to wait and see if it diminishes.  If it didn't and no other symptoms turned up (like decrease sleep, or agitation or irritability), I'd be thinking again about the brain scan.  If it diminishes I'd attribute it to the earlier mood state that we'd conclude was continuing to resolve.  

As you can see I'd be holding off on the schizoaffective label.  For one thing, once you get it people seem to stop thinking and it can be really hard to shake it even if subsequent evidence does not support that way of seeing things.  For another, the immediate implication is that you'll have to stay on an antipsychotic all the time, which deserves to be very thoroughly tested and shown repeatedly to be true (as long as your symptoms are relatively mild and not troubling you or anyone else too much).  

Finally, Neurontin is really not a favorite of mine and I'd be a little suspicious that it could be involved in this somehow; however, your doc' could have figured out something really ideal for you here so don't even think about changing that Neurontin without talking with her (you weren't going to do that by any indication in your letter; I just have to make that very clear in this setting...).  

Good luck with all this. 

Dr. Phelps

Published January, 2003