Schizoaffective Disorder

Schizoaffective Disorder

Schizoaffective Disorder

Schizoaffective disorder (SAD) is a mental health condition characterized by mood disorder and psychotic disorder symptoms that do not have enough of the criteria for diagnosis of a mood disorder or schizophrenia individually.

SAD is often misdiagnosed as a mood disorder or a psychotic disorder, but the main difference with schizoaffective disorder is that in addition to the manic or depressive episodes, the psychotic symptoms can last for two or more weeks without any major mood episode. The right diagnosis will ensure the right treatment.

Prevalence

SAD affects less than 0.8% of the general population at some point during their lives, and the onset of symptoms usually occurs between 16 and 30 years of age. It is more common in females than males; however, this is because of the high proportion of females in the depressive subcategory, whereas the bipolar subtype affects men and women equally.

Symptoms of Schizoaffective disorder:

Mood symptoms can be:

  • Manic – such as mania, hypomania
  • Grandiosity – such as inflated self-esteem
  • Agitation, irritability
  • Risk Taking
  • Rapid speech and racing thoughts, low concentration
  • Less need of sleep

OR

  • Depressive thoughts – such as apathy
  • Fatigue
  • Feelings of sadness, hopelessness, emptiness, worthlessness, and guilt
  • Suicidal thoughts
  • Weight and appetite changes

OR

  • A mix of both depression and mania, either occurring at the same time or in short succession.

Psychotic symptoms can be both:

  • Positive: hallucinations – mostly in the form of “hearing” voices, delusions, and disorganized speech
  • Negative:

    • Alogia – lack of spontaneous speech
    • Avolition – loss of motivation
    • Anhedonia – inability to experience pleasure
    • Blunted affect – lessened intensity of expressed emotion

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Diagnosis of Schizoaffective Disorder:

A full physical exam, lab work, possible brain scan, and review of mental health and family history are done first to rule out any medical or substance abuse reasons for the symptoms. It is especially important to check for reactions to medications the person is currently on, as these are sometimes responsible for psychotic episodes.


DSM-5 lists the following diagnostic criteria for schizoaffective disorder:

  • An uninterrupted period of illness during which there is a major mood episode (major
    depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1: Depressed mood.
  • Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
  • Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
  • The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Types of Schizoaffective Disorder:

There are two types of schizoaffective disorder:

  • 1 – Bipolar type, characterized by symptoms of mania, hypomania, or a mixed episode
  • 2 – Depressive type, characterized by symptoms of depression only

SAD, Psychotic Mood Disorder, Schizophrenia, and Schizophreniform Disorder

  • Psychotic mood disorder – is diagnosed when psychotic symptoms are confined to an episode of mania or depression (with or without mixed features), namely either psychotic bipolar disorder or psychotic major depression.
  • SAD, schizophreniform disorder, or schizophrenia – is only diagnosed when psychotic states persist for a protracted period of two weeks or longer without coexistent mood symptoms.

Causes of Schizoaffective Disorder:

The exact cause of SAD remains unknown; however, it has been suggested that biological and environmental factors are possible:


  • Genetic – There is evidence to suggest a genetic link between SAD, schizophrenia, and psychotic mood disorders.
  • Biological – Still at a theory level, it’s thought there is dysfunctional processing of serotonin and dopamine and a malfunctioning neural network in the brain
  • Environmental – Stress, marijuana use – especially if started in early adolescence

Schizoaffective Disorder complications:

The complications of SAD include:

  • Impairment in social, occupational, academic, and relational functioning
  • Increased risk of suicidal thoughts and suicide attempts
  • Coexistence with other conditions such as anxiety disorders and substance use disorders
  • Family and relationship conflict
  • Job loss, poverty, homelessness
  • Health problems

Treatment of Schizoaffective Disorder:

The treatment of SAD includes psychotherapy and medication. Hospitalization may be necessary when there is a risk to self and/or others. Psychiatric and occupational rehabilitation can help to promote recovery of mental and social functioning in people with this chronic condition.


  • Psychotherapy

    • Talking therapy – such as family or group therapy help with the verbal processing of what’s been going on, along with support and understanding from others in the same place. As much educational information as is known is provided to the person and his or her family to give understanding about the illness and help prevent relapse through their support.
    • Individual therapy – helps the person build trust with a therapist and learn coping skills when in stressful situations, communication skills, conflict resolution steps, and methods of self-care.
    • Cognitive behavioral therapy – can help a person understand the disorder, its triggers, and how to plan for early warning signs so they can get help quickly
    • Electroconvulsive therapy – might be considered in the person suffering from a deep depression or manic episode that therapy and medication are not affecting. This consists of sending an electrical current through the brain. This is a controversial option due to the risk of memory loss.
    • Transcranial Magnetic Stimulation (TMS) – is a newer treatment (currently in the testing phase) for those who are not good candidates for other treatments or medications.
    • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes regular mealtimes, exercise, sunlight, and a sleep schedule. This helps manage mood swings.
  • Community support – drop-in mental health visits, work skills training, employment support, drop-in centers, exercise sessions, internet forums
  • Intensive case management (ICM) – Assigns a case manager to the person to help coordinate care and assist in practical ways.
  • Medication

    • Antipsychotics – such as lurasidone can relieve psychotic symptoms in the acute stage and are prescribed at the minimum dose for long-term management
    • Antimanics – such as lithium help balance dopamine levels
    • Mood stabilizers – anticonvulsants such as carbamazepine can help stabilize a manic mood or major depression by decreasing nerve impulses in the brain
    • Antidepressants – SSRIs such as fluoxetine can help control levels of serotonin and dopamine in the brain
    • Benzodiazapines – such as diazepam can help reduce acute anxiety, but it’s usually only prescribed for a short term

Symptoms of Schizoaffective disorder:

Mood symptoms can be:

  • Manic – such as mania, hypomania
  • Grandiosity – such as inflated self-esteem
  • Agitation, irritability
  • Risk Taking
  • Rapid speech and racing thoughts, low concentration
  • Less need of sleep

OR

  • Depressive thoughts – such as apathy
  • Fatigue
  • Feelings of sadness, hopelessness, emptiness, worthlessness, and guilt
  • Suicidal thoughts
  • Weight and appetite changes

OR

  • A mix of both depression and mania, either occurring at the same time or in short succession.

Psychotic symptoms can be both:

  • Positive: hallucinations – mostly in the form of “hearing” voices, delusions, and disorganized speech
  • Negative:

    • Alogia – lack of spontaneous speech
    • Avolition – loss of motivation
    • Anhedonia – inability to experience pleasure
    • Blunted affect – lessened intensity of expressed emotion

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Diagnosis of Schizoaffective Disorder:

A full physical exam, lab work, possible brain scan, and review of mental health and family history are done first to rule out any medical or substance abuse reasons for the symptoms. It is especially important to check for reactions to medications the person is currently on, as these are sometimes responsible for psychotic episodes.


DSM-5 lists the following diagnostic criteria for schizoaffective disorder:

  • An uninterrupted period of illness during which there is a major mood episode (major
    depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1: Depressed mood.
  • Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
  • Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
  • The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Types of Schizoaffective Disorder:

There are two types of schizoaffective disorder:

  • 1 – Bipolar type, characterized by symptoms of mania, hypomania, or a mixed episode
  • 2 – Depressive type, characterized by symptoms of depression only

SAD, Psychotic Mood Disorder, Schizophrenia, and Schizophreniform Disorder

  • Psychotic mood disorder – is diagnosed when psychotic symptoms are confined to an episode of mania or depression (with or without mixed features), namely either psychotic bipolar disorder or psychotic major depression.
  • SAD, schizophreniform disorder, or schizophrenia – is only diagnosed when psychotic states persist for a protracted period of two weeks or longer without coexistent mood symptoms.

Causes of Schizoaffective Disorder:

The exact cause of SAD remains unknown; however, it has been suggested that biological and environmental factors are possible:


  • Genetic – There is evidence to suggest a genetic link between SAD, schizophrenia, and psychotic mood disorders.
  • Biological – Still at a theory level, it’s thought there is dysfunctional processing of serotonin and dopamine and a malfunctioning neural network in the brain
  • Environmental – Stress, marijuana use – especially if started in early adolescence

Schizoaffective Disorder complications:

The complications of SAD include:

  • Impairment in social, occupational, academic, and relational functioning
  • Increased risk of suicidal thoughts and suicide attempts
  • Coexistence with other conditions such as anxiety disorders and substance use disorders
  • Family and relationship conflict
  • Job loss, poverty, homelessness
  • Health problems

Treatment for Schizoaffective Disorder:

The treatment of SAD includes psychotherapy and medication. Hospitalization may be necessary when there is a risk to self and/or others. Psychiatric and occupational rehabilitation can help to promote recovery of mental and social functioning in people with this chronic condition.


  • Psychotherapy

    • Talking therapy – such as family or group therapy help with the verbal processing of what’s been going on, along with support and understanding from others in the same place. As much educational information as is known is provided to the person and his or her family to give understanding about the illness and help prevent relapse through their support.
    • Individual therapy – helps the person build trust with a therapist and learn coping skills when in stressful situations, communication skills, conflict resolution steps, and methods of self-care.
    • Cognitive behavioral therapy – can help a person understand the disorder, its triggers, and how to plan for early warning signs so they can get help quickly
    • Electroconvulsive therapy – might be considered in the person suffering from a deep depression or manic episode that therapy and medication are not affecting. This consists of sending an electrical current through the brain. This is a controversial option due to the risk of memory loss.
    • Transcranial Magnetic Stimulation (TMS) – is a newer treatment (currently in the testing phase) for those who are not good candidates for other treatments or medications.
    • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes regular mealtimes, exercise, sunlight, and a sleep schedule. This helps manage mood swings.
  • Community support – drop-in mental health visits, work skills training, employment support, drop-in centers, exercise sessions, internet forums
  • Intensive case management (ICM) – Assigns a case manager to the person to help coordinate care and assist in practical ways.
  • Medication

    • Antipsychotics – such as lurasidone can relieve psychotic symptoms in the acute stage and are prescribed at the minimum dose for long-term management
    • Antimanics – such as lithium help balance dopamine levels
    • Mood stabilizers – anticonvulsants such as carbamazepine can help stabilize a manic mood or major depression by decreasing nerve impulses in the brain
    • Antidepressants – SSRIs such as fluoxetine can help control levels of serotonin and dopamine in the brain
    • Benzodiazapines – such as diazepam can help reduce acute anxiety, but it’s usually only prescribed for a short term
Sources DRUGS.com – Medications for Schizoaffective Disorder | THE LANCET – Schizophrenia | BMJ – Schizophrenia Treatment | NIH – Intensive case management for severe mental illness | NIH – Cannabis Use during Adolescent Development: Susceptibility to Psychiatric Illness | MAYO CLINIC – Schizoaffective Symptoms and Causes | Martin LF, Hall MH, Ross RG, Zerbe G, Freedman R, Olincy A (December 2007). “Physiology of schizophrenia, bipolar disorder, and schizoaffective disorder”. The American Journal of Psychiatry. 164 (12): 1900–6. | Kaplan, HI; Saddock, VA (2007). Synopsis of Psychiatry. New York: Lippincott, Williams & Wilkins. | Martin LF, Hall MH, Ross RG, Zerbe G, Freedman R, Olincy A (December 2007). “Physiology of schizophrenia, bipolar disorder, and schizoaffective disorder”. The American Journal of Psychiatry. 164 (12): 1900–6. | Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychiatric Publishing, Inc., 2003 | McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (March 2007). “Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial”. American Journal of Psychiatry. 164 (3): 437–41.