According to the American Psychological Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), schizoaffective disorder encompasses many of the diagnostic features of schizophrenia with a mood component.
In this article, we explore the characteristics, causes, and diagnosis of schizoaffective disorder, as well as possible routes of treatment.
What is schizoaffective disorder?
Schizoaffective disorder combines symptoms of mood disorders and schizophrenia.
For this reason, some people refer to the combination of schizophrenia and mood disorder symptoms as schizoaffective-type schizophrenia, although this is not a type of schizophrenia recognized by the DSM-5.
Schizoaffective disorder may include bipolar symptoms, such as mania or depression, as well as features of schizophrenia, including hallucinations and delusions. Symptoms can also include erratic speech or behavior and a lack of emotional expression and motivation
A person with schizoaffective disorder may experience auditory hallucinations, which means hearing sounds and voices that are not real. They may also experience delusions and paranoia. Speech and thinking may be disorganized, and a person may find it hard to function both socially and at work.
One study from Finland estimated that schizoaffective disorder occurs in around 3 in every 1,000 people. However, due to difficulties in separating the condition from schizophrenia or bipolar disorder, the real prevalence of this set of symptoms is unknown.
Treatment can help, but schizoaffective disorder is a complex condition, and it is harder to treat than a mood disorder alone.
Symptoms of schizoaffective disorder include the symptoms of schizophrenia, such as:
- an uninterrupted period of illness, during which there is a major depressive or manic mood episode occurring alongside schizophrenia symptoms.
- delusions or hallucinations for a further 2 weeks in the absence of a major depressive or manic mood episode throughout the lifetime of the illness.
- symptoms that meet criteria for a major mood episode and are present for the majority of the total duration of the active and residual portions of the illness.
- disturbance that is not attributable to another medical condition or the effects of a substance, such as a drug of abuse or medication.
Specific symptoms include:
- delusions, or fixed or false beliefs
- disorganized, confused, and unclear thinking
- unusual thoughts and perceptions
- paranoid ideas and thoughts
- periods of depression
- manic mood, or unexpected boosts of energy, with behaviors that are out of character
- erratic and uncontrollable temper
- incoherent speech, often switching between topics that do not relate to the current conversation
- difficulties in holding attention
- catatonic behavior in which a person hardly responds or seems agitated without an apparent cause
- a lack of concern for personal hygiene or physical appearance
- sleep disturbances and difficulties
In schizoaffective disorder, the most common mood disorders that accompany these features of schizophrenia are bipolar disorder and depression.
Scientists do not yet know why people develop schizoaffective disorder but some think it may have a genetic component.
According to the National Institutes of Health (NIH), a person may be at an increased risk of developing schizoaffective disorder if a first-degree relative, such as a parent, sibling, or child, has it.
Some studies have suggested that children born to men who are in their late 30s and 40s at the time of conception may have a higher risk of developing a schizophrenia- spectrum disorder, including schizoaffective disorder. However, there is not enough evidence to confirm this.
A psychiatrist or psychiatric nurse practitioner can diagnose schizoaffective disorder.
A medical professional will base their diagnosis of schizoaffective disorder on a person's self-reported experiences, as well as descriptions of unusual or uncharacteristic behavior reported by family members, friends, and colleagues.
A psychiatrist or psychiatric nurse practitioner might diagnose schizoaffective disorder in a clinical assessment.
A number of criteria define the condition. These criteria focus on a person's specific signs and symptoms, as well as how long they have been experiencing these effects.
According to DSM-5, the criteria include:
- schizophrenia with mood symptoms
- a mood disorder with symptoms of schizophrenia
- both a mood disorder and schizophrenia
- a non-schizophrenic psychotic disorder alongside a mood disorder
According to the APA, other criteria include recognizing positive symptoms, which refers to active changes in thought patterns or behavior, including:
- incoherent or disordered speech
- disorganized behavior in the form of inappropriate dress or frequent weeping
A medical professional may also note negative symptoms. These include a loss of function or withdrawal that would probably be noticeable in a person who does not have the condition.
Negative symptoms may include:
- a declining interest in previously enjoyable activities, such as socializing, sexual relations, and interpersonal relationships
- problems concentrating
- changes in sleep cycle
- low motivation to leave the house
- social difficulties in communicating with people
Before making a diagnosis, the doctor must rule out other general medical conditions with similar symptoms, including:
- Cushing's syndrome
- HIV-related illnesses
- temporal lobe epilepsy
- thyroid or parathyroid problems
- alcohol or drug use disorders
- metabolic syndrome
They can rule out these conditions using a range of blood tests and scans, including electroencephalography (EEG) and CT scans.
Bizarre delusions or hallucinations consisting of at least two voices talking to each other or just one voice participating in a running commentary of the individual's actions meet the criteria for diagnosis alone.
An individual's particular presentation of schizoaffective disorder might fit into at least two subtypes based on the mood aspect of the disorder. These include:
- Bipolar type: A person experiences manic or mixed episodes.
- Depressive type: Only major depressive episodes occur, without manic or mixed episodes.
Distinguishing between schizoaffective disorder, schizophrenia, and mood disorder is a diagnostic challenge. However, in schizoaffective disorder, the mood symptoms are more pronounced and generally last much longer than in schizophrenia.
Schizoaffective disorder may also occur alongside catatonia, which involves a set of symptoms where movement and behavior will change.
Psychiatrists often find diagnosing and treating schizoaffective disorders challenging.
Treatment typically involves a combination of medications, such as antipsychotics, antidepressants, or mood stabilizers, and psychological interventions, such as counseling.
The type and level of treatment depend on the severity of symptoms and the subtype involved.
Antidepressants might help with the mood aspect of the disorder.
A variety of medications is available to treat schizoaffective disorder, including:
- Antipsychotics, or neuroleptics: These can relieve psychotic symptoms, such as hallucinations, paranoia, and delusions. Examples include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).
- Mood stabilizers: This type of medication helps to regulate the highs and lows of bipolar disorder in people who have bipolar-type schizoaffective disorder. Examples include lithium (Eskalith, Lithobid) and divalproex (Depakote).
- Antidepressants: These can reduce symptoms of major depression, including hopelessness, lack of concentration, insomnia, and low mood. Examples include citalopram (Celexa) and fluoxetine (Prozac).
Counseling and psychotherapy
Therapy sessions aim to help an individual understand their condition, regain some quality of life, and start building towards the future.
Sessions typically focus on real-life plans, relationships, and how to deal with problems. The therapist may also introduce new behaviors to practice at home and in workplace settings.
Group or family therapy sessions offer a chance to discuss problems with loved ones or other people having the same experience. During periods of psychosis, these sessions can help a person with schizoaffective disorder make sense of the world around them. Group work can also reduce feelings of isolation.
Some older research has suggested that the prognosis for schizoaffective disorder may be slightly better than that of schizophrenia and slightly worse than psychotic affective disorder. However, no more recent studies are available to confirm this.
Complications of schizoaffective disorder include a higher risk of developing schizophrenia, major depression, or bipolar disorder.
What are the earliest signs of a schizophrenic disorder?
Various studies have sought to identify the prodromal symptoms of schizophrenia, or symptoms and signs that occur before the illness fully develops.
Experts have offered a variety of opinions and diagnostic criteria but have not come to a consensus. Unfortunately, early symptoms are often overlooked either by parents or the individual who are mostly unaware of the fact that they are experiencing changes which may indicate schizophrenia.
Anyone who notices unusual changes in their or a loved one’s behavior or mood should talk to a doctor.Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.