Experts disagree on whether schizoaffective disorder should be classified as a type of schizophrenia or a separate condition. It has been described as,"Intermediate between schizophrenia and bipolar disorder, and [it] may not be a separate diagnostic entity."
Schizoaffective disorder affects the emotions and cognition. Cognition includes knowing, thinking, judging and problem-solving.
There may be recurring episodes of high, or manic, and low, or depressed, mood, or a combination of the two, alternating with features of schizophrenia, such as hallucinations, delusions, disorganized speech or behavior, and a lack of emotional expression and motivation.
The patient may "hear things," and they may experience delusions and paranoia. Speech and thinking may be disorganized, and they may find it hard to function both socially and at work.
According to the National Alliance on Mental Illness (NAMI), the condition affects 0.3 percent of the population in the United States.
Treatment can help, but schizoaffective disorder is a complex condition, and it is harder to treat than a mood disorder alone.
>Like schizophrenia, schizoaffective disorder can involve hallucinations.
Symptoms schizoaffective disorder vary from one person to another.
Psychotic symptoms include hallucinations, paranoid thoughts, and disorganized thinking, as well as mood disturbance, depression, or manic moods.
Psychotic symptoms and mood disturbances may occur at the same time, or they may alternate. There are usually cycles of symptom severity.
The symptoms can result in antisocial behavior, and the patient can become isolated.
Specific symptoms include:
- Delusions; fixed or false beliefs
- Disorganized, confused and unclear thinking
- Unusual thoughts and perceptions
- Memory problems
- Paranoid ideas and thoughts
- Periods of depression
- Manic mood, or an unexpected boost of energy, with behaviors that are out of character
- Poor temper control
- Incoherent speech
- Irrelevant speech
- Attention problems
- Catatonic behavior, in which the patient hardly responds, or seems agitated for no apparent reason
- Lack of concern for personal hygiene or physical appearance
- Difficulty falling or staying asleep.
The most common mood disorders to accompany the features of schizophrenia are bipolar disorder and depression.
The exact causes of schizoaffective disorder are unclear, but it is believed to derive from an imbalance of the neurotransmitters serotonin and dopamine in the brain. Neurotransmitters are chemicals that help to pass on electronic signals in the brain, and they help to control mood.
Like schizophrenia, schizoaffective disorder is thought to stem from variations that affect brain development during childhood.
Genetics can play a role. Having a close relative with schizoaffective disorder, schizophrenia, or a mood disorder increases the risk of developing the disorder.
Advanced paternal age at the time of conception is a common cause of genetic mutations, and it has been linked to a higher risk of schizophrenia spectrum disorders, including schizoaffective disorder.
According to NAMI, men and women develop the condition at the same rate, but men tend to show symptoms at an earlier age.
Diagnosis is based on experiences reported by the patient and behavior abnormalities reported by family members, friends and colleagues to a psychiatrist, psychiatric nurse, social worker or clinical psychologist in a clinical assessment.
Schizoaffective order involves periods of depression.
For a diagnosis of schizoaffective disorder to be made, a number of criteria must be met. These criteria focus on whether or not a person has specific signs and symptoms, and for how long.
According to the American Psychological Association's (APA's) Diagnostic and Statistical Manual of Mental Disorders (DSM), the criteria include:
- Schizophrenia with mood symptoms
- A mood disorder with schizophrenia symptoms
- Both a mood disorder and schizophrenia
- A non-schizophrenia psychotic disorder, as well as a mood disorder.
Other APA criteria include delusions, hallucinations, and incoherent or disorganized speech, in which a person may jump from one topic to another in mid-sentence. Disordered speech can be a sign of a formal thought disorder.
Disorganized behavior may be seen in inappropriate dress or frequent weeping.
"Negative symptoms" may include a decline in or lack of emotional expressiveness, speech, and motivation, and an inability to derive pleasure from events normally considered enjoyable, such as eating, exercise, social interaction, or sexual activities.
Before making a diagnosis, the physician must rule out other general medical conditions with similar symptoms, Cushing's syndrome, HIV-related illness, temporal lobe epilepsy, neurosyphilis, thyroid or parathyroid problems, alcohol abuse, drug abuse, and metabolic syndrome.
Blood tests can exclude thyroid problems, chronic disease, and metabolic disturbance, among others. Electroencephalography (EEG) can rule out epilepsy and a CT scan to check for brain lesions.
If the patient's delusions are deemed bizarre, or if hallucinations consist of at least two voices talking to each other or just one voice participating in a running commentary of the patient's actions, then that symptom alone meets the criteria for diagnosis.
There are at least two subtypes, based on the mood aspect of the disorder:
- Bipolar type: A patient experiences a manic or mixed episode
- Depressive type: Only major depressive episodes occur, without manic or mixed episodes.
Distinguishing between schizoaffective disorder, schizophrenia, and mood disorder may be difficult. In schizoaffective disorder the mood symptoms are more prominent, and they generally last much longer than in schizophrenia.
Treatment can be difficult, because patients may not realize that they need help. It normally involves a combination of medications, such as antipsychotics, antidepressants or mood stabilizers, and psychological interventions, such as counseling.
Treatment will depend on the severity of symptoms are the subtype involved.
- Antipsychotics, or neuroleptics, can relieve psychotic symptoms, such as hallucinations, paranoia, and delusions. Examples include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).
- Mood stabilizers help to smooth out the highs and lows of bipolar disorder in patients with bipolar-type schizoaffective disorder. Examples include lithium (Eskalith, Lithobid) and divalproex (Depakote).
- Antidepressants can reduce hopelessness, lack of concentration, insomnia, and sadness in patients with major depression. Examples include citalopram (Celexa) and fluoxetine (Prozac).
Counseling can help patients to understand their condition.
Counseling and psychotherapy can help the patient understand their condition and feel positive about the future. Sessions typically focus on real-life plans, relationships, and how to deal with problems. The therapist may also introduce new behaviors for home and workplace settings.
Group or family therapy sessions offer a chance to discuss problems with other people. During periods of psychosis, these sessions can help as a reality check. Group work can also reassure patients that they are not alone.
Research has suggested that the prognosis for schizoaffective disorder may be slightly better than that for schizophrenia, although this has not been confirmed.
Complications of schizoaffective disorder include a higher risk of developing schizophrenia, major depression or bipolar disorder.