Schizoaffective Disorder vs. Schizophrenia: Correct Diagnosis Ensures Effective Treatment

If you have been diagnosed with schizophrenia or schizoaffective disorder, it is vital that you receive the highest quality treatment in order to recover. However, this is only possible if your diagnosis is correct to begin with. By exploring the differences between schizoaffective disorder vs. schizophrenia, you can gain a better understanding of these conditions as well as the challenges of diagnosis and treatment. If you have not found resolution of your symptoms in treatment thus far, or if you believe that you have been misdiagnosed, a residential treatment program may be the best place to gain diagnostic clarity and receive the comprehensive care you need to heal.

Receiving a psychotic disorder diagnosis can be heartbreaking, partially because many assume that such a diagnosis means a poor prognosis. While the treatability of depression and anxiety is now well-known, psychotic disorders are often imagined to have poor outcomes. Unfortunately, this perpetuates the stigmas surrounding these complex illnesses. Tragically, it can also make people living with these disorders and their families feel hopeless and alone in their struggles.

It is true that psychotic disorders present unique treatment challenges. However, today there are more and better resources than ever before for treating these illnesses, including schizophrenia and schizoaffective disorders. New antipsychotics are offering symptom relief with fewer side effects and expanded medication administration methods are helping people adhere to treatment plans. The value of psychotherapy and psychosocial supports is increasingly recognized, and the possibilities of holistic treatments are being explored. Simultaneously, early diagnosis and intervention are now firmly linked to better treatment outcomes.

Of course, effective treatment relies on being correctly diagnosed in the first place. Unfortunately, people with psychotic disorders may be especially vulnerable to misdiagnosis. In particular, the overlaps between schizophrenia and schizoaffective disorder increase risk of misdiagnosis, which can keep people living with these illnesses from receiving appropriate care. A study in European Archives of Psychiatry and Clinical Neuroscience, for example, found “significant disagreement between research and clinical diagnoses.” More specifically, clinicians were far more likely to diagnose patients with schizoaffective disorder while researchers were more likely to diagnose those same patients with schizophrenia. You can better understand what you are experiencing and potentially promote diagnostic clarity by exploring the features of schizoaffective disorder vs. schizophrenia.

Schizoaffective Disorder vs. Schizophrenia

What underlies both schizoaffective disorder and schizophrenia is the experience of psychosis. Hallucinations and delusions disconnect you from reality, interfering with your ability to care for yourself, engage in healthy interpersonal relationships, participate in educational and vocational activities, and think in a logical, reality-based way. However, the two disorders differ in significant ways.

Schizophrenia is defined by positive psychotic symptoms and typically accompanied by negative symptoms such as cognitive, memory, and problem-solving difficulties, social withdrawal, ahedonia, flat affect, and speech disturbances. While schizoaffective disorder shares the positive and negative symptoms of schizophrenia, it must also include the presence of a simultaneous, yet separate, mood disorder. Depending on the type of mood disorder you are experiencing, your disorder will fall into one of two types:

  • Depressive Type: You experience depressive episodes, but do not experience mania.
  • Bipolar Type: You experience manic episodes and may also experience depressive episodes.

Significantly, these mood episodes must occur both during and independently from psychosis. In other words, your mood episodes are not a response to your psychotic experiences, nor are they the temporary result of external triggers. Additionally, psychosis cannot be the product of a mood episode, such as in the case of psychotic depression or bipolar disorder. Also unlike those with psychotic depression or bipolar disorder, the psychotic experiences of people with schizoaffective disorder are typically mood incongruent.

It is worth noting that many people with schizophrenia will also experience mood disturbances, particularly depressed mood, at some point during the course of their illness. This often occurs in response to the schizophrenia itself; as psychosis lifts and you can see your situation more clearly, you may experience feelings of helplessness and fears regarding your future. Medications, substance abuse, and negative life events may also trigger depressed mood and depression-like symptoms. Additionally, negative symptoms of schizophrenia can mimic symptoms of depression, although such negative symptoms do not include the “prominent blue mood” that is typically present in depression. While depressed mood and affect are indeed common, it is important to understand that they do not necessarily constitute a mood disorder and distinguishing between these phenomena is essential for correct diagnosis.

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Challenges in Diagnosis and Treatment

The overlapping symptomatology of schizophrenia and schizoaffective disorder often presents significant diagnostic challenges for clinicians. In some cases, mood disturbances are missed altogether due to a singular focus on psychotic symptoms. In other cases, the nature of mood disturbances is misunderstood, resulting in incorrect or missed identification of a mood disorder. This may happen for a number of reasons, including a client’s reluctance to disclose mood symptoms or inability to recognize such symptoms, particularly when overwhelmed by the experience of psychosis. Meanwhile, clinicians may fail to ask about mood episodes in a way that will clarify their origin. As the authors of the European Archives of Psychiatry and Clinical Neuroscience European Archives of Psychiatry and Clinical Neuroscience study note, there is also evidence that “clinicians choose the less severe diagnosis for psychotic patients,” which is commonly understood to be schizoaffective disorder.

This understanding of schizoaffective disorder as less severe may at first appear counterintuitive. After all, treating schizoaffective disorder requires addressing both psychotic and mood disorder symptoms simultaneously, typically through the use of antipsychotics combined with antidepressants, antipsychotics, and/or mood stabilizers, as well as psychotherapy. Indeed, striking the right balance between treatment of psychotic and mood symptoms can be a challenge. However, research consistently suggests that people with schizoaffective disorder have better treatment outcomes than people with schizophrenia. As Dr. Jeffery M. Lyness writes, “The outcomes of schizoaffective disorder are heterogeneous but on average intermediate between those of schizophrenia and mood disorder.” The potential for better outcomes may lead some psychiatrists to err on the side of increased treatability when determining diagnosis. The same reasoning is thought to partially account for the prevalence of misdiagnosing schizoaffective disorder as bipolar disorder.

When schizophrenia is misdiagnosed as schizoaffective disorder or schizoaffective disorder is misdiagnosed as schizophrenia, it prevents you from receiving the care that you need to heal. For people with schizoaffective disorder, for example, the untreated mood disorder will typically continue to create distressing symptoms and functional disturbances. For people with schizophrenia, unnecessary treatment with antidepressants, antipsychotics, or mood stabilizers may result in disruptive side-effects, including medication-induced mood disturbances.

Toward Diagnostic Clarity and Comprehensive Care

If you are struggling with schizophrenia or schizoaffective disorder that has not successfully responded to treatment, it may be time to seek more intensive treatment. It may also be valuable to be re-assessed to confirm diagnosis and ensure that you are being treated for the condition you actually have.

For many, residential treatment programs are the ideal setting to achieve diagnostic clarity and engage in intensive treatment to find rapid relief from symptoms. In these programs, you can undergo in-depth psychological assessment to determine the nature of your psychiatric distress. Simultaneously, the oversight provided by the residential environment allows clinicians to closely observe your symptoms as well as your response to pharmacotherapies in order to further refine diagnosis. As such, you can develop a complete picture of your psychiatric health and create a personalized treatment plan that will address your individual needs.

While medication is the cornerstone of treatment for both schizophrenia and schizoaffective disorder, it alone is typically not enough to create true recovery. The medical community is increasingly recognizing the value of treatment plans that combine medication with psychotherapy and family support. This holistic approach has been found to decrease symptom severity, improve interpersonal relationships, and enhance overall quality of life while keeping “dosages of antipsychotic medication as low as possible.” Residential treatment programs are ideal spaces to engage in such an approach due to their ability to offer a broad range of therapeutic modalities designed to provide the specific forms of support you require. This allows you to develop both the insight and the skills to cope with your disorder in healthy ways both during and after your time in residential care.

High-quality residential treatment programs also offer your loved ones to take an active role in your recovery through family and couples therapy. This can be an instrumental part of your healing journey, allowing you to gain a deeper understanding of each other’s needs, resolve conflict, and improve communication. By working together, you can forward with renewed stability, resilience, and confidence.

Bridges to Recovery offers comprehensive treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles programs and how we can help you or your loved one start on the path to healing.