Schizoaffective Disorder

Schizoaffective disorder is a chronic and serious mental health condition characterized by both psychotic and mood symptoms. It causes the symptoms of schizophrenia, such as delusions, hallucinations, and disorganized speaking. It also causes episodes of major depression, mania, or both. Schizoaffective disorder can be successfully treated with medications, therapy, and good social support, but it can also cause serious impairment when not treated. Individuals who receive ongoing care are likely to be able to minimize symptoms and live a fulfilling life.

What is Schizoaffective Disorder?

Schizoaffective disorder is a very serious and chronic mental illness that causes symptoms of both schizophrenia and a mood disorder. The latter may be symptoms of either bipolar disorder or depression, which may include depressive symptoms, manic symptoms, or both. The schizophrenic symptoms may include hallucinations, delusions, and disordered thoughts and speech.

The symptoms, complications, and co-occurring disorders of schizoaffective disorder can cause serious impairment in a person’s life. It can cause social impairment and isolation, can contribute to substance use disorders, and can even make it impossible to live independently or hold down a job. Treatment for schizoaffective disorder can help manage symptoms and greatly improve quality of life and independence.

Types of Schizoaffective Disorder

There are two main subtypes of schizoaffective disorder that may be diagnosed in a patient with this condition. The types are based on the kind of mood disorder symptoms the person experiences. In both types the individual has signs and symptoms of schizophrenia, but the mood symptoms may differ. The two diagnostic types of schizoaffective disorder are:

  • Depressive schizoaffective disorder. The depressive type occurs when a person experiences both schizophrenia symptoms and depression symptoms, such as a persistent low mood, fatigue, lethargy, and loss of interest in activities.
  • Bipolar schizoaffective disorder. The bipolar type causes schizophrenia symptoms and symptoms of mania. There may also be symptoms of depression. Mania is an elevated mood with high energy, fast talking, and impulsive behaviors.

A person who meets the diagnostic criteria for schizoaffective disorder is diagnosed with the depressive type if there has never been an episode of mania. Just one manic episode, even if there are also depressive symptoms, requires a diagnosis of the bipolar type.

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Symptoms and Diagnosis of Schizoaffective Disorder

The symptoms of schizoaffective disorder include symptoms of schizophrenia along with those of either depression or mania or both. The first diagnostic criterion is that a patient exhibits at least two of the major symptoms of schizophrenia and that at least one of the two is hallucinations, delusion, or disorganized speech:

  1. Delusions. These are persistent and false beliefs. A person continues to believe they are real even when presented with evidence to the contrary. An example could include believing in conspiracy theories or paranoia about the intentions of a friend or family member.
  2. Hallucinations. Hallucinations are sensations that a person experiences as real but that are not actually real. These may be auditory, such as hearing voices, which is common with schizophrenia, but they may also be visual or involve touch, smell, or taste.
  3. Disorganized speech and thoughts. Schizophrenia can cause a person’s thoughts to race and jump illogically from one thing to another, which leads to disorganized patterns of speech.
  4. Unusual behaviors. The disorganized or unusual behaviors caused by this condition may include overreactions, aggression, agitation, strange movements, childlike behaviors, and others.
  5. Negative symptoms. These are characterized by lacking something, such as emotions or emotional response. A person may have a flat or emotionless affect or may move very slowly or not at all.

To be diagnosed with schizoaffective disorder a person must have symptoms of a significant mood episode at the same time as experiencing the schizophrenic symptoms as well as periods of only schizophrenia. The mood symptoms may include those of depression, mania, or both. Depressive symptoms include:

  • Persistent, almost daily feelings of sadness and hopelessness
  • Fatigue and lethargy
  • A lack of interest in normal activities
  • Problems with concentrating, memory, or getting things done
  • Feeling ashamed, guilty, or worthless
  • Sleeping difficulties, including either insomnia or over-sleeping
  • Weight gain or loss due to changes in eating habits
  • Agitation and irritability or a slowed affect.
  • Thoughts of suicide and death, or suicidal behaviors

Symptoms of mania include:

  • A sense of euphoria or extreme joy, often a wired feeling and unusual optimism
  • Very high energy and activity levels
  • Sleeping too little
  • Thoughts that race from subject to subject, often causing confused speech
  • Distractibility, lack of focus
  • Impulsive and risky behaviors, some that have serious consequences

These are the diagnostic criteria that mental health professionals use to determine if a patient has schizoaffective disorder, but there are often other signs. Schizoaffective disorder, especially when untreated, can spill over into many areas of life and include complications caused by the condition. Additional signs someone may be struggling with schizoaffective disorder include:

  • Withdrawal from friends and family
  • Difficulties at work or school
  • Lapses in hygiene
  • Poor judgment and risky behaviors
  • Self-harm, such as cutting
  • Financial difficulties
  • Substance abuse
  • Legal problems

Causes and Risk Factors

As with other mental illnesses, there is no definite known cause for schizoaffective disorder. It is thought to have a genetic component, as it tends to run in families. Early environmental factors may play a role in the development of this mental illness; anything that negatively impacts the development of the brain may cause changes that make a person more susceptible to developing the condition.

Neurotransmitters in the brain are likely to be contributing factors, especially dopamine, but how they come to be altered in someone with schizoaffective disorder is not understood. Likewise, there is evidence that there are differences in brain structures that may help explain why some people develop this condition. Known risk factors for schizoaffective disorder include family history, especially in the immediate family, stressful situations or experiences of trauma, and taking psychoactive drugs.

Co-Occurring Disorders

Someone with schizoaffective disorder is more likely to also have other conditions, especially mental illnesses and substance use disorders. This may be true because all of these conditions have similar risk factors. It may also be explained by the fact that someone with an untreated condition like schizoaffective disorder is more likely to misuse substances as a way to cope or that substance use can trigger episodes of mental illnesses.

By definition of schizoaffective disorder, bipolar disorder and depression coincide with the condition. But one of the most common mental illnesses, aside from these two, that co-occurs with schizoaffective disorder is anxiety disorder. Any kind of substance use disorder is also more common in people with this condition than in the general public.

Treatment and Prognosis of Schizoaffective Disorder

Treatment for schizoaffective disorder is important because, although there is no cure for the condition, it can be successfully managed. Treatment usually includes two main components: medication and therapy. Medications used include antipsychotics to manage the schizophrenia symptoms, mood stabilizers to treat bipolar symptoms, and antidepressants to treat depressive episodes.

The only medication that is actually approved for treating schizoaffective disorder is paliperidone (Invega), an antipsychotic. However, doctors often prescribe additional drugs. It can take time to determine which combination of medications will provide a patient with the best symptom relief and the fewest side effects. It is important to follow a doctor’s instructions about medications and not stop using them without guidance.

Therapy is a complementary approach used to treat patients who are managing symptoms with medications. Individual behavioral therapies help patients learn to manage behaviors and negative emotions, set goals, and work on relationships. Family therapy can help families work together to learn more about the condition and how to support a loved one. Group therapy and support helps develop social skills. There are also many alternative and creative therapies, lifestyle changes, vocational training, and other strategies that can support treatment and help a patient live a more normal, stable life.

The prognosis for schizoaffective disorder when diagnosed and treated is very good. The chances of having a normal life, managing symptoms, and living independently are better than with other psychotic conditions. To get to this point requires a professional diagnosis and a commitment to ongoing, potentially lifelong treatment.