Schizoaffective Disorder Treatment
Schizoaffective disorder, a serious mental illness characterized by both symptoms of schizophrenia and of a mood disorder, can be effectively managed with ongoing treatment. Medications, including antipsychotics and drugs to address mood episodes, are crucial for treatment. Therapy is also important for helping patients manage symptoms and restore function. Additional therapies, social support, family involvement, managing co-occurring disorders, and good, ongoing self-care are also useful in treating schizoaffective disorder.
Schizoaffective disorder is a serious and chronic mental illness that can be managed with the right combination of treatment strategies. This condition is characterized by symptoms of schizophrenia, which are psychotic symptoms, along with episodes and symptoms of bipolar disorder or major depression. This combination of symptoms can have a big impact on a person’s life, making it difficult to function normally.
The prognosis for patients diagnosed with schizoaffective disorder is generally good, however. With the right treatment plan, a commitment to long-term treatment, and support from family and friends, someone living with this condition can get better. Treatment plans vary by individual but in general include a combination of medications, therapy, social support, and self-management.
Diagnosing Schizoaffective Disorder
The first step in getting effective treatment for schizoaffective disorder is an accurate diagnosis. This condition can be tricky to diagnose, because it causes symptoms of more than one mental illness. It may be easy to mistake it for schizophrenia or a mood disorder, when really it is a combination of both. Diagnosis requires an evaluation by a mental health professional, who uses the medical and mental health history of the patient, observations, and interviewing to determine if a person meets the criteria for schizoaffective disorder. These criteria include:
- A period of time during which a person experiences both a significant mood episode, which may be manic or depressive, along with certain symptoms of schizophrenia
- Experiencing either hallucinations, delusions, or both over a period of two or more weeks, during which the patient does not also have a mood episode
- Having symptoms of bipolar disorder or major depression for most of the period during which there are active mental illness symptoms
- Symptoms of the mental illness not explained by a different mental health or medical condition or by substance use
The two most important components of treatment for schizoaffective disorder are medications and therapy. While individual plans will vary to some degree by patient, the best and most effective treatment plans include both of these elements. Medications alone will not treat or cure this condition, and therapy alone is not enough to manage symptoms.
Because schizoaffective disorder causes the psychotic symptoms of schizophrenia, like hallucinations and delusions, patients benefit from using antipsychotic medications. These drugs are useful in managing and reducing the symptoms, but it is often necessary to try more than one before getting the best results. It is very important for patients to stick with one medication long enough to determine if it is effective and to never stop taking it without talking to the prescribing physician.
There are two different classes of antipsychotics. First generation drugs, also known as typical antipsychotics, are older and may cause more severe side effects. Second generation, or atypical, antipsychotics are newer and cause fewer and less severe side effects. Doctors will typically begin treatment by prescribing a newer drug, but for some patients the first generation medications work better. First generation antipsychotics include:
- Fluphenazine (Modecate)
- Haloperidol (Haldol)
- Loxapine (Loxitane)
Typical antipsychotics may cause muscle stiffness and cramping, tremors, weight gain and metabolic syndrome, and dry mouth. There is also a risk that first generation antipsychotics will cause a very serious condition called tardive dyskinesia. It is characterized by repetitive, involuntary muscle movements. The risk is higher the longer a person has been taking an antipsychotic.
Second generation antipsychotics also carry the risk of tardive dyskinesia, but it is less likely. More common side effects include weight gain and metabolic syndrome, high cholesterol, and sexual dysfunction. There is just one antipsychotic that is specifically approved to treat schizoaffective disorder—paliperidone—but doctors may try various drugs to find which one is most effective for each individual. Examples of atypical antipsychotics include:
- Asenapine (Saphris)
- Clozapine (Clozaril)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Paliperidone (Invega)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
Antipsychotics are used to minimize the psychotic symptoms caused by schizoaffective disorder, but most patients also need medications to manage mood episodes. There are two types of schizoaffective disorder, based on the type of mood disorder a person experiences: bipolar type and depressive type. Those with the depressive type can benefit from antidepressants, including:
- Citalopram (Celexa)
- Duloxetine (Cymbalta)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
Antidepressants must be used for several weeks before effectiveness can be determined, and it can be dangerous to stop using them suddenly. It is very important to follow a doctor’s instructions when using these drugs. Potential side effects include vomiting, diarrhea, nausea, weight gain, drowsiness, and sexual dysfunction.
Patients with the bipolar type of schizoaffective disorder may benefit from mood stabilizing drugs. These help reduce the mood swings that a patient may experience between depression and mania. Lithium is commonly used, but anticonvulsants can also be used as mood stabilizers. Potential side effects of these drugs include headaches, rashes, nausea, vomiting, excessive thirst and urination, weight change, back pain, and vision changes. Examples of anticonvulsants used to stabilize mood include:
- Carbamazepine (Equetro)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Valproic acid (Depakote)
Therapy for Treating Schizoaffective Disorder
Therapy is also a crucial component of treating schizoaffective disorder. Medication alone is not enough to effectively manage the condition. There are many different types of therapy and some people may do better with one than another. Commonly, though, behavioral therapies are used, especially cognitive behavioral therapy, or CBT.
CBT and other behavioral therapies target a patient’s negative thought and behavior patterns and help them learn to recognize and change them. These therapies are action-oriented and help patients develop healthy coping skills, make and achieve goals, relate more effectively to other people, develop better relationships, and make other types of positive changes to help manage and live with schizoaffective disorder.
Family-based therapies can also be very useful for people with schizoaffective disorder. Patients often rely on family members for support, so involving them in therapy is often effective. Family therapy and education helps teach family more about the condition and how to support a loved one who lives with this illness. Family therapy also helps family members have better relationships with each other.
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Additional Treatment Strategies
While behavioral and family therapies and medications are the backbone of treatment for schizoaffective disorder, there are many other elements that can help manage this condition. Alternative therapies, for instance, which are often available at residential treatment facilities, can further support symptom management and give patients other outlets for expression. There are creative therapies using music, art and drama, animal therapies, massage therapy, and also types of alternative medicine, like acupuncture, that can provide benefits for patients.
Self-care and management of the illness is also important, especially when patients leave treatment and are faced with living at home again. Treatment programs can teach patients how to manage their illness once outside the safe environment of a residential facility. In addition to keeping up with treatment, including medications and regular therapy sessions, patients can use a number of self-care tools to maintain wellness:
- Social support, including spending time with friends and family and joining mental health support groups
- Relaxation strategies and healthy coping mechanisms, such as meditation, deep breathing exercises, or yoga
- Good health practices, like eating well, exercising, and getting enough sleep
- Avoiding drugs and alcohol
Treating Co-Occurring Conditions
Someone who has been diagnosed with schizoaffective disorder may also have co-occurring conditions, including other mental illnesses or substance use disorders. Also, many patients who take antipsychotics develop physical health problems like metabolic syndrome, weight gain, and type 2 diabetes. For overall wellness, it is important that patients are screened and treated for these other conditions. Addressing all of a person’s health concerns, both physical and mental, is an important part of effective treatment and improving quality of life.
Living with schizoaffective disorder can cause serious impairment, but there is hope for anyone who gets an accurate diagnosis and who is prepared to commit to a treatment plan. With medications, therapy, and other treatment strategies that address all of a person’s needs and concerns, the symptoms of schizoaffective disorder can be effectively minimized and managed, restoring normal functioning.