Schizoaffective Disorder

Schizoaffective disorder is a thought disorder that includes both psychotic features (as seen in schizophrenia), and mood symptoms that may be either depressive or manic in presentation. The psychotic and mood symptoms may occur together or at different times. Schizoaffective disorder is diagnosed in fewer people than is schizophrenia: Approximately 1 percent of the population worldwide will be diagnosed with schizophrenia; 0.3 percent with schizoaffective disorder. Because the prevalence of schizoaffective disorder is low and because it includes both mood and psychotic features, the disorder can be difficult to diagnose. 

While at least two primary criteria for schizophrenia must be present, an important distinction is that people with schizoaffective disorder are more functional in terms of self-care and in their ability to interact with others. 

Symptoms

In order to be diagnosed with schizoaffective disorder, the DSM-5 states that at least two psychotic symptoms must be present, as well as mood symptoms of a specific duration. 

The symptoms of psychosis (which are identical to the primary criteria for schizophrenia) include:

  • Hallucinations
  • Delusions
  • Disorganized thinking, speech, or behavior, which may include catatonia
  • Flat affect or anhedonia (so-called "negative" symptoms of schizophrenia)

The mood symptoms that must be present include:

  • Mania
  • Racing thoughts 
  • Rapid speech
  • Bizarre or risk-taking behavior
  • Depression

Because the symptoms of schizoaffective disorder overlap with those of bipolar or depressive disorder and schizophrenia, the condition can be difficult to diagnose. Schizoaffective disorder is diagnosed when there is a period of time with a major depressive or manic mood and, at the same time, at least two psychotic symptoms appear, or when there is no sign of a major mood disorder but clear symptoms of schizophrenia/psychosis persist for at least two weeks. Although there may be periods of time when there are no symptoms of a mood disorder, they are present most of the time.

Causes

Although the cause is unclear, heredity is thought to play a role in schizoaffective disorder. People with a parent or sibling who has schizoaffective disorder, schizophrenia, or bipolar disorder may be at higher than average risk for developing this condition. The use of psychoactive drugs and extreme or chronic stress may contribute to onset for those who have an underlying predisposition to develop schizoaffective disorder. 

Treatment

Treatments for schizoaffective disorder are similar to treatments for schizophrenia. Antipsychotics are the mainstay of treatment. Mood stabilizing drugs and antidepressants are often prescribed as well. The disorder can go into remission when the proper medication is taken.

Treatment may also include psychotherapy, such as cognitive-behavioral therapy to improve the person’s understanding of the condition and help him or her manage day-to-day life, as well as family-focused therapy for the person’s family members.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • National Alliance on Mental Illness website. Schizoaffective Disorder. 
  • Tiihonen J, Walhbeck K, Lonnqvist J, et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ.    

Last reviewed 04/13/2017