Schizoaffective Disorder

What is Schizoaffective Disorder?

Schizoaffective disorder is often misdiagnosed in mental health treatment, making it one of the most commonly misunderstood mental conditions. Some researchers suggest changes to the way this disorder is defined, while others argue it should be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide used by health professionals to diagnose mental conditions. When this disorder was first added to the DSM, there were serious doubts about whether the diagnosis was reliable or useful. The disorder is part of a series of conditions that have similar diagnostic criteria, which makes differentiating schizoaffective disorder from other mental health conditions challenging.

What Causes Schizoaffective Disorder?

The term ‘schizoaffective disorder’ initially popped up as a subtype of schizophrenia in the first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook used by health professionals to diagnose mental conditions. Eventually, schizoaffective disorder became recognized as its own condition despite no clear differences in cause or physical manifestation from schizophrenia.

Unfortunately, there haven’t been any decisive studies on what causes this disorder. Yet, by looking at potential causes of mood disorders and schizophrenia separately, we can still discuss certain possibilities.

Research indicates that up to 50% of people with schizophrenia also suffer from depression. The development of mood disorders and schizophrenia is influenced by multiple factors. These include genetic traits, social circumstances, traumatic experiences, and stress.

If a person has schizophrenia, it appears their immediate family members (siblings, parents, children) might be at an increased risk of developing schizoaffective disorder and vice versa. Additionally, individuals may have higher chances of developing schizoaffective disorder, if they have a close relative with bipolar disorder schizophrenia, or schizoaffective disorder itself.

Risk Factors and Frequency for Schizoaffective Disorder

Schizoaffective disorder is a complex mental health condition. Since it was first defined, the criteria used to diagnose schizoaffective disorder have changed and evolved, making it a challenge to conduct large-scale studies on its occurrence and impact. Despite this, we do know a few key things about who it tends to affect.

• Approximately 30% of schizoaffective disorder cases develop between 25 and 35 years old.
• It is more common in women than in men.
• It is about one-third as common as schizophrenia.
• About 0.3% of the population will experience schizoaffective disorder at some point in their lives.
• Schizoaffective disorder accounts for 10 to 30% of hospital admissions related to psychotic conditions.

Signs and Symptoms of Schizoaffective Disorder

Determining whether someone has schizoaffective disorder starts with a full medical history. The focus is on whether the patient meets the specific criteria for schizoaffective disorder, as outlined by the DSM-5.

The criteria for diagnosing schizoaffective disorder are as follows:

• An uninterrupted period of illness where there’s both a serious mood episode (depressive or manic) and at least two symptoms of schizophrenia. The depressive episode must involve a saddened mood.
• Presentations such as delusions, hallucinations, disorganized speech, very disorganized or irregular behavior, or evident absence of expression or initiative. Out of these symptoms, at least one must be from the first three.
• Experiencing hallucinations and delusions for a minimum of two weeks, without a great mood episode.
• Displaying symptoms of a serious mood episode for the majority of the illness. This includes both active and non-active parts of the illness.
• This disorder cannot be linked to substance abuse or the consequences of a different medical condition.

The assessment then differentiates between two different types of schizoaffective disorder:

• Bipolar type: includes incidences of mania and potentially major depression.
• Depressive type: only includes incidences of major depression.

Please note that it is not enough to show symptoms of schizophrenia along with a significant mood episode to receive a diagnosis of schizoaffective disorder. The full criteria must be met. More information can be found in the relevant sections below.

The last part of the evaluation involves objective and physical examinations. In order to rule out other potential diagnoses, a full mental status examination, a physical examination, and a neurological examination should be given.

Testing for Schizoaffective Disorder

Typically, a diagnosis can often be made based on a patient’s symptoms and a doctor’s physical examination. However, sometimes additional tests or imaging might be useful to confirm the diagnosis. These extra tests could include a magnetic resonance imaging (MRI) scan, an electroencephalography (EEG) test which records the electrical activity of your brain, or a computed tomography (CT) scan.

Depending on your symptoms and history, the doctor might ask you to have certain laboratory tests. If your symptoms are not typical, these tests could prove to be beneficial. The lab tests can include a complete blood count (CBC), a test to check your cholesterol and fat levels (lipid panel), a urine drug screen, a urine pregnancy test, a urine test (urinalysis), a test to check the functioning of your thyroid gland (TSH level), a rapid plasma reagent test (a test for syphilis), and a HIV test.

If your doctor finds anything unusual in your neurological exam, which is an assessment of your nervous system and how it’s working, you might be asked to have an MRI or CT scan of your brain. These scans will help your doctor rule out any abnormalities inside your brain.

Treatment Options for Schizoaffective Disorder

Schizoaffective disorder is generally treated with a combination of medication and therapy, each tailored to the individual’s specific needs. The majority of patients with schizoaffective disorder are treated with a type of medication known as an antipsychotic. Additionally, around 20% of patients also take a mood-stabilizer, and 19% combine their antipsychotic medication with an antidepressant. Before beginning treatment, it’s important to assess if the individual poses a risk to themselves or others which could require they be admitted to a hospital. This could also be the case if they’re neglecting daily tasks or their ability to function has dropped significantly.

Medication for schizoaffective disorder can include the following types:

Antipsychotics works by targeting overactive brain responses that can cause symptoms like hallucinations, negative feelings, disordered speech and behavior which are common among patients with schizoaffective disorder. Some well-known antipsychotics are risperidone, olanzapine, quetiapine, and haloperidol. There is also a medication called clozapine that can be used in severe cases.

Mood-stabilizers are for patients who experience periods of rapid thoughts, impulsivity, inflated self-esteem, many ideas, increased level of activity, lesser need for sleep, and excessive talking. Examples of mood-stabilizers are lithium, valproic acid, carbamazepine, and lamotrigine. These are typically used if the patient has a history of manic or hypomanic symptoms.

Antidepressants are used to combat depression associated with schizoaffective disorder. The type of antidepressants called selective-serotonin reuptake inhibitors (SSRIs) is a preferred choice because it has fewer side effects and is typically easier for patients to tolerate. Common SSRIs include fluoxetine, sertraline, and citalopram.

The combination of medication and therapy can be beneficial for patients with schizoaffective disorder. Therapy can not only include one-on-one sessions with a professional, but also supports involving family or group therapy sessions, and educational programs to learn more about the disorder and how to manage it.

Individual therapy focuses on normalizing thought processes, helping the patient understand their disorder, and reducing symptoms. They’d work on everyday goals, how to navigate social situations, and how to deal with conflicts.

Family or group therapy is another crucial component. Educating the family about the disorder and its treatment greatly helps consistency with medication intake, ensuring the individual attends appointments, and providing ongoing support considering the changing nature of the disorder. Group programs can be particularly helpful for patients who’ve been socially isolated, as it provides a community of shared experiences.

A last resort treatment method called electroconvulsive therapy (ECT) is also used for urgent situations or patients who haven’t responded to other treatment options. Symptoms that usually call for ECT are catatonia and aggression. ECT is considered safe and effective for most long-term admitted patients.

What else can Schizoaffective Disorder be?

Because it includes a mix of both psychotic and mood symptoms, schizoaffective disorder can easily be confused with other mental conditions. When examining schizoaffective disorder, doctors need to rule out the following disorders:

• Schizophrenia
• Major depressive disorder with psychotic symptoms
• Bipolar disorder

Here’s how these conditions compare:

Schizophrenia VS Schizoaffective Disorder: To diagnose schizoaffective disorder, there must be a clear period of at least two weeks where only psychotic symptoms (such as delusions and hallucinations) occur, with no mood issues. A significant mood episode (like depression or mania) must be present for most of the illness. However, if psychotic symptoms are the dominant feature during most of the illness duration, the diagnosis is more inclined towards schizophrenia. Schizophrenia also requires 6 months of prodromal or residual symptoms, unlike schizoaffective disorder.

Major Depressive Disorder with Psychotic Features VS Schizoaffective Disorder: Those with major depression with psychotic features experience psychotic symptoms only during their mood episodes. In contrast, schizoaffective disorder needs a minimum of 2 weeks where only psychotic symptoms exist without mood issues. People with major depressive disorder with psychotic features don’t meet the requirement for a schizoaffective disorder diagnosis.

Bipolar Disorder VS Schizoaffective Disorder: Similarly, people with bipolar disorder with psychotic features only have psychotic symptoms during a manic episode. Again, schizoaffective disorder requires a period of at least 2 weeks where there are only psychotic symptoms without mood issues. The psychotic features in bipolar disorder don’t meet the conditions for a diagnosis of schizoaffective disorder.

What to expect with Schizoaffective Disorder

Diagnosing schizoaffective disorder can be challenging because the criteria doctors use to identify it change from time to time. However, according to a study by Harrison and colleagues in 2001, about 50% of people with this type of psychotic illness had favorable outcomes. This means they had few or no symptoms and/or were able to hold down a job.

The results of this study were significantly influenced by how early the treatment was started and how well the treatment plan – which includes medications and therapy – was followed.

Possible Complications When Diagnosed with Schizoaffective Disorder

When schizoaffective disorder is not properly treated, it can lead to serious problems, impacting both social interactions and daily activities. This can result in problems like joblessness, loneliness, and difficulties in taking care of one’s own basic necessities.

However, the problems resulting from untreated mental disorders extend beyond just social and functional issues. Research has indicated that up to 5% of people suffering from a mental illness involving severe loss of touch with reality may end their own lives over time. Additionally, it has been found that among all suicide incidents, 10% can be related back to individuals dealing with these serious mental health conditions.

• Job loss
• Social isolation
• Difficulty with self-care
• Potential suicide risk (up to 5% in those with serious mental illnesses)
• Contribution to overall suicide statistics (10% of all suicides linked to severe mental health conditions)

Preventing Schizoaffective Disorder

Patients and their loved ones can greatly benefit from learning more about their illness and the ways to manage it. This includes:

– Urging the patient to participate in treatment and recovery programs. These programs include cognitive-behavioral therapy, which is a kind of talk therapy that can help a patient deal with problematic thoughts and behaviors, as well as programs for tackling drug and alcohol misuse.

– Offering social skills training. This is a type of therapy that teaches patients how to interact effectively and appropriately with others.

– Providing emotional support and guidance in daily life. This can include helping them to deal with stressful situations or to make important decisions.

– Teaching self-care practices and actions that can help the patient become more independent. This could include tasks like preparing meals, managing medications, or taking care of personal hygiene.

– Helping the patient find and keep a job through supported employment, which offers services like job coaching or training.