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    Schizoaffective Disorder

    Schizoaffective disorder
    By Mayo Clinic Staff
    Dec. 23, 2008

    Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms ? such as hallucinations or delusions ? and of mood disorder symptoms, such as mania or depression.

    Not all experts agree that schizoaffective disorder should be treated as a distinct disorder. Some regard the condition simply as schizophrenia with some mood symptoms, while others view schizoaffective disorder as a separate disease with its own symptoms and treatments.

    Untreated, people with schizoaffective disorder may lead lonely lives and have trouble holding down a job or attending school. Or, they may rely heavily on family or psychiatric group homes.

    With treatment, people with schizoaffective disorder have a better prognosis than do people with schizophrenia, but not as good as people with mood disorders alone.

    Symptoms
    The symptoms of schizoaffective disorder vary from person to person. Generally, people who have the condition experience psychotic symptoms ? such as hallucinations, disorganized thinking and paranoid thoughts ? as well as a mood disturbance, such as depressed or manic mood. They tend to be very antisocial and shunned by the people around them.

    Psychotic features and mood disturbances may occur at the same time or may appear on and off interchangeably. The course of the schizoaffective disorder usually features cycles of severe symptoms followed by an improved outlook. To establish a diagnosis, a person must have demonstrated, at some point, delusions or hallucinations for at least two weeks without evidence of mood disorder symptoms.

    Most commonly, the mood disorder accompanying the schizophrenic features is either bipolar disorder (bipolar-type schizoaffective) or depression (depressive-type schizoaffective).

    Signs and symptoms of schizoaffective disorder may include:

    • Strange or unusual thoughts or perceptions
    • Paranoid thoughts and ideas
    • Delusions ? having false, fixed beliefs
    • Hallucinations, such as hearing voices
    • Unclear or confused thoughts (disorganized thinking)
    • Bouts of depression
    • Manic mood or a sudden increase in energy and behavioral displays that are out of character
    • Irritability and poor temper control
    • Thoughts of suicide or homicide
    • Irrelevant or incoherent speech
    • Catatonic behavior ? lack of response, sometimes with an extreme agitation that's not influenced by the environment
    • Deficits in attention and memory
    • Lack of concern about hygiene and physical appearance
    • Changes in energy and appetite
    • Sleep disturbances, such as difficulty falling asleep or staying asleep

    When to see a doctor
    If you suspect a friend or loved one may have schizoaffective disorder, be on the lookout for symptoms of psychosis as well as a mood disorder.

    People with schizoaffective disorder aren't likely to seek treatment. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional. Be prepared to accompany the person if necessary.

    Causes
    Schizoaffective disorder, like schizophrenia, appears to have distinct genetic links. It's unknown exactly what causes the disorder, but some experts believe it involves brain chemistry, such as an imbalance of serotonin and dopamine in the brain. Serotonin and dopamine are neurotransmitters ? chemicals that help relay electronic signals in the brain ? and help regulate mood.

    Other experts have speculated whether fetal exposure to toxins or viral illness, or even birth complications, may play a role.

    Risk factors
    Schizoaffective disorder is thought to be a neurodevelopmental disorder ? which involves delays or variations in the way a child's brain develops ? like in schizophrenia. Genetics plays a role in development of the disorder, and people with relatives who have schizoaffective disorder are more likely to develop this condition. Environmental factors also may be involved.

    Older people are more likely to have the depressive-type schizoaffective disorder, while younger people tend toward the bipolar type.

    Factors that increase the risk of developing the schizoaffective disorder include:

    • Having a relative who has schizophrenia
    • Having a relative who has a mood disorder
    • Having a relative who has schizoaffective disorder
    • Being at risk of developing schizophrenia

    Complications
    People with schizoaffective disorder are at an increased risk of:

    • Developing schizophrenia
    • Having major depression
    • Having bipolar disorder

    In addition, complications that may directly or indirectly accompany these conditions also may be experienced with schizoaffective disorder.

    Preparing for your appointment
    You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

    Here's some information to help you prepare for your appointment, and what to expect from your doctor.

    What you can do

    • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
    • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
    • Write down your key personal information, including any major stresses or recent life changes.
    • Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications, vitamins, supplements or other natural remedies you're taking.
    • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
    • Write down questions to ask your doctor.

    Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For schizoaffective disorder, some basic questions to ask your doctor include:

    • What is likely causing my symptoms or condition?
    • Other than the most likely cause, what are possible causes for my symptoms or condition?
    • How will you determine my diagnosis?
    • Is my condition likely temporary or chronic?
    • What treatments do you recommend for this disorder?
    • What are the side effects of medications commonly used for this condition?
    • How long will it take for medications to noticeably improve my symptoms?
    • If the first medication we try isn't effective, what will you recommend next?
    • Would talk therapy help me? If yes, should my family participate?
    • How much improvement can I expect if I follow your recommended treatment plan?
    • I have these other health conditions. How can I best manage them together?
    • Are there any restrictions that I need to follow?
    • Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
    • Is there a generic alternative to the medicine you're prescribing me?
    • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

    In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

    What to expect from your doctor
    Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

    • Do you have close relationships with family members? How about friends?
    • Have you recently felt depressed, hopeless, fatigued and disinterested in things that you normally enjoy? If yes, how long would you say those symptoms lasted?
    • Have you recently felt euphoric and extremely optimistic, with increased energy and a belief that you can accomplish anything? If yes, how long would you say those symptoms lasted?
    • Have you noticed a change in your appetite or in your need for sleep, either positive or negative?
    • What other symptoms have you noticed? Are they continuous, or occasional?
    • When did you first notice these symptoms?
    • What do you suspect is causing your symptoms?
    • Have your family members or friends expressed concern about your behavior?
    • Has anyone suggested that you see or hear things that don't exist?
    • Do you ever feel that you're being watched, or that people are out to get you?
    • Have you ever felt that you could influence other people and events through your thoughts?
    • Have you ever thought about harming yourself or others? Have you ever actually done so?
    • Have any of your close relatives been diagnosed or treated for mental illness?

    What you can do in the meantime
    While you're waiting for your appointment, ask friends or family members if they have felt concerned about your behavior. You'll also want to find out about your family's medical history, including any history of mental illness. If you have fantasies about hurting yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately.

    Tests and diagnosis
    Diagnosis of schizoaffective disorder usually comes after an in-depth interview with your doctor. If your doctor suspects a psychiatric condition, he or she might take a complete medical, psychiatric and social history and also ask about symptoms and mental well-being. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted.

    To be diagnosed with schizoaffective disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

    DSM criteria for the diagnosis of schizoaffective disorder include:

    • Schizophrenia along with mood symptoms
    • A mood disorder along with symptoms of schizophrenia
    • Both a mood disorder and schizophrenia
    • A psychotic condition other than schizophrenia, plus a mood disorder

    Also, diagnosis requires that the condition is not due to the direct effects of a substance or due to a general medical condition.

    In addition, the person must never have met the criteria for any other schizophrenic disorder. It's possible that symptoms may be mimicked by other medical conditions, such as steroid use, Cushing's syndrome, HIV-related illness, temporal lobe epilepsy, neurosyphilis, thyroid or parathyroid problems, alcohol or other drug abuse or dependence, and metabolic syndrome.

    Treatments and drugs
    People with schizoaffective disorder generally respond best to a combination of medications and counseling. The exact regimen varies depending on the type and severity of symptoms, and whether the disorder is depressive-type or bipolar-type.

    In general, doctors prescribe medications to alleviate psychotic symptoms, stabilize mood and treat depression. Meanwhile, psychotherapy can help curb distorted thoughts, teach appropriate social skills and diminish social isolation.

    Medications may include:

    • Antipsychotics. Also called neuroleptics, doctors prescribe these medications to alleviate psychotic symptoms, such as delusions, paranoia and hallucinations. Antipsychotic medications include clozapine (Clozaril), risperidone (Risperdal) and olanzapine (Zyprexa).
    • Mood-stabilizing medications. When the schizoaffective disorder is bipolar-type, mood stabilizers can level out the highs and lows of bipolar disorder, also known as manic depression. People with bipolar disorder have episodes of mania and depressed mood. Examples of mood stabilizers include lithium (Eskalith, Lithobid) and divalproex (Depakote).
    • Antidepressants. When depression is the underlying mood disorder, antidepressants can alleviate feelings of sadness, hopelessness, or difficulty with sleep and concentration. Common medications include citalopram (Celexa), fluoxetine (Prozac) and escitalopram (Lexapro).

    Nonmedication therapy may include:

    • Psychotherapy and counseling. Building a trusting relationship in therapy can help people with schizoaffective disorder better understand their condition and feel hopeful about their future. Effective sessions focus on real-life plans, problems and relationships. New skills and behaviors specific to settings such as the home or workplace also may be introduced.
    • Family or group therapy. Treatment can be more effective when people with schizoaffective disorder are able to discuss their real-life problems with others. Supportive group settings can also help decrease social isolation and provide a reality check during periods of psychosis.

    In general, people with schizoaffective disorder have a better prognosis than do people with schizophrenia, but not as good as that of people with mood disorders only. However, long-term treatment is necessary, and the prognosis varies from person to person.

  2. #2

    Re: Schizoaffective disorder

    I personally think that bipolar and schizophrenia run on the same axis and schizo-affective disorder falls somewhere inbetween. So some people might be more prone to the hypomania and depression and others may be more prone to psychosis and some may experience mixed states.

  3. #3
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    Re: Schizoaffective disorder

    Dr. Baxter-

    How does a child therapist/child psychiatrist diagnosis a youngster (tween) with symptoms related to both BP/schizophrenia (mostly related to the latter)? My son has been showing symptoms for a while and we haven't been able to pin point it down until the last month. I came home from his appointment today and did a search on both childhood illness' and flipped out. Myself, I have my own issues... He has FAE/ADHD/RAD due to adoption related issues. He is an at risk child and has been thru a lot due to severe neglect as an infant from overseas orphan issues/birthmom neglect/abuse/fetal alcohol related problems/rickets/malnurishment. He has been in therapy for attachment problems (5 years worth in his early years)... and seen a child psychiatrist for over half of his life and on meds for almost his entire life.

    He is to be evaluated from his therapist and recommended for therapy. What can we expect from the therapy evaluation and sessions? As an older child I have no clue what to expect. He lies constantly to us, his teachers, peers and the child psychiatrist. The doctor is aware of this. I'm very worried about him as his mom of what will happen to him regardless of the outcome/diagnosis in general. Just what his future holds. DH and I know that we might be supporting him as an adult but we fear that he could end up in juvie-hall if he doesn't straighten up. That is how bad things are getting. Is this normal for this type of diagnosis'? What can we do other than therapy and meds? I didn't end up in juvie-hall but was a handful as a child. His lack of hygiene is beyond disgusting. He thinks the cop shows on tv are actually real along with movies. We have finally convinced him they are not real. He is obsessed with certain tv shows, rocks constantly and listens to music or will just rock. He has since he was an infant. I wondered then if it was beyond RAD issues. So did one of his other therapists.

    Thank you for your time.

    C
    A loving heart is the truest wisdom

  4. #4
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    Re: Schizoaffective disorder

    I'm not a child psychologist and I think it is more difficult to diagnose certain disorders early in childhood so I'm not sure how much help or insight I can provide. Certainly, the combination of FAS and ADHD is challenging enough and both can be associated with antisocial behavior. This of course does not doom him to a life before the courts. But you are doing the right thing by trying to clarify the diagnosis and get early intervention.

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