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David Baxter

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Schizoaffective disorder is not a distinct disease entity
By Andrew Czyzewski
25 February 2008
J Affect Disord 2008; 106: 209-217

Schizoaffective disorder does not appear to be a distinct disease entity, nor is it a variant or comorbid type of schizophrenia or mood disorder, results of a systematic review demonstrate.

Instead, Elie Cheniaux (Federal University of Rio de Janeiro, Brazil) and colleagues favor a model whereby schizoaffective disorder represents an intermediary position on a "psychosis continuum" between schizophrenia at one extreme and mood disorders at the other.

Ever since its first description by Kasanin in 1933, schizoaffective disorder has raised a considerable amount of debate regarding its precise definition.

Patients with schizoaffective disorder present with psychotic and affective symptoms, but there is uncertainty regarding its relationship with schizophrenia and mood disorders.

Searching the literature, the researchers found over 100 clinical studies describing comparisons between at least 10 schizoaffective disorder patients and at least 10 schizophrenia or mood disorder patients.

Collating data from the studies, Cheniaux et al. looked for differences and similarities between the three disorders in terms of demographics, family morbidity, complementary exams (e.g., structural neuroimaging) symptomatology, and other clinical variables such as suicidal behavior and substance abuse.

Cheniaux and colleagues found no evidence to support the often-cited theory that schizoaffective disorder is an atypical form of schizophrenia or mood disorder, since many studies found differences between the conditions, particularly in terms of positive and negative symptoms.

The researchers also found no evidence to support the view that schizoaffective disorder is a comorbidity in which the same patient suffers from both schizophrenia and mood disorder simultaneously.

This was evidenced by the fact that various studies found similarities between schizophrenia and schizoaffective disorder and, at the same time, differences between schizoaffective disorder and mood disorders or vice versa.

The results of the study seem to discount the possibility that schizoaffective disorder constitutes a discrete mental disorder, since many studies found similarities between schizoaffective disorder and schizophrenia or mood disorders.

This demonstrates that schizoaffective disorder cannot be unequivocally distinguished from schizophrenia or mood disorders, say the researchers.

Discussing overall trends in the study, Cheniaux et al. say that schizoaffective disorder could simply represent a heterogeneous group of schizophrenia and mood disorder patients.

However, they say a more likely explanation would be that there exists a single psychosis whereby schizophrenia and mood disorders constitute extremes of continuum and schizoaffective disorder lies somewhere in the middle.

Abstract
 

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