SCHIZOAFFECTIVE DISORDER

What is schizoaffective disorder? Schizoaffective disorder is a disorder in which mood swings similar to those found in bipolar disorder are present together with symptoms of schizophrenia (delusions, hallucinations, disorganized speech, disorganized behavior and negative symptoms). To be diagnosed with schizoaffective disorder, there must also have been a period of at least two weeks of delusions or hallucinations without prominent mood symptoms.

There are two sub-types of schizoaffective disorder:

1.Schizoaffective bipolar type – where symptoms include manic episodes or manic and depressive episodes

2.Schizoaffective depressive type – where the symptoms include depressive episodes only. Distinguishing schizoaffective disorder from schizophrenia and mood disorder with psychotic features is often difficult and can only occur over a period of time.

What are the symptoms? During a depressive episode, symptoms may include poor appetite, weight loss, insomnia, agitation, general slowing down, loss of energy and loss of interest in usual activities, feelings of worthlessness, guilt, difficulties with concentration, and suicidal thoughts. During an episode of mania, symptoms may include an increase in work, social and sexual activity, racing thoughts and talking, inflated self-esteem, grandiosity, reduced need for sleep, and self-destructive behaviors.

Psychotic symptoms may include delusions, hallucinations, disorganized speech, disorganized behavior, total immobility, lack of facial expression, and loss of motivation.

How is schizoaffective disorder distinguished from schizophrenia or bipolar disorder? The distinction between schizoaffective disorder and schizophrenia or bipolar disorder is not easy. Emotion and behavior are more fluid and less easy to classify than physical symptoms. Seriously depressed people often have delusions or hallucinations. Mania can be difficult to distinguish from an acute episode of schizophrenia, and a depressive episode can be either a symptom of an acute phase of schizophrenia or a reaction to it. For this reason, over time a diagnosis of schizophrenia or bipolar disorder may be altered to schizoaffective disorder.

What causes schizoaffective disorder? The cause of schizoaffective disorder is unknown, although many view this disorder as a variant of schizophrenia. Current theories suggest that an imbalance of chemicals in the brain, coupled with predisposing factors, including genetic and environmental influences, create a vulnerability to this disorder.

Treatment and recovery from schizoaffective disorder Research indicates that a biopsychosocial approach addressing a combination of biological (medication), psychological (counselling, relaxation) and social factors, has the best recovery outcomes for people with schizoaffective disorder.

Medications Advancements in medication are continually improving the outlook for people with a mental illness. Medications used to treat schizoaffective disorder include antipsychotic medications, and antidepressants and/or mood stabilizers. Antipsychotic medications are effective for most people in reducing psychotic symptoms. Typically psychotic symptoms will be treated first and then the mood symptoms. There are two reasons – first, because untreated psychotic symptoms can have severe long-term consequences, and second because antidepressants and lithium (used for bipolar disorder) take several weeks to start working. After psychotic symptoms have ceased, the mood symptoms may be treated with antidepressants, lithium, anticonvulsants or electroconvulsive therapy. Sometimes an antipsychotic drug is combined with lithium or an antidepressant and then gradually withdrawn, then restored if necessary. But studies on treatment of this disorder suggest that antipsychotic medications are the most effective.

References:
Andreasen NC, Black DW. Introductory Textbook of Psychiatry. (4th ed.). Arlington, VA: American Psychiatric Publishing, Inc., 2006
Sadock BJ, Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: BehavioralSciences/Clinical Psychiatry (10th ed.). Philadelphia, PA, Lippincott, Williams, & Wilkins;2007.

More detail on mental health/mental illnesses may be found at: http://www.nimh.nih.gov/health/index.shtml or www.samhsa.gov/