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Schizoaffective Disorder

Patients who show concurrent symptoms of both mood disorders (bipolar or depressive types) and psychotic disorder are given the diagnosis of schizoaffective disorder. Onset is usually during young adulthood. The chronic symptoms are typically fewer and less severe than among those patients with schizophrenia.

Causes

Most mental health experts believe that schizoaffective disorder is a variation of schizophrenia, but the exact cause remains unclear. Current theory suggests that schizoaffective disorder is triggered by a range of factors working in combination including:

• Genetic susceptibility
• Environmental factors such as stress
• Imbalances of brain chemicals (neurotransmitters).

Signs and symptoms

The disorder usually comes on gradually. One of the most telling signs is a tendency for the victim's emotional reactions to be out of synch with the situation---or lacking entirely. Other symptoms include:

• Changes in eating or sleeping habits, energy level, or weight
• Confusion
• Inability to make decisions
• Hallucinations
• Delusions
• Ideas that do not connect or make sense
• A preference for solitude
• Loss of interest in normal activities such as work or school
• Neglect of personal hygiene
• Repetitive actions
• Long periods of immobility
• Strange statements
• Thoughts of harming oneself or others

Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) classification, a schizoaffective disorder is diagnosed if the patient's symptoms meet the following criteria:

• The patient experiences a period of uninterrupted illness in which there is a major depressive episode (with depressed mood), a manic episode, or a mixed episode, concurrent with symptoms of schizophrenia.
• During the same period of illness, there are delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
• The patient experiences symptoms of the mood episode and they are present for a substantial portion of the total duration of the active and residual periods of the illness.
• The illness of the patient is not due to direct physiologic effects of a substance (drug abuse, medication) or a general medical condition.

The schizoaffective disorder may be a specific type:

• In the bipolar type, the disturbance includes a manic or a mixed episode, or a manic or a mixed episode plus a major depressive episode.
• In the depressive type, the disturbance includes only major depressive episodes.

Treatment

As is indicated by the symptoms, treatment must focus on both psychotic and mood disorders. Antipsychotics are used to control the symptoms of schizophrenia. Antidepressant and antimanic medications are used for the mood disorder. Psychotherapy can be useful to help the patient understand the nature of the illness and the necessity of ongoing treatment. Support groups increase socialization and provide safe opportunities to build interpersonal skills. The family should be encouraged to attend a support group to understand the illness better and to learn ways they can be supportive of the patient.

Complications

Complications are similar to those for schizophrenia and major mood disorders. These include:

• Problems following medical treatment and therapy
• Abuse of drugs in an attempt to self-medicate
• Problems resulting from manic behavior (for example, spending sprees, sexual indiscretions)
• Suicidal behavior due to depressive or psychotic symptoms