What is Schizoaffective Disorder?
Schizoaffective disorder is a serious and chronic mental illness that must be diagnosed by a mental health professional. It causes symptoms of psychosis, like those seen in patients with schizophrenia, including hallucinations and delusions, while also causing mood symptoms like depression. Schizoaffective disorder requires professional treatment with medications and psychotherapy.
Schizoaffective Disorder and Related Definitions
Schizoaffective disorder is a mental health condition that causes symptoms of both schizophrenia and either depression or bipolar disorder. Possible symptoms include hallucinations, delusions, mood changes, mania, and feelings of sadness and hopelessness. This is a chronic and incurable mental illness, but with a diagnosis and treatment it can be managed, and most patients can return to a normal lifestyle.
Until recently, categorizing schizoaffective disorder as a separate disorder from schizophrenia was controversial. Recently it was added to the latest edition of the DSM, the manual used by psychiatrists to diagnose conditions, and is accepted by experts as a unique psychotic disorder that causes a range of symptoms. These include symptoms of schizophrenia and of mood disorders like bipolar disorder and major depression. To better understand what this condition is, it helps to know a few related terms:
- Schizophrenia. Schizophrenia is a mental illness, sometimes referred to as a brain disorder, that causes distortions in the way a person thinks and perceives reality. It causes psychosis, a break with reality, and related symptoms like hallucinations and delusions. It also causes disorganized thinking and communicating, and unusual behaviors.
- Major depression/depression. Major depression is a mood disorder and is often referred to as just depression. It causes feelings of extreme sadness that persist, as well as other symptoms like apathy, fatigue, changes in sleep and weight, difficulty thinking and concentrating, physical pain, and suicidal thoughts.
- Bipolar disorder. Bipolar disorder is characterized by changes in mood, cycling between depression and mania.
- Mania. Mania causes a person to feel euphoric and highly energized. During mania a person may feel unstoppable, but also delusional. It causes someone to speak rapidly, engage in risky behaviors, sleep less, and to have inflated self-esteem.
Schizoaffective Disorder vs. Schizophrenia: What are the Differences?
The symptoms and characteristics of schizoaffective disorder include many of those that are seen in someone with schizophrenia. In fact, at one time, schizoaffective disorder was not a unique diagnosis but a subtype of schizophrenia. The main difference is that someone with schizophrenia does not experience persistent symptoms of bipolar disorder or depression. Schizophrenia can affect mood, but those symptoms do not persist.
Another important difference in terms of schizoaffective disorder vs. schizophrenia is that psychotic symptoms like hallucinations and delusions tend to persist in the latter. With schizoaffective disorder on the other hand, those symptoms are more likely to come and go. Finally, treatment for each condition differs in some ways. Both may require the use of antipsychotic medications, but with schizoaffective disorder a patient may also need antidepressants or mood stabilizers to control mood symptoms.
What are Typical Schizoaffective Disorder Symptoms?
The symptoms that someone with schizoaffective disorder experiences can be categorized as three types: schizophrenic symptoms, depressive symptoms, and manic symptoms. Not all people diagnosed with the condition will experience manic symptoms. Schizoaffective disorder symptoms that can be characterized as schizophrenic include:
- Delusions. Delusions are persistent beliefs that are false and that continue in spite of evidence that they are false. For example, a person may believe that he is being followed by government agents.
- Hallucinations. Hallucinations are visions or voices that are not real but that the person hearing or seeing them believes are real. Hearing voices is common with schizophrenia and schizoaffective disorder.
- Disorganized thoughts and speech. Rapid and confusing thoughts can lead to speech that doesn’t make sense to anyone else and that may sound garbled.
- Negative symptoms. Schizophrenia and schizoaffective disorder can cause a person to seem emotionless, to have a flat affect or way of talking, and to have less interest in activities and relationships.
Someone with schizoaffective disorder symptoms will also experience some of the characteristics of major depression, including:
- Feelings of sadness and hopelessness
- Feelings of guilt or shame
- Suicidal thoughts and behaviors
- Fatigue and apathy
- Changes in sleep and appetite
- Irritability or anger
- Difficulty concentrating, thinking, or making decisions
- Loss of interest in activities
Bipolar schizoaffective disorder also causes periods of mania, which may include the following symptoms:
- An inflated sense of self-esteem
- Extreme energy
- A feeling of euphoria and of being able to do anything
- Racing thoughts and speech
- Agitation and irritability
- Risky behaviors
- Sleeping less
Schizoaffective Disorder Bipolar Type
Bipolar schizoaffective disorder is characterized by cycling between periods of mania and periods of depression, while also experiencing symptoms of schizophrenia. It is not uncommon for a patient with this type of the condition to be diagnosed first with bipolar disorder or schizophrenia. Later, it may become clear that the patient has symptoms of both conditions, and a more accurate diagnosis is made. An important characteristic of schizoaffective disorder bipolar type is that the patient experiences bipolar disorder at the same time he or she has symptoms of schizophrenia.
Schizoaffective Disorder Depressive Type
The depressive type of schizoaffective disorder is characterized by the lack of mania. A person with the depressive type experiences symptoms of depression while also experiencing the symptoms of schizophrenia. Schizophrenia may cause occasional mood disorder symptoms, like those of depression, but a diagnosis of schizoaffective disorder means that the mood symptoms persist over time.
Diagnosing Schizoaffective Disorder
To diagnose schizoaffective disorder, DSM V, the Diagnostic and Statistical Manual of Mental Disorders, is the go-to source for psychiatrists and other mental health professionals. This guide lists agreed-upon criteria for making a diagnosis. Another way that the condition is often categorized is through the diagnostic coding language that medical professionals use. The schizoaffective disorder ICD-9 code is 295.7, which also covers mixed schizophrenia, psychosis with mood and schizophrenia symptoms, and cyclic schizophrenia.
The diagnostic criteria for schizoaffective disorder include characteristics that a mental health professional uses during a psychiatric evaluation, including:
- Symptoms of schizophrenia along with symptoms of depression, mania, or both that occur at the same time and persist for a certain period of time
- At least a two-week period in which there are psychotic symptoms, like hallucinations, but no mood symptoms
Importantly, these characteristic symptoms must not be caused by any kind of medication or illicit drug.
What are the Most Effective Schizoaffective Disorder Treatments?
Following a diagnosis of schizoaffective disorder, a patient should work with a psychiatrist and other mental health professionals to develop an effective treatment plan. The plan typically includes both pharmacotherapy and psychotherapy. Two main categories of medications are used to treat these patients: antipsychotics to manage the symptoms of schizophrenia and mania and antidepressants to relieve depressive symptoms.
Using medications is important because it is difficult to manage and control these symptoms with therapy alone. There are risks of side effects, but these are generally outweighed by the potential benefits the medications give to each patient. Even so, it may take a few tries with different drugs to find one or two that work best with minimal side effects.
Psychotherapy is also an important tool for treating schizoaffective disorder treatment and, when used in combination with appropriate medications, can help a patient feel better, keep the condition under control, and be able to live independently and be productive and active. Therapy sessions with a mental health professional are useful because they help a patient learn to control disordered and negative thoughts, change behaviors, and recognize signs of an approaching episode of psychosis, mania, or depression.
Therapy sessions can also help a patient with more practical aspects of his or her life, such as setting and reaching goals, managing relationships, working with others, and being able to work or go to school successfully. Social support groups are also useful for patients, as is group therapy, and therapy sessions with family members or a partner or spouse.
Schizoaffective Disorder and Suicide – Complications
In addition to the direct symptoms of schizoaffective disorder, a person with this condition may also experience complications, which can lead to negative life consequences or even trigger thoughts or acts of suicide. For instance, untreated psychosis can make it difficult to hold down a job, which in turn can lead to poverty and homelessness. Managing positive relationships while living with schizoaffective disorder is also challenging, so this condition can cause a person to become isolated.
Schizoaffective disorder and suicide too often go hand-in-hand as well. The difficulty of coping with the symptoms and the resulting complications can lead to suicidal thoughts and behaviors. This is especially true for anyone who is not being treated by a professional team. This is why it is so important to get a diagnosis and to get and stick with a treatment plan.
Even with all the difficulties of schizoaffective disorder, the outlook is mostly positive for someone who gets this diagnosis. This is a chronic condition, but it can be managed. A commitment to treatment, even when the symptoms have gone into remission, is crucial. Relapses are common, so sticking with the treatment, no matter how good the patient feels, is important. With effective treatment and support from loved ones, someone with schizoaffective disorder has every opportunity to live a normal life, to live independently, and to have satisfying and meaningful work and relationships, just like anyone else.