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SCHIZOAFFECTIVE DISORDER
 



SYNOPSIS

Schizoaffective Disorder F25 - ICD10 Description, World Health Organization
Episodic disorders in which both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes. Other conditions in which affective symptoms are superimposed on a pre-existing schizophrenic illness, or co-exist or alternate with persistent delusional disorders of other kinds, are classified under F20-F29 (schizophrenia, schizotypal and delusional disorders). Mood-incongruent psychotic symptoms in affective disorders do not justify a diagnosis of schizoaffective disorder.

    F25.0 Schizoaffective disorder, manic type

    A disorder in which both schizophrenic and manic symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a manic episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, manic type.

    F25.1 Schizoaffective disorder, depressive type

    A disorder in which both schizophrenic and depressive symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a depressive episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, depressive type.

    F25.2 Schizoaffective disorder, mixed type

Schizoaffective Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with schizoaffective disorder needs to meet all of the following criteria:

  • Active-Phase Symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these symptoms must be delusions, hallucinations, or disorganized speech:

    • Delusions.

    • Hallucinations.

    • Disorganized speech (e.g. frequent derailment or incoherence).

    • Grossly disorganized or catatonic behavior.

    • Negative symptoms (i.e., diminished emotional expression or avolition).

  • Concurrent with an uninterrupted period of active-phase symptoms, there is either a manic or major depressive episode:

    • Manic Episode

      • A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently goal-directed behavior or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

      • During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

        • Inflated self-esteem or grandiosity.

        • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

        • More talkative than usual or pressure to keep talking.

        • Flight of ideas or subjective experience that thoughts are racing.

        • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

        • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

        • Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

      • The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

      • The episode is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or another medical condition.

        A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode.

    • Major Depressive Episode

      • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. One of the symptoms must be depressed mood.

        Note: Do not include symptoms that are clearly attibutable to another medical condition.

        • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

        • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

        • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

        • Insomnia or hypersomnia nearly every day.

        • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

        • Fatigue or loss of energy nearly every day.

        • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

        • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

        • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

      • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

      • The episode is not attributable to the physiological effects of a substance or to another medical condition.

  • Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

  • Symptoms that meet criteria for a major mood episode are prresent for the majority of the total duraction of the active and residual portions of the illness.

  • The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • Specify whether:

    • Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur.

    • Depressive type: This subtype applies if only major depressive episodes are part of the presentation.

  • Specify if:

    • With catatonia: The clinical picture is dominated by three (or more) of the following symptoms:

      • Stupor (i.e., no psychomotor activity; not actively relating to environment).

      • Catalepsy (i.e., passive induction of a posture held against gravity).

      • Waxy flexibility (i.e., slight, even resistance to positioning by examiner).

      • Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).

      • Negativism (i.e., opposition or no response to instructions or external stimuli).

      • Posturing (i.e., spontaneous and active maintenance of a posture against gravity).

      • Mannerism (i.e., odd, circumstantial caricature of normal actions).

      • Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).

      • Agitation, not influenced by external stimuli.

      • Grimacing.

      • Echolalia (i.e., mimicking another's speech).

      • Echopraxia (i.e., mimicking another's movements).

Schizoaffective Disorder is a diagnosis midway between the diagnosis of schizophrenia and bipolar I disorder. In schizophrenia, an individual can have major depressive or manic episodes. However, schizophrenia is not diagnosed if the total duration of these mood episodes last longer than 50% of the total duration of the (active + residual) illness. In bipolar I disorder, an individual can become psychotic during a major depressive or manic episode. However, bipolar I disorder is not diagnosed if an individual becomes psychotic in the absence of a concurrent major depressive or manic episode. In schizoaffective disorder, an individual has a mixture of psychotic and major depressive or manic episode(s) which fail to meet the diagnostic criteria for either schizophrenia or bipolar I disorder. This disorder is not due to a drug, medication, or other medical illness. The bipolar type of schizoaffective disorder is more common in younger patients, whereas the depressive type is more common in older patients. Individuals with this disorder have a better prognosis than individuals with schizophrenia but a worse prognosis than individuals with bipolar I disorder. Diagnostic reliability is much lower for schizoaffective disorder compared with schizophrenia, bipolar disorder, and major depressive disorder.

Effective Therapies

In terms of treatment, the medications used for schizophrenia and bipolar I disorder are also used in schizoaffective disorder. Treatment should be lifelong; since this is potentially a very serious illness, with on average a 15- to 20-year reduction in life expectancy. For individuals with this disorder who refuse to take their antipsychotic medication, there is the option of giving them injections of long-lasting antipsychotic medication (that can last one month). The very powerful, but potentially more dangerous, antipsychotic medication, clozapine, is an option for individuals that have failed to respond to two previous antipsychotic medications. Mood stabilizer medications and antidepressants are used in combination with these antipsychotic medications. Effective psychological treatments include: assertive community treatment, supported employment, skills training, token economy interventions, and family-based services. Intensive case management (ICM) reduces hospitalization, improves adherence to care, and improves social functioning.


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Ineffective Therapies

Cognitive behavioral therapy (CBT) was not effective in reducing symptoms in schizophrenia, or in preventing relapse in bipolar I disorder. Vitamins, dietary supplements, cognitive training and cognitive rehabilitation have all proven to be ineffective in the treatment of psychotic disorders.

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