What triggers schizoaffective disorder?

Schizoaffective disorder is a mental health condition that is characterized by the presence of psychotic symptoms, such as hallucinations and/or delusions, along with mood episodes such as mania or depression. Although there are no clear causes of the development of the condition, there are several possible triggers or risk factors.

Can stress and trauma trigger schizoaffective disorder?

It is possible that stress or trauma could trigger an episode of psychosis or significant mood changes, both of which could indicate the initial development of schizoaffective disorder. Stress or trauma could also make ongoing symptoms of the condition worse ^[1][2].

Stressful or traumatic events that could trigger schizoaffective disorder may include childhood trauma or more recent events, such as ^[1]:

• Abuse and neglect
• Bullying
• Racism
• Relationship or family issues
• Death of a loved one
• Financial or professional difficulties
• Housing issues

Research suggests that up to two thirds of people with a diagnosis of a psychotic disorder, such as schizoaffective disorder, have experienced a traumatic event, indicating that these experiences could contribute to the development of psychosis ^[3].

Childhood trauma, such as neglect and physical, sexual, and emotional abuse, have been shown to increase the risk of developing mental illness, such as mood or psychotic disorders.

For example, studies show that around a third of people with a psychotic disorder have experienced childhood trauma. This prevalence is three times higher than that of the general population. The research then suggests that childhood trauma may be a causal factor of psychosis or may contribute to the development of psychotic disorders ^[3][4][5].

It is important to note that these studies cannot specifically determine the relationship between trauma and schizoaffective disorder. There are many people who experience childhood trauma who do not go on to develop a psychotic disorder, so there are likely several variable factors involved in the development of the condition ^[2][3].

However, it is likely that trauma and stress can trigger an episode or worsen the condition in those who are at a high risk of developing schizoaffective disorder due to other factors ^[1][5].

Can substance abuse cause schizoaffective disorder?

There is a high prevalence of those with a schizophrenia-related disorder who also have a co-occurring alcohol or substance use disorder. Although there is a great deal of research to indicate a clear link between psychotic disorders and substance use disorders, it is not exactly clear if psychosis can directly lead to alcohol and drug use ^[6][7][8].

However, schizoaffective disorder and any other non-substance related diagnosis cannot be determined if someone is under the influence, so substance use cannot by definition trigger a schizoaffective episode. In these cases, the individual will be diagnosed with substance-induced psychosis.

In many cases, alcohol and substance use may be a form of self-medication, or could be influenced by social, environmental, or other factors, many of which can contribute to the development of both psychosis and substance use disorders ^[6][9].

Although the link between alcohol and substance use and psychosis is not fully understood, research does indicate that symptoms and outcomes of psychotic disorders are often worsened by drug and alcohol use. As such, substance use cannot directly cause schizoaffective disorder but may increase the risk of triggering a psychotic episode or exacerbating symptoms ^[6][7].

Psychosis can also be drug-induced, and research continues to explore the relationship and difference between substance-induced psychosis and primary psychotic disorders that co-occur with substance use disorders, as they may have similar presentations, but the underlying causes and mechanisms are likely to be different ^[5][8].

Many studies suggest a link between the early use of cannabis and the development of psychosis. Again, there may also be other environmental and social factors that influence this link. It is also possible that those experiencing psychotic symptoms use cannabis because of their condition to try and reduce positive symptoms ^[9].

However, research does indicate that early or long-term cannabis use can worsen the severity of psychotic symptoms and may contribute to temporary drug-induced psychosis ^[5][9].

Similarly, drug-induced psychosis has been seen in users of substances such as amphetamine, ketamine, and LSD. This indicates that these substances can cause psychotic symptoms. Therefore, these substances are likely to worsen symptoms of schizoaffective disorder and could trigger a psychotic episode in an individual with several high-risk factors ^[8].

Other potential causes of schizoaffective disorder

There are no clear causes of schizoaffective disorder and research into the development of this condition specifically is limited. Limited research may be due to changes in diagnostic criteria and/or similarities between schizoaffective disorder and other schizophrenia-related disorders ^[2][6].

However, there are several factors that are believed to be linked to an increased risk of developing schizoaffective disorder and other psychotic disorders.

Genetics

The likelihood of developing schizoaffective disorder has been found to be greatly increased in those who have a direct family member with schizophrenia, bipolar disorder, or schizoaffective disorder, suggesting that there is a genetic heritability to the condition ^[1][2].

Neurobiology

Certain chemical imbalances have been found in the brains of those with schizoaffective disorder, indicating that brain chemistry plays a part in the development of the condition.

Similarly, many people with schizoaffective disorder respond well to antipsychotic or antidepressant medications that impact levels of dopamine and serotonin, suggesting that abnormal levels of these neurotransmitters can contribute to the development of schizoaffective disorder ^[1][2].

Furthermore, altered volumes of white matter and other parts of the brain have been found in those with schizoaffective disorder, indicating that abnormalities in the brain may cause or exacerbate symptoms of the condition ^[2].

Other possible causes

Several other possible causes or risk factors of psychotic disorders have been suggested amongst researchers, including environmental and social factors, as well as complications during pregnancy and childbirth.

Research is limited into the causes of schizoaffective disorder specifically. However, various studies suggest possible causes for the development of psychotic disorders, particularly schizophrenia, that may also be linked to the development of schizoaffective disorder and other psychoses.

For example, living in urban areas, family migration, ethnic minority, low socioeconomic status, infection or malnutrition during pregnancy, and complications with fetal development or delivery may all contribute to a higher risk of psychosis, thereby potentially increasing the risk of schizoaffective disorder ^[5][10].