Schizoaffective disorder is a mental health condition that involves psychotic symptoms similar to those that occur with schizophrenia, such as hallucinations and delusions, as well as mood disorder symptoms comparable to those occurring with major depression [1]. The condition is more common among women when compared to men, and it is typically treated with a combination of medication and therapy [2].

What is shizoaffective disorder?

Schizoaffective disorder is a diagnosable mental health condition that leads to symptoms of psychosis, including hallucinations and delusions, as well as mood disorder symptoms, like depression. A person who lives with this disorder will experience mood disorder symptoms alongside psychosis for a majority of the duration of their illness, but they also have periods during which they experience only psychosis, without mood-related symptoms. Left untreated, it can lead to social isolation and difficulty with working, caring for oneself, or functioning in daily life [2].

Types of schizoaffective disorder

While there are general criteria that accompany schizoaffective disorder, there are also two distinct types of this mental health condition: bipolar type and depressive type. The features of each type are described below:

  • Bipolar type: Individuals with the bipolar type of schizophrenia experience psychotic symptoms, as well as manic episodes. They may also experience major depressive episodes, but they must experience episodes of mania to meet the criteria for the bipolar type of schizoaffective disorder [2]. A person who is experiencing a manic episode displays symptoms such as increased activity, racing thoughts, extremely elated or irritable mood, and high productivity with a reduced need for sleep [3]. Manic episodes can vary in length. Generally, symptoms of mania need to be present most of the day for at least a week, but if someone requires hospitalization, there is no minimum duration of symptoms required for making a diagnosis [4].
  • Depressive type: This type of schizoaffective disorder involves psychotic symptoms accompanied by depressive episodes. A person in the midst of a depressive episode will experience symptoms such as feeling sad or down, being unable to concentrate or complete simple tasks, losing interest in their usual activities, and experiencing thoughts of suicide [3]. To meet the criteria for a depressive episode, a person must have symptoms of depression each day for at least two weeks [5].

Symptoms of schizoaffective disorder

Symptoms of schizoaffective disorder vary based upon whether a person experiences the bipolar or depressive type of the disorder. Symptoms that can be present in all cases of schizoaffective disorder are as follows [2]:

  • Delusions: Untrue beliefs that persist even when a person is provided with evidence that the belief is false.
  • Hallucinations: Auditory, visual, or tactile sensations that are not actually present.
  • Disorganized speech: Incoherent speech, such as talking about loosely connected ideas or in a nonsensical fashion.
  • Catatonic behavior: Unusual behaviors, such as fast movements, repetitive motions, and sitting still in uncomfortable positions.
  • Negative symptoms: Lack of speech, reduced motivation, and lack of emotional expression.

Symptoms of the bipolar type of schizoaffective disorder include the following indicators of mania [4]:

  • Extremely irritable or elated mood
  • Racing thoughts
  • Reduced need for sleep
  • Increased productivity without signs of being tired
  • Excessive talking
  • Distraction
  • Elevated self-esteem
  • Risky behavior, such as going on shopping sprees, engaging in unprotected sex, or misusing drugs

On the other hand, indicators of a depressive episode occurring in the depressive type of schizoaffective disorder are as follows [5]:

  • Depressed mood
  • Lack of interest in usual activities that typically bring pleasure
  • Losing or gaining a significant amount of weight without trying, or experiencing significant changes in appetite
  • Sleeping either too much or too little, or experiencing disrupted sleep
  • Changes in activity level, which are observable by others – this can include either excessive activity, such as pacing, or, on the opposite end of the spectrum, a slowing down of movement
  • Low energy levels and reduced productivity
  • Feeling worthless or guilty without reason for guilt
  • Difficulty with concentrating or making decisions
  • Suicidal ideation or attempts

Causes of schizoaffective disorder

As with many mental health conditions, there is no single known cause of schizoaffective disorder, but rather a variety of risk factors that are believed to contribute to the development of the condition. Experts have noted that social factors, stress, trauma, and genetics increase the risk of schizoaffective disorder. Having a relative with schizoaffective disorder, schizophrenia, or bipolar disorder can increase the risk that a person will develop the condition.[2]

Schizoaffective disorder is also associated with abnormalities in brain structure and function, including the way the brain processes chemicals like dopamine [2]. Furthermore, the use of certain drugs, especially LSD, may trigger the onset of schizoaffective disorder symptoms [1].

Diagnosing schizoaffective disorder

Schizoaffective disorder is diagnosed using criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A mental health professional like a social worker, psychologist, or psychiatrist will perform an assessment and use this manual to make a diagnosis of schizoaffective disorder. The DSM outlines the following criteria for diagnosing schizoaffective disorder [2]:

  • An uninterrupted period of mental illness during which a person experiences psychotic symptoms of schizophrenia, coupled with either a depressive or manic symptoms.
  • Demonstrating at least two psychotic symptoms of schizophrenia, which could include hallucinations, delusions, disorganized speech, catatonic behavior, or negative symptoms. At least one of the two symptoms must be hallucinations, delusions, or disorganized speech.
  • At some point during the course of the disorder, the person has experienced hallucinations and delusions for a two-week period, without any mood symptoms.
  • For most of the time the person has had the disorder, there have been mood symptoms alongside symptoms of psychosis.
  • The symptoms cannot be explained by substance use, such as a drug or medication leading to mood disturbances.

Since schizoaffective disorder can look similar to schizophrenia, when a mental health professional is making a diagnosis they have to be sure to rule out schizophrenia as a diagnosis. For instance, some patients may have both schizophrenia and a co-occurring mood disorder like depression.

A distinguishing aspect to schizoaffective disorder is that individuals with this condition will have periods of at least two weeks during which they only experience psychotic symptoms, like hallucinations and delusions, without any symptoms of depression or mania. [2].

Prevention of schizoaffective disorder

There is no guaranteed method of preventing schizoaffective disorder, as the exact cause is unknown, but the condition can be managed with early recognition and treatment. If you or a loved one shows signs of schizoaffective disorder, reaching out to a mental health professional can connect you with the treatment that is needed to help you address the symptoms of the condition and continue to lead a fulfilling life.

Keep in mind that even if you have a family history of schizoaffective disorder, this does not mean you are guaranteed to develop the condition. If you know you have risk factors, you can take steps to maintain strong mental health by developing healthy stress management habits and avoiding the use of drugs, given substance misuse can be a risk factor for developing schizoaffective disorder [2].

Treatment for schizoaffective disorder

Schizoaffective disorder is typically managed through a combination of medication and therapy [2]. Some of these approaches are described in more detail below.

Medication for schizoaffective disorder

Medication can be helpful for treating symptoms of psychosis, as well as mood-related symptoms of schizoaffective disorder. Some common medications used in schizoaffective disorder treatment include [2]:

  • Antipsychotics: These medications block dopamine receptors in the brain, as too much dopamine can lead to psychotic symptoms like hallucinations and delusions. This class of drugs includes but is not limited to risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol.
  • Mood stabilizers: This class of medications is commonly used in the treatment of bipolar disorder to reduce the severity of mania. Lithium, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine fall under this category.
  • Antidepressants: Because schizoaffective disorder can involve episodes of depression, medications that are used in the treatment of depression can be beneficial. A common class of antidepressants called SSRIs may be used to treat schizoaffective disorder. Some medications under this category are fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine.

Therapy for schizoaffective disorder

Medications can target some of the biological causes of schizoaffective disorder symptoms, such as abnormalities in dopamine and serotonin activity. Therapy is also effective, as it can help people to cope with symptoms and learn about ways to manage the disorder.

In individual sessions, a therapist can educate patients about ways to manage schizoaffective disorder, provide them with support for changing unhelpful thinking patterns, and work with them to set and track goals in order to improve the client's quality of life.

Family and group therapy sessions are also helpful. It is beneficial for family members to learn about their loved one’s mental health condition, so they can offer support. Group therapy provides a safe setting in which people with schizoaffective disorder can share their experiences and learn from others who are coping with the same struggles.

Finally, some patients with schizoaffective disorder may benefit from electroconvulsive therapy (ECT). This modality is typically used when other treatment methods fail, or when a patient is chronically hospitalized. ECT has been found to be beneficial for reducing aggressive behaviors and self-harm and improving functioning in people with schizoaffective disorder [6]. ECT requires a patient to be placed under anesthesia while certain areas of the brain are stimulated electrically [7].

Hospitalization for schizoaffective disorder

In some cases, people with schizoaffective disorder may be unable to safely care for themselves in the community. depressive symptoms may lead to suicide attempts, or manic behavior may place a person in risk of serious danger. Similarly, a person who has hallucinations and delusions may be unable to care for themselves.

If someone with schizoaffective disorder has severe symptoms, they may require hospitalization in order to achieve stability. Depending upon the laws and policies of a specific jurisdiction, a mental health professional or other healthcare provider may be able to place a person with schizoaffective disorder in the hospital involuntarily, so they can receive treatment. Once the person is stabilized and capable of living independently in the community, they can be discharged and sent home.

Self-care for schizoaffective disorder

If you have schizoaffective disorder, it’s important to care for yourself. The following tips can help you to manage your symptoms:

  • Learn about your condition. It is helpful to educate yourself about your condition so that you know what to expect, as well as the best ways to manage your mental health. A therapist, social worker, or psychologist can provide you with additional education about schizoaffective disorder.
  • Establish support networks. Attending support group meetings and staying connected with supportive friends and family can be essential. Having a healthy support network will reduce the impact of social isolation and provide you with a source of encouragement.
  • Stay engaged in treatment. There is no cure for schizoaffective disorder, but caring for yourself by engaging in treatment can decrease the risk of complications from the condition and reduce the impact that symptoms have on your daily life.

How to help someone with schizoaffective disorder

If a friend or family member has schizoaffective disorder, there are things you can do to help. Consider the following strategies:

  • Learn about the condition. Making an effort to learn about schizoaffective disorder helps you to be more supportive to your loved one. If you know about the condition, you’ll be able to recognize signs that your loved one needs support, and you’ll have a better understanding of their behavior.
  • Check in on them. When people live with a serious mental health condition, they may not always know how to ask for help. It can be helpful if you periodically check in on your loved one to ask if they need additional support.
  • Encourage them to seek treatment. It can be difficult to manage symptoms of schizoaffective disorder without treatment. If your loved one is hesitant to reach out for help, encourage them to engage with a mental health professional.
  • Remind them to take medication. Some people may forget to take medications that are prescribed for schizoaffective disorder. Others may be resistant to taking medication. Reminding your loved one to take any prescribed medications can reinforce the behavior.

FAQs about schizoaffective disorder

How common is schizoaffective disorder?

Schizoaffective disorder is uncommon and occurs only about one-third as often as schizophrenia. Estimates have shown that 0.3% of people will experience schizoaffective disorder during their lives [2].

What is the outlook for people with schizoaffective disorder?

With treatment, people with schizoaffective disorder can function quite well. Research suggests that around half of people with the condition have minimal symptoms and are able to maintain employment. On the other hand, when schizoaffective disorder is not treated, it can lead to complications, and a person may have difficulty functioning in daily life and taking care of themselves [2].

What is the difference between schizoaffective disorder and schizophrenia?

Schizoaffective disorder may seem similar to schizophrenia, but it is a distinct condition. A person with schizoaffective disorder experiences psychotic symptoms, which are also seen in schizophrenia. What makes the two conditions different is that people with schizoaffective disorder also have mood disorder symptoms related to either depression or mania. A person with schizophrenia may have depression alongside schizophrenia, but in schizoaffective disorder, a person experiences periods during which they have symptoms of psychosis in the absence of mood symptoms [2].

Resources:

  1. National Alliance on Mental Illness. (n.d). Schizoaffective disorder. Retrieved October 1, 2022 from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder
  2. Wy, T.J.P., & Saadabadi, A. (2022). Schizoaffective disorder. National Library of Medicine. Retrieved October 1, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK541012/
  3. National Institute of Mental Health. (2022). Bipolar disorder. Retrieved October 2, 2022 from https://www.nimh.nih.gov/health/topics/bipolar-disorder
  4. Substance Abuse and Mental Health Services Administration. (2016). DSM-IV to DSM-5 manic episode criteria comparison. National Library of Medicine. Retrieved October 2, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t7/
  5. Substance Abuse and Mental Health Services Administration. (2016). DSM-IV to DSM-5 major depressive episode/disorder comparison. National Library of Medicine. Retrieved October 2, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/
  6. Iancu, I., Pick, M., Seener-Lorsh, O., & Dannon, P. (2015). Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results. Neuropsychiatric Disease and Treatment, 11, 853-862. doi: 10.2147/NDT.S78919
  7. American Psychiatric Association. (2019, July). What is electroconvulsive therapy (ECT)? Retrieved October 2, 2022 from https://www.psychiatry.org/patients-families/ect