Recognizing a Schizoaffective Episode

Schizoaffective disorder is a complex and often misunderstood mental health condition that combines features of schizophrenia and a mood disorder like bipolar disorder or major depressive disorder. People with schizoaffective disorder can experience depression, mania, and psychosis. As a result, the disorder often has a significant impact on the lives of those diagnosed and their loved ones. Recognizing when someone is experiencing a schizoaffective episode requires an understanding of its core characteristics, symptoms, and diagnostic criteria.

What Is Schizoaffective Disorder?

Previously viewed as a standalone condition, mental health professionals now generally believe schizoaffective disorder falls within the spectrum of schizophrenia. It is characterized by the presence of psychotic symptoms such as hallucinations or delusions, along with mood disturbances that include either depressive or manic episodes. 

Schizoaffective disorder exists in two primary subtypes ^[1]. Bipolar type involves episodes of mania, with or without depressive episodes. Depressive type, on the other hand, involves only major depressive episodes alongside psychotic symptoms.

Schizoaffective disorder generally manifests during late adolescence or early adulthood, typically from ages 16 to 30 ^[1]. Onset coincides with significant life changes, such as completing education and entering the workforce. Individuals may experience psychotic symptoms, mood swings, or a combination of both during this time. It is slightly more common among women than men, particularly in the depressive subtype ^[1].

Causes of Schizoaffective Disorder

The exact cause of schizoaffective disorder is still unknown. However, most experts believe it results from a combination of genetic, environmental, and neurochemical factors ^[2].

Contributing elements that may trigger a schizoaffective episode include:

• A family history of schizophrenia, bipolar disorder, or depression
• Exposure to chronic or acute stress, especially in early development
• Abnormalities in brain chemicals such as dopamine and serotonin
• Structural or functional differences in areas of the brain related to emotion and cognition

Characteristics of a Schizoaffective Episode

A schizoaffective episode occurs when an individual experiences both psychotic symptoms and mood disturbances at the same time. These episodes can vary widely in duration, severity, and presentation, making diagnosis particularly challenging ^[3].

Diagnostic Criteria for a Schizoaffective Episode

A healthcare provider specializing in mental health conditions, such as a psychologist or a psychiatrist, will diagnose schizoaffective disorder by determining if symptoms and behaviors match the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ^[4].

The diagnostic criteria listed in the DSM-5 for schizoaffective disorder include ^[5]:

• A period of uninterrupted mental health symptoms that affect mood (mania or depression) and include symptoms of schizophrenia (delusions, hallucinations, disorganized speech and behavior, etc)
• Hallucinations and delusions lasting at least two or more weeks without mood symptoms
• Symptoms that affect mood are present a majority of the time 
• No evidence of a substance use disorder or medications that may cause symptoms

Symptoms of Schizoaffective Disorder

Clinicians generally divide the symptoms of schizoaffective disorder into two categories: psychotic symptoms and mood disorder symptoms ^[6]. Individuals experience a different combination and intensity of symptoms that significantly impact multiple areas of daily life. In some cases, the symptoms make it difficult to maintain employment.

Psychotic Symptoms

Psychotic features often resemble those seen in schizophrenia and may include:

• Hallucinations: Perceiving sounds, images, or sensations not based in reality, with auditory hallucinations being most common
• Delusions: Strongly held false beliefs, often involving themes of persecution, grandeur, or reference
• Disorganized Thinking: Incoherent speech, rapid topic switching, or trouble organizing thoughts
• Disorganized or Catatonic Behavior: Unpredictable or inappropriate actions, ranging from agitation to complete unresponsiveness
• Emotional Dysregulation: Blunted or inappropriate emotional responses
• Motor Disturbances: Rigid movements, strange postures, or repetitive behaviors
• Difficulty Completing Everyday Tasks: Challenges in managing responsibilities, personal hygiene, and social interactions

Mood Disorder Symptoms

Mood symptoms vary depending on whether the individual is experiencing the bipolar or depressive type of the disorder.

Bipolar type symptoms commonly experienced are:

• Elevated or irritable mood
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Increased energy and activity levels
• Rapid speech and racing thoughts
• Impulsivity and risky behaviors (excessive spending, sexual risk-taking)
• Distractibility and poor judgment

Depressive symptoms commonly experienced are:

• Persistent sadness or hopelessness
• Loss of interest in activities once found enjoyable
• Low energy and chronic fatigue
• Appetite and weight changes
• Difficulty concentrating
• Feelings of worthlessness or guilt
• Thoughts of death or suicide

Challenges in Diagnosis

Schizoaffective disorder is notoriously difficult to diagnose due to symptom overlap with other mental health conditions, particularly schizophrenia and bipolar disorder. For instance, severe depression may involve hallucinations, while depressive symptoms can accompany schizophrenia after psychotic episodes. 

Several factors can complicate a schizoaffective diagnosis ^[2]. For example, mood symptoms and psychosis often occur together in other conditions. Patients also tend to underreport or fail to recognize psychotic episodes. Additionally, symptoms can evolve, and there are no definitive lab tests to confirm the condition.

A diagnosis typically requires a comprehensive psychiatric evaluation and a detailed history of symptom onset, duration, and frequency. Experts may also rely on observations from family members and use standardized assessment tools to differentiate between schizoaffective disorder and related conditions.

Treatment Options for Schizoaffective Episodes

Effective management of symptom progression in schizoaffective disorder requires a comprehensive, long-term treatment plan tailored to the individual. Treatment tends to include a combination of medication, therapy, and psychosocial support ^[7].

Pharmacological Treatment

Several medications are used to treat schizoaffective disorder. Antipsychotic medications are used as first-line treatment to manage hallucinations and delusions. Antidepressants are prescribed for individuals experiencing depressive symptoms. For those who need more than one class of medication to achieve symptom control, combinations of antidepressants and an antipsychotic are used.

Psychotherapy

Therapy plays an important role in treating schizoaffective disorder, particularly when it comes to managing symptoms, developing healthy coping mechanisms, and providing support. For example, cognitive behavioral therapy (CBT) helps the patient identify and change distorted thought patterns. Interpersonal therapy focuses on improving communication and social skills, while psychoeducation educates the patient and family members about the condition and treatment plan.

Additional Interventions

When medication and therapy aren’t enough to relieve the symptoms of schizoaffective disorder, additional interventions are available. For individuals with severe depression or treatment-resistant symptoms, a psychiatrist might suggest electroconvulsive therapy (ECT). It is a non-invasive medical treatment that is performed under anesthesia and involves using small electric currents to trigger a brief, controlled seizure in the brain. ECT creates changes in brain chemistry that can improve certain mental health symptoms.

Psychosocial rehabilitation is another intervention used for schizoaffective disorder. It assists with job training, social integration, and independent living skills. The main goals are to ensure patient adherence with medication, improve coping skills, empower patients against stigmatization, and provide training to the family or caregivers. Psychosocial rehabilitation can decrease difficulties at home, school, and work.

Family and peer support also play a vital role in treating schizoaffective disorder. Loved ones are encouraged to learn about the disorder, how to react calmly in difficult situations, and how to work towards positive outcomes. Family members and peers may also find talk therapy helpful, as it teaches them to cope with their feelings while connecting them with others going through similar experiences.

Life With Schizoaffective Disorder

Timely diagnosis and intervention can significantly improve long-term outcomes for individuals experiencing a schizoaffective episode. Without treatment, the condition can lead to social isolation, unemployment, poor physical health, mental health stigma, and more.

While schizoaffective disorder may be challenging to diagnose, help is available. People first tend to notice symptoms that interfere with daily routines, interpersonal relationships, and overall well-being. Working with a healthcare provider helps in developing a treatment plan that best manages symptoms.

With continued treatment, medications, and psychotherapy, schizoaffective disorder symptoms can eventually go into remission. However, it can take several months to years before symptoms stabilize, so commitment to treatment is essential.