What Is Schizoaffective Disorder?
Schizoaffective disorder is a chronic mental illness having combined features of schizophrenia, such as delusions and hallucinations, and a mood disorder, such as depression and mania.
Schizoaffective disorder occurs in about 0.3% of the general population. Its incidence is the same in both sexes, but in men, it tends to occur at an earlier age. Usually, it shows up between the ages of 16 and 30.
It is of two types, both having some schizophrenia symptoms:
- Bipolar type: exhibits episodes of mania and sometimes major depression
- Depressive type: exhibits only major depressive episodes
Since it has features of both schizophrenia and mood disorder, it may often be misdiagnosed at first as either of them. Schizoaffective disorder responds well to medication and therapy. However, relapses are common.
Symptoms of Schizoaffective Disorder
The symptoms of schizoaffective disorder can at times be severe, and hence need to keep a close watch on them. The symptoms can vary from person to person and depending on the type of the disorder:
- Delusions: False fixed beliefs, which a person holds on to despite being shown evidence to the contrary
- Hallucinations: Seeing, hearing, feeling, smelling or tasting something that is not there in reality.
- Mania: Episodic and sudden increase in energy levels and euphoria leading to risky behavior that is not in keeping with the nature of the person, like going on a spending spree or indulging in excessive work or sleeplessness. These symptoms occur only in the bipolar type.
- Depression: Feelings of emptiness, sadness, lack of self-worth, and other symptoms of depression.
- Disorganized thinking: Give partial answers to questions or give unrelated answers
- Impaired functioning: Academics, occupation, and socialization take a hit
- Lack of personal care: Unkempt physical appearance without cleanliness
Causes of Schizoaffective Disorder
The exact cause of schizoaffective disorder is not known. There are however some well-known risk factors that increase the likelihood of it occurring, such as:
- Family history: If there is a first-degree relative with schizophrenia, mood disorder, or schizoaffective disorder then it is more likely that the person will suffer from schizoaffective disorder.
- Stress: Stressful events like bereavement, separation or divorce, starting a new job, a layoff from a job, can trigger the illness.
- Viral infections: Certain viral infections are thought to increase the risk, though it is unclear how that happens.
- Substance abuse: Use of drugs like LSD increases the risk.
- Different brain structure or chemistry: Brain scans are helping to show that the brain structure and chemistry may be found to be altered in those with this disorder.
Diagnosis depends on the history of your illness and the clinical features it is exhibiting. Investigations like blood tests or MRI may be needed to rule out other illnesses as causes of the symptoms.
The diagnostic criteria for schizoaffective disorder as per DSM-5 (American Psychiatric Association, 2013, pp. 105-106) are:
- An episode of either depression or mania, occurring along with symptoms of schizophrenia.
- Delusions and/or hallucinations present for 2 or more weeks without depression or mania.
- Mood disorder symptoms present for the majority of the total duration of the illness.
- Symptoms should not be attributable to the abuse of drugs or medication or another medical condition.
Co-occurring Conditions / Complications
Often the following conditions or complications can occur in schizoaffective disorder (American Psychiatric Association, 2013, p. 110):
- Substance abuse disorders
- Anxiety disorders
- Increased incidence of medical conditions
- Decreased life expectancy
- Social conflicts and isolation
- Unemployment, poverty, and homelessness
- Suicidal ideations and attempts
Treatment of Schizoaffective Disorder
Treatment of schizoaffective disorder comprises:
Medication for Schizoaffective Disorder
Delusions and hallucinations need to be treated with an antipsychotic medication – in the US, paliperidone (Invega) is the only FDA-approved drug for this condition. Other medications are prescribed depending on the type of schizoaffective disorder: a mood stabilizer like lithium in case of bipolar type, and an antidepressant like selective serotonin reuptake inhibitor (SSRI) in case of depressive type.
Counseling and Therapy
The patient will need counseling on how best to deal with the everyday issues consequent upon the illness, and educated about the illness and how to set and accomplish goals. Cognitive behavioral therapy can help the patient change the negative thought patterns and behavior that are present with feelings of depression. Family therapy can sensitize other family members to the illness and defuse conflicts within the family. Group therapy can help the patient avoid social isolation and also get a reality check during psychotic episodes.
If symptoms are not adequately controlled by medications and therapy, then the patient may need electroconvulsive therapy (ECT). This involves zapping the brain with electric current, often administered under general anesthesia. ECT is thought to reverse the symptoms by changing brain chemistry.
Life Skills Training for Schizoaffective Disorder
Patient should be imparted social skills training to improve his communication and social interactions. They should also be taught to negotiate successfully the home and work environments by learning a few basic skills. They also need support to train for, find and hold on to a job.
Acute uncontrolled episodes will require hospitalizations.
Note that there is no way to prevent schizoaffective disorder. But, early diagnosis and treatment can decrease some of the burdens of the disease, such as relapses, hospitalizations, and family and interpersonal conflicts.
American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.
Mayo Clinic, n.d. Schizoaffective Disorder. [Online]
Available at: https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504
[Accessed 22 August 2019].
National Alliance on Mental Illness (NAMI), n.d. Schizoaffective Disorder. [Online]
Available at: https://www.nami.org/learn-more/mental-health-conditions/schizoaffective-disorder
[Accessed 22 August 2019].
WebMD, n.d. Schizoaffective Disorder. [Online]
Available at: https://www.webmd.com/schizophrenia/guide/mental-health-schizoaffective-disorder#1
[Accessed 22 August 2019].