Schizoaffective disorder is a condition that mental health professionals describe as a combination of symptoms of both schizophrenia and either a major depressive disorder or bipolar disorder. It is estimated that the prevalence of this condition is less than 1 percent.
Generally, this disorder varies greatly from person to person, and it is not as well-understood or defined as some other mental health conditions, including schizophrenia. However, the disorder can cause major difficulties with daily functioning and may adversely impact schoolwork and employment.
Experts believe that genetics, structural changes in the brain, and environmental stressors may all increase a person’s risk of developing this illness. Individuals who have a parent with the disorder are at an elevated risk of contracting it themselves, and scientists have also noted that individuals with the disorder show changes in the structures of the brain that regulate mood and thought. Some researchers also believe that viral infections may be involved in the development of this disorder. Others note that stressful situations may increase the risk of this disorder if a person is already predisposed to developing it.
This disease is rare in children, and symptoms usually begin sometime between the ages of 16 and 30. For reasons that are currently unknown, it seems that women are more likely to be diagnosed than men.
People with this condition may display a wide variety of symptoms, and not everyone will have all of the typical symptoms. However, the symptoms that are present will most likely be severe. Since all individuals with this condition will show some symptoms of the psychosis that is common in schizophrenia, people may expect to have hallucinations, delusions, paranoia, and slow body movements or an absence of movement (catatonia). People may have thoughts that are very disorganized, and their communication skills and ability to respond to questions may be impaired.
Individuals who have the type of this condition that shares features of major depressive disorder may also experience low mood, sadness, feelings of emptiness or hopelessness, and a loss of interest in activities. They may also have suicidal thoughts. People who experience the form of this disorder that shares characteristics of bipolar disease may have symptoms of mania such as risky or impulsive behavior (e.g. reckless driving, gambling, spending sprees), racing thoughts, talking faster than usual, a reduced need for sleep, and a feeling of euphoria.
Schizophrenia is a disorder that is characterized by elements of psychosis. People experience delusions, hallucinations, and a “flat affect” (reduced expression of emotion in the face and voice). They may also have difficulty finishing activities that they begin. While both schizophrenia and schizoaffective disorder can be debilitating, people with schizophrenia do not have the additional symptoms of depression or bipolar mania that those with schizoaffective disorder have; this is the major difference between schizoaffective disorder vs. schizophrenia. For example, in addition to having hallucinations, individuals with a schizoaffective condition may also have feelings of emptiness, hopelessness, or intense sadness. Alternatively, if they are experiencing a form of the disease that includes mania, they may have hallucinations or other symptoms of psychosis along with euphoria and risky behavior. For this reason, schizoaffective conditions may be more difficult to diagnose and treat than schizophrenia.
Scientists have identified two major types of schizoaffective conditions. In the first type, known as the bipolar type, people experience symptoms of psychosis along with episodes of mania. In some cases, they may also have episodes of major depression. In the second type of this disorder, known as the depressive type, people experience psychosis accompanied by major depressive episodes. Unlike the bipolar type, those with the depressive type do not have any symptoms or episodes of mania.
To be diagnosed with a schizoaffective condition, a patient must have experienced an episode of either depression or mania that was accompanied by schizophrenic symptoms. At least two symptoms of schizophrenia, including hallucinations, delusions, disorganized thinking, a “flat affect,” or catatonia must have been present. To diagnose this condition, the patient would need to have either delusions or hallucinations for a period of at least two weeks, and the depressive or bipolar mania symptoms would also need to be present for most of that time.
Making a diagnosis of this condition can be a complex process that involves a battery of tests. To have the best chance of making a correct diagnosis, doctors will need to be certain that there are no other medical causes for a person’s symptoms. For this reason, the individual will normally have a health history and physical examination by a medical doctor or psychiatrist prior to being referred to a Mental health team.
For the health history, the doctor will ask the patient about any personal or family history of cardiovascular disease, epilepsy, neurological conditions, cancer, mental health conditions, substance use, and tobacco use. He or she will also want to know about all medications the patient is currently taking, including over-the-counter medications, vitamins, or herbal supplements.
After taking the health history, the doctor will begin the physical examination. Since some mental health conditions and the medications used to treat them can cause changes in weight, cardiovascular health, and the function of the liver and kidneys, the clinician will pay particular attention to these areas during the examination. To establish a baseline that can be used to monitor treatment progress, doctors will record the patient’s height, weight, blood pressure, pulse, temperature, and respiration rate. The physician will also use a stethoscope to listen to the patient’s heartbeat. He or she will check that the heart rhythm and rate are normal and listen for any abnormal clicks or other sounds that may indicate potential murmurs, valve issues, or arrhythmias.
To help the doctor hear sounds as clearly as possible, he or she may listen once with the patient sitting up and again with the patient lying down. The clinician will also listen to the patient’s breathing to check that the lung sounds are clear and that there is no sign of congestion. Next, the doctor will gently feel the patient’s abdominal area to check for tenderness or lumps. During this part of the exam, the doctor may also assess the size of the liver and check for any tenderness over the kidneys. Finally, the doctor will conclude the exam by checking the patient’s sensation, reflexes, grip strength, and range of motion. He or she will do specific tests that check the function of the cranial nerves. If the doctor needs more information to help with a diagnosis, he or she may order blood tests and MRI scans of the brain to assess for any other medical causes that may be contributing to the patient’s condition.
After completing the physical examination, the patient will likely be referred for a mental health evaluation. At this point, the mental health provider will have a detailed interview with the patient. He or she will ask a series of questions about the patient’s mood and thoughts, and the interview will specifically focus on any signs of psychosis, mania, or depression that are associated with schizoaffective conditions. If necessary, the mental health provider may speak with the patient’s physician and family to gather more information.
Treatment for schizoaffective conditions typically includes both medication and counseling. Most patients ahave prescribedan antipsychotic medication, and some patients may need to take a combination of these. Depending on the type of medication, patients may be able to take it as a daily pill, or they may also be able to have it as an injection either once or twice a month. A type of antipsychotic medication called paliperidone is designed specifically for the treatment of schizoaffective disorders. Paliperidone may help patients think more clearly, and it reduces feelings of agitation. The medicine can also help patients feel more positive about their lives, and this may improve their ability to participate in activities that they enjoy. While taking this medication, patients should be vigilant for potential side effects, including weight gain, increased blood glucose and cholesterol, abdominal pain, dizziness, sleepiness, and lightheadedness. Patients should report these side effects to their medical team, and they should also mention any other concerns they may have while taking this medicine.
In addition to antipsychotics, doctors may prescribe antidepressants or medications for bipolar disorder when treating this disease. Patients will be monitored closely by their physicians while taking any of these medicines, and they may need to have frequent follow-up appointments to monitor their weight, heart health, and changes in blood chemistry.
Several different counseling techniques are used in the treatment of this condition. Elements of cognitive behavioral therapy and skills training are integrated to help patients learn healthy methods of coping with and responding to the challenges of this disorder. Patients learn to observe their feelings without having to act on them, and they are also taught ways in which they might reframe negative thoughts into more positive ones. Family therapy may also be included to give patients additional support.
For patients who do not respond to medication, electroconvulsive therapy (ECT) may sometimes be considered. The procedure is performed under general anesthesia so that the patient is completely asleep. Tiny electric currents are passed through the brain, and these cause a small, brief seizure. For reasons that are as yet unknown, researchers believe that this treatment alters brain chemistry in a way that may quickly improve or even reverse the symptoms of certain mental health conditions. The treatment is most often used for catatonia, severe depression, severe mania, psychosis, and agitation.
Since schizoaffective conditions can be very severe, hospitalization may sometimes be required. For example, patients who are experiencing hallucinations or delusions and those who are having suicidal thoughts may need to be hospitalized for their safety. Hospitalization can help the patient feel calm and safe, and appropriate medication and intensive counseling can be provided to help patients feel better more quickly.
Even with treatment, some patients with this disease may experience complications. These complications may be more likely to occur if patients go off their prescribed medication. Potential complications vary widely and may include social isolation, conflicts with family and friends, anxiety, and alcohol or substance use issues. In severe cases, patients may experience unemployment, poverty, homelessness, suicidal thoughts or actions, and serious medical conditions.
To help prevent these complications, patients may receive social skills training as part of their counseling sessions. These sessions aim to help patients develop the skills that are needed to communicate effectively with others, and patients use role-playing to practice skills that are needed at home, in the workplace, and in other specific settings. To help avoid unemployment and poverty, patients with schizoaffective conditions may be eligible to receive vocational rehabilitation and supported employment in their area. These services help patients find, apply for, and keep employment.
This condition can present unique challenges for both patients and their families and friends. If you notice any of the symptoms above in a friend or loved one, it is important that a medical and psychological evaluation be conducted promptly. If you can, offer to go with your friend or loved one to a medical appointment, and take notes on any treatment options or other recommendations that the doctor provides.
If your friend is in treatment for this illness, encourage him or her to continue taking all prescribed medications, and educate yourself as much as possible about the disease and the potential side effects of the medications. Know the names and contact information of your friend’s doctors and mental health specialists, and consider contacting these individuals right away if you notice that your friend may be experiencing suicidal thoughts or hallucinations. If you feel that you need it, consider attending a support group for