Schizoaffective Disorder

Photo courtesy of BrightQuest Treatment CentersOpens in new window Schizoaffective disorder has elements of both schizophrenia and a mood (affective) disorder. It is generally considered to be a form of schizophrenia, lying on the schizophrenia spectrum. There are two subtypes of schizoaffective disorder: the depressive subtype is characterized by major depressive episodes, while the bipolar subtype is characterized by manic episodes with or without depressive symptoms.

Characteristic symptoms of schizoaffective disorder generally fall into four categories: positive symptoms, negative symptoms, symptoms of mania, and depression:

1. Positive symptoms are the presence of thoughts, perceptions, and behaviors that are usually absent in people without schizoaffective disorder. These include hallucinations (seeing and hearing things that are not there), delusions (false beliefs), and thought disturbances (e.g., jumping from topic to topic, making up new words, speech that does not make sense).
2. Negative symptoms are absence of behaviors, thoughts, or perceptions that would normally be present in people without schizoaffective disorder. These include blunted affect (lack of expression), apathy, anhedonia (inability to experience pleasure), poverty of speech (not saying much), and inattention. Residual and negative symptoms are usually less severe and less chronic with schizoaffective disorder than those seen in schizophrenia.

3. Symptoms of mania involve an excess of behavior, activity, or mood. These may include euphoric or expansive mood, irritability, inflated self-esteem or grandiosity, decreased need for sleep, rapid or pressured speech, racing thoughts, distractibility, increased goal-directed activity (a great deal of time spent pursuing specific goals, at work, school, or sexually), and excessive involvement in pleasurable activities with high potential for negative consequences (e.g., increased substance use, spending sprees, sexual indiscretions, risky business ventures).
4. Depressive symptoms involve a deficit of activity and mood. Symptoms include depressed mood, sadness, diminished interest or pleasure (anhedoniaOpens in new window), changes in appetite or sleeping patterns, decreased activity level, fatigue, loss of energy, feelings of worthlessness, inappropriate guilt, decreased concentration, inability to make decisions, and preoccupation with thoughts of death.

Schizoaffective disorder usually starts in late adolescence or early adulthood, most often between the ages of 16 and 30. Because it is difficult to differentiate schizoaffective disorder from schizophrenia and bipolar disorder, detailed information on the prevalence and demographics of schizoaffective disorder is lacking. Estimates suggest that there is a higher incidence of schizoaffective disorder in women than in men. The bipolar subtype of schizoaffective disorder is more common in young adults, while the depressive subtype is more common in older adults (American Psychiatric Association, 2000).

The disorder lasts a lifetime, although symptoms and functioning can improve with time and treatment. Symptom severity also varies over time, sometimes requiring hospitalization. The cause of schizoaffective disorder is not known, although prevailing theories suggest that an imbalance of the neurotransmitter dopamine (a chemical messenger) is at the root of both schizophrenia and schizoaffective disorder.

Schizoaffective disorder is one of the more common, chronic, and disabling mental illnesses. Although its exact prevalence is not clear, it may range from 2 to 5 in 1,000 people (0.2% to 0.5%). Schizoaffective disorder may account for one-quarter to one-third of all people diagnosed with schizophrenia (National Alliance on Mental Illness, 2003)

Features associated with schizoaffective disorder include poor occupational functioning, a restricted range of social contact, difficulties with self-care, increased risk of suicide, increased risk for later developing episodes of pure mood disorder, schizophrenia, or schizopheniform disorder (similar to schizophrenia). Schizoaffective disorder is also associated with alcohol and other substance-related disorders (resulting from attempts to self-medicare).

Anosognosia (i.e., poor insight that one is ill) is also common in schizoaffective disorder, but the deficits in insight may be less severe and pervasive than in schizophrenia. A combination of medication and psychosocial intervention is generally used to treat schizoaffective disorder. Medications include antipsychotics, mood stabilizers, and antidepressants.

The effectiveness of psychosocial interventions has been researched less for schizoaffective disorder than for schizophrenia or mood disorders. However, the evidence suggests that beneficial treatments include cognitive-behavioral therapy, social skills training, vocational rehabilitation, family therapy, and case management.

The bipolar subtype of schizoaffective disorder has a better prognosis than the depressive subtype. Everyone responds to treatment differently. While a brief period of treatment can provide effective relief with a return to normal functioning for one person, another person may require ongoing long-term treatment.