Schizoaffective disorder

Definition
Schizoaffective disorder includes elements of both psychosis and mood disorder. Psychotic symptoms mean a loss of contact with reality, and may include hallucinations (hearing voices or seeing things that are not present), and delusions (false, fixed beliefs). Symptoms of mood disorder include very low or very high mood with sleep disturbances, changes in energy and appetite, disrupted concentration, and generally poor daily function. Schizoaffective illness features a close interconnection between these 2 sets of symptoms.

Causes, incidence, and risk factors

People with this condition often seek treatment for problems with mood, daily function or intrusive thoughts.

To be diagnosed with schizoaffective disorder, a person must experience psychotic symptoms - but normal mood - for at least 2 weeks.

The exact cause of the condition is unknown, but factors that affect the development of both psychosis and mood disorders may play a role. These factors may include a strong genetic component and other biochemical factors.

It is not known how commonly schizoaffective disorder occurs, but it is believed to be less common than schizophrenia or mood disorders. Women may be affected more often than men. While mood disorders are relatively common in children, a full syndrome of schizophrenia is not. Therefore schizoaffective disorder tends to be rare in children.

Symptoms

The clinical signs and symptoms of schizoaffective disorder include all the signs and symptoms of psychotic and mood disorders, appearing together or in alternating fashion. The course feature cycles of worsening and improvement, or long-term deterioration. The symptoms of schizoaffective disorder vary greatly from person to person.

     
  • Symptoms of clinical Depression and mania include:       o Elevated, inflated, or depressed mood       o Irritability and poor temper control       o Symptoms that could be seen during a manic or depressed state (changes in appetite, energy, sleep)  
  • Psychotic symptoms that persist for at least 2 weeks without significant mood symptoms:       o Hallucinations (particularly auditory hallucinations, “hearing voices”)       o Delusions of reference (for example, believing that someone on TV or the radio is speaking directly to you or that secret messages are hidden in common objects)       o Paranoia (a feeling that everyone or a particular person or agency is out to get you)       o Deteriorating concern with hygiene, grooming       o Disorganized and illogical speech

Signs and tests

     
  • Psychiatric evaluation for identification of symptoms  
  • History of current behavior and symptoms

The combination of psychotic and mood symptoms in schizoaffective disorder can be seen in other illnesses, such as Bipolar disorder. The extreme disturbance in mood is an important part of the illness.

However, the psychotic symptoms in schizoaffective disorder do not necessarily resolve with effective treatment of the mood disorder. Such symptoms usually do resolve in the treatment of mood disorders with psychotic features. Also, psychotic symptoms usually continue for at least 2 weeks with normal mood.

Any medical, psychiatric, or drug-related condition that causes psychotic or mood symptoms must be considered. Patients undergoing treatment with steroids, abusers of cocaine, amphetamines and phencyclidine (PCP), and some patients with seizure disorders, are particularly likely to have concurrent schizophrenic and mood disorder symptoms.

Treatment

The treatment of people with schizoaffective disorder varies, but generally involves medications to stabilize mood and to treat psychosis. Neuroleptic medications (antipsychotics) are used to treat psychotic symptoms.

Lithium may be used to manage mania and to stabilize mood. Anti-seizure medications such as valproic acid and carbamazepine are effective mood stabilizers. These medications may take up to 3 weeks to relieve symptoms.

Usually the combination of antipsychotic and mood-stabilizing medication controls both depressive and manic symptoms, but antidepressants may also be needed in some cases.

Expectations (prognosis)

People with schizoaffective disorder may have a favorable prognosis, with a greater chance of returning to a previous level of functioning than patients with other psychotic disorders. However, long-term treatment is necessary, and individual outcomes may vary.

Complications
Complications are similar to those for schizophrenia and major mood disorders. These include:

     
  • Problems complying with therapeutic regimens  
  • Abuse of substances in an attempt to self-medicate  
  • Problems resulting from manic behavior (for example, spending sprees, sexual indiscretions)  
  • Suicidal behavior due to depressive or psychotic symptoms

Calling your health care provider

Call your provider or mental health professional if you or someone you know is experiencing any of the following:

     
  • Strange or unusual thoughts or perceptions  
  • Inability to care for basic personal needs  
  • Bouts of Depression with feelings of hopelessness or helplessness  
  • Increase in energy and involvement in risky behavior that is sudden in onset and out of character (for instance, going days without sleeping and feeling no need for sleep)  
  • Symptoms worsening or not improving with treatment  
  • Feelings and thoughts of suicide

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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