Schizoaffective Disorder

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.
Reading NAMI's content on schizophrenia and bipolar disorder will offer many overlapping resources for schizoaffective disorder. Because schizoaffective disorder is less well-studied than the other two conditions, many interventions are borrowed from their treatment approaches.
Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia because it shares symptoms of multiple mental health conditions.
Schizoaffective disorder is seen in about 0.3% of the population. Men and women experience schizoaffective disorder at the same rate, but men often develop the illness at an earlier age. Schizoaffective disorder can be managed effectively with medication and therapy. Co-occurring substance use disorders are a serious risk and require integrated treatment.

Symptoms

The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:
  • Hallucinations, which are seeing or hearing things that aren’t there.
  • Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence.
  • Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated.
  • Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression.
  • Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.

Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.
  • Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.
  • Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.
  • Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.
  • Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.

Diagnosis

Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: bipolar type and depressive type. To be diagnosed with schizoaffective disorder a person must have the following symptoms.
  • A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.
  • Delusions or hallucinations for two or more weeks in the absence of a major mood episode.
  • Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the illness.
  • The abuse of drugs or a medication are not responsible for the symptoms.

Treatment

Schizoaffective disorder is treated and managed in several ways:
  • Medications, including mood stabilizers, antipsychotic medications and antidepressants
  • Psychotherapy, such as cognitive behavioral therapy or family-focused therapy
  • Self-management strategies and education

Related Conditions

A person with schizoaffective disorder may have additional illnesses:
People with schizoaffective disorder are often treated with a combination of medications and psychotherapy. How well treatment works depends on the type of schizoaffective disorder, its severity and its duration.

Medications

Doctors and other mental health professionals will often prescribe medications to relieve symptoms of psychosis, stabilize mood and treat depression. The only medication approved by the FDA to treat schizoaffective disorder is the antipsychotic drug paliperidone (Invega).
However, some medications approved for the treatment of other mental health conditions may be helpful for schizoaffective disorder. These medications include:
  • Antipsychotics. A health care provider will prescribe antipsychotics to relieve symptoms of psychosis, such as delusions and hallucinations.
  • Antidepressants. When schizoaffective disorder is depressive-type antidepressants can alleviate feelings of sadness, despair and trouble concentrating.
  • Mood stabalizers. When biplar disorder is the underlying mood disorder, mood stablizers can help stabalize the highs and lows.

Psychotherapy

Family involvement, psychosocial strategies, self-care peer support, psychotherapy and integrated care for co-occurring substance abuse can all be part of an individual support plan.
  • Cognitive behavioral therapy (CBT) helps change the negative thinking and behavior associated with feelings of depression. The goal of this therapy is to recognize negative thoughts and to teach coping strategies. With conditions like schizoaffective disorder that have symptoms of psychosis, additional cognitive therapy is added to basic CBT (CBTp). CBTp helps people develop coping strategies for persistent symptoms that do not respond to medicine.

Alternative Treatment Options

For cases where medication and psychotherapy do not work for a person with schizoaffective disorder, ECT may be worth considering. ECT involves transmitting short electrical impulses into the brain. Although ECT is a highly effective treatment for severe depression, it is not the first choice in treating schizoaffective disorder.

Cultural Considerations

Research has shown that African Americans and Latinos are more likely to be misdiagnosed with schizoaffective disorder, so people who have been diagnosed should make sure that their mental health professional understands their background and shares their expectations for treatment.

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