Schizoaffective disorder is a mental health disorder characterized by a combination of symptoms of schizophrenia, including hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.
Schizoaffective disorder shares symptoms with schizophrenia and bipolar disorder, and this can lead to misdiagnosis. Schizoaffective disorder is less well studied than the other two, so many interventions and treatments are borrowed from schizophrenia and bipolar disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), schizoaffective disorder is seen in about 0.3% of the population. The incidence of schizoaffective disorders is higher in women than men due to the increased incidence of the depressive type in females.
Untreated schizoaffective disorder can result in problems with functioning at work, at school, and in social situations. People with schizoaffective disorder might have difficulty holding down a job or attending school. It can be isolating and lead to loneliness.
The exact cause of schizoaffective disorder is unknown, but a combination of factors, including genetics and brain structure and functioning, can contribute to the development of the disorder.
The following factors increase the risk of developing schizoaffective disorder:
- A close blood relative with schizoaffective disorder, schizophrenia, or bipolar disorder.
- Use of mind altering drugs (psychoactive or psychotropic)
- Stressful events
The typical age of onset for schizoaffective disorder is early adulthood, although it can occur anytime from adolescence through late in life.
There are two major subtypes of schizoaffective disorder:
Bipolar type: This subtype is given if a manic episode is part of the presentation of symptoms. Major depressive episodes can also occur with this subtype.
Depressive type: This subtype is given if only major depressive episodes are part of the presentation.
People will experience different symptoms depending on the type diagnosed.
The course of schizoaffective disorder often features cycles of severe symptoms (that require close monitoring) followed by periods of improvement. Symptoms may include some of the following:
- Hallucinations: Seeing or hearing things that aren’t there.
- Delusions: False, fixed beliefs.
- Disorganized thinking: Only partially answering questions or responding to questions with unrelated answers.
- Manic behavior: For the Bipolar subtype, people can experience feelings of euphoria, racing thoughts, risky behavior (sexual, financial) or sudden increase in energy and behavior that’s out of character.
- Depressed mood: For the Depressive type, people can experience feelings of worthlessness, sadness, and other symptoms of depression.
- Impaired functioning: Occupational, academic, social.
- Problems managing personal care: Physical appearance, cleanliness, self-care (brushing teeth, hair, etc.)
Diagnosis of schizoaffective disorder is complicated because it includes symptoms of both schizophrenia and bipolar disorder or depressive disorder. To be diagnosed with schizoaffective disorder, the following must be present:
- An uninterrupted period during which there is a major mood episode (manic of depressive), occurring at the same time that symptoms of schizophrenia are present.
- Delusions or hallucinations for two weeks or more in the absence of a major mood episode (during the course of the illness).
- Symptoms that meet criteria for a major mood episode are present for the majority of the duration of the illness
- Symptoms are not attributable to drug use or medication.
The lifetime risk of suicide for schizoaffective disorder is 5%, and the presence of depressive symptoms is correlated with a higher risk for suicide.
Schizoaffective disorder is associated with social and occupational dysfunction, and can lead to complications:
- Social isolation
- Substance abuse
- Family discord
- Health problems
Treatment for schizoaffective disorder varies depending on the type and severity of the symptoms, but individuals typically respond well to a combination of medication, psychotherapy, and life skills training. Hospitalization is necessary in some cases.
Medication management: Medication can include antipsychotic medications (to manage symptoms like delusions and hallucinations), mood stabilizers (for bipolar type), and antidepressants (for depressive type.)
Psychotherapy: Individual cognitive behavioral therapy and family focused therapy can help individuals with schizoaffective disorder manage and learn to cope with their symptoms. Group therapy helps decrease social isolation.
Life skills training: Learning social and vocational skills can help reduce isolation and improve the quality of life for individuals with schizoaffective disorder. Social skills training helps improve communication and improve interactions with others both at home and in the work setting, and vocational training helps people prepare for, find, and maintain employment.
There is no cure for schizoaffective disorder, so long-term treatment is required. With proper treatment, people with schizoaffective disorder are able to work, improve their relationships, and avoid relapses.