Schizoaffective disorder is a complex mental disorder that includes 2 components:
- Psychotic component (hallucinations, delusions, disorganized speech or behavior)
- Mood component (mania or depression)
Based on the mood symptoms, there are 2 subtypes:
- Depressive type: no active or past manic phase
- Bipolar type: active manic phase or history of manic phase
- Lifetime prevalence: 0.32%
- Women are more commonly affected than men.
- Young patients tend to have the bipolar subtype.
- Older patients tend to have the depressive subtype.
- The exact pathophysiology is still unknown.
- Initially assumed to be a subtype of schizophrenia
- The disorder may be caused by abnormalities in 1 of the following:
- Imbalance in brain neurotransmitters:
- Structural brain abnormalities:
- Reduced hippocampal volumes
- Thalamic abnormalities
- White matter abnormalities
- Imbalance in brain neurotransmitters:
- Risk factors:
- 1st-degree relative with schizoaffective disorder, schizophrenia, or bipolar disorder
- Stressful or traumatic life events
- Drug consumption
DSM-V diagnostic criteria
Diagnostic criteria include the following:
- Disorganized speech
- Grossly disorganized or unusual behavior
- Negative symptoms:
- Flat affect
- Poor attention
- History of 1 major mood episode (mania or depression)
- History of 1 episode of psychotic symptoms (hallucinations or delusions) without mood symptoms
- Substance use and other medical conditions as causes for the symptoms must be excluded.
It is important to distinguish schizoaffective disorder from mood disorders with psychotic features:
- Psychotic symptoms must be present without mood symptoms for an episode lasting at least 2 weeks.
- Mood symptoms are usually still present for the majority of the course of illness.
- Schizoaffective disorder: Psychotic symptoms can be present without mood symptoms.
- Mood disorders with psychotic features: Psychotic symptoms can be present only during mood symptoms.
Management and Complications
Psychotherapy and psychoeducation have proven to be helpful.
The pharmacologic therapy utilized depends on the disease subtype:
- Depressive type: antipsychotic + antidepressant (selective serotonin reuptake inhibitor (SSRI)) → (note: use antidepressants carefully due to risk of increased psychotic/manic symptoms)
- Bipolar type: antipsychotic + mood stabilizer (lithium, valproic acid)
- Suicide or suicide attempts
- Social isolation
- Unemployment, poverty, homelessness
- Further health problems
- Anxiety disorders
- Alcohol or other substance use disorders
- Mood disorders with psychotic features: depression or mania with psychotic features (hallucinations, delusions) that occur only during the mood episode. In schizoaffective disorder, patients must experience a period of at least 2 weeks in which they experience psychotic features without the presence of any mood symptoms.
- Schizophrenia: a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. Schizophrenia is associated with a decline in both cognitive and social functioning. Treatment includes antipsychotics in conjunction with behavioral therapy. Schizoaffective disorder is differentiated by a major mood disorder (manic or depressive) that is present for the majority of the illness. Unlike in schizophrenia, schizoaffective disorder does not require a 6-month period of prodromal symptoms to be diagnosed.
- Wy TJP, Saadabadi A. Schizoaffective Disorder. (2020). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541012/
- Sadock BJ, Sadock VA, Ruiz P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 7, Schizophrenia spectrum and other psychotic disorders, pages 300-346. Philadelphia, PA: Lippincott Williams and Wilkins.
- Mojtabai, R. (2021). Brief psychotic disorder. UpToDate. Retrieved March 18, 2021, from https://www.uptodate.com/contents/brief-psychotic-disorder
- National Alliance on Mental Illness. Schizoaffective Disorder. Retrieved June 14, 2021, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder