Schizoaffective Disorder

Schizoaffective disorder is a mental disorder that is marked by 2 components: a psychotic component (hallucinations or delusions) and a mood component (mania or depression). Patients must therefore meet the diagnostic criteria for both major mood disorder and schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia. Confirming the timing of symptoms is the key to successfully diagnosing this disorder, which is often misdiagnosed. The treatment regimen consists of psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy as well as pharmacotherapy with antipsychotics, antidepressants, and mood stabilizers, similar to the approaches used for schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia and mood disorders.

Last update:

Table of Contents

Share this concept:

Share on facebook
Share on twitter
Share on linkedin
Share on reddit
Share on email
Share on whatsapp

Overview

Definition

Schizoaffective disorder is a complex mental disorder that includes 2 components:

  • Psychotic component (hallucinations, delusions, disorganized speech or behavior)
  • Mood component (mania or depression)

Classification

Based on the mood symptoms, there are 2 subtypes:

  • Depressive type:
    • Periods of major depression
    • No active or past manic phase
  • Bipolar type:
    • Active manic phase or history of manic phase
    • With or without depression

Epidemiology

  • 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.

Pathophysiology

  • The exact pathophysiology is still unknown.
  • Initially assumed to be a subtype of schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia
  • The disorder may be caused by abnormalities in 1 of the following:
    • Imbalance in brain neurotransmitters: 
      • Serotonin
      • Norepinephrine
      • Dopamine
    • Structural brain abnormalities:
      • Reduced hippocampal volumes 
      • Thalamic abnormalities
      • White matter abnormalities
  • Risk factors:
    • 1st-degree relative with schizoaffective disorder, schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia, or bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder
    • Stressful or traumatic life events
    • Drug consumption

Diagnosis

DSM-V diagnostic criteria

Diagnostic criteria include the following:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or unusual behavior
  • Negative symptoms:
    • Flat affect
    • Avolition
    • Anhedonia
    • Poor attention
    • Alogia
  • 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.

Further considerations

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

Psychotherapy and psychoeducation have proven to be helpful.

Pharmacotherapy

The pharmacologic therapy utilized depends on the disease subtype:

  • Depressive type: antipsychotic Antipsychotic Antipsychotics, also called neuroleptics, are used to treat psychotic disorders and alleviate agitation, mania, and aggression. Antipsychotics are notable for their use in treating schizophrenia and bipolar disorder and are divided into 1st-generation antipsychotics (FGAs) and atypical or 2nd-generation antipsychotics. First-Generation Antipsychotics + antidepressant Antidepressant Antidepressants encompass several drug classes and are used to treat individuals with depression, anxiety, and psychiatric conditions, as well as those with chronic pain and symptoms of menopause. Antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and many other drugs in a class of their own. Serotonin Reuptake Inhibitors and Similar Antidepressant Medications (selective serotonin reuptake inhibitor (SSRI)) → (note: use antidepressants carefully due to risk of increased psychotic/manic symptoms)
  • Bipolar type: antipsychotic Antipsychotic Antipsychotics, also called neuroleptics, are used to treat psychotic disorders and alleviate agitation, mania, and aggression. Antipsychotics are notable for their use in treating schizophrenia and bipolar disorder and are divided into 1st-generation antipsychotics (FGAs) and atypical or 2nd-generation antipsychotics. First-Generation Antipsychotics + mood stabilizer (lithium, valproic acid)

Complications

  • Suicide Suicide Suicide is one of the leading causes of death worldwide. Patients with chronic medical conditions or psychiatric disorders are at increased risk of suicidal ideation, attempt, and/or completion. The patient assessment of suicide risk is very important as it may help to prevent a serious suicide attempt, which may result in death. Suicide or suicide attempts 
  • Social isolation
  • Unemployment, poverty, homelessness
  • Further health problems
  • Anxiety disorders
  • Alcohol or other substance use disorders

Differential Diagnosis

  • 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 Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia, schizoaffective disorder does not require a 6-month period of prodromal symptoms to be diagnosed. 

References

  1. Wy TJP, Saadabadi A. Schizoaffective Disorder. (2020). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541012/
  2. 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.
  3. Mojtabai, R. (2021). Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder. UpToDate. Retrieved March 18, 2021, from https://www.uptodate.com/contents/brief-psychotic-disorder
  4. National Alliance on Mental Illness. Schizoaffective Disorder. Retrieved June 14, 2021, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details