Schizoaffective Disorder (ScAD)

What is Schizoaffective Disorder (ScAD)

Schizoaffective disorder is a mental illness.

It causes symptoms that are a mixture of a psychotic disorder (schizophrenia) and a mood (affective) disorder.

A psychotic disorder involves losing touch with reality.

ScAD usually occurs in cycles. Periods of severe symptoms may be followed by periods of less severe symptoms or improvement.

The illness affects men and women equally, but it usually appears at an earlier age (teenage or early adult years) in men.

People who have family members with schizophrenia, bipolar disorder, or ScAD are at higher risk of developing ScAD.

ScAD may interfere with personal relationships or normal daily activities. People with ScAD are at a higher risk for:

• Job loss.
• Social aloneness (isolation).
• Health problems.
• Anxiety.
• Substance use disorders.
• Suicide.

Schizoaffective disorder is one of the most misdiagnosed psychiatric disorders in clinical practice.

In fact, some researchers have proposed revisions to the diagnostic criteria, and others have suggested removing the diagnosis altogether from the DSM-5.

There were significant concerns regarding the reliability and utility of the diagnosis when it was first introduced in the DSM.

The challenges lie within the diagnostic criteria itself since the disorder is part of a spectrum that shares criteria with many other prominent psychiatric disorders found in clinical practice.

How common is Schizoaffective Disorder?

Research shows that 30% of cases of Schizoaffective Disorder occur between the ages of 25 and 35, and it occurs more frequently in women.

Schizoaffective disorder occurs about one-third as frequently as schizophrenia, and the lifetime prevalence appears to be around 0.3%.

Estimates are that schizoaffective disorder comprises 10 to 30% of inpatient admissions for psychosis

What increases the risk?

The following factors may make you more likely to develop Schizoaffective Disorder:

• Problems during your mother’s pregnancy and after your birth, such as:
  • Your mother having the flu (influenza) during the second semester of the pregnancy.
  • Exposure to drugs, alcohol, illnesses, or other poisons (toxins) before birth.
  • Low birth weight.
• A brain infection or viral infection.
• Problems with brain structure or function.
• Having family members with bipolar disorder, ScAD, or schizophrenia.
• Substance abuse.
• Having been diagnosed with a mental health condition in the past.
• Being a victim of neglect or long-term (chronic) abuse.

What causes this condition?

The exact cause of Schizoaffective Disorder is not known.

• The term schizoaffective disorder first appeared as a subtype of schizophrenia in the first edition of the DSM.
• It eventually became its own diagnosis despite a lack of evidence for unique differences in etiology or pathophysiology.
• Therefore, there have been no conclusive studies on the etiology of the disorder. However, investigating the potential causes of mood disorders and schizophrenia as individual disorders allows for further discussion.
• Some studies show that as high as 50% of people with schizophrenia also have comorbid depression.
• The pathogenesis of both mood disorders and schizophrenia is multifactorial and covers a range of risk factors, including genetics, social factors, trauma, and stress.
• Among people with schizophrenia, there is a possible increased risk for first-degree relatives for schizoaffective disorder and vice-versa; there may be increased risk among individuals for schizoaffective disorder who have a first-degree relative with bipolar disorder schizophrenia, or schizoaffective disorder

What are the symptoms of Schizoaffective Disorder?

At any one time, people with Schizoaffective Disorder may have psychotic symptoms only or have both psychotic and affective symptoms.

Psychotic symptoms may include:

• Hearing, seeing, or feeling things that are not there (hallucinations).
• Having fixed, false beliefs (delusions). The delusions usually include being attacked, harassed, or plotted against (paranoid delusions).
• Speaking in a way that makes no sense to others (disorganized speech).
• Confusing or odd behavior.
• Loss of motivation for normal daily activities, such as self-care.
• Withdrawal from social contacts (social isolation).
• Lack of emotions.

Affective symptoms may include:

• Symptoms similar to major depression, such as:
  • Depressed mood.
  • Loss of interest in activities that are usually pleasurable (anhedonia).
  • Sleeping more or less than normal.
  • Feeling worthless or excessively guilty.
  • Lack of energy or motivation.
  • Trouble concentrating.
  • Eating more or less than usual.
  • Thinking a lot about death or suicide.
• Symptoms similar to bipolar mania. Bipolar mania refers to periods of severe elation, irritability, and high energy that are experienced by people who have bipolar disorder. These symptoms may include:
  • Abnormally elevated or irritable mood.
  • Abnormally increased energy or activity.
  • More confidence than normal or feeling that you are able to do anything (grandiosity).
  • Feeling rested after getting less sleep than normal.
  • Being easily distracted.
  • Talking more than usual or feeling pressure to keep talking.
  • Feeling that your thoughts are racing.
  • Engaging in high-risk activities.

How is this diagnosed?

ScAD is diagnosed through an assessment by your health care provider. Your health care provider may refer you to a mental health specialist for evaluation. The mental health specialist:

• Will observe and ask questions about your thoughts, behavior, mood, and ability to function in daily life.
• May ask questions about your medical history and use of drugs, including prescription medicines. Certain medical conditions and substances can cause symptoms that resemble ScAD.
• May do blood tests and imaging tests.

There are two types of ScAD:

• Depressive ScAD. This type is diagnosed when you have only depressive symptoms.
• Bipolar ScAD. This type is diagnosed if your affective symptoms are only manic or are a mixture of manic and depressive.

How is this treated?

Schizoaffective Disorder is usually a lifelong (chronic) illness that requires long-term treatment. Treatment may include:

• Medicine. Different types of medicine are used to treat ScAD. The exact combination depends on the type and severity of your symptoms.
  • Antipsychotic medicine may be used to control psychotic symptoms such as delusions, paranoia, and hallucinations.
  • Mood stabilizers may be used to balance the highs and lows of bipolar manic mood swings.
  • Antidepressant medicines may be used to treat depressive symptoms.
• Counseling or talk therapy. Individual, group, or family counseling may be helpful in providing education, support, and guidance. Many people with ScAD also benefit from social skills and job skills (vocational) training.

A combination of medicine and counseling is usually best for managing the disorder over time. A procedure in which electricity is applied to the brain through the scalp (electroconvulsive therapy) may be used to treat people with severe manic symptoms who do not respond to medicine and counseling.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider. Check with your health care provider before starting new medicines.
• Surround yourself with people who care about you and can help you manage your condition.
• Keep stress under control. Stress may make symptoms worse.
• Avoid alcohol and drugs. They can affect how medicine works and make symptoms worse.
• Keep all follow-up visits as told by your health care provider and counselor. This is important.

Contact a health care provider if:

• You are not able to take your medicines as prescribed.
• Your symptoms get worse.

Get help right away if:

• You feel out of control.
• You or others notice warning signs of suicide, such as:
  • Increased use of drugs or alcohol
  • Expressing feelings of not having a purpose in life or feeling trapped, guilty, anxious, agitated, or hopeless.
  • Withdrawing from friends and family.
  • Showing uncontrolled anger, recklessness, and dramatic mood changes.
  • Talking about suicide or searching for methods.

If you ever feel like you may hurt yourself or others, or have thoughts about taking your own life, get help right away. You can go to your nearest emergency department or call:

• Your local emergency services (911 in the U.S.).
• A suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255. This is open 24 hours a day.

Summary

Schizoaffective disorder is a mental health condition that combines symptoms of both schizophrenia and mood disorders, such as major depressive disorder or bipolar disorder. It’s considered a complex and relatively rare condition, and its diagnosis involves the presence of psychotic symptoms and mood symptoms that occur together over a significant period of time.

Key features of schizoaffective disorder include:

1. Psychotic Symptoms: Individuals with schizoaffective disorder experience symptoms similar to those seen in schizophrenia. These may include hallucinations (perceiving things that aren’t present), delusions (false beliefs), disorganized thinking, and disorganized or abnormal behavior.
2. Mood Symptoms: The disorder also involves mood disturbances, which can be in the form of major depressive episodes or manic episodes (elevated, hyperactive mood) that are characteristic of bipolar disorder. These mood symptoms occur alongside the psychotic symptoms.
3. Criteria for Both Schizophrenia and Mood Disorder: For a diagnosis of schizoaffective disorder, the individual must meet criteria for both schizophrenia and a mood disorder, and the mood symptoms must be present for a substantial portion of the illness.
4. Duration of Symptoms: The psychotic and mood symptoms should be present for a significant portion of the illness, usually at least two weeks when there are no prominent mood symptoms.
5. Subtypes: Schizoaffective disorder is further classified into two subtypes based on whether the mood symptoms are predominantly depressive or manic. The depressive subtype involves major depressive episodes, while the bipolar subtype involves manic or mixed episodes.
6. Functional Impairment: The symptoms of schizoaffective disorder can significantly impact an individual’s ability to function in daily life, including relationships, work, and self-care.

The exact cause of schizoaffective disorder is not well understood, but it likely involves a combination of genetic, environmental, and neurobiological factors. It is generally a chronic condition, and treatment often involves a combination of antipsychotic medications to manage the psychotic symptoms and mood stabilizers or antidepressants to address the mood symptoms. Psychotherapy, family support, and lifestyle modifications can also be beneficial in managing the disorder.

Due to the complexity of schizoaffective disorder, diagnosis and treatment should be carried out by qualified mental health professionals. If you or someone you know is experiencing symptoms that may indicate schizoaffective disorder, it’s important to seek professional help for accurate diagnosis and appropriate treatment.