What is schizoaffective disorder?
Schizoaffective disorder is a serious mental illness that affects about one in 100 people. Schizoaffective disorder as a diagnostic entity has features that resemble both schizophrenia and also serious mood (affective) symptoms. Many of the strategies used to treat both schizophrenia and affective conditions can be employed for this condition. These include antipsychotic and mood stabilizing medications, family involvement, psychosocial strategies, self-care peer support, psychotherapy and integrated care for co-occurring substance abuse (when appropriate).
A person who has schizoaffective disorder will experience delusions, hallucinations, other symptoms that are characteristic of schizophrenia and significant disturbances in their mood (e.g., affective symptoms). According to the DSM-IV-TR, people who experience more than two weeks of psychotic symptoms in the absence of severe mood disturbances—and then have symptoms of either depression or bipolar disorder—may have schizoaffective disorder. Schizoaffective disorder is thought to be between the bipolar and schizophrenia diagnoses as it has features of both.
Depressive symptoms associated with schizoaffective disorder can include—but are not limited to—hopelessness, helplessness, guilt, worthlessness, disrupted appetite, disturbed sleep, inability to concentrate, and depressed mood (with or without suicidal thoughts). Manic (bipolar) symptoms associated with schizoaffective disorder can include increased energy, decreased sleep (or decreased need for sleep), distractibility, fast (“pressured”) speech, and increased impulsive behaviors (e.g., sexual activities, drug and alcohol abuse, gambling or spending large amounts of money).
While it is a hot-topic of debate within the mental health field, most experts believe that schizoaffective disorder is a type of chronic mental illness that has psychotic symptoms at the core and with depressive and manic symptoms as a secondary—but equally debilitating—component. Because it consists of a wide range of symptoms, some people may be inappropriately diagnosed with schizoaffective disorder. This is problematic because it can lead to unnecessary treatments, specifically medication-treatment with antipsychotics when they are not otherwise indicated.
People who have depression or mania as their primary mental illness may experience symptoms of psychosis (including disorganized speech, disorganized behavior, delusions, or hallucinations) during severe episodes of their mood disorder but will not have these symptoms if their mood disorder is well treated. Sometimes people with other mental illnesses including borderline personality disorder may also be incorrectly diagnosed with schizoaffective disorder. This further underscores how important it is to have regular and complete mental health assessments from one’s doctors, preferably over time so that patterns of what is happening and what works can be fully understood together.
What treatments are available?
For most people with schizoaffective disorder, treatment will be very similar to treatment of schizophrenia and will include antipsychotic medications to help addresses symptoms of psychosis. Finding the right type and dose of antipsychotic medication is important and requires collaboration with a doctor. In some case, people with schizoaffective disorder will be offered treatment with long-acting-injectable (also called LAI, decanoate) formulations of antipsychotic medications. These FDA approved medications—including haloperidol (Haldol Decanoate), risperidone (Risperdal Consta), palperidone (Invega Sustenna)—are given in the form of an intramuscular injection (“shot”) approximately once or twice each month and have been shown to decrease the rates of relapse and hospitalization in people with psychotic illnesses.
Treatments such as cognitive behavioral therapy to target psychotic symptoms, supports groups including NAMI’s Family-to-Family to increase family and community support, peer support and connection, and work-and-school rehabilitation, such as social skills training, are very helpful for people with schizoaffective disorder. Maintaining a healthy lifestyle is also of critical importance: the role of good sleep hygiene, regular exercise, and a balanced diet cannot be underestimated. Omega-3 fatty acids (commonly marketed as “Fish Oil”) are an over-the-counter supplement that some may find useful.
Symptoms of depression—in people with schizoaffective disorder—may be treated with antidepressant medications or lithium in addition to antipsychotic medications. People with bipolar symptoms may be treated with mood-stabilizers such as lithium or anti-convulsants, including valproic acid (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol), in addition to their antipsychotic medications. The key is to find a prescriber you can work with to learn the best way to address your symptoms as part of your recovery plan.
There are some studies that suggest that older (“first-generation,” “typical”) antipsychotic medications are not as effective in controlling the mood symptoms associated with schizoaffective disorder as newer (“second-generation,” “atypical”) antipsychotic medications. These newer antipsychotic medications include clozapine (Clozaril), risperidone (Risperidal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). Newer antipsychotic medications may be less likely to cause side effects such as tardive dyskinesia but they are more likely to cause weight gain, high cholesterol, and increased blood sugars, which can lead to diabetes. Check out NAMI Hearts & Minds for more information. Given how complicated these choices may be, it is necessary for any individual with schizoaffective disorder and their loved ones to discuss medication management strategies with their doctors.
Families, friends, and others can be most helpful in providing empathic and non-judgmental support of their loved one. With this support, the proper medications, and effective psychosocial treatments, many people with schizoaffective disorder will do well and will be able to actively participate in a recovery journey.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., November 2012
The authors would like to thank Dilip Jeste, M.D., who was responsible for a previous version of this review.
Schizoaffective Disorder is characterized by the presence of a generally continuous psychotic illness plus intermittent mood episodes. Mood episodes are present for the majority of the total duration of the illness, which can include either one or both of the following:
The psychotic illness criteria resembles criterion A of the schizophrenia diagnosis. requiring at least two of the following symptoms, for at least one month:
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behavior
- Negative symptoms (e.g., affective flattening, alogia, avolition)
(Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.)
The occurrence of the delusions or hallucinations must be in the absence of any serious mood symptoms for at least 2 weeks. The mood disorder, however, must be present for a significant minority of the time. The symptoms of this disorder also can not be better explained by the use or abuse of a substance (alcohol, drugs, medications) or a general medical condition (stroke). If the mood symptoms are present for only a relatively brief period, the diagnosis is schizophrenia, not schizoaffective disorder. Occupational functioning is frequently impaired, but this is not a defining criterion (in contrast to schizophrenia). Restricted social contact and difficulties with self-care are associated with schizoaffective disorder, but negative symptoms may be less severe and less persistent than those seen in schizophrenia. Schizoaffective disorder is less common than schizophrenia.
This disorder has been adapted for updated 2013 DSM-5 criteria; diagnostic code 295.70
An unshakable theory or belief in something false and impossible, despite evidence to the contrary.
Examples of some of the most common types of delusions are:
- Delusions of persecution or paranoia – Belief that others — often a vague “they” — are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Russians are trying to poison me with radioactive particles delivered through my tap water”). Click here to learn more about paranoid delusions, or here to learn more about persecutory delusions.
- Delusions of reference – A neutral event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a celebrity is sending a message meant specifically for them. Click here to learn more about delusions of reference.
- Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). Click here to learn more about delusions of grandeur.
- Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”). Click here to learn more about delusions of control.
Example: The patient believes he is able to communicate telepathically with the U.S. President and no one can convince him otherwise, although he admits he’s never actually tried it.
A hallucination is a sensation or sensory perception that a person experiences in the absence of a relevant external stimulus. That is, a person experiences something that doesn’t really exist (except in their mind). A hallucination can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, etc.
Auditory hallucinations (e.g. hearing voices or some other sound) are most common type of hallucination in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Hallucinations can often be meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
The patient complains of an overwhelming chemical smell in and around his room; no one else smells it, although he insists it’s still there and says he feels faint.