Schizoaffective Disorder – Causes, Signs and Symptoms

Schizoaffective Disorder

Also called: Depressive Schizoaffective Disorder, Bipolar Schizoaffective Disorder

Summary

Schizoaffective disorder is a condition in which patients exhibit signs of both schizophrenia (including hallucinations and delusions) and mood disorders (such as depression or mania).

Patients usually develop schizoaffective disorder in late adolescence or early adulthood.  It is more common among women, but men tend to develop schizoaffective disorder at an earlier age than women. 

There are two different types of schizoaffective disorder. The bipolar type occurs when patients exhibit symptoms of bipolar disorder and the depressive type occurs when patients display symptoms of depression.

Scientists do not know what causes schizoaffective disorder. However, like schizophrenia, genetic and environmental factors are thought to play a role in its development. An imbalance of brain chemicals may also be a factor in the development of the disorder.

Symptoms of schizoaffective disorder include those of schizophrenia, bipolar disorder and depression. Some common symptoms of schizophrenia include hallucinations and delusions. Bipolar disorder is characterized by episodes of excitability (mania) alone or both these and episodes of depression. Common symptoms of depression include sadness, fatigue and persistent thoughts of suicide.

Schizoaffective disorder is diagnosed by mental health professionals using a specific set of criteria. In general, patients must exhibit symptoms of schizophrenia along with symptoms of a depressive, manic, or mixed episode. Patients must also have psychotic symptoms without experiencing mood disorder symptoms for at least two weeks to be diagnosed with the condition.

Schizoaffective disorder cannot be prevented. It is treated with medications, such as antipsychotics, mood stabilizers, antidepressants and anticonvulsants. Most patients also benefit from therapy, such as cognitive behavioral therapy(CBT). It is important for patients to receive support from friends and family members because patients often resist treatment or fail to take medication on a regular basis.

About schizoaffective disorder

Schizoaffective disorder is a condition in which patients exhibit symptoms of both schizophrenia and a mood disorder (a disorder marked by unusually elevated [manic] or depressed moods).

Schizophrenia is a disorder in which patients find it difficult to distinguish between real and imaginary experiences, think logically, have normal emotional responses to others and behave appropriately in social situations. Some common symptoms include delusions (false beliefs that a person holds despite evidence to the contrary) and hallucinations (sensory perceptions of phenomena that are not actually there).

Mood disorders associated with schizoaffective disorder include bipolar disorder and depression. Bipolar disorder is a condition characterized by episodes of excitability (mania) alone or both these and episodes of depression. Depression is a disorder marked by feelings of sadness, anger and/or frustration that last for at least two weeks.

Patients usually develop schizoaffective disorder in late adolescence or early adulthood. It is not known how many people have schizoaffective disorder, but the condition is believed to be less common than schizophrenia or mood disorders. It is more common among women, but men tend to develop it at an earlier age than women.  Men with the disorder tend to exhibit traits that are considered antisocial (hostile to or disruptive of normal standards of social behavior). Schizoaffective disorder is rare in children.

Schizoaffective disorder is a lifelong illness that can impact a patient’s ability to function at work, home, school and in other environments. Like depression, patients with schizoaffective disorder are at increased risk of suicide. Patients with schizoaffective disorder may also develop substance abuse problems.

The prognosis (probable outcome or course of a disease) is somewhat better for patients with schizoaffective disorder than those with schizophrenia. It is considerably worse, however, than the prognosis for patients with mood disorders.

Types and differences

Schizoaffective disorder is not well understood. However, the condition seems to take the following forms:

  • Schizoaffective disorder, bipolar type. The patient has symptoms of schizophrenia, such as delusions (false beliefs that a person holds despite evidence to the contrary) and/or hallucinations (sensory perceptions of phenomena that are not actually there). During the same period of illness, they also experience a manic episode (a period of unusually high energy, sometimes including uncontrollable excitement) or a mixed episode (symptoms of mania occur with or alternate with periods of depression). This type may be more common in younger adults.
  • Schizoaffective disorder, depressive type. Patient has symptoms of schizophrenia, such as delusions or hallucinations, while also experiencing a major depressive episode (depressed mood and/or loss of interest in pleasure in all or most activities that lasts for at least two weeks). Research indicates that people with this form of the disorder are at higher risk for suicide. This type may be more common in older adults.

Risk factors/causes of schizoaffective disorder

The cause of schizoaffective disorder is unknown. However, like schizophrenia, genetic and environmental factors may play a role in its development.

Some possible environmental factors associated with the development of schizoaffective disorder include:

  • Exposure to viruses or malnutrition in the womb
  • Complications during birth, such as mild brain damage
  • Psychosocial factors, such as stressful environmental conditions

Some researchers believe the disorder may be linked to an imbalance of chemicals knownasneurotransmitters, which allow nerve cells to send messages to each other.

Signs and symptoms of schizoaffective disorder

Patients with schizoaffective disorder experience symptoms of both schizophrenia and a mood disorder.

Symptoms of schizophrenia include:

  • Hallucinations. A perception by the senses of phenomena that are not actually there. It can involve any of the five senses: sight, hearing, smell, touch or taste, although auditory (hearing) hallucinations are the most common in patients with schizophrenia. Patients with schizophrenia may respond verbally to auditory hallucinations.
  • Delusions. False beliefs that a person holds despite evidence to the contrary. Some common types of delusions include delusions of persecution (patients believe they are being tormented, followed, tricked, spied on or ridiculed) and delusions of grandeur (patients believe they are persons of high status, such as a god or a movie star).
  • Thought disorder. Patients often have unusual thought processes. They may have difficulty organizing thoughts or connecting them logically. Speech may also be disorganized and illogical (sometimes called loose associations). For instance, patients may connect thoughts by rhymes or puns rather than by logic.

Patients with the bipolar type of schizoaffective disorder also experience symptoms of bipolar disorder, which may include:

  • Elevated, expansive or irritable mood alternating with depressed mood
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Racing thoughts
  • Distractibility
  • Excessive involvement in pleasurable activities that have a high potential for negative consequences, such as shopping sprees, sexual promiscuity and poor financial decisions

Patients with the depressive type of schizoaffective disorder also exhibit symptoms of depression, which may include:

  • Sadness
  • Reduced pleasure in everyday activities
  • Significant weight loss (when not dieting) or weight gain
  • Insomnia (inability to sleep) or hypersomnia (excessive sleepiness)
  • Restlessness or a slowing down of motor (motion) activity
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Reduced ability to concentrate
  • Deterioration in personal hygiene
  • Recurrent thoughts of death or suicide

At certain times, patients experience symptoms of schizophrenia and a mood disorder simultaneously. At other times, they only experience symptoms of one disorder. The following description is an example of how the illness may progress: A patient experiences hallucinations and delusions (symptoms of schizophrenia) for two months before experiencing symptoms of depression. Then, the symptoms of schizophrenia and depression are experienced simultaneously for three months. With treatment, the symptoms of depression disappear, but the schizophrenia symptoms tend to persist for a month before they disappear.

Patients experiencing any of these signs and symptoms – or loved ones who notice any of these signs and symptoms in patients – should notify their physician.

Diagnosis methods for schizoaffective disorder

The diagnosis of schizoaffective disorder usually begins with a physical examination by a physician, a medical history and a list of medications. A physician may also inquire about any family history of mental illness.

Some questions a physician may ask a patient include:

  • Has the patient been hearing sounds or seeing images that others do not?
  • Does the patient have beliefs that others do not seem to share?
  • Has the patient been feeling unusually happy or sad?

A physician may try to rule out other mental or physical illnesses that may be causing symptoms. Blood or urine tests may be conducted to determine whether medications, substance abuse or physical illness is contributing to symptoms. Some infections, cancers, nervous system disorders, thyroid disorders and immune system disorders can produce psychotic symptoms. Psychosis is also a possible side effect of some prescription medications, such as stimulants.

If a physician suspects that a patient has schizoaffective disorder, the patient may be referred to a psychiatrist for psychiatric evaluation and treatment.

Schizoaffective disorder is complicated and can sometimes be difficult to diagnose. Patients are diagnosed with the condition when they exhibit symptoms, but do not meet the criteria for either schizophrenia or mood disorders. For this reason, mental health professionals have developed specific criteria for diagnosing schizoaffective disorder. Patients must meet the following criteria to be diagnosed with the condition, including:

  • During a continuous period of illness, for a substantial part of at least one month, patients must experience two or more of the following symptoms:
    • Delusions (only one symptom is required if the delusion is bizarre, such as being abducted in a spaceship).
    • Hallucinations (only one symptom is required if hallucinations are of at least two voices talking to each other or of a voice that persistently comments on a patient’s thoughts or actions).
    • Disorganized speech.
    • Disorganized or catatonic behavior.
    • Any type of negative symptoms (absence of thoughts and behaviors that would otherwise be expected) such as flattened affect (reduced expression of emotion), reduced speech or loss of ability to initiate or sustain planned activities (avolition).
  • During the same period of illness, the patient must experience one of the following:
    • A major depressive episode (depressed mood and/or loss of interest or pleasure in all or most activities that lasts for at least two weeks).
    • A manic episode (a period of unusually high energy, sometimes including uncontrollable excitement).
    • A mixed episode (a period in which symptoms of both mania and depression occur or alternate rapidly).
  • For at least two weeks during the period of illness, the patient must experience delusions or hallucinations and no prominent symptoms of a mood disorder.
  • The mood disorder symptoms must be present during a substantial part of the active and residual portions of the illness.
  • The symptoms must not be caused by a medical condition, substance abuse or prescription medication side effects.

It is sometimes difficult for a mental health professional to distinguish schizoaffective disorders from other mental illnesses. In fact, some patients are diagnosed with other conditions before they are diagnosed with schizoaffective disorder.

Treatment options for schizoaffective disorder

Since the cause of schizoaffective disorder remains unknown, the focus of treatment is to control symptoms. There is no cure, although, the condition can often be managed with proper treatment.

Patients are usually treated at home. However, they may be treated in a hospital if they experience acute symptoms, such as severe delusions or hallucinations, suicidal thoughts, an inability to care for themselves, severe substance abuse problems or are a threat to themselves or others.

The most common treatment for schizoaffective disorder is medication. Medications used to treat the disorder include:

  • Antipsychotics (also known as neuroleptics). They help relieve psychotic symptoms such as hallucinations, delusions and disorganized thinking. These drugs work by correcting an imbalance in the chemicals that help brain cells communicate with each other.
  • Mood stabilizers. Patients with the bipolar type of schizoaffective disorder may be treated with mood stabilizers (medications of various drug classes that are effective at treating fluctuations of mood, regardless of the cause of fluctuation).
  • Antidepressants. Patients with the depressive type of schizoaffective disorder may be treated with antidepressants. These medications are primarily used to prevent or treat depression, anxiety and problems with obsession. They appear to work by increasing the level of neurotransmitters (chemicals that help cells communicate) in the brain.

    Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.
  • Anticonvulsants. These medications are primarily used to prevent seizures but are sometimes prescribed as mood stabilizers to treat mania and/or depression in schizoaffective patients.

Patients are usually first treated with antipsychotics. After psychotic symptoms have subsided, they are treated with mood stabilizers, antidepressants or anticonvulsants to address symptoms of a mood disorder. However, patients are sometimes prescribed medications to treat psychosis and mood disorder symptoms simultaneously.

Patients with schizoaffective disorder are sometimes treated with electroconvulsive therapy (ECT, a procedure that involves using an electric current to produce a seizure). According to the National Mental Health Association, an estimated 100,000 people receive ECT each year for conditions including schizoaffective disorder, primarily in hospital psychiatric units or psychiatric hospitals.

In addition to medication, patients with schizoaffective disorder are also sometimes treated with psychosocial rehabilitation (therapy that involves both social and psychological behavior). Some treatment techniques include:

  • Rehabilitation. Emphasizes social and vocational training to help patients function more effectively in the community. Programs may include vocational counseling, job training, money management, learning to use public transportation and practicing social and workplace communication skills.
  • Family education/therapy. Patients often live with family members who must be as informed as possible to provide support to patients. Family members learn ways to recognize stressful situations that may trigger a relapse or ensure patients adhere to medication schedules.
  • Cognitive behavioral therapy(CBT). This is useful for patients with symptoms that persist even after taking medication. Therapists teach patients how to monitor the reality of their thoughts and perceptions, how to ignore auditory hallucinations and how to cope with apathy (lack of emotion, motivation or enthusiasm) that can be immobilizing.

Patients with schizoaffective disorder often need assistance from family members, friends and others to ensure that they continue to receive treatment and take their medications as prescribed. If patients stop taking medications, psychotic symptoms, depression and mania are likely to reappear and may impact their ability to tend to basic needs, such as food, clothing and shelter. Family and friends can also help patients set realistic goals for coping with their illness. It is important to always show support and encouragement because patients who feel pressured or criticized often regress, making symptoms worse.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with physicians regarding their conditions. Patients and their loved ones may wish to ask their doctor the following questions about schizoaffective disorder:

  1. What is schizoaffective disorder?
  2. How is it different from schizophrenia?
  3. How is it different from depression and bipolar disorder?
  4. What are some of the most common symptoms of schizoaffective disorder?
  5. What types of medications should I use to treat my schizoaffective disorder?
  6. Should I be treated with therapy as well as medication?
  7. What type of therapy is best for me?
  8. Is there a cure for my schizoaffective disorder?
  9. A family member has schizoaffective disorder. Will he/she be able to live on his/her own, or should I arrange for someone to care for him/her?
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