Schizoaffective disorder is a mental disorder in which a person experiences a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania. The two types of schizoaffective disorder — both of which include some symptoms of schizophrenia — are:
- Bipolar type, which includes episodes of mania and sometimes major depression
- Depressive type, which includes only major depressive episodes
Schizoaffective disorder may run a unique course in each affected person, so it’s not as well-understood or well-defined as other mental health conditions. An untreated schizoaffective disorder may lead to problems functioning at work, at school and in social situations, causing loneliness and trouble holding down a job or attending school. People with schizoaffective disorder may need assistance and support with daily functioning. Treatment can help manage symptoms and improve quality of life.
Schizoaffective disorder symptoms may vary from person to person. The course of schizoaffective disorder usually features cycles of severe symptoms followed by periods of improvement with less severe symptoms. Signs and symptoms of schizoaffective disorder depend on the type — bipolar or depressive type — and may include, among others:
- Delusions — having false, fixed beliefs, despite evidence to the contrary
- Hallucinations, such as hearing voices or seeing things that aren’t there
- Symptoms of depression, such as feeling empty, sad or worthless
- Periods of manic mood or a sudden increase in energy with behaviour that’s out of character
- Impaired communication, such as only partially answering questions or giving answers that are completely unrelated
- Impaired occupational, academic and social functioning
- Problems with managing personal care, including cleanliness and physical appearance
When to see a doctor
If you think someone you know may have schizoaffective disorder symptoms, talk to that person about your concerns. Although you can’t force someone to seek professional help, you can offer encouragement and support and help find a qualified doctor or mental health professional. If your loved one can’t provide his or her food, clothing or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.
Suicidal thoughts or behaviour
Talk of suicide or suicidal behaviour may occur in someone with a schizoaffective disorder. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.
The exact cause of schizoaffective disorder is not known. A combination of factors may contribute to its development, such as genetics and variations in brain chemistry and structure.
Factors that increase the risk of developing schizoaffective disorder include:
- Having a close blood relative who has schizoaffective disorder, schizophrenia or bipolar disorder
- Stressful events that trigger symptoms
- Taking mind-altering (psychoactive or psychotropic) drugs
People with schizoaffective disorder are at an increased risk of:
- Suicide, suicide attempts or suicidal thoughts
- Social isolation
- Family and interpersonal conflicts
- Anxiety disorders
- Developing alcohol or other substance abuse problems
- Significant health problems
- Poverty and homelessness
Diagnosis of the schizoaffective disorder involves ruling out other mental health disorders and concluding that symptoms are not due to substance use, medication or a medical condition. Determining a diagnosis of schizoaffective disorder may include:
- Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
- Tests and screenings. These may include tests that help rule out conditions with similar symptoms and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
- Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanour and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for suicide. This also includes a discussion of family and personal history.
- Diagnostic criteria for schizoaffective disorder. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
People with schizoaffective disorder generally respond best to a combination of medications, psychotherapy and life skills training. Treatment varies, depending on the type and severity of symptoms, and whether the disorder is the depressive or bipolar type. In some cases, hospitalisation may be needed. Long-term treatment can help to manage the symptoms.
In general, doctors prescribe medications for a schizoaffective disorder to relieve psychotic symptoms, stabilise mood and treat depression. These medications may include:
- The only medication approved by the Food and Drug Administration specifically for the treatment of schizoaffective disorder is the antipsychotic drug paliperidone (Invega). However, doctors may prescribe other antipsychotic drugs to help manage psychotic symptoms such as delusions and hallucinations.
- Mood-stabilizing medications. When the schizoaffective disorder is a bipolar type, mood stabilisers can help level out the manic highs and depressing lows.
- When depression is the underlying mood disorder, antidepressants can help manage feelings of sadness, hopelessness, or difficulty with sleep and concentration.
In addition to medication, psychotherapy, also called talk therapy, may help. Psychotherapy may include:
- Individual therapy. Psychotherapy may help to normalise thought patterns and reduce symptoms. Building a trusting relationship in therapy can help people with schizoaffective disorder better understand their condition and learn to manage symptoms. Effective sessions focus on real-life plans, problems and relationships.
- Family or group therapy. Treatment can be more effective when people with the schizoaffective disorder can discuss their real-life problems with others. Supportive group settings can also help decrease social isolation and provide a reality check during periods of psychosis.
Life skills training
Learning social and vocational skills can help reduce isolation and improve quality of life.
- Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities. New skills and behaviours specific to settings such as the home or workplace can be practised.
- Vocational rehabilitation and supported employment. This focuses on helping people with schizoaffective disorder prepare for, find and keep jobs.
During crisis periods or times of severe symptoms, hospitalisation may be necessary to ensure safety, proper nutrition, adequate sleep, and basic personal care and cleanliness.
For adults with schizoaffective disorder who do not respond to psychotherapy or medications, electroconvulsive therapy (ECT) may be considered.
COPING AND SUPPORT
Schizoaffective disorder requires ongoing treatment and support. People with schizoaffective disorder can benefit from:
- Learning about the disorder. Education about schizoaffective disorder may help the person stick to the treatment plan. Education also can help friends and family understand the disorder and be more compassionate.
- Paying attention to warning signs. Identify things that may trigger symptoms or interfere with carrying out daily activities. Make a plan for what to do if symptoms return. Contact the doctor or therapist if needed to prevent the situation from worsening.
- Joining a support group. Support groups can help make connections with others facing similar challenges. Support groups may also help family and friends cope.
- Asking about social services assistance. These services may be able to help with affordable housing, transportation and daily activities.
Also, avoid drugs, tobacco and alcohol. Drugs, tobacco and alcohol can worsen schizoaffective symptoms or interfere with medications. If necessary, get appropriate treatment for a substance use problem.
PREPARING FOR YOUR APPOINTMENT
If you think you may have schizoaffective disorder or that your loved one may have it, take steps to prepare for the appointment, whether it’s with a primary care doctor or a mental health professional, such as a psychiatrist. If the appointment is for a relative or friend, offer to go with him or her. Getting the information first-hand will help you know what you’re facing and how you can help your loved one.
Credit: Mayo Clinic, 27 October 2017.