Introduction

Schizoaffective disorder is a serious mental illness that has features of two different conditions, schizophrenia and an affective (mood) disorder, either major depression or bipolar disorder. Schizophrenia is a brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality and relates to others. Depression is an illness that is marked by feelings of sadness, worthlessness or hopelessness, as well as problems concentrating and remembering details. Bipolar disorder is characterized by cycling mood changes, including severe highs (mania) and lows (depression). Schizoaffective disorder is a life-long illness that can impact all areas of daily living, including work or school, social contacts and relationships. Most people with this illness have periodic episodes, called relapses, when their symptoms surface. While there is no cure for schizoaffective disorder, symptoms often can be controlled with proper treatment.

What Are the Symptoms of Schizoaffective Disorder?

A person with schizoaffective disorder has severe changes in mood and some of the psychotic symptoms of schizophrenia, such as hallucinations, delusions and disorganized thinking. Psychotic symptoms reflect the person's inability to tell what is real from what is imagined. Symptoms of schizoaffective disorder may vary greatly from one person to the next and may be mild or severe. Symptoms of schizoaffective disorder may include:

Depression
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Poor appetite Weight loss or gain Changes in sleeping patterns (sleeping very little or a lot) Agitation (excessive restlessness) Lack of energy Loss of interest in usual activities Feelings of worthlessness or hopelessness Guilt or self-blame Inability to think or concentrate Thoughts of death or suicide

Mania
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Increased activity, including work, social and sexual activity Increased and/or rapid talking Rapid or racing thoughts

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Little need for sleep Agitation Inflated self-esteem Distractibility Self-destructive or dangerous behavior (such as going on spending sprees, driving recklessly or having unsafe sex)

Schizophrenia
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Delusions (strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information) Hallucinations (the perception of sensations that aren't real, such as hearing voices) Disorganized thinking Odd or unusual behavior Slow movements or total immobility Lack of emotion in facial expression and speech Poor motivation Problems with speech and communication

What Causes Schizoaffective Disorder?

While the exact cause of schizoaffective disorder is not known, researchers believe that genetic, biochemical and environmental factors are involved.
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Genetics (heredity): A tendency to develop schizoaffective disorder may be passed on from parents to their children. Brain chemistry: People with schizophrenia and mood disorders may have an imbalance of certain chemicals in the brain. These chemicals, called neurotransmitters, are substances that help nerve cells in the brain send messages to each other. An imbalance in these chemicals can interfere with the transmission of messages, leading to symptoms. Environmental factors: Evidence suggests that certain environmental factors -such as a viral infection, poor social interactions or highly stressful situations -may trigger schizoaffective disorder in people who have inherited a tendency to develop the disorder.

Who Gets Schizoaffective Disorder?

Schizoaffective disorder usually begins in the late teen years or early adulthood, often between the ages of 16 and 30. It seems to occur slightly more often in women than in men and is rare in children.

How Common Is Schizoaffective Disorder?

Because people with schizoaffective disorder have symptoms of two separate mental illnesses, it is often misdiagnosed. Some people may be misdiagnosed as having schizophrenia, and others may be misdiagnosed with a mood disorder. As a result, it is difficult to determine exactly how many people actually are affected by schizoaffective disorder. However, it is believed to be less common than either schizophrenia or affective disorder alone. Estimates suggest that about one in every 200 people (0.5%) develops schizoaffective disorder at some time during his or her life.

How Is Schizoaffective Disorder Diagnosed?

If symptoms of schizoaffective disorder are present, the doctor will perform a complete medical history and physical exam. Although there are no laboratory tests to specifically diagnose schizoaffective disorder, the doctor may use various tests -- such as X-rays or blood tests -- to rule out a physical illness as the cause of the symptoms. If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. A diagnosis of schizoaffective disorder is made if a person has periods of uninterrupted illness and has, at some point, an episode of mania, major depression or mix of both while also having symptoms of schizophrenia. In addition, to diagnose the illness, the person must display a period of at least two weeks of psychotic symptoms without the mood symptoms.

How Is Schizoaffective Disorder Treated?

Treatment for schizoaffective disorder typically involves medication to stabilize the mood and treat the psychotic symptoms. In addition, psychotherapy (a type of counseling) and skills training may be useful for improving interpersonal, social and coping skills.
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Medication: The choice of medication depends on the mood disorder associated with the illness. The primary medications used to treat the psychotic symptoms associated with schizophrenia, such as delusions, hallucinations and disordered thinking, are called antipsychotics. The mood-related symptoms may be treated with an antidepressant medication or a mood stabilizer such as lithium. These medications may or may not be used in combination with an antipsychotic medication. Psychotherapy: The goal of therapy is to help the patient learn about the illness, establish goals and manage everyday problems related to the disorder. Family therapy can help families deal more effectively with a loved one who has schizoaffective disorder, enabling them to better help their loved one. Skills training: This generally focuses on work and social skills, grooming and hygiene, and other day-to-day activities, including money and home management.

Hospitalization: Most people with schizoaffective disorder are treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their conditions.

What Is the Outlook for People With Schizoaffective Disorder?

There is no cure for schizoaffective disorder, but treatment has been shown to be effective in minimizing the symptoms, and in helping the person better cope with the disorder and improve social functioning.

Can Schizoaffective Disorder Be Prevented?

There is no known way to prevent schizoaffective disorder. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations, and help decrease the disruption to the person's life, family and friendships. WebMD Medical Reference

Schizoaffective disorder
Last reviewed: February 7, 2010. Schizoaffective disorder is a mental condition that causes both a loss of contact with reality (psychosis) and mood problems.

Causes, incidence, and risk factors

The exact cause of schizoaffective disorder is unknown. Changes in genes and chemicals in the brain (neurotransmitters) may play a role. Some experts do not believe it is a separate disorder from schizophrenia. Schizoaffective disorder is believed to be less common than schizophrenia and mood disorders. Women may have the condition more often than men. Schizoaffective disorder tends to be rare in children.

Symptoms
The symptoms of schizoaffective disorder are different in each person. Often, people with schizoaffective disorder seek treatment for problems with mood, daily function, or abnormal thoughts. Psychosis and mood problems may occur at the same time, or by themselves. The course of the disorder may involve cycles of severe symptoms followed by improvement. The symptoms of schizoaffective disorder can include:
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Changes in appetite and energy Disorganized speech that is not logical False beliefs (delusions), such as thinking someone is trying to harm you (paranoia) or thinking that special messages are hidden in common places (delusions of reference) Lack of concern with hygiene or grooming Mood that is either too good, or depressed or irritable Problems sleeping Problems with concentration Sadness or hopelessness Seeing or hearing things that aren't there (hallucinations) Social isolation Speaking so quickly that others cannot interrupt you

Signs and tests

Your health care provider will do a psychiatric evaluation to find out about your behavior and symptoms. You may be referred to a psychiatrist to confirm the diagnosis. To be diagnosed with schizoaffective disorder, you must have psychotic symptoms during a period of normal mood for at least 2 weeks. The combination of psychotic and mood symptoms in schizoaffective disorder can be seen in other illnesses, such as bipolar disorder. Extreme disturbance in mood is an important part of schizoaffective disorder. Your health care provider should consider and rule out medical, psychiatric, and drugrelated conditions that cause psychotic or mood symptoms before making a diagnosis of schizoaffective disorder. For example, psychotic or mood disorder symptoms can occur in people who:
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Abuse cocaine, amphetamines, or phencyclidine (PCP)

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Have seizure disorders Take steroid medications

Treatment
Treatment can vary. In general, your health care provider will prescribe medications to improve your mood and treat psychosis.
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Antipsychotic medications are used to treat psychotic symptoms. Antidepressant medications or "mood stabilizers" may be prescribed to improve mood.

Talk therapy can help with creating plans, solving problems, and maintaining relationships. Group therapy can help with social isolation. Support and work training may be helpful for work skills, relationships, money management, and living situations.

Expectations (prognosis)
People with schizoaffective disorder have a greater chance of going back to their previous level of function than do people with most other psychotic disorders. However, long-term treatment is often needed, and results can vary from person to person.

Complications
Complications are similar to those for schizophrenia and major mood disorders. These include:
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Abuse of drugs in an attempt to self-medicate Problems following medical treatment and therapy Problems due to manic behavior (for example, spending sprees, overly sexual behavior) Suicidal behavior

Calling your health care provider

Call your health care or mental health provider if you or someone you know is experiencing any of the following:
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Depression with feelings of hopelessness or helplessness Inability to care for basic personal needs

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Increase in energy and involvement in risky behavior that is sudden and not normal for you (for instance, going days without sleeping and feeling no need for sleep) Strange or unusual thoughts or perceptions Symptoms that get worse or do not improve with treatment Thoughts of suicide or of harming others

References
1. Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 28.

Review Date: 2/7/2010.

Schizoaffective Disorder

World Health Organization ICD-10

The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992

F25 Schizoaffective Disorder

These are episodic disorders in which both affective and schizophrenic symptoms are prominent within the same episode of illness, preferably simultaneously, but at least within a few days of each other. Their relationship to typical mood (affective) disorders and to schizophrenic disorders is uncertain. They are given a separate category because they are too common to be ignored. Other conditions in which affective symptoms are superimposed upon or form part of a pre-existing schizophrenic illness, or in which they coexist or alternate with other types of persistent delusional disorders, are classified under the appropriate category. Mood-incongruent delusions or hallucinations in affective disorders do not by themselves justify a diagnosis of schizoaffective disorder.

Patients who suffer from recurrent schizoaffective episodes, particularly those whose symptoms are of the manic rather than the depressive type, usually make a full recovery and only rarely develop a defect state.

Diagnostic Guidelines
A diagnosis of schizoaffective disorder should be made only when both definite schizophrenic and definite affective symptoms are prominent simultaneously, or within a few days of each other, within the same episode of illness, and when, as a consequence of this, the episode of illness does not meet criteria for either schizophrenia or a depressive or manic episode. The term should not be applied to patients who exhibit schizophrenic symptoms and affective symptoms only in different episodes of illness. It is common, for example, for a schizophrenic patient to present with depressive symptoms in the aftermath of a psychotic episode (see post-schizophrenic depression). Some patients have recurrent schizoaffective episodes, which may be of the manic or depressive type or a mixture of the two. Others have one or two schizoaffective episodes interspersed between typical episodes of mania or depression. In the former case, schizoaffective disorder is the appropriate diagnosis. In the latter, the occurrence of an occasional schizoaffective episode does not invalidate a diagnosis of bipolar affective disorder or recurrent depressive disorder if the clinical picture is typical in other respects.

F25.0 Schizoaffective Disorder, Manic Type

A disorder in which schizophrenic and manic symptoms are both prominent in the same episode of illness. The abnormality of mood usually takes the form of elation, accompanied by increased self-esteem and grandiose ideas, but sometimes excitement or irritability are more obvious and accompanied by aggressive behaviour and persecutory ideas. In both cases there is increased energy, overactivity, impaired concentration, and a loss of normal social inhibition. Delusions of reference, grandeur, or persecution may be present, but other more typically schizophrenic symptoms are required to establish the diagnosis. People may insist, for example, that their thoughts are being broadcast or interfered with, or that alien forces are trying to control them, or they may report hearing voices of varied kinds or express bizarre delusional ideas that are not merely grandiose or persecutory. Careful questioning is often required to establish that an individual really is experiencing these morbid phenomena, and not merely joking or talking in metaphors. Schizoaffective disorders, manic type, are usually florid psychoses with an acute onset; although behaviour is often grossly disturbed, full recovery generally occurs within a few weeks.

Diagnostic Guidelines

There must be a prominent elevation of mood, or a less obvious elevation of mood combined with increased irritability or excitement. Within the same episode, at least one and preferably two typically schizophrenic symptoms (as specified for schizophrenia [F20], diagnostic guidelines (a) - (d)) should be clearly present. This category should be used both for a single schizoaffective episode of the manic type and for a recurrent disorder in which the majority of episodes are schizoaffective, manic type. Includes: * schizoaffective psychosis, manic type * schizophreniform psychosis, manic type

F25.1 Schizoaffective Disorder, Depressive Type

A disorder in which schizophrenic and depressive symptoms are both prominent in the same episode of illness. Depression of mood is usually accompanied by several characteristic depressive symptoms or behavioural abnormalities such as retardation, insomnia, loss of energy, appetite or weight, reduction of normal interests, impairment of concentration, guilt, feelings of hopelessness, and suicidal thoughts. At the same time, or within the same episode, other more typically schizophrenic symptoms are present; patients may insist, for example, that their thoughts are being broadcast or interfered with, or that alien forces are trying to control them. They may be convinced that they are being spied upon or plotted against and this is not justified by their own behaviour. Voices may be heard that are not merely disparaging or condemnatory but that talk of killing the patient or discuss this behaviour between themselves. Schizoaffective episodes of the depressive type are usually less florid and alarming than schizoaffective episodes of the manic type, but they tend to last longer and the prognosis is less favourable. Although the majority of patients recover completely, some eventually develop a schizophrenic defect.

Diagnostic Guidelines
There must be prominent depression, accompanied by at least two characteristic depressive symptoms or associated behavioural abnormalities as listed for depressive episode; within the same episode, at least one and preferably two typically schizophrenic symptoms (as specified for schizophrenia), diagnostic guidelines (a)-(d) should be clearly present. This category should be used both for a single schizoaffective episode, depressive type, and for a recurrent disorder in which the majority of episodes are schizoaffective, depressive type.

Includes: * schizoaffective psychosis, depressive type * schizophreniform psychosis, depressive type