Schizoaffective disorder
Definition
Schizoaffective disorder is a mental condition that causes both a loss of contact with reality (psychosis) and mood problems.
Causes
The exact cause of schizoaffective disorder is unknown. Changes in genes and chemicals in the brain (neurotransmitters) may play a role.
Schizoaffective disorder is believed to be less common than schizophrenia and mood disorders. Women may have the condition more often than men.
Although mood disorders are somewhat common in children, schizophrenia is not. Therefore schizoaffective disorder tends to be rare in children.
Symptoms
The signs and 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 changes may occur at one time, or off and on by themselves.
Psychotic symptoms can last for at least 2 weeks without major mood symptoms. The course of the disorder involves cycles of severe symptoms followed by improvement.
The symptoms of schizoaffective disorder include:
- Changes in appetite and energy
- Believing that someone on TV or the radio is speaking directly to you or that secret messages are hidden in common objects (delusions of reference)
- Disorganized speech that is not logical
- False beliefs (delusions)
- Feeling that everyone or one person or agency is out to get you (paranoia)
- Irritability and poor temper control
- Lack of concern with hygiene, grooming
- Problems sleeping
- Seeing or hearing things (hallucinations -- especially "hearing voices")
- Trouble concentrating
- Very good or bad mood
Exams and Tests
Your health care provider will do a psychiatric evaluation to find out about your behavior and symptoms.
To be diagnosed with schizoaffective disorder, you must have psychotic symptoms - but 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. The extreme disturbance in mood is an important part of schizoaffective disorder.
The health care provider must consider and rule out any medical, psychiatric, or drug-related condition that causes psychotic or mood symptoms before making a diagnosis of schizoaffective disorder. Schizophrenic or mood disorder symptoms can occur in people who:
- Abuse cocaine, amphetamines, or phencyclidine (PCP)
- Have seizure disorders
- Take steroid medications
Treatment
Treatment can vary. Generally, the health care provider will prescribe medications to stabilize mood and to treat psychosis. Neuroleptic medications (antipsychotics) are used to treat psychotic symptoms.
Lithium may be used to manage mania and stabilize mood. Anti-seizure medications such as valproic acid and carbamazepine are effective mood stabilizers. These medications may take up to 3 weeks to relieve symptoms.
Usually the combination of antipsychotic and mood-stabilizing medication controls both depressive and manic symptoms, but some people may also need antidepressants.
Outlook (Prognosis)
People with schizoaffective disorder have a greater chance of going back to their previous level of function than do people with other psychotic disorders. However, long-term treatment is necessary and results can vary from person to person.
Possible Complications
Complications are similar to those for schizophrenia and major mood disorders. These include:
- 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
When to Contact a Medical Professional
Call your health care or mental health provider if you or someone you know is experiencing any of the following:
- Feelings and thoughts of suicide
- Inability to care for basic personal needs
- 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)
- Periods of depression with feelings of hopelessness or helplessness
- Strange or unusual thoughts or perceptions
- Symptoms getting worse or not improving with treatment
References
Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:126-127.
Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 48.
Addington D, Bouchard RH, Goldberg J, Honer B, Malla A, Norman R, Tempier R. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry, 2005;50:7s-57s.
International early psychosis association writing group. International clinical practice guidelines for early psychosis. Br J Psychiatry, 2005;187:s120-s124.
Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
