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What Are the Symptoms of Schizoaffective Disorder?

What Are the Symptoms of Schizoaffective Disorder?


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Some people, including many medical experts, believe the symptoms of the disorder make it a subtype of schizophrenia.

This is not quite so. Schizoaffective disorder has its own diagnostic criteria and list of specific symptoms, even though it’s categorized under schizophrenia spectrum.

When you live with schizoaffective disorder, you may experience symptoms of both schizophrenia and certain mood disorders.

You may experience these symptoms together or separately, and usually in cycles.

Schizoaffective disorder affects about 0.3% of the general population. Researchers are still working to fully understand the condition.

Living with schizoaffective disorder can be challenging, but the condition is treatable, and you can manage symptoms with the help of a professional.

Schizoaffective disorder is a longstanding mental health condition. It’s characterized by a combination of psychosis symptoms and mood disorder symptoms.

Symptoms of psychosis include hallucinations and delusions, while mood disorder symptoms include mania and depression.

In other words, schizoaffective disorder presents as a depressive or bipolar disorder layered on schizophrenia symptoms.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) establishes the criteria for diagnosing schizoaffective disorder.

This reference book for mental health professionals states that the diagnosis of this condition is reached when you meet the primary criteria for schizophrenia while also having mood disorder symptoms.

Criteria for schizophrenia must be met in every case, even if temporarily. For this, two or more of the following symptoms must be present for an uninterrupted period of time:

  • delusions
  • disorganized speech
  • hallucinations
  • disorganized or catatonic behavior
  • negative symptoms (e.g., loss of pleasure, flat expressions, lack of motivation)

But that’s not all. To reach a diagnosis, these criteria must also be met:

  • having hallucinations or delusions without mood symptoms for a period of two or more consecutive weeks
  • experiencing a major mood episode like depression or mania
  • having mood symptoms that are present for most of the duration of the condition
  • having symptoms that are not explained by substance use, like drugs or alcohol consumption

As the symptoms suggest, schizoaffective disorder affects your mood, thoughts, and behavior.

Your symptoms and the duration of the episodes may vary. Sometimes, you might not have any dominant symptoms between episodes.

You might also experience recurring episodes, although this is not always the case with schizoaffective disorder.

Just as there is more than one type of mood disorder, there are also different subtypes of schizoaffective disorder.

Each type presents with different symptoms.

Bipolar type

Bipolar type is diagnosed when symptoms of schizophrenia overlap with symptoms of bipolar disorder, specifically manic episodes.

If you have this type of schizoaffective disorder, you may experience symptoms such as:

  • agitation and distraction
  • major depressive episodes
  • disorganized thinking
  • episodes of mania — feeling overly energetic or excited
  • inflated self-esteem or grandiosity
  • racing thoughts
  • restlessness
  • low impulse control

Depressive type

Depressive type is diagnosed only if major depressive episodes are dominant among your symptoms.

Symptoms of depressive type include:

  • change in appetite and weight
  • major depressive episodes
  • disinterest in everyday activities
  • fatigue
  • feelings of worthlessness or helplessness
  • indecisiveness
  • recurrent thoughts of self-harm or suicide
  • sleeping too little or too much

There are no laboratory or equipment tests to diagnose schizoaffective disorder.

To provide a diagnosis, a mental health professional will want to learn more about your concerns, personal and family medical history, and dominant symptoms.

They will then compare these observations with the criteria established by the DSM-5.

Mood disorders like depression and bipolar disorder mainly affect your emotional expression and regulation. In other words, they’re affective disorders.

On the other hand, schizophrenia primarily affects your thinking and cognition.

With schizoaffective disorder, you experience a combination of symptoms that affect both your emotions and your thinking abilities.

Some people mistakenly think schizophrenia and schizoaffective disorder are the same condition. People with schizophrenia, however, do not experience predominant mood episodes.

In the psychiatric community, some experts also believe schizoaffective disorder should be considered a subtype of schizophrenia instead of a standalone psychotic disorder.

This is because when you look at the dominant symptoms, schizoaffective disorder may resemble schizophrenia more than it does depressive or bipolar disorders.

In fact, a set criterion to receive this diagnosis is that you must have two or more symptoms of psychosis, typical of schizophrenia.

The DSM-5 considers schizoaffective disorder a standalone diagnosis, although it appears in the chapter on schizophrenia spectrum and other psychotic disorders.

You can manage symptoms of schizoaffective disorder through long-term treatment that typically involves a combination of medication and therapy.

Symptoms of psychosis, however, often require immediate medical intervention.

It’s important to seek immediate help if you are experiencing any of the following:

  • depression with feelings of hopelessness or helplessness
  • inability to control your impulses, which might lead you to engage in behavior that puts your safety or that of someone else in jeopardy
  • difficulty caring for your personal needs or the needs of those under your care
  • hallucinations
  • thoughts of suicide or harming yourself or others

What Are the Symptoms of Schizoaffective Disorder? - Psychology

The incidence of Schizoaffective Disorder is higher in women than in men, which is mostly accounted for by an increased incidence among women of the Depressive Type.

Schizophrenic Disorders are more prevalent among individuals with lower Social Economic Status. The lower the SES, the more prevalent the Schizophrenic Disorders appear to be.

Little research has occurred examining which cultural factors, if any, both increase and decrease the risk of developing a Schizophrenic Disorder. Although, Schizophrenic Disorders appear to occur less often in what we consider to be third-world, or less industrially developed, countries.

Epidemiology

The prevalence rate for Schizoaffective disorder widely varies. Studies do show that Schizoaffective Manic patients appear to comprise 3-5% of psychiatric admissions to typical clinical centers.

Etiology

There is no single causal factor, a certain causal sequence of events, or one entity (genetic or otherwise) in the etiology of Schizoaffective Disorder. Although the exact etiology of Schizoaffective disorder is unknown, it may involve the balance of dopamine and serotonin in the brain. Others believe that it may be due to in-utero exposure to viruses, malnutrition, or even birth complications.

There is substantial evidence that there is an increased risk for Schizophrenia in first-degree biological relatives of individuals with Schizoaffective Disorder. Most studies show that relatives of individuals with Schizoaffective Disorder are at increased risk for Mood Disorders. As a group, Schizoaffective patients have family histories with increased genetic loading for both Schizophrenia and Mood Disorders.

The prognosis for Schizoaffective Disorder tends to be better than that for Schizophrenia and worse than that for Mood Disorders. The presence of precipitating events or stressors is associated with a better prognosis.

Differential Diagnosis

Substance-Induced Psychotic Disorder and Substance-Induced Delirium are distinguished from Schizoaffective Disorder by the fact that a substance is judged to be etiologically related to the symptoms.

Distinguishing Schizoaffective Disorder from Schizophrenia: In Schizoaffective Disorder, there must be a mood episode that is concurrent with the active-phase symptoms of Schizophrenia, mood symptoms must be present for a substantial portion of the total duration of the disturbance, and delusions or hallucinations must be present for at least 2 weeks in the absence of prominent mood symptoms. In contrast, mood symptoms in Schizophrenia have a duration that is brief, occur only during the prodromal or residual phases, or do not meet full criteria for a mood episode.

Distinguishing Schizoaffective Disorder from Mood Disorder with Psychotic Features: If psychotic symptoms occur exclusively during periods of mood disturbance, the diagnosis is Mood Disorder with Psychotic Features. In Schizoaffective Disorder, symptoms should not be counted toward a mood episode if they are clearly the result of symptoms of Schizophrenia. Criterion A for Schizoaffective Disorder, the Major Depressive Episode must include pervasive depressed mood.

Mood disturbances, especially depression, commonly develop during the course of Delusional Disorder. However, such presentations do not meet criteria for Schizoaffective Disorder because the psychotic symptoms in Delusional Disorder are restricted to non-bizarre delusions and therefore do not meet Criterion A for Schizoaffective Disorder.

Schizoaffective Disorder and Schizophrenia: because the relative proportion of mood to psychotic symptoms may change over the course of the disturbance, the appropriate diagnosis for an individual episode of illness may change from Schizoaffective Disorder to Schizophrenia. The diagnosis may also change for different episodes of illness separated by a period of recovery. If psychotic symptoms and affective symptoms always overlap, the person is diagnosed with an affective disorder, whereas if psychotic symptoms are present some of the time, in the absence of an affective syndrome, the person meets criteria for either Schizoaffective Disorder or Schizophrenia. Schizoaffective Disorder is diagnosed if the mood symptoms are prolonged

Empirically supported treatments

Schizoaffective patients respond better to lithium than do schizophrenics, but not as well as Bipolar patients.

Electroconvulsive therapy (ECT) is indicated for Schizoaffective disorder that has an acute onset, presence of hallucinations or delusions, and acute and severe mania, and that has been found to be non-responsive to psychotropic medications. However, some studies find that ECT is not productive in reducing hallucinations or delusions.

There is no cure for Schizoaffective Disorder. However, the most effective approach toward treating the Schizophrenic Disorders seems to be a combination of pharmaceutical, behavioral, cognitive, and family therapy, with the use of anti-psychotic medications seen as the primary treatment modality.

Pharmacotherapy with an antidepressant, an antipsychotic, and/or mood stabilizer is also a mainstream treatment. In quite a few instances, effective treatment modalities will work on attempting to rid the individual of hallucinations, delusions, and disorganized aspects of behavior, or at the very least, attempt to lessen these symptoms.

Even so, many individuals will relapse, even if their treatment is maintained.

Common medicines for neuroleptic symptoms are Olanzapine, Risperidone, Quetiapine, Aripiprazole, and Ziprasidone. Mood stabilizer medications examples are Lithium salt, Valproate semisodium, and Carbamazepine.


Cognitive impairment in schizoaffective disorder: a comparison with non-psychotic bipolar and healthy subjects

Objective: Only a few studies have examined specifically the neuropsychological performance of schizoaffective patients.

Method: The sample consisted of 34 euthymic DSM-IV schizoaffective patients, who were compared with 41 euthymic bipolar patients without history of psychotic symptoms and 35 healthy controls. Euthymia was defined by a score of 6 or less at the Young Mania Rating Scale and a score of 8 or less at the Hamilton Depression Rating Scale for at least 6 months. Patients were compared with several clinical, occupational, and neuropsychological variables such as executive function, attention, verbal and visual memory and the two groups were contrasted with 35 healthy controls on cognitive performance. The three groups were compared using mancova after checking the potential role of several co-variables.

Results: Schizoaffective patients showed greater impairment than controls and bipolar patients, in several domains, including verbal memory, executive function, and attentional measures. Bipolar patients without history of psychosis performed similar to the controls except for verbal fluency.

Conclusion: Schizoaffective disorder carries more neurocognitive impairment than non-psychotic bipolar disorder and more occupational difficulties.


Diagnosis of Schizoaffective Disorder

There are no laboratory tests to specifically diagnose schizoaffective disorder. So doctors rely on your medical history and your answers to certain questions. (Doctors call this the clinical interview.) They also use various tests such as brain imaging (like MRI scans) and blood tests to make sure that another type of illness isn’t causing your symptoms.

If the doctor finds no physical cause, they may refer you to a psychiatrist or psychologist. These mental health professionals are trained to diagnose and treat mental illnesses. They use specially designed interview and assessment tools to evaluate a person for a psychotic disorder.

In order to get diagnosed with schizoaffective disorder, you must have:

  • Periods of uninterrupted illness
  • An episode of mania, major depression, or a mix of both
  • Symptoms of schizophrenia
  • At least two periods of psychotic symptoms, each lasting 2 weeks. One of the episodes must happen without depressive or manic symptoms.

Prevention

Can schizoaffective disorder be prevented?

There’s no way to prevent schizoaffective disorder. But make sure to get an early diagnosis and treatment if you start noticing symptoms, either in yourself or a loved one. Prompt treatment helps avoid or reduce frequent relapses and hospitalizations. It can also decrease the disruption to the person’s life, family and relationships.

What other conditions might a person with schizoaffective disorder have?

A person with schizoaffective disorder may have other mental health conditions as well, including:


Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.

  • Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.
  • Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.
  • Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.
  • Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.

Symptoms of schizoaffective disorder

With schizoaffective disorder you will experience some symptoms of depression, mania and psychosis.

Depression

  • Low or negative mood
  • Feeling tired, slowed down with less energy
  • Feeling hopeless, guilty, worthless
  • Uninterested in things you usually like doing
  • Difficulty sleeping
  • Feeling more or less hungry than usual, possibly resulting in weight change
  • Thoughts of death or suicide

Mania

You may experience the following if you have mania:

  • Feeling positive even when things aren’t going well for you
  • Feeling overly active, energetic or restless
  • Talking very quickly, jumping from one idea to another and struggling to focus on one topic
  • Racing thoughts
  • Not needing much sleep
  • Being more irritable, argumentative or aggressive than usual
  • Being more social than usual
  • Doing things you wouldn’t normally do such as spending lots of money, using drugs, being promiscuous or gambling

Schizophrenic symptoms

Schizophrenia is a mental illness which affects the way you think. Symptoms can have an effect on how to cope with daily life. These include:


Symptoms

Symptoms of schizoaffective disorder tend to be severe and vary for each individual. They can be broadly categorized into those that fall under depressive symptoms, manic symptoms, and schizophrenia symptoms. Those with bipolar type will experience cycling of depressive and manic symptoms, while those with the depressive type will only experience the depressive symptoms

Depressive Symptoms

  • Psychological: Sadness, worthlessness, hopelessness, restlessness, lack of energy, loss of interest in usual activities, trouble concentrating, guilt, self-blame, thoughts of death or suicide
  • Physical: Poor appetite, weight loss or gain, sleeping too much or too little,

Mania

  • Psychological: Risky or self-destructive behavior (e.g., spending sprees, reckless driving, risky sexual practices), euphoria, irritable mood, racing thoughts, grandiose, easily distracted
  • Physical: Increased energy and/or more active than usual (e.g., at work, socially, sexually), talking more or faster than unusual, reduced need for sleep

Psychotic Symptoms

  • Psychological: Paranoia, delusions, hallucinations, disorganized thinking, impaired communication, lacking emotion in facial expressions and speech (negative symptoms), low motivation (avolition)
  • Physical: slow movements or no movement (catatonia), poor personal hygiene

While the psychotic symptoms listed above describe how schizoaffective disorder appears to an outsider, it is also helpful to learn what these symptoms feel like to a person with the disorder.

Disorganized Thinking

If you are experiencing disorganized thinking, you may feel like your thoughts are fuzzy or everything feels disconnected. When you speak, you may not be able to remember what you were talking about, so it's hard for people to follow what you say. You may also feel like your thoughts are not within your control.

Thinking You Are Being Controlled

You may think you are being controlled by outside forces like aliens, God, or the devil. You may feel someone is inserting thoughts into your head or that your thoughts are being removed. You might also feel like others can hear your thoughts or access them.

Hallucinations

You may hear one or more voices that sound real and seem to come from outside you but that nobody else can hear. You might start to talk to them or do things that they tell you to do. In fact, these voices are created by your brain and are not real.

Delusions

Delusions are things you believe 100 percent to be true but that are not thought to be real by everyone else. They may begin all of a sudden or form over time. Sometimes they are related to the voices that you hear and seem to explain them in some way. Most often delusions are paranoid, such that you think people are plotting against you or spying on you. You might choose to avoid those people as it can feel very scary.

Suicidal Ideation and Prevention

Suicidal ideation and behavior can also be a problem for some people with schizoaffective disorder. If someone you know is in danger of attempting suicide or harming another person, stay with that person while you call 911 or your local emergency number. The other alternative is to take the person to the nearest hospital emergency room if you believe that you can do so safely.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.


Treatment and psychotherapy

To date, there are no tests or biological measures that can help us diagnose Schizoaffective Disorder. There is no certainty as to whether there is a neurobiological difference between Schizoaffective Disorder and schizophrenia in terms of their associated characteristics (such as their brain, structural or functional abnormalities, cognitive deficits, and genetic factors). Therefore, in this case planning highly effective therapies is very difficult.

Clinical intervention, therefore, focuses on the possibility of mitigating symptoms and training patients in accepting new standards of life and managing their emotions and self-care and social behaviors.

For the pharmacological treatment of Schizoaffective Disorder, antipsychotics, antidepressants and mood stabilizers are usually used, while the most indicated psychotherapy for Schizoaffective Disorder would be the cognitive-behavioral type. In order to implement this last action, the two pillars of the disorder must be treated.



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