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Schizoaffective disorder

Definition

Schizoaffective disorder is a mental condition that causes both psychosis and mood problems.

Psychosis means a person has a loss of contact with reality and may have hallucinations (hearing voices or seeing things that are not present) and delusions (false, fixed beliefs). Mood disorder problems may include a very bad or very good mood with sleep disturbances, changes in energy and appetite, disrupted concentration, and poor daily function.

Causes

The exact cause of schizoaffective disorder is unknown. Genetics and body chemistry 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. While mood disorders are relatively common in children, a full syndrome of schizophrenia is not. Therefore schizoaffective disorder tends to be rare in children.

Symptoms

The signs and symptoms of schizoaffective disorder vary greatly from person to person.

Often times, persons with schizoaffective disorder seek treatment for problems with mood, daily function, or intrusive thoughts. Psychosis and mood changes may occur at one time, or off and on by themselves. Psychotic symptoms can persist for at least 2 weeks without significant mood symptoms. The course of the disorder feature cycles of severe symptoms followed by improvement. 

The symptoms of schizoaffective disorder include:

• Elevated, inflated, or depressed mood
• Irritability and poor temper control
• Symptoms that could be seen during a manic or depressed state (changes in appetite, energy, sleep)
• Hallucinations (particularly auditory hallucinations, "hearing voices")
• Delusions of reference (for example, believing that someone on TV or the radio is speaking directly to you or that secret messages are hidden in common objects)
• Paranoia (a feeling that everyone or a particular person or agency is out to get you)
• Deteriorating concern with hygiene, grooming
• Disorganized and illogical speech

Exams and Tests

The health care provider will perform a psychiatric evaluation to identify symptoms and ask questions about the patient's current behavior and symptoms.

To be diagnosed with schizoaffective disorder, a person must experience 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 the schizoaffective disorder

Any medical, psychiatric, or drug-related condition that causes psychotic or mood symptoms must be considered and ruled out before a diagnosis of schizoaffective disorder is made. Persons who take steroid medications, have seizure disorders, or who abuse cocaine, amphetamines, and phencyclidine (PCP) can have concurrent schizophrenic and mood disorder symptoms.

Treatment

The treatment of people with schizoaffective disorder varies. Generally, medications are prescribed to stabilize mood and to treat psychosis. Neuroleptic medications (antipsychotics) are used to treat psychotic symptoms.

Lithium may be used to manage mania and to 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 antidepressants may also be needed in some cases.

Outlook (Prognosis)

People with schizoaffective disorder have a greater chance of returning to a previous level of functioning than patients with other psychotic disorders. However, long-term treatment is necessary and individual outcomes may vary.

Possible Complications

Complications are similar to those for schizophrenia and major mood disorders. These include:

• Problems following medical treatment and therapy
• Abuse of drugs in an attempt to self-medicate
• Problems resulting from manic behavior (for example, spending sprees, sexual indiscretions)
• Suicidal behavior due to depressive or psychotic symptoms

When to Contact a Medical Professional

Call your provider or mental health professional if you or someone you know is experiencing any of the following:

• Strange or unusual thoughts or perceptions
• Inability to care for basic personal needs
• Bouts of depression with feelings of hopelessness or helplessness
• Increase in energy and involvement in risky behavior that is sudden in onset and out of character (for instance, going days without sleeping and feeling no need for sleep)
• Symptoms worsening or not improving with treatment
• Feelings and thoughts of suicide

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.

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