What Is Schizoaffective Disorder?
Schizoaffective disorder is a chronic mental health condition that involves symptoms of both schizophrenia and a mood disorder like major depressive disorder or bipolar disorder. In fact, many people with schizophrenia are incorrectly diagnosed at first with depression or bipolar disorder.
Scientists don’t know for sure if schizoaffective disorder is related mainly to schizophrenia or a mood disorder. But it’s usually viewed and treated as a combination of both conditions.
Only a tiny number of people get schizoaffective disorder: 0.03% of the population. It’s equally likely to affect men and women, but men usually get it at a younger age. Doctors can help manage it, but most people diagnosed with it have relapses. People who have it often have problems with substance use as well.
Types of Schizoaffective Disorder
There are two types. Each has some schizophrenia symptoms:
- Bipolar type: Episodes of mania and sometimes major depression
- Depressive type: Only major depressive episodes
Symptoms of Schizoaffective Disorder
Schizoaffective disorder is almost a blend of the symptoms of schizophrenia and bipolar disorder. In bipolar disorder, you have mood swings that include depression and mania. If you have schizoaffective disorder, you can have these bipolar symptoms. But separate from those, you also get psychotic symptoms similar to schizophrenia for at least 2 weeks at a time.
The symptoms can vary greatly from one person to the next and can be mild or severe. They may include:
- Delusions: False, sometimes strange beliefs that the person refuses to give up, even when they get the facts
- Depression symptoms: Feeling empty, sad, or worthless
- Hallucinations: Sensing things that aren't real, such as hearing voices
- Lack of personal care: Not staying clean or keeping up appearance
- Mania or sudden, out-of-character jumps in energy levels or happiness, racing thoughts, or risky behavior
- Problems with speech and communication, only giving partial answers to questions, or giving answers that are unrelated (The doctor may call this disorganized thinking.)
- Trouble at work, school, or in social settings
Causes of Schizoaffective Disorder
Scientists don’t know the exact cause. Risk factors for schizoaffective disorder include:
- Genetics: You may inherit a tendency to get features linked to schizoaffective disorder from your parents.
- Brain chemistry and structure: If you have schizophrenia and mood disorders, you might have problems with brain circuits that manage mood and thinking. Schizophrenia is also tied to lower levels of dopamine, a brain chemical that also helps manage these tasks.
- Environment: Some scientists think things like viral infections or highly stressful situations could play a part in getting schizoaffective disorder if you’re at risk for it. How that happens isn’t clear.
- Drug use: Taking mind-altering drugs. (Your doctor may call them psychoactive or psychotropic drugs.)
Schizoaffective disorder usually begins in the late teen years or early adulthood, often between ages 16 and 30. It seems to happen slightly more often in women than in men. It's rare in children.
Because schizoaffective disorder combines symptoms that reflect two mental illnesses, it’s easily confused with other psychotic or mood disorders. Some doctors may diagnose schizophrenia. Others may think it’s a mood disorder. As a result, it’s hard to know how many people actually have schizoaffective disorder. It’s probably less common than either schizophrenia or mood disorders alone.
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.
Treatment of Schizoaffective Disorder
- Medication: What you take depends on whether you have symptoms of depression or bipolar disorder, along with symptoms that suggest schizophrenia. The main medications that doctors prescribe for psychotic symptoms such as delusions, hallucinations, and disordered thinking are called antipsychotics. All these drugs can probably help with schizoaffective disorder, but paliperidone extended release (Invega) is the only drug that the FDA has approved to treat it. For mood-related symptoms, you might take an antidepressant medication or a mood stabilizer, like lithium (Eskalith).
- Psychotherapy: The goal of this type of counseling is to help you learn about your illness, set goals, and manage everyday problems related to the disorder. Family therapy can help families get better at relating to and helping a loved one who has schizoaffective disorder.
- Skills training: This generally focuses on work and social skills, grooming and self-care, and other day-to-day activities, including money and home management.
- Hospitalization: Psychotic episodes may require a hospital stay, especially if you’re suicidal or threaten to hurt others.
- Electroconvulsive therapy: This treatment may be an option for adults who don’t respond to psychotherapy or medications. It involves sending a quick electric current through your brain. (You’ll get a type of medicine called general anesthesia to help you sleep through it.) It causes a brief seizure. Doctors use it because they think it changes your brain chemistry and may reverse some conditions.
Complications of Schizoaffective Disorder
This condition may raise your risk of:
- Alcohol or other substance abuse problems
- Anxiety disorders
- Conflict with family, friends, co-workers, and otherss
- Poverty and homelessness
- Significant health problems
- Social isolation
- Suicide, suicide attempts, or suicidal thoughts
Prevention of Schizoaffective Disorder
You can’t prevent the condition. But if you’re diagnosed and start treatment as soon as possible, it can help you avoid or ease frequent relapses and hospitalizations and help cut the disruptions in your life, family, and friendships.
Schizoaffective Disorder vs. Schizophrenia
Schizoaffective disorder has the features of schizophrenia, like hallucinations, delusions, and disorganized thinking, along with those of a mood disorder, like mania and depression. At first, it’s often misdiagnosed as one of the two.
As a result, schizoaffective disorder treatment often pairs antipsychotics with antidepressants, while schizophrenia treatment centers on antipsychotics. Both conditions rely on therapy.