Schizoaffective Disorder

Overview

What is schizoaffective disorder?

Schizoaffective disorder is a serious mental health condition. It has features of two different disorders:

  • “Schizo” means the psychotic symptoms of schizophrenia. This brain disorder changes how a person thinks, acts and expresses emotions. It also affects how someone perceives reality and relates to others.
  • “Affective” refers to a mood disorder, or severe changes in a person’s mood, energy and behavior.

There’s no cure for schizoaffective disorder. But treatment can help people manage symptoms and improve their quality of life.

What are the types of schizoaffective disorder?

There are two types of schizoaffective disorder: bipolar schizoaffective disorder and depressive schizoaffective disorder. The two types are based on the associated mood disorder the person has:

  • Bipolar disorder type: This condition features one or two types of different mood changes. People with bipolar disorder have severe highs (mania) alone or combined with lows (depression).
  • Depressive type: People who have depression have feelings of sadness, worthlessness and hopelessness. They may have suicidal thoughts. They may also experience concentration and memory problems.

How does schizoaffective disorder affect people?

This lifelong illness can affect all areas of a person’s life. A person with schizoaffective disorder can find it difficult to function at work or school. It also affects people’s relationships with family, friends and loved ones.Many people with schizoaffective disorder have periodic episodes. There are times when their symptoms surface and times when their symptoms might disappear for a while.

Who gets schizoaffective disorder?

The condition usually begins in the late teens or early adulthood, up to age 30. It rarely occurs in children. Studies suggest the disorder is more likely to occur in women than men.

How common is schizoaffective disorder?

Schizoaffective disorder is rare. Research estimates that 3 in every 1000 people (0.3%) will develop schizoaffective disorder in their lifetime.Still, it’s difficult to know exactly how many people have the condition because of the challenging diagnosis. People with schizoaffective disorder have symptoms of two different mental health conditions. Some people might get misdiagnosed with schizophrenia. Others might get misdiagnosed with a mood disorder.

Symptoms and Causes

What causes schizoaffective disorder?

Researchers don’t know the exact cause of schizoaffective disorder. They believe several factors are involved:

  • Genetics: Schizoaffective disorder might be hereditary. Parents may pass down the tendency to develop the condition to their children. Schizoaffective disorder can also occur in several members of an extended family.
  • Brain chemistry: People with the disorder may have an imbalance of brain chemicals called neurotransmitters. These chemicals help nerve cells in the brain communicate with each other. An imbalance can throw off these connections, leading to symptoms.
  • Brain structure: Abnormalities in the size or composition of different brain regions (such as the hippocampus, thalamus) may be associated with developing schizoaffective disorder.
  • Environmental factors: Certain environmental factors may trigger schizoaffective disorder in people who inherited a higher risk. Factors may include highly stressful situations, emotional trauma or certain viral infections.
  • Drug use: Using psychoactive drugs, such as marijuana, may lead to the development of schizoaffective disorder.

What are the symptoms of schizoaffective disorder?

Symptoms of schizoaffective disorder vary from one person to the next. They can range from mild to severe.

Someone with schizoaffective disorder experiences psychotic symptoms. They also experience severe mood changes, with symptoms of depression, mania or both. A person with schizoaffective disorder will have psychotic symptoms that occur alone and with mood changes.

Psychotic symptoms:

  • Delusions (false beliefs with no basis in reality that the person won’t give up, even if given evidence to the contrary).
  • Hallucinations (perceived sensations that aren’t real, such as hearing voices or seeing shadows).
  • Inability to tell real from imaginary.
  • Disorganized speech (difficulty producing clear and coherent sentences).
  • Unclear thinking.
  • Odd or unusual behavior.
  • Paranoia.
  • Lack of emotion in facial expression and speech.
  • Poor motivation.
  • Slow movements or inability to move.

Depression symptoms:

  • Low or sad mood
  • Thoughts of death or suicide.
  • Feelings of worthlessness or hopelessness.
  • Guilt or self-blame.
  • Lack of energy and low mood
  • Loss of interest in usual activities.
  • Poor appetite.
  • Changes in sleeping patterns (sleeping a little or a lot).
  • Trouble thinking or concentrating.
  • Weight loss or gain.

Mania symptoms:

  • Agitation.
  • Distractibility.
  • Increased or rapid talking.
  • Increased work, social and sexual activity.
  • Inflated self-esteem.
  • Not sleeping much.
  • Rapid or racing thoughts.
  • Self-destructive or dangerous behavior (spending sprees, reckless driving, unsafe sex).

Diagnosis and Tests

How is schizoaffective disorder diagnosed?

If someone is showing symptoms of schizophrenia and a mood disorder, see a healthcare provider. The provider will do a medical history and physical examination. There are no lab tests to diagnose schizoaffective disorder. But the provider may use X-rays and blood tests to rule out other illnesses that may be causing the symptoms.

If there is no physical cause for the symptoms, the provider may refer the person to a psychiatrist or psychologist. These professionals specialize in diagnosing and treating conditions tied to mental and behavioral health.

How does a psychiatrist or psychologist diagnose schizoaffective disorder?

Mental health professionals use specially designed interview and assessment tools to diagnose psychotic disorders. They listen to the person (or a loved one) describe the symptoms. They also watch the person’s speech, movement and behavior.

Providers figure out if these symptoms and behaviors match a specific disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The American Psychiatric Association publishes the DSM-5. It’s considered the reference book for mental health conditions.

According to the DSM-5, a person has schizoaffective disorder if they have:

  • Periods of uninterrupted mental illness, such as having symptoms of depression or another mood disorder for a long time.
  • Episode of mania, major depression or both while also having symptoms of schizophrenia.
  • At least two weeks of psychotic symptoms (such as delusions or hallucinations) without mood symptoms.
  • No evidence of a substance use disorder or medications that may be causing the symptoms.

Management and Treatment

How is schizoaffective disorder treated?

Treatment for schizoaffective disorder involves medication combined with psychotherapy and skills training. The medication helps stabilize the person’s mood and treats the psychotic symptoms. The therapy and skills training help improve their relationships and coping skills.

What medications treat schizoaffective disorder?

The provider will figure out the right medicine based on the type of mood disorder the person has:

  • Antipsychotics: This is the primary medicine used to treat the psychotic symptoms that come with schizophrenia — for example, delusions, hallucinations and disordered thinking.
  • Antidepressants: An antidepressant or mood stabilizer such as lithium can help treat mood-related symptoms. Sometimes, a person needs both an antidepressant and an antipsychotic.

How does psychotherapy treat schizoaffective disorder?

During therapy, the person talks to a trained mental health professional. The goal of psychotherapy is for the person to:

  • Learn about the illness.
  • Establish goals.
  • Manage everyday problems related to the disorder.

Family therapy can also help. A therapist can help families learn how to cope with the illness and support their loved one. Family therapy helps improve symptoms and quality of life for the person with the disorder.

How does skills training help a person with schizoaffective disorder?

This type of counseling helps a person manage their everyday lives better. It often focuses on:

  • Day-to-day activities, such as money and home management.
  • Grooming and hygiene.
  • Social skills.
  • Work.

Does someone with schizoaffective disorder need to be hospitalized?

Most people with this disorder can get outpatient treatment. They go to a clinic or hospital for treatment during the day and then return home. Sometimes, people have severe symptoms, though, or they’re in danger of harming themselves or others. They may need to be hospitalized to stabilize their condition.

Are there side effects of schizoaffective treatment?

The medications may cause side effects.

Side effects of lithium:

Side effects of antidepressants (varies depending on the type of antidepressant):

Side effects of antipsychotic medications:

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:

Outlook / Prognosis

What’s the outlook for schizoaffective disorder?

There’s no cure for schizoaffective disorder. But treatment can help. The right combination of medication and therapy can:

  • Help the person cope with the disorder.
  • Improve social functioning.
  • Lessen symptoms.

Living With

How should I take care of myself (or a loved one) when it comes to schizoaffective disorder?

Perhaps you’ve noticed signs of schizoaffective disorder in yourself or a loved one. Those symptoms may include prolonged hallucinations, delusions, depression or manic episodes. The first step is to talk to a healthcare provider. Getting diagnosis and treatment as soon as possible helps improve symptoms and promote a good quality of life. Be sure to follow your provider’s treatment instructions:

  • Attend therapy sessions, including individual and family therapy.
  • Stay in contact with your provider, who can help manage and adjust your treatments as necessary.
  • Take medications as directed. Talk to your provider to help manage side effects from the medications.
  • Treat substance use disorders, if necessary.

When should I go to the emergency room?

If you or a loved one seems in danger of harming themselves or others, get help right away. Go to an emergency room, call 911, or call the National Suicide Prevention Lifeline at 800.273.8255. This national network of local crisis centers provides free, confidential emotional support to people in suicidal crisis or emotional distress. It’s available 24/7.

What else should I ask my healthcare provider?

If you or a loved one has schizoaffective disorder, ask your provider:

  • What medication will help?
  • What other therapy can help?
  • Will this disorder ever go away?
  • How long will treatment continue?
  • Is there a higher risk for other conditions or disorders?

A note from Cleveland Clinic

Schizoaffective disorder is a serious mental health condition. It has features of both schizophrenia and a mood (affective) disorder. Schizoaffective symptoms may include symptoms of mania, depression and psychosis. It’s important to get treatment as soon as possible. If you notice symptoms of schizoaffective disorder, talk to a healthcare provider. Treatment for schizoaffective disorder includes medication and therapy. While there’s no cure for this disorder, treatment helps improve people’s symptoms and quality of life.

Last reviewed by a Cleveland Clinic medical professional on 05/24/2021.

References

  • StatPearls. . Accessed 05/23/2021.Schizoaffective Disorder (https://www.ncbi.nlm.nih.gov/books/NBK541012/)
  • Medscape. . Accessed 05/23/2021.Schizoaffective Disorder (https://emedicine.medscape.com/article/294763-overview)
  • Medline Plus. . Accessed 05/23/2021.Schizoaffective Disorder (https://medlineplus.gov/genetics/condition/schizoaffective-disorder/)
  • Merck Manuals. . Accessed 05/23/2021.Schizoaffective Disorder (https://www.msdmanuals.com/home/mental-health-disorders/schizophrenia-and-related-disorders/schizoaffective-disorder)
  • National Alliance on Mental Illness. . Accessed 05/23/2021.Schizoaffective Disorder (https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder)

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