Schizoaffective Disorder

Overview

What is schizoaffective disorder?

Schizoaffective disorder is a serious mental illness that has features of two different disorders—schizophrenia and an affective (mood) disorder, either major depressive disorder or bipolar disorder.

Schizophrenia is a brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others.

Depression is an illness that is marked by feelings of sadness, worthlessness, or hopelessness. It may also include problems concentrating and remembering details.

Bipolar disorder is characterized by cycling mood changes, including severe highs (mania) and lows (depression).

Schizoaffective disorder is a life-long illness that can impact all areas of daily living, including:

  • Work
  • School
  • Social contacts
  • Relationships

Most people with this disorder have periodic episodes, when their symptoms surface. While there is no cure for schizoaffective disorder, symptoms may often be controlled with treatment, particularly with medications.

Who gets schizoaffective disorder?

Schizoaffective disorder usually begins in the late teen years or early adulthood, often between the ages of 16 and 30. It seems to occur slightly more often in women than in men and is rare in children.

How common is schizoaffective disorder?

Because people with schizoaffective disorder have symptoms of two separate mental illnesses, it is often misdiagnosed. Some people might be misdiagnosed as having schizophrenia, and others might be misdiagnosed with a mood disorder. As a result, it is difficult to determine exactly how many people actually are affected by schizoaffective disorder.

However, it is believed to be less common than either schizophrenia or affective disorder alone. Estimates suggest that about one in every 200 people (.5 percent) develops schizoaffective disorder at some time during his or her life.

Symptoms and Causes

What are the symptoms of schizoaffective disorder?

A person with schizoaffective disorder has severe changes in mood and some of the psychotic symptoms of schizophrenia, such as:

  • Hallucinations
  • Delusions
  • Paranoia
  • Disorganized thinking

Psychotic symptoms may include the inability to tell what is real from what is imagined. Symptoms of schizoaffective disorder might vary greatly from one person to the next and might be mild or severe. Symptoms might include the following:

Depression symptoms

  • Depressed or low mood
  • Poor appetite
  • Weight loss or gain
  • Changes in sleeping patterns (sleeping very little or a lot)
  • Agitation (excessive restlessness)
  • Lack of energy
  • Loss of interest in usual activities
  • Feelings of worthlessness or hopelessness
  • Guilt or self-blame
  • Inability to think or concentrate
  • Thoughts of death or suicide

Mania symptoms

  • Increased activity, including work, social, and sexual activity
  • Increased and/or rapid talking
  • Rapid or racing thoughts
  • Little need for sleep
  • Agitation
  • Inflated self-esteem
  • Distractibility
  • Self-destructive or dangerous behavior (such as going on spending sprees, driving recklessly, or having unsafe sex)

Psychotic symptoms

  • Delusions (strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information)
  • Hallucinations (the perception of sensations that aren’t real, such as hearing voices)
  • Disorganized or confused thinking
  • Odd or unusual behavior
  • Slow movements or total immobility
  • Lack of emotion in facial expression and speech
  • Poor motivation
  • Problems with speech and communication

What causes schizoaffective disorder?

While the exact cause of schizoaffective disorder is not known, researchers believe that genetic, biochemical, and environmental factors are involved.

  • Genetics (heredity): A tendency to develop schizoaffective disorder may be passed on from parents to their children, and may be present in several members of an extended family.
  • Brain chemistry: People with schizophrenia and mood disorders might have an imbalance of certain chemicals in the brain. These chemicals, called neurotransmitters, are substances that help nerve cells in the brain send messages to each other. An imbalance in these chemicals can interfere with the transmission of messages, leading to symptoms.
  • Environmental factors: Evidence suggests that certain environmental factors—such as a viral infection, poor social interactions, or highly stressful situations—may trigger schizoaffective disorder in people who have inherited a tendency to develop the disorder.

Diagnosis and Tests

How is schizoaffective disorder diagnosed?

If symptoms are present, the doctor will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose schizoaffective disorder, the doctor might use various diagnostic tests—such as X-rays or blood tests—to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illness.

Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. The doctor or therapist bases his or her diagnosis on the person’s report of symptoms, and his or her observation of the person’s attitude and behavior.

The doctor or therapist then determines if the person’s symptoms point to a specific disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association and is the standard reference book for recognized mental illnesses.

According to the DSM-5, a diagnosis of schizoaffective disorder is made if a person has periods of uninterrupted illness and has, at some point, an episode of mania, major depression, or mix of both while also having symptoms of schizophrenia. In addition, the person has a period of at least two weeks of psychotic symptoms without the mood symptoms.

Management and Treatment

How is schizoaffective disorder treated?

Treatment typically involves medication to stabilize the mood and treat the psychotic symptoms. In addition, psychotherapy (a type of counseling) and skills training might be useful for improving interpersonal, social, and coping skills.

  • Medication — The choice of medication depends on the mood disorder associated with the illness. The primary medications used to treat the psychotic symptoms associated with schizophrenia—such as delusions, hallucinations, and disordered thinking—are called anti-psychotics. The mood-related symptoms might be treated with an antidepressant medication or a mood stabilizer such as lithium. These medications might or might not be used in combination with an anti-psychotic medication.
  • Psychotherapy — The goal of therapy is to help the patient learn about the illness, establish goals, and manage everyday problems related to the disorder. Family therapy can help families deal more effectively with a loved one who has schizoaffective disorder, enabling them to contribute to a better outcome for the person.
  • Skills training — This generally focuses on work and social skills, grooming and hygiene, and other day-to-day activities, including money and home management.
  • Hospitalization — Most patients with schizoaffective disorder are treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others might require hospitalization to stabilize their conditions.

What are the side effects of treatment?

Common side effects of lithium include:

  • Nausea
  • Loss of appetite
  • Mild diarrhea
  • Dizziness
  • Hand tremors
  • Low thyroid hormone

Side effects vary depending on the type of antidepressant medication used, but common side effects include:

  • Sleepiness or trouble sleeping
  • Dry mouth
  • Constipation or diarrhea
  • Weight gain or loss
  • Headache
  • Sweating
  • Sexual problems (delayed orgasm, erectile dysfunction)

Common side effects of antipsychotic medications include:

  • A slowing down of movements
  • Sedation
  • Weight gain
  • Increased cholesterol and triglycerides
  • Increased risk of diabetes

What are the complications of schizoaffective disorder?

Possible complications include:

  • Refusal to follow treatment, possibly due to the side effects of the medications
  • Alcohol or drug abuse
  • Dangerous or suicidal behavior

Prevention

Can schizoaffective disorder be prevented?

There is no known way to prevent schizoaffective disorder. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations, and help decrease the disruption to the person’s life, family, and friendships.

Outlook / Prognosis

What is the outlook for people with schizoaffective disorder?

There is no cure for schizoaffective disorder, but treatment has been shown to be effective in minimizing the symptoms, and in helping the person cope with the disorder and improve social functioning.

Last reviewed by a Cleveland Clinic medical professional on 04/21/2014.

References

  • National Alliance on Mental Illness (NAMI). Schizoaffective disorder Accessed 4/21/2014
  • Schizoaffective disorder. In: Diagnostic and Statistical Manual of Mental Disorders, DSM-5. American Psychiatric Publishing, Incorporated; 2013.
  • Shelton RC. Chapter 17. Other Psychotic Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF. eds. CURRENT Diagnosis & Treatment: Psychiatry, 2e. New York, NY: McGraw-Hill; 2008. http://0-accessmedicine.mhmedical.com.library.ccf.org/content.aspx?bookid=336&Sectionid=39717889. Accessed 4/21/2014.
  • Havemann, J. Center for Behavioral Health. Cleveland Clinic, Cleveland, Ohio. 4/21/ 2014.

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