The term schizoaffective disorder was first used in the 1930s to describe patients with acute psychotic symptoms such as hallucinations and delusions along with disturbed mood. These patients tended to function well before becoming psychotic; their psychotic symptoms lasted relatively briefly; and they tended to do well afterward. Over the years, however, the term schizoaffective disorder has been applied to a variety of patient groups. The current definition contained in the American Psychiatric Association'sDiagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) recognizes patients with schizoaffective disorder as those whose mood symptoms are sufficiently severe to warrant a diagnosis of depression or other full-blown mood disorder and whose mood symptoms overlap at some period with psychotic symptoms that satisfy the diagnosis of schizophrenia (e.g. hallucinations, delusions, or thought process disorder).
Causes and symptoms
The cause of schizoaffective disorder remains unknown and subject to continuing speculation. Some investigators believe schizoaffective disorder is associated with schizophrenia and may be caused by a similar biological predisposition. Others disagree, stressing the disorder's similarities to mood disorders such as depression and bipolar disorder (manic depression). They believe its more favorable course and less intense psychotic episodes are evidence that schizoaffective disorder and mood disorders share a similar cause.
Many researchers, however, believe schizoaffective disorder may owe its existence to both disorders. These researchers believe that some people have a biologic predisposition to symptoms of schizophrenia that varies along a continuum of severity. On one end of the continuum are people who are predisposed to psychotic symptoms but never display them. On the other end of the continuum are people who are destined to develop outright schizophrenia. In the middle are those who may at some time show symptoms of schizophrenia, but require some other major trauma to set the progression of the disease into motion. It may be an early brain injury—either through a complicated delivery, prenatal exposure to the flu virus or illicit drugs; or it may be emotional, nutritional or other deprivation in early childhood. In this view, major life stresses, or a mood disorder like depression or bipolar disorder, may be sufficient to trigger the psychotic symptoms. In fact, patients with schizoaffective disorder frequently experience depressed mood or mania within days of the appearance of psychotic symptoms. Some clinicians believe that "schizomanic" patients are fundamentally different from "schizodepressed" types; the former are similar to bipolar patients, while the latter are a very heterogeneous group.
Symptoms of schizoaffective disorder vary considerably from patient to patient. Delusions, hallucinations, and evidence of disturbances in thinking—as observed in full-blown schizophrenia—may be seen. Similarly, mood fluctuations such as those observed in major depression or bipolar disorder may also be seen. These symptoms tend to appear in distinct episodes that impair the individual's ability to function well in daily life. But between episodes, some patients with schizoaffective disorder remain chronically impaired while some may do quite well in day-to-day living.
Diagnosis
There are no accepted tissue or brain imaging tests or techniques to diagnose schizophrenia, mood disorders, or schizoaffective disorder. Instead, physicians look for the hallmark signs and symptoms of schizoaffective disorder described above, and they attempt to rule out other illnesses or conditions that may produce similar symptoms. These include:
Mania. True manic patients can experience episodes of hallucinations and delusions similar to those seen in schizoaffective disorder; but these do not persist for long periods after the mania recedes, as they do in schizoaffective disorder.
Psychotic depression. Patients with psychotic depression experience hallucinations and delusions similar to those seen in schizoaffective disorder; but these symptoms do not persist after the depressive symptoms recede, as they do in schizoaffective disorder.
Schizophrenia. Depressed mood, mania, or other symptoms may be present in patients with schizophrenia, but patients with schizoaffective disorder will meet all the criteria set out for a full-blown mood disorder.
Medical and neurological disorders that mimic psychotic/affective disorders.
Treatment
Antipsychotic medications used to treat schizophrenia and the antidepressant drugs and mood stabilizers used in depression and bipolar disorder are the primary treatments for schizoaffective disorder.
Unfortunately these treatments have not been well studied in controlled investigations. Studies suggest that traditional antipsychotics such as haloperidol are effective in treating psychotic symptoms. Newer generation antipsychotics, such as clozaril and risperidone, have not been as well studied, but also appear effective. For patients with symptoms of bipolar disorder, lithium is often the mood stabilizer of choice; and it is often augmented with an anticonvulsant such as valproate. For those with depressive symptoms, the evidence supporting the use of antidepressant medications in addition to antipsychotic medications is more mixed. Electroconvulsive therapy (electric shock) is frequently tried in patients who otherwise do not respond to antidepressant or mood stabilizing drugs.
While the mainstay of treatment for schizoaffective disorder is antipsychotic medications and mood stabilizers, certain forms of psychotherapy for both patients and family members can be useful. Therapy designed to provide structure and help augment patients' ability to solve problems may aid in improving patients' ability to function in the day-to-day world, reducing stress and the risk of recurrence. Vocational and other rehabilitative training can help patients to work on skills they need to develop. Whereas hospitalization may be necessary for acute psychotic episodes, half-way houses and day hospitals can provide needed treatment while serving as a bridge for patients to reenter the community.
Alternative treatment
While alternative therapies should never be considered a replacement for medication, these treatments can help support people with schizoaffectve disorder and other mental illnesses. Dietary modifications that eliminate processed foods and emphasize whole foods, along with nutritional supplementation, may be helpful. Acupuncture, homeopathy, and botanical medicine can support many aspects of the person's life and may help decrease the side effects of any medications prescribed.
Prognosis
In general, patients with schizoaffective disorder have a more favorable prognosis than do those with schizophrenia, but a less favorable course than those with a pure mood disorder. Medication and other interventions can help quell psychotic symptoms and stabilize mood in many patients, but there is great variability in outcome from patient to patient.
Prevention
There is no known way to prevent schizoaffective disorder. Treatment with antipsychotic and mood stabilizing drugs may prevent recurrences. Some researchers believe prompt treatment can prevent the development of full-blown schizophrenia, but this remains the subject of some disagreement.
BOOKS
Gabbard, Glen O. Treatment of Psychiatric Disorders. Washington, DC: American Psychiatric Press, 1995.
Kaplan, Harold I., and Benjamin J. Sadock. Comprehensive Textbook of Psychiatry/VI. Baltimore: Williams & Wilkins, 1995.
PERIODICALS
Keck Jr., Paul E., et al. "New Developments in the Pharmacologic Treatment of Schizoaffective Disorder." Journal of Clinical Psychiatry 57 (1996): 41-48.
ORGANIZATIONS
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. <http://www.psych.org>.
National Alliance for Research on Schizophrenia and Depression. 60 Cutter Mill Road, Suite 200, Great Neck, NY 11021. (516) 829-0091. <http://www.mhsource.com>.
Richard H. Camer
KEY TERMS
Bipolar disorder—Also referred to as manic depression, it is a mood disorder marked by alternating episodes of extremely low mood (depression) and exuberant highs (mania).
Mood disorder—A collection of disorders that includes major depression and bipolar disorder. They are all characterized by major disruptions in patients' moods and emotions.
Schizophrenia—A major mental illness marked by psychotic symptoms, including hallucinations, delusions, and severe disruptions in thinking.
