Click Here to read the criteria for Schizoaffective
Disorder from the
American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders
(DSM-IV).
Click Here to
read the ICD-10 Classifications for Schizoaffective Disorder from the World Health
Organization.
Schizoaffective Disorder is an often debilitating mental illness
characterized by symptoms of a thought disorder (hallucinations and/or irrational
thinking) and a mood disorder (depression or manic activity). This illness may present a
variety of symptoms from each category, and symptoms may be mild or severe.
-
 Definition
- Symptoms
- Cause
- Course
- Treatment
- Self-Management
- Dealing with Relapse
- Bipolar vs. Schizoaffective
-
Schizoaffective disorder is an illness in which there are both severe mood swings
(mania and/or depression), and some of the psychotic symptoms of schizophrenia. Most of
the time mania or depression coexist with psychotic symptoms, but there must be at least
one two-week period in which there are only psychotic symptoms without any symptoms of
mania or depression.
During the depressed state the following symptoms may be present: poor appetite, weight
loss, inability to sleep, agitation, general slowing down, loss of interest in usual
activities, lack of energy or fatigue, feelings of worthlessness, self-reproach, excessive
guilt, inability to think or concentrate, or thoughts of death or suicide. During the
manic state the following symptoms may occur: increase in social, work or sexual activity,
increased talkativeness, rapid or racing thoughts, grandiosity, decreased need for sleep,
increased goal-directed activity, agitation, inflated self-esteem, distractibility and
involvement in self-destructive activities. Psychotic symptoms may include delusions,
hallucinations, incoherence, severely disorganized speech or thinking, grossly
disorganized behavior, total immobility, lack of facial emotional expression, lack of
speech or motivation.
The cause is unknown, but most researchers believe it is caused by a combination of
biological, genetic and environmental factors.
Schizoaffective disorder is a lifelong illness for most people. The exact course of the
illness varies from person to person, but most people have a worsening of symptoms
periodically, during times of stress. These periods of increased symptoms are called
relapses. They may be severe enough to limit functioning and may make hospitalization
necessary. After a relapse, there is usually a gradual return to the previous level of
functioning. Between relapses, most people experience mild, if any, symptoms.
Schizoaffective Disorder may be difficult to treat, treatment most usually consists of
psychotherapy, medications and skills training. As the symptoms of the thought disorder
are typically treated with different medications than the symptoms of depression or mania.
Arriving at the proper balance of medication is often complex and may take time. This can
be frustrating to the mentally ill person, as well as to the family and friends. The
medications most often used to treat schizoaffective disorder include the antipsychotic
medications, antidepressants, lithium, and/or other mood stabilizers. Often several
medications are used in combination.
In terms of treatment approaches, research to date suggests that the most effective
treatment for schizoaffective disorder is a continuum of care model, which has a focus on
Social Rehabilitation. The Social Rehabilitation Model is aimed at assisting the diagnosed
client with learning the skills necessary to live an independent life style. This includes
medication management, independent living skills, socialization and vocational and a
variety of other support systems.
Research suggests that a person recently diagnosed with schizoaffective disorder can best
be treated and success achieved if allowed to participate in an environment in which
counseling support and vocational services are offered on a 24-hour basis. It has been
found to be most effective for people not to be hospitalized for too long but rather to
move into a residential setting such as mentioned above. After this, we find moving into
less and less restricted programs to be effective, whereby the diagnosed person eventually
gets their own apartment or living arrangements and perhaps attends an outpatient program
to assist with continued living skills.
Some of the measures a person with schizoaffective disorder can take to maximize
recovery are:
- Accept that you have a prolonged illness.
- Identify your strengths and limitations.
- Make clear, realistic goals.
- After a relapse, go slowly and gradually back to your responsibilities.
- Plan a regular, consistent, predictable daily routine.
- Make your home as quiet, calm and relaxed as you can.
- Identify and reduce stress. Make only one change in your life at a time.
- Work toward an active and trusting relationship with the staff involved in your
treatment.
- Take your medication regularly, as prescribed.
- Identify early signs of relapse. Make your own early warning list.
- Get involved with a group of people you feel comfortable with.
- Avoid street drugs.
- Whether or not you drink alcohol is a very individual decision you should make with your
prescriber.
- Eat a well-balanced diet.
- Get enough rest.
- Get regular exercise.
- If you're not sure whether your feelings or fears are based in reality, ask someone you
trust or compare your behavior with others.
- Accept that there may be setbacks from time to time.
During a well period, the patient and therapist should make a written plan for what to
do if signs of relapse appear. A friend or family member can also be involved. The plan
should include:
- Specific warning signs of relapse.
- An agreement to call the therapist immediately when warning signs of relapse appear.
- An agreement to notify friends and family who can help decrease stress and stimulation.
- A list of specific ways to decrease stress and stimulation and increase structure.
The distinction between bipolar disorder (BD) and schizoaffective disorder
(SD) is sometimes difficult, in part because SD is not well-defined or well-understood;
and in part, because younger patients presenting with BD often have psychotic features,
leading (or misleading) therapists to diagnose either schizophrenia or SD. This does not
mean, however, that your new psychiatrist is wrong.
The trick is in sorting out the "longitudinal course" of the illness over a
period of months or years :
In bipolar disorder, the individual usually returns to a relatively high level of
function in between manic and depressive bouts, though some do not. Psychotic features, if
present, are confined to the manic or depressive phases.
By definition, SD individuals must show a period of time during which they meet
criteria for both the "A" symptoms of schizophrenia (delusions, hallucinations)
AND either a manic or major depressive episode. In addition, SD patients must show a
"disconnect" - a period of at least two weeks in which they have psychotic
features (delusions or hallucinations) without any prominent mood symptoms.
In practice, it is often difficult to sort out such meticulous details, since most
people who are becoming psychotic do not keep careful notes on the course of their
symptoms! Very often, we rely on family or spouse to help us make the diagnosis. In
theory, someone with MDPF usually experiences mood and psychotic features simultaneously,
with both types of symptoms coming and going over roughly the same time period. But in
fact it is not always so clear, since some people begin with a non-psychotic depressive or
manic episode and eventually develop delusional features. Generally, though, MDPF patients
do not have prolonged delusional periods without mood symptoms.
There is also a good deal of heterogeneity in the SD category, with bipolar-type SD
patients often resembling classic bipolar individuals and depressive-type SD patients
looking more like MDPF patients. |
