Schizoaffective Disorder

Schizoaffective disorder (SZA, SZD, or SAD) is a chronic mental health condition characterized by abnormal thought processes and dysregulated emotions. There are two types of schizoaffective disorder: the bipolar type, which includes episodes of mania and major depression, and the depressive type, which involves major depressive episodes. 

While the exact cause of schizoaffective disorder is unclear, it is thought to be multifactorial. There appears to be a genetic component, as having a close relative (e.g., biological parent or sibling) with schizoaffective disorder or schizophrenia can increase the chances of having schizoaffective disorder. In addition to genetics, there may also be biochemical and physiological dysfunction of serotonin, norepinephrine, and dopamine. Those with schizoaffective disorder may also experience abnormalities in the size or composition of specific regions in the brain (e.g., the hippocampus and thalamus).  

The signs and symptoms of schizoaffective disorder are similar to the symptoms of schizophrenia, which include positive symptoms (e.g., delusions, hallucinations, disorganized speech, and behavior) and negative symptoms (e.g., flat affect, impaired emotional expression, avolition). The hallucinations of schizoaffective disorder may be auditory (e.g., hearing voices or music); visual (e.g., seeing flashing colors); somatic (e.g., feeling pain or touch); olfactory (e.g., odd smells); or gustatory (e.g., strange taste) and may result in bizarre and unusual behavior. While hallucinations are the perception of sensing something non-existent, delusions represent fixed false beliefs, such as the radio talking to them. Furthermore, disorganized speech most commonly presents as tangentiality (i.e., talking about random, irrelevant ideas) and circumstantiality (i.e., use of excessive irrelevant details). Other examples of disorganized speech used by those with schizoaffective disorder include neologisms (i.e., use of made-up words) and word salad (i.e., jumble of incoherent speech). 

Mood-related symptoms such as depression, suicidal ideations, and manic episodes are common. Depressive symptoms include sadness, loss of interest or pleasure in activities that were usually enjoyable, feeling quickly tired and slowed down, difficulty concentrating or making decisions, and unexplained aches and pains. 

Mania refers to periods of euphoria, grandiosity, and hyperactivity. The individual may feel an increase in energy and a decreased need for sleep. Overall, those with schizoaffective disorder may have difficulties managing their personal hygiene and maintaining their physical appearance. Occupational, academic, and social functioning may be severely impaired. An individual with schizoaffective disorder may also experience cognitive deficits, including difficulties with memory and learning. 

There is no cure for schizoaffective disorder, and symptoms can be lifelong and debilitating; however, management of schizoaffective disorder typically involves both pharmacotherapy and psychotherapy, with different medications used to treat the varying symptoms. Antipsychotics (e.g., clozapine, olanzapine) can be used for psychotic symptoms, while antidepressants (e.g., fluoxetine, paroxetine) treat depressive episodes. Mood-stabilizing medication (e.g., lithium, valproic acid, carbamazepine, lamotrigine) can control manic or hypomanic episodes. Psychotherapy offered by a mental health professional can be very beneficial for treating those diagnosed with schizoaffective disorder. Individualized psychotherapy focuses on the individual and helps set goals, improve wellness, and promote self-management. Cognitive behavioral therapy (CBT) is another treatment option for those with schizoaffective disorder. CBT aims to help individuals become aware of their symptoms and develop coping strategies to help manage their behavior. Education for individuals with schizoaffective disorder and their family members must ensure medication and psychotherapy compliance. Additionally, some individuals might benefit from social skills training, employment assistance, and access to support group programs. Finally, Electroconvulsive therapy (ECT) might be used as a last resort in individuals resistant to treatment, catatonic, or aggressive. 

With psychotherapy and medications, individuals can go into remission and become free of symptoms. Studies have shown that almost half of individuals with the schizoaffective disorder go into remission after five years of appropriate treatment. Some individuals can function well socially for two-year stretches.