What Is It, Causes, Signs, Symptoms, and More
Editors:Alyssa Haag,Stefan Stoisavljevic, MD,Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator:Jessica Reynolds, MS
Copyeditor:Stacy Johnson, LMSW
What is 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.Schizoaffective disorder falls into the category of schizophrenia spectrum disorders, which include schizophrenia, schizophreniform disorder, schizotypal personality disorder, and schizoid personality disorder. Both types of schizoaffective disorder consist of symptoms of schizophrenia; however, in schizoaffective disorder, there is the addition of a mood disorder, such as depression or bipolar disorder.
What causes schizoaffective disorder?
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).Environmental factors such as life stressors (e.g., death of a loved one, loss of a job, or end of a relationship) present additional risk factors for the onset of illness. Lastly, psychoactive drugs such as lysergic acid diethylamide (LSD) increase the risk of developing schizoaffective disorder.
What are the signs and symptoms of schizoaffective disorder?
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.The onset of symptoms usually begins in late teens or early adulthood. It rarely occurs in children. Lifetime prevalence is uncertain, with an estimated rate of approximately 0.3 percent of the population having schizoaffective disorder. Many people with schizoaffective disorder are often incorrectly diagnosed with bipolar disorder or schizophrenia since presenting symptoms can be very similar and overlap.
How is a schizoaffective disorder diagnosed?
The diagnosis of schizoaffective disorder is made when the individual has features of both schizophrenia and a mood disorder—either bipolar disorder or depression—but does not strictly meet diagnostic criteria for either alone. Diagnosis is based on observed behavior during a physical exam and the individual’s reported experiences elicited through history taking and interviews. The criteria for diagnosis include a mood disorder (e.g., depression, bipolar) and more than two of the following: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. Furthermore, at least one of the first three schizophrenic criteria must be met. Additionally, there have to be delusions or hallucinations that persist for at least two weeks without the presence of a mood episode. The symptoms must significantly impair day-to-day functioning and not have another underlying cause (e.g., general medical conditions such as previous cerebrovascular accidents, traumatic brain injury, Wilson disease, etc.). Substance use-induced psychosis must likewise be ruled out with a urine toxicology screen.
How is schizoaffective disorder treated?
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.
What are the most important facts to know about schizoaffective disorder?
Schizoaffective disorder is a mental health condition that falls under the category of schizophrenia spectrum disorders and consists of two subtypes: the bipolar type and depressive type. As a schizophrenia spectrum disorder, the individual may experience positive symptoms such as delusions, hallucinations, and disorganized speech and behavior; negative symptoms, including avolition and impaired expression of emotions. Those with schizoaffective disorder may also have mood disorder symptoms, such as major depression or bipolar disorder. Manic episodes can be present where the individual experiences euphoria, inflated self-esteem, and a decreased need for sleep. In order to make the diagnosis of schizoaffective disorder, delusions and hallucinations (e.g., hearing voices) must be present without concurrent mood symptoms for at least two weeks. Treatment includes antipsychotic medications, mood regulation medications, or antidepressant medications, depending on the individual’s symptoms. Psychotherapy in the form of individual psychotherapy, cognitive behavioral therapy, family therapy, education, social skills training, employment assistance, and support groups can also be used to induce remission.
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Resources for research and reference
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Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry. 2020;177(9):868-872. doi:https://doi.org/10.1176/appi.ajp.2020.177901
Malaspina D, Owen MJ, Heckers S, et al. Schizoaffective disorder in the DSM-5. Schizophrenia Research. 2013;150(1):21-25. doi:https://doi.org/10.1016/j.schres.2013.04.026
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National Alliance on Mental Illness. Schizoaffective Disorder. NAMI: National Alliance on Mental Illness. Accessed July 19, 2022. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder