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Schizoaffective Disorder

Overview

Schizoaffective disorder is a chronic mental illness that causes a person to experience dramatic changes in their thoughts, moods, and behaviors. It often endures throughout a person’s lifetime. The condition arises when a person has both schizophrenia, a brain disorder that changes the way a person thinks, acts, and perceives reality, and a mood disorder, which causes severe changes in mood or behavior. The symptoms of schizoaffective disorder can be life-altering, causing affected individuals to have hallucinations, embrace false beliefs, and experience depression or mania. Cycles of severe symptoms are often followed by periods of improvement, during which there are no symptoms.

People are most often diagnosed with schizoaffective disorder during young adulthood, typically between the ages of 25 and 35, although the condition can affect anyone at any age. Schizoaffective disorder occurs more frequently in women than in men. And the condition is rare—it affects about 0.3% of Americans, which is 3 in every 1,000 people.

Because it is so uncommon, schizoaffective disorder isn’t always correctly diagnosed at first. Some people instead receive a diagnosis of either bipolar disorder or schizophrenia. There is no cure for schizoaffective disorder, but when it is correctly identified, medication and psychotherapy may help people manage their symptoms.

What is schizoaffective disorder?

Schizoaffective disorder is a rare mental health condition that occurs when a person experiences two conditions simultaneously: schizophrenia and a mood disorder. People with the condition may experience symptoms of schizophrenia, such as delusions and hallucinations, as well as symptoms of a mood disorder, such as depression or mania.

There are two types of schizoaffective disorder:

  • Schizoaffective disorder, bipolar type, in which people experience manic episodes
  • Schizoaffective disorder, depressive type, in which people experience depressive episodes

What causes schizoaffective disorder?

Experts don’t yet know what causes schizoaffective disorder. Because the condition runs in some families, a genetic predisposition may be responsible. Another possible cause is an imbalance of certain chemicals in the brain, such as dopamine, norepinephrine, or serotonin. Abnormalities or changes in a person’s brain structure may also cause the condition. Additionally, the use of psychoactive drugs, such as LSD, have been linked to the development of schizoaffective disorder. What’s more, taking mind-altering drugs may worsen symptoms when an underlying disorder is present.

What are the symptoms of schizoaffective disorder?

People with schizoaffective disorder typically have symptoms that overlap with symptoms of schizophrenia, depression, and/or mania.

Symptoms of schizoaffective disorder that are similar to schizophrenia include:

  • Experiencing hallucinations (seeing or hearing things that aren’t there)
  • Experiencing delusions (holding false beliefs)
  • Using disorganized speech (speaking in a way that does not make sense to others)
  • Adopting odd, confusing behaviors
  • Losing interest in maintaining one’s hygiene or self-care
  • Finding it difficult to relate to other people

Symptoms of schizoaffective disorder that are similar to depression include:

  • Having feelings of intense sadness that endure for two or more weeks
  • Losing interest in the people, places, and activities that are most important to the person
  • Experiencing changes in eating and sleeping habits
  • Having lower energy levels than usual
  • Having thoughts about death or suicide

Symptoms of schizoaffective disorder that are similar to mania include:

  • Having higher energy levels than usual
  • Experiencing an intensely more upbeat mood than usual
  • Feeling that anything can be achieved
  • Having racing thoughts
  • Feeling the need to talk constantly, or more than usual
  • Experiencing sleep difficulty
  • Feeling distracted
  • Engaging in risky behaviors

What are the risk factors for schizoaffective disorder?

Certain conditions may increase a person’s risk of schizoaffective disorder, including:

  • A family history of bipolar disorder, schizoaffective disorder, or schizophrenia
  • A personal history of substance abuse
  • A chemical imbalance in the brain
  • Abnormalities in brain structure, some of which may arise while the brain is developing before birth
  • A personal history of substance abuse and/or abuse or neglect

How is schizoaffective disorder diagnosed?

Schizoaffective disorder may be diagnosed after your doctor or a mental health professional learns about your mental and physical health history. They may also perform a physical exam and offer diagnostic tests to rule out other health conditions.

When you share your medical history, tell your doctor about your symptoms and when they began. (They may also seek input and perspective from a family member.) Doctors should ask about your history of physical and mental illnesses. It will also be necessary to share what medications and recreational drugs you take. (Cocaine, PCP, and amphetamines can cause symptoms that could be confused with schizoaffective disorder.)

During a physical exam, doctors will take note of your mood and ability to interact and answer questions as expected. Doctors will also look for signs or symptoms of other conditions that may be causing your symptoms.

Your provider will determine if these symptoms and behaviors match a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a reference book for mental health conditions published by the American Psychiatric Association.

According to the DSM-5, a person has schizoaffective disorder if they have:

  • Periods of uninterrupted mental illness, such as having symptoms of depression or another mood disorder for a long time
  • An episode of mania, major depression, or both while also having symptoms of schizophrenia
  • At least two weeks of psychotic symptoms (such as delusions or hallucinations) without mood symptoms
  • No evidence of a substance use disorder or medications that may be causing the symptoms

In addition, to rule out other health conditions, you may undergo the following diagnostic tests:

  • Blood and urine tests, to check for abnormalities that could indicate HIV, thyroid disorders, or other conditions
  • Drug tests, to look for substances that could be causing an altered mental state
  • Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), to look for seizure disorders or structural abnormalities within the brain

How is schizoaffective disorder treated?

Schizoaffective disorder is treated with medication and psychotherapy (also called talk therapy). Patients with schizoaffective disorder who are unable to care for themselves or pose a threat to themselves or others will be hospitalized while beginning medication therapy. They may be admitted to a psychiatric inpatient unit for treatment.

Medications. Antipsychotic medications are prescribed to help control delusions, hallucinations, and other schizophrenia-type symptoms. Antidepressants and mood stabilizers are prescribed to treat and prevent future episodes of depression or mania. These episodes are often severely disruptive to the patient’s life and the lives of those around them. In some cases, these may be life-threatening. Preventing future episodes of psychosis, mania, or depression is a primary emphasis of treatment for schizoaffective disorder. Patients with schizoaffective disorder typically need to take medication for the rest of their lives to manage the condition.

A number of antipsychotic medications may help patients manage schizophrenia-type symptoms, including:

  • Haloperidol
  • Paliperidone
  • Risperidone
  • Olanzapine
  • Aripiprazole
  • Ziprasidone
  • Quetiapine
  • Iloperidone
  • Asenapine
  • Clozapine

Antidepressants for patients with depressive-type schizoaffective disorder include:

  • Sertraline
  • Fluoxetine

Mood stabilizers for patients with bipolar-type schizoaffective disorder include:

  • Lithium
  • Carbamazepine
  • Divalproex

Psychotherapy. Patients with schizoaffective disorder should also receive psychotherapy services in conjunction with medication. Doctors or therapists may recommend a mix of individual therapy, family therapy, and group therapy. Therapy should help patients learn how to manage their activities of daily living, improve their cognitive functioning, and/or ignore hallucinations or delusions. Involving family members in therapy may lead to better patient outcomes.

Cognitive-behavioral therapy (CBT), in particular, provides patients with coping skills, which they learn after understanding how their thoughts and beliefs affect their actions and emotions. CBT may help patients learn how to manage stress, determine whether their thoughts are based in reality, and recognize worsening symptoms, so they know when to seek additional help.

When possible, psychotherapy should include social skills and job training to help patients find ways to stay actively involved in the community. This may prevent them from experiencing social isolation and unemployment, lowering their risk of being readmitted to the hospital for care.

What is the outlook for people with schizoaffective disorder?

Because schizoaffective disorder is a chronic condition, it’s necessary for patients to take medication and seek therapy for the rest of their lives. About half of all patients are able to manage their symptoms over time. Programs focused on early intervention may help to improve these numbers in the future.

Between 10% and 30% of people with schizoaffective disorder may need to be hospitalized at some point to help stabilize or treat the condition. About 10% of people with schizoaffective disorder die by suicide. Medications for schizoaffective disorder, especially lithium and clozapine, have been shown to prevent suicides and decrease risk of death from all causes when taken consistently.

What makes Yale unique in its treatment of schizoaffective disorder?

“Recent studies have shown that early diagnosis and intervention are important in helping patients recover from episodes of psychosis, mania, and depression associated with schizoaffective disorder and regain healthy, productive lives,” says Yale psychiatrist Robert Beech, MD, PhD. “The PRIME clinic is a specialty clinic specifically designed for persons, ages 12 to 25, who are experiencing worrisome changes in their thoughts, experiences, and/or feelings that may be early warning signs of schizophrenia or schizoaffective disorder. The Specialized Treatment Early in Psychosis (STEP) clinic is a collaborative program of the Connecticut Department of Mental Health & Addiction Services and Yale University Department of Psychiatry that provides intensive treatment for patients who have recently been diagnosed with schizophrenia or schizoaffective disorder. Both clinics focus on helping patients develop effective strategies to manage and overcome their symptoms, so they can live healthy and independent lives.”