ICD-10 code: F25.9
Schizoaffective disorder is part of a cluster of diagnoses called the schizophrenia spectrum and other psychotic disorders. Schizophrenia spectrum and other psychotic disorders are a group of psychiatric conditions that include:
These disorders are characterized by symptoms that can be divided into two groups: positive and negative.
Positive symptoms include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal motor behavior (including catatonia). Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Hallucinations are perception-like experiences that occur without external stimulus. Disorganized thinking/speech is characterized by a derailment or loose associations in an individual's speech pattern. Grossly disorganized or abnormal motor behavior is a difficulty in sustaining goal-oriented behavior. This may manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable agitation.
Negative symptoms include diminished emotional expression, avolition, alogia and anhedonia. Negative symptoms are those that involve a loss of normal function or experience. Diminished emotional expression is the reductions in the expression of emotions in the face, eye contact, intonation of speech, and movement of hand, head, and face that normally give an emotional emphasis to speech. Avolition is a decrease in motivated self-initiated purposeful movement. Alogia is manifested by diminished speech output. Anhedoia is the decreased ability to experience pleasure from positive stimuli.
Schizoaffective disorder is a neuropsychiatric disorder that encompasses clinical features found in both mood disorders and schizophrenia. Schizoaffective disorder is characterized by delusions, hallucinations, formal thought disorder, or negative symptoms that co-occur with depressed mood with or without additional symptoms of mania.
In addition, delusions or hallucinations must occur in the absence of a major mood episode (depressive or manic), and mood symptoms must be present for the majority of the illness. These disturbances must not be related to substance use or medication.
There are two types of schizoaffective disorder:
The disorder may occur in a variety of temporal patterns. The following is a typical pattern: An individual may have pronounced auditory hallucinations and persecutory delusions for at least 2 months before the onset of a major depressive episode. The psychotic symptoms and the full major depressive episode are then present for at least 3 months. Then, the individual recovers completely from the major depressive episode, but the psychotic symptoms persist for at least another month before they disappear.
Schizoaffective disorder is approximately one-third as common as schizophrenia, affecting approximately 0.3% of adults. Onset of schizoaffective disorder typically occurs in early adulthood, although onset can occur anywhere from adolescence to late in life.
Schizoaffective disorder, bipolar type may be more common in young adults, whereas schizoaffective disorder, depressive type, may be more common in older adults. The incidence of schizoaffective disorder is higher in women than men, mainly due to increased incidence of the depressive subtype among women.
Schizoaffective disorder is associated with social and occupational impairment, but there is substantial variability in impairment among individuals with schizoaffective disorder. Restricted social contact and difficulties with self-care are associated with schizoaffective disorder, but negative symptoms may be less severe and less persistent than those seen in schizophrenia. Poor insight is common in schizoaffective disorder, but also to a potentially lesser degree than in schizophrenia.
Schizoaffective disorder is frequently comorbid with other conditions, especially substance use disorders and anxiety disorders. Distinguishing schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features is often difficult.
As with schizophrenia, there is a strong genetic component to schizoaffective disorder. Specifically, there may be increased risk for schizoaffective disorder among first-degree relatives of individuals with schizophrenia, as well as those with bipolar disorder and schizoaffective disorder. In addition, risk factors including paternal age and in utero exposure to maternal famine have also been hypothesized to contribute to the development of schizophrenia. Early childhood trauma has also been associated with childhood psychotic symptoms. Children who experienced maltreatment by an adult or bullying by peers were found to be at a higher risk for psychotic disorders later in life. There are no tests or biological measures that can assist in making the diagnosis of schizoaffective disorder. Whether schizoaffective disorder differs from schizophrenia with regard to associated features such as structural or functional brain abnormalities, cognitive deficits, or genetic risk factors is unclear.
The Schizoaffective Disorder Working Group suggests that in the absences of established norms and rigorous treatment standards, definitive treatment guidelines are premature.
However, available evidence suggests that selection of medications for treating Schizoaffective Disorder depend on whether depressive or bipolar subtypes are present, and that early psychopharmacological treatment in combination with good premorbid functioning often improves outcomes. Antipsychotic medications are typically prescribed, either in combination with an antidepressant or mood stabilizer, depending on whether the individual presents with depressive or bipolar subtype, respectively.
In addition, psychotherapeutic approaches are typically used in conjunction with medication to improve functioning.
Pharmacological Treatments
According to the Society of Clinical Psychology , treatments for schizophrenia and related disorders with strong research support include:
And behavioral and psychosocial treatments with modest research support include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for better validated treatments described above, might be considered.