Schizoaffective Disorder in Adults

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:

• Bipolar type: A manic episode (persistently elevated, expansive, or irritable mood) is part of the schizophrenic presentation. Major depressive episodes may also occur.
• Depressive type: A major depressive episode (depressed mood, loss of interest or pleasure) is part of the schizophrenic presentation.

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, 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.

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

• Antipsychotic Medications
• Risperidone
• Aripiprazole
• Olanzapine
• Quetiapine
• Haloperidol
• Ziprasidone
• Clozapine (best for refractory cases)
• Paliperidone
• Iloperidone
• Asenapine

• Mood Stabilizer Medications (Bipolar Subtype)

• Lithium
• Carbamazepine
• Divalproex
• Valproic Acid

• Antidepressant Medications (Depressive Subtype)

• Sertraline

• Fluoxetine

• Benzodiazepines (anxiety, insomnia, akathisia)

• Antiepileptics

• e.g., Topirimate

According to the Society of Clinical Psychology , treatments for schizophrenia and related disorders with strong research support include:

• Family Psychoeducation & Support: helps improve family functioning, problem solving and communication skills, and decrease relapse rates.
• Cognitive Behavior Therapy: includes social skills training, problem-solving strategies and self-help skills.
• Social Skills Training: Uses the principles of behavior therapy to teach communication skills, assertiveness skills, and other skills related to disease management and independent living.
• Assertive Community Treatment: A multidisciplinary team approach to intensive case management involving a high frequency of patient contact (typically at least once a week), low patient to staff ratios, and community outreach, allowing integration of medication management, rehabilitation, and social services as well as individualization to patients.
• Supported Employment: An approach to vocational rehabilitation for individuals with serious mental illness that emphasizes integration of employment and mental health services, rapid community employment, individualized job development, and ongoing job support.
• Cognitive Remediation: These interventions are designed to improve cognitive function through repeated practice of cognitive tasks and / or strategy training, taking into account the motivational and emotional deficits that are often present in schizoaffective disorder.

And behavioral and psychosocial treatments with modest research support include:

• Acceptance and Commitment Therapy: This treatment aims to change the relationship individuals have with their own thoughts, feelings, memories, and physical sensations that are feared or avoided. Acceptance and mindfulness strategies are used to teach patients to decrease avoidance, attachment to cognitions, and increase focus on the present.
• Cognitive Adaptation Training: This treatment teaches the individual with schizophrenia to use strategies that compensate for (or work around) the cognitive deficits associated with schizophrenia.
• Illness Management and Recovery: This treatment emphasizes recovery by helping clients set and pursue personally meaningful goals. IMR combines 1) psychoeducation about mental illness, 2) cognitive-behavioral approaches to medication management, 3) planning for relapse prevention, 4) social skills training to strengthen social support, and 5) coping skills to manage symptoms of mental illness.

Additional Treatments to Consider

Preliminary evidence suggests that the following strategies, while not a substitute for better validated treatments described above, might be considered.

• Electroconvulsive Therapy (ECT)
• Omega-3 Fatty Acid Supplements