Schizoaffective Disorder

Author: Guy E Brannon, MD; Chief Editor: Stephen Soreff, MD

Background
Schizoaffective disorder is defined according to Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision (DSM-IV-TR) criteria or International Classification of Diseases, Tenth Revision (ICD10) coding. It is a perplexing mental illness that has both features of schizophrenia, including hallucinations,
delusions, and distorted thinking, and features of a mood disorder, such as depression or mania. The coupling of
symptoms from these divergent spectrums makes diagnosing and treating patients who are schizoaffective
difficult.

The diagnosis is made when the patient has features of both schizophrenia and a mood disorder but does not
strictly meet diagnostic criteria for either illness alone. Unfortunately, it is often difficult to determine whether a
patient has 2 separate illnesses (schizophrenia or a mood disorder), a combination of illnesses (schizophrenia
with a mood disorder), or perhaps even a distinct and separate illness apart from schizophrenia or a mood
disorder.
An accurate diagnosis is made when the patient meets criteria for major depressive disorder or mania while also
meeting the criteria for schizophrenia. Moreover, the patient must have psychosis for at least 2 weeks without a
mood disorder.
Men with schizoaffective disorder tend to exhibit antisocial personality traits. [1] The age of onset is later for
women than for men, and as a consequence of limited research in this area, the exact etiology and epidemiology
are unclear. Patients with schizoaffective disorder are thought to have a better prognosis than that of patients
with schizophrenia. Treatment consists of both pharmacotherapy and psychotherapy.

Case study

A 50-year-old white man who had been suffering from a psychotic disorder since age 28 years had been treated
with antipsychotic medications with good results.
During the patients last medication check, his psychiatrist noticed that he appeared irritated. On further
questioning, the patient reported insomnia, rapid speech, distractibility, and grandiosity. He became angry with
the psychiatrist for inquiring about auditory and visual hallucinations. The patient was diagnosed with
schizoaffective disorder, bipolar type. The psychiatrist initiated treatment with a mood stabilizer, with good
results. The patient continued on both the antipsychotic and the mood stabilizer, and this approach was
successful.

Pathophysiology
The exact pathophysiology of schizoaffective disorder is unknown but may involve imbalance of
neurotransmitters in the brain.[2] Abnormalities of the neurotransmitters serotonin, norepinephrine, and
dopamine could play a role in this disorder.

Etiology
Although the cause of schizoaffective disorder is unknown, it may be similar to the cause of schizophrenia. To
date, no specific genetic markers have been identified. In utero exposure to viruses, malnutrition, or even birth
complications may play a role. More research is needed to fully elucidate the causes of schizoaffective disorder.

Epidemiology
The lifetime prevalence of schizoaffective disorder is thought to be approximately 0.32%, [3] with a range of 0.50.8%.[4] This rate is only an estimate; no studies have been performed. The international prevalence rates are
difficult to determine, because the diagnostic criteria have changed over the last few years.
Young people with schizoaffective disorder tend to have a diagnosis with the bipolar subtype, whereas older
people tend to have the depressive subtype. Schizoaffective disorder affects more women than men, but this
appears to be influenced by the fact that more women are in the depressive subtype as compared with the
bipolar subtype. Men with schizoaffective disorder tend to exhibit antisocial traits and behavior in contrast to
other personality traits. In addition, the age of onset is later for women than for men. No race-based difference
in diagnosis is observed.

Prognosis
The prognosis for patients with schizoaffective disorder is thought to lie between that of patients with
schizophrenia and that of patients with a mood disorder. That is, the prognosis is better with schizoaffective
disorder than with schizophrenia alone but worse than with a mood disorder alone.
Individuals with the bipolar subtype are thought to have a prognosis similar to those with bipolar type I,
whereas the prognosis of people with the depressive subtype is thought to be similar to that of people with
schizophrenia. Overall, determination of the prognosis is difficult.[5, 6, 7, 8]
The incidence of suicide is estimated at 10%. Also consider difference in suicide attempts among different
ethnic groups.[9, 10] Caucasian individuals have a higher rate of suicide than African Americans. Persons who
immigrated to a country have higher suicide rates then people born in that country. In regards to gender, women
attempt suicide more than men, but men complete suicide more often.[2]

A poor prognosis in patients with schizoaffective disorder is generally associated with a poor premorbid history,
an insidious onset, no precipitating factors, a predominant psychosis, negative symptoms, an early on
Patient Education
Patients should be educated about the following:

Social skills training

Medication compliance
Reducing expressed emotions
Cognitive rehabilitation
Family therapy

Family education should involve reduction of expressed emotions, criticism, hostility, or overprotection of the
patient; such reduction may lead to decreases in relapse rates.
For useful online patient information, visit the following sites:

MayoClinic, Schizoaffective disorder

National Alliance on Mental Illness (NAMI), Schizoaffective Disorder
MedlinePlus, Schizoaffective disorder

set, an unremitting course, or their having a family member with schizophrenia.

History
Obtain a complete medical history. Diagnostic criteria for schizoaffective disorder are as follows[11] :

An uninterrupted period of illness occurs during which a major depressive episode, a

manic episode, or a mixed episode occurs with symptoms that meet criterion A for
schizophrenia. The major depressive episode must include criterion A1 (ie, depressed
mood).
During the same period of illness, delusions or hallucinations occur for at least 2 weeks, in
the absence of prominent mood symptoms.

Symptoms that meet the criteria for mood episodes are present for a substantial portion of
the total active and residual periods of illness.
The disturbance is not due to the direct physiologic effects of a substance (eg, illicit drugs,
medications) or a general medical condition.
The bipolar type is diagnosed if the disturbance includes a manic or a mixed episode (or a
manic or a mixed episode and major depressive episodes).
The depressive type is diagnosed if the disturbance includes only major depressive
episodes.
Severity scales

Several scales are available for rating the severity of disease in patients with schizophrenia or schizoaffective
disorder.

These scales include those for positive and negative symptoms (eg, Positive and Negative Symptom Scale for
Schizophrenia [PANSS][12] ) and many for depression and bipolar rating (eg, Hamilton depression scale, Young
mania scale). Such tools can be used for baseline and outcome measurements and may be useful in assessing
the patients progress.
The cut down, annoyed, guilty, and eye opener (CAGE) Questionnaire is useful to inquire about alcohol
consumption in patients with schizoaffective disorder.[13]

Physical Examination
In addition to obtaining a medical history, perform a complete mental status examination, physical examination,
and neurologic examination to assist with the evaluation and rule out other disease processes.

Although the mental status examination varies for each patient, there are a number of items that are commonly
assessed in most patients with possible schizoaffective disorder. Because of the variability of the presentation of
this disorder, any or all symptoms of schizophrenia, bipolar disorder, or major depressive disorder may
manifest, depending on the presenting subtype, as follows:

Appearance - Ranges from well-groomed to disheveled

Eye contact - Appropriate, increased, or decreased
Facial expression - Neutral, angry, euphoric, sad
Motor - Possible psychomotor agitation or retardation
Cooperativeness - May cooperate or may be uncooperative
Mood - Euthymic, depressed, or manic
Affect - Ranges from appropriate to flat

Speech - Ranges from poverty to flight of ideas or pressured

Suicidal ideation - May or may not be present
Homicidal ideation - May or may not be present
Orientation - To elicit responses concerning orientation (ie, person, place, time, situation),
ask the patient questions, as follows. What is your full name? Do you know where you
are? What is the month, date, year, day of the week, and time? Do you know why you
are here?
Consciousness - levels of consciousness are determined by the interviewer and are rated
as (1) coma, characterized by unresponsiveness; (2) stuporous, characterized by response
to pain; (3) lethargic, characterized by drowsiness; and (4) alert, characterized by full
awareness.

Concentration and attention - Ask the patient to subtract 7 from 100, then to repeat the
task from that response. This is known as serial 7s. Next, ask the patient to spell the word
world forward and backward.
Reading and writing - Ask the patient to write a simple sentence (noun/verb). Then, ask
patient to read a sentence (eg, Close your eyes.). The part of the MMSE evaluates the
patients ability to sequence.
Memory - To evaluate a patients memory, have him or her respond to the following
prompts. For remote memory, What was the name of your first grade teacher? For
recent memory, What did you eat for dinner last night? For immediate memory, Repeat
these 3 words: pen, chair, flag. Tell the patient to remember these words. Then, after 5
minutes, have the patient repeat the words.
Delusions - Any type possible (eg, paranoid, thought insertion or withdrawal, grandiose,
bizarre, to name a few)

Hallucinations - Any type possible (most common is auditory, least common is gustatory)
Insight - Range varies
Judgment - Range varies

Inquiring about suicidal ideation at each visit is always important, because individuals with schizoaffective
disorder have a significant lifetime risk for suicide. In addition, the interviewer should inquire about past acts of
self-harm or violence. Ask the following types of questions when determining suicidal ideation or intent: Do
you have any thoughts of wanting to harm or kill yourself? and Do you have any thoughts that you would be
better off dead?
If the reply is positive for these thoughts, inquire about specific plans, suicide notes, family history (anniversary
reaction), and impulse control. Also, ask how the patient views suicide to determine if a suicidal gesture or act
is ego-syntonic or ego-dystonic. Next, determine if the patient will contract for safety.

Inquiring about homicidal ideation or intent during each patient interview is also important. Ask the following
types of questions to help determine homicidal ideation or intent: Do you have any thoughts of wanting to hurt
anyone? and Do you have any feelings or thoughts that you wish someone were dead? If the reply to 1 of
these questions is positive, ask the patient if he or she has any specific plans to injure someone and how he or
she plans to control these feelings if they occur again.

Diagnostic Considerations
The diagnosis is made when the patient has features of both schizophrenia and a mood disorder but does not
strictly meet diagnostic criteria for either illness alone. Unfortunately, it is often difficult to determine whether a
patient has 2 separate illnesses (schizophrenia or a mood disorder), a combination of illnesses (schizophrenia
with a mood disorder), or perhaps even a distinct and separate illness apart from schizophrenia or a mood
disorder.[14, 15, 16, 17, 18, 19]

Go to Emergent Treatment of Schizophrenia, Childhood-Onset Schizophrenia, and Schizophreniform Disorder

for complete information on these topics.
Other conditions to be considered include the following:

Steroid use
Temporal lobe epilepsy
Complex partial seizure disorder[20]
Neurosyphilis[21]
Thyroid problems

Alcohol abuse or dependence

Metabolic syndrome[22]
Delirium
Narcolepsy[23]

Differentials

Amphetamine-Related Psychiatric Disorders

Bipolar Affective Disorder
Brief Psychotic Disorder

Cocaine-Related Psychiatric Disorders

Cushing Syndrome
Depression

Hallucinogens
HIV Disease
Hyperparathyroidism

Phencyclidine (PCP)-Related Psychiatric Disorders

Schizophrenia

Other Tests
If the patients neurologic findings are abnormal, performing CT or MRI to rule out any suspected intracranial
pathology may be appropriate.
Perform psychological testing to assist with diagnosis (eg, Structured Clinical Interview for Axis I DSM-IV
Disorders [SCID-1]).
Perform EEG if indications are present.[25]
Histologic findings include decreased amounts of cortical gray matter and increased fluid-filled spaces.

Long-Term Monitoring
For best results, patients require medication and psychotherapy.
When an inpatient who has schizoaffective disorder makes the transition to being an outpatient, stressing the
importance of medication compliance is crucial.
Patients with schizoaffective disorder often lack judgment and insight into their illness. They commonly refuse
to continue the medications started in the hospital after they are discharged. When patients begin to feel better
as a result of their medications, they may think that they no longer need to take them; such thinking leads to the
discontinuance of medication and typically results in a return to the hospital within the next several weeks or so.
Noncompliance can also be due to adverse effects of the medication, such as sedation and weight gain.
If possible, select once-daily or long-acting medications, such as decanoate injections, to help with patient
compliance. In addition, address the issue of compliance with a family member. Always discuss all the risks,
benefits, adverse effects, and alternatives of each medication with the patient and family.

Approach Considerations
Treatment consists of both pharmacotherapy and psychotherapy. Written informed consent must be obtained
before pharmacologic therapy is started.
If patients are suicidal, homicidal, or gravely disabled, admit them to an inpatient psychiatric unit. Inpatient
treatment is mandatory for patients who are dangerous to themselves or others and for patients who cannot take
care of themselves. If patients with schizoaffective disorder represent a danger to self or others or are gravely
disabled and are unwilling to seek help on a formal voluntary basis, they may need to be committed for further
evaluation and treatment.
Consider transfer to a medical surgical hospital, if needed. Also consider transfer to a residential or group home,
if needed. Be familiar with local mental health laws.
Smoking cessation[26] and noncompliance with medications[27] are special concerns.

Go to Emergent Treatment of Schizophrenia, Childhood-Onset Schizophrenia, and Schizophreniform Disorder

for complete information on these topics.

Pharmacologic Therapy
Several medications are used to treat schizoaffective disorder. Agent selection depends on whether the
depressive or manic subtype is present. Early treatment with medication along with good premorbid function
often improves outcomes.[28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46]
In the depressive subtype, combinations of antidepressants (eg, sertraline, fluoxetine) plus an antipsychotic (eg,
haloperidol, risperidone, olanzapine, aripiprazole,[47] ziprasidone[48] ) are used. In refractory cases, clozapine has
been used as an antipsychotic agent.[49] In the manic subtype, combinations of mood stabilizers (eg, lithium,
carbamazepine, divalproex) plus an antipsychotic are used.
Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes of antidepressants.
Because their adverse-effect profiles are less prominent than the profiles of other drugs, improved compliance is

promoted. SSRIs do not have the cardiac dysrhythmia risk associated with tricyclic antidepressants. This risk is
especially pertinent in overdose, and suicide risk must always be considered when one treats a child or
adolescent with a mood disorder.
Physicians are advised to be aware of the following information and to use appropriate caution when they
consider treatment with SSRIs in the pediatric population.
In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory
that most SSRIs are not suitable for use by persons younger than 18 years for treatment of depressive illness.
After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with
SSRIs, except in the case of fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the
treatment of depressive illness in patients younger than 18 years.
In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding
reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive

disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various
antidepressant drugs in pediatric patients. The FDA asked that additional studies be performed because
suicidality occurred in both treated and untreated patients with major depression and thus could not be
definitively linked to drug treatment.
Noncompliance with medications is a complication of therapy. If noncompliance with medications is an issue,
one may seek a court order to force the patient to take medications (eg, in lieu of rehospitalization), which may
help increase medication compliance.

Psychotherapy and Psychoeducational Programs

Patients who have schizoaffective disorder can greatly benefit from psychotherapy, as well as
psychoeducational programs.
They should receive therapy that involves their families, develops their social skills, and focuses on cognitive
rehabilitation. Expressed emotions must be reduced in all areas of a patients life, including stress-reduction

techniques employed to prevent relapse[50] and possible rehospitalization. Psychotherapies should include
supportive therapy and assertive community therapy in addition to individual and group forms of therapy and
rehabilitation programs.
Treatment includes education about the disorder and its treatment, family assistance in compliance with
medications and appointments, and maintenance of structured daily activities (eg, a schedule of daily events)
for the patient.
Family involvement is needed in the treatment of this particular disorder.[51] Family education is particularly
important in this disorder secondary to the various mood and psychotic states. Families need information
regarding the patients mediations and the dynamic nature of this illness.
For further information, families can contact the National Alliance on Mental Illness (NAMI) or Self-Help
Association Regarding Emotions (SHARE; 1-800-832-8032).

Dietary Measures
No specific diet is recommended for patients with schizoaffective disorder.

Activity Restriction
Restrict activity if patients represent a danger to themselves or to others or if they are gravely disabled.
Otherwise, encourage patients who are schizoaffective to continue their normal routines and strengthen their
social skills whenever possible.

Medication Summary
Several medications are used to treat schizoaffective disorder. Agent selection depends on whether the depressive or
manic subtype is present. Early treatment with medication along with good premorbid function often improves outcomes.

In the depressive subtype, combinations of antidepressants (eg, sertraline, fluoxetine) plus an antipsychotic (eg,
haloperidol, risperidone, olanzapine, aripiprazole, or ziprasidone) are used. In refractory cases, clozapine has been used as
an antipsychotic agent. In the manic subtype, combinations of mood stabilizers (eg, lithium, carbamazepine, divalproex)
plus an antipsychotic are used.
Of the many medications and combinations available to treat schizoaffective disorder, a few are reviewed below.

Antipsychotics
Class Summary: These agents ameliorate psychosis and aggressive behavior.
Haloperidol (Haldol)

Haloperidol is used for management of psychosis, as well as motor and vocal tics in children and adults. The
mechanism of action not clearly established, but the drug has a selective effect on the central nervous system
(CNS) by competitively blocking postsynaptic dopamine (D2) receptors in the mesolimbic dopaminergic

system; increases in dopamine turnover are responsible for the tranquilizing effect. With subchronic therapy,
depolarization blockade and D2 postsynaptic blockade are responsible for antipsychotic action.
Risperidone (Risperdal, Risperdal Consta)
Risperidone is a selective monoaminergic antagonist that binds to dopamine D2 receptors with a
20 times lower affinity than it binds to serotonin type 2 (5-HT2) receptors. It also binds to alpha1adrenergic receptors with lower affinity to H1-histaminergic and alpha2-adrenergic receptors. It
improves negative symptoms of psychosis and decreases occurrence of extrapyramidal effects.

Risperidone is also available in a long-acting intramuscular (IM) formulation (Risperdal Consta).

Olanzapine (Zyprexa)

Olanzapine is an atypical antipsychotic with a broad pharmacologic profile across receptor systems (eg,
serotonin, dopamine, cholinergic muscarinic, alpha-adrenergic, histamine). Its antipsychotic effect is from

antagonism of dopamine and serotonin type 2 receptors. It is indicated for treatment of psychosis and bipolar
disorder.
Clozapine (Clozaril, FazaClo)
Clozapine has a weak affinity for D1, D2, D3, and D5 receptors and a high affinity for the D4
receptor. It also acts as an antagonist at adrenergic, cholinergic, histaminergic, and serotonergic
receptors. However, it does not induce catalepsy, nor does it inhibit apomorphine-induced
stereotypy. The risk of agranulocytosis limits the use of clozapine to patients who are
nonresponsive to or intolerant of classic neuroleptic agents.

Quetiapine (Seroquel)
Quetiapine is a newer antipsychotic for long-term management. It may antagonize dopamine
and serotonin effects. Improvements over earlier antipsychotics include fewer anticholinergic
effects and less dystonia, parkinsonism, and tardive dyskinesia.
Ziprasidone (Geodon)
Ziprasidone antagonizes D2, D3, 5-HT2A, 5-HT2C, 5-HT1A, 5-HT1D, and alpha1-adrenergic
receptors. It has a moderate antagonistic effect for histamine H1. It moderately inhibits reuptake
of serotonin and norepinephrine.
Aripiprazole (Abilify)
Aripiprazole improves positive and negative schizophrenic symptoms. Its mechanism of action is
unknown but is hypothesized to differ from that of other antipsychotics. Aripiprazole is thought to

be a partial D2 and 5-HT1A) agonist and antagonizes 5-HT2A. No QTc-interval prolongation is

noted in clinical trials.
Iloperidone (Fanapt)

Iloperidone is an atypical antipsychotic agent that is indicated for acute treatment of schizophrenia. Its precise
mechanism of action is unknown. It antagonizes D2 and 5-HT2 receptors.

Antidepressants
Class Summary

Antidepressant agents decrease aggression and treat the underlying illness.

Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred over the other classes of antidepressants.
Because the adverse-effect profiles of SSRIs are less prominent than the profiles of other drugs, improved
compliance is promoted. SSRIs do not have the cardiac dysrhythmia risk associated with tricyclic

antidepressants. Dysrhythmia risk is especially pertinent in overdose, and suicide risk must always be
considered when one treats a child or adolescent with a mood disorder.
Physicians are advised to be aware of the following information and to use appropriate caution when they
consider treatment with SSRIs in the pediatric population.
In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory
that most SSRIs are not suitable for use by persons younger than 18 years for treatment of depressive illness.
After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with
SSRIs, except in the case of fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the
treatment of depressive illness in patients younger than 18 years.
In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding
reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive
disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various
antidepressant drugs in pediatric patients. The FDA asked that additional studies be performed because

suicidality occurred in both treated and untreated patients with major depression and thus could not be
definitively linked to drug treatment.
Fluoxetine (Prozac)

Fluoxetine is an SSRI used to treat impulse-control problems or underlying illness. It selectively inhibits
presynaptic serotonin reuptake with minimal or no effect in reuptake of norepinephrine or dopamine.
Sertraline (Zoloft)

Sertraline is an SSRI used to treat impulse-control problems or underlying illness. It selectively inhibits
presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine.

Paroxetine (Paxil)

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on
norepinephrine and dopamine neuronal reuptake.
For maintenance dosing, make dosage adjustments to maintain the patient on the lowest effective dosage, and
reassess the patient periodically to determine the need for continued treatment.
Fluvoxamine (Luvox)

Fluvoxamine enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. It does not
significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects
than tricyclic antidepressants.
It has been shown to reduce repetitive thoughts, maladaptive behaviors, and aggression and to increase social
relatedness and language use.

Citalopram (Celexa)

Citalopram enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. No head-tohead comparisons of SSRIs exist, although, based on metabolism and adverse effects, citalopram is considered
the SSRI of choice for patients with head injury.
SSRIs are the antidepressants of choice because of their minimal anticholinergic effects.
Escitalopram (Lexapro)
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and S-enantiomer of citalopram. It
is used for the treatment of depression. The mechanism of action is thought to be potentiation of
serotonergic activity in the CNS, resulting from the inhibition of CNS neuronal reuptake of
serotonin. The onset of depression relief may be obtained after 1-2 weeks, which is sooner than
other antidepressants.

Mood Stabilizers
Class Summary: Mood stabilizers stabilize the mood imbalance associated with
bipolar disorder.
Valproic acid, divalproex sodium (Depakote, Depakene, Depacon, Stavzor)
Valproic acid may increase brain gamma-aminobutyric acid (GABA) levels by inhibiting
aminobutyrate aminotransferase. GABA inhibits presynaptic and postsynaptic discharges. In
addition to its use as mood stabilizer, valproic acid is also used for migraine headaches, epilepsy,
and mania.
Oxcarbazepine (Trileptal)

Oxcarbazepine's pharmacologic activity is primarily from its 10-monohydroxy metabolite (MHD). It may block
voltage-sensitive sodium channels, inhibit repetitive neuronal firing, and impair synaptic impulse propagation.

Its anticonvulsant effect may also occur by affecting potassium conductance and high-voltage activated calcium
channels.
Drug pharmacokinetics are similar in children older than 8 years and adults. Children younger than 8 years have
a 30-40% increased clearance compared with older children and adults. Use of oxcarbazepine in children
younger than 2 years has not been studied in controlled trials.
Lithium (Lithobid)

Lithium is indicated to treat bipolar disorder. The specific mechanism of action unknown, but the drug alters
sodium transport in nerve and muscle cells and influences reuptake of serotonin, norepinephrine, or both at cell
membranes.

Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)

Carbamazepine is indicated to treat epilepsy and trigeminal neuralgia. Research and clinical experience indicate
that it is effective in treating manic subtype schizoaffective disorder.
Introduction

Schizoaffective disorder is a serious mental illness that has features of two different conditions, schizophrenia
and an affective (mood) disorder, either major depression or bipolar disorder.
Schizophrenia is a brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives
reality and relates to others. Depression is an illness that is marked by feelings of sadness, worthlessness or
hopelessness, as well as problems concentrating and remembering details. Bipolar disorder is characterized by
cycling mood changes, including severe highs (mania) and lows (depression).

Schizoaffective disorder is a life-long illness that can impact all areas of daily living, including work or school,
social contacts and relationships. Most people with this illness have periodic episodes, called relapses, when
their symptoms surface. While there is no cure for schizoaffective disorder, symptoms often can be controlled
with proper treatment.
What Are the Symptoms of Schizoaffective Disorder?

A person with schizoaffective disorder has severe changes in mood and some of the psychotic symptoms of
schizophrenia, such as hallucinations, delusions and disorganized thinking. Psychotic symptoms reflect the
person's inability to tell what is real from what is imagined. Symptoms of schizoaffective disorder may vary
greatly from one person to the next and may be mild or severe. Symptoms of schizoaffective disorder may
include:
Depression
Poor appetite
Weight loss or gain

Changes in sleeping patterns (sleeping very little or a lot)

Agitation (excessive restlessness)
Lack of energy
Loss of interest in usual activities
Feelings of worthlessness or hopelessness
Guilt or self-blame
Inability to think or concentrate
Thoughts of death or suicide

Mania
Increased activity, including work, social and sexual activity
Increased and/or rapid talking
Rapid or racing thoughts

Little need for sleep

Agitation
Inflated self-esteem
Distractibility
Self-destructive or dangerous behavior (such as going on spending sprees, driving
recklessly or having unsafe sex)

Schizophrenia
Delusions (strange beliefs that are not based in reality and that the person refuses to give
up, even when presented with factual information)
Hallucinations (the perception of sensations that aren't real, such as hearing voices)
Disorganized thinking
Odd or unusual behavior

Slow movements or total immobility

Lack of emotion in facial expression and speech
Poor motivation
Problems with speech and communication

What Causes Schizoaffective Disorder?

While the exact cause of schizoaffective disorder is not known, researchers believe that genetic,
biochemical and environmental factors are involved.
Genetics (heredity): A tendency to develop schizoaffective disorder may be passed on from
parents to their children.
Brain chemistry: People with schizophrenia and mood disorders may have an imbalance of
certain chemicals in the brain. These chemicals, called neurotransmitters, are substances

that help nerve cells in the brain send messages to each other. An imbalance in these
chemicals can interfere with the transmission of messages, leading to symptoms.
Environmental factors: Evidence suggests that certain environmental factors -- such as a
viral infection, poor social interactions or highly stressful situations -- may trigger
schizoaffective disorder in people who have inherited a tendency to develop the disorder.

Who Gets Schizoaffective Disorder?

Schizoaffective disorder usually begins in the late teen years or early adulthood, often between the ages of 16
and 30. It seems to occur slightly more often in women than in men and is rare in children.

How Common Is Schizoaffective Disorder?

Because people with schizoaffective disorder have symptoms of two separate mental illnesses, it is often
misdiagnosed. Some people may be misdiagnosed as having schizophrenia, and others may be misdiagnosed
with a mood disorder. As a result, it is difficult to determine exactly how many people actually are affected by
schizoaffective disorder. However, it is believed to be less common than either schizophrenia or affective
disorder alone. Estimates suggest that about one in every 200 people (0.5%) develops schizoaffective disorder
at some time during his or her life.
How Is Schizoaffective Disorder Diagnosed?

If symptoms of schizoaffective disorder are present, the doctor will perform a complete medical history and
physical exam. Although there are no laboratory tests to specifically diagnose schizoaffective disorder, the

doctor may use various tests -- such as X-rays or blood tests -- to rule out a physical illness as the cause of the
symptoms.
If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or
psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses.
Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a
psychotic disorder. A diagnosis of schizoaffective disorder is made if a person has periods of uninterrupted
illness and has, at some point, an episode of mania, major depression or mix of both while also having
symptoms of schizophrenia. In addition, to diagnose the illness, the person must display a period of at least two
weeks of psychotic symptoms without the mood symptoms.
Featured:
Schizoaffective disorder is a mental illness that features schizophrenia and a mood disorder,
either major depression or bipolar disorder. Symptoms include agitation, suicidal thoughts, little

need for sleep, delusions, hallucinations, and poor motivation. Treatment may involve
psychotherapy, medication, skills training, or hospitalization.