Schizoaffective Disorder Vs. Schizophrenia

While they may not be as common as most other mental health conditions (schizoaffective disorder generally affects 0.3% of people in the US and schizophrenia approximately 0.32%), both schizophrenia and schizoaffective disorder can significantly impact a person's thoughts, emotions, and behaviors. 

The two have separate diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and experts still debate whether they should be categorized as two distinct conditions. A clue to the primary difference between them lies within their names:

• Schizophrenia: "Schizo" derives from the Latinized form of the Greek “skhizein,” meaning "to split," and "phrenia" derives from “phrenos,” meaning "heart, mind." 
• Schizoaffective: This word features the same prefix plus "affective," a psychological term generally referring to mood or feelings. 

Though the differences between the two are primarily centered around emotional dysregulation symptoms, other distinctions exist as well. Both conditions are typically treated with a combination of therapy and medication.

Schizophrenia spectrum disorders can be treatable

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Schizophrenia signs and symptoms

People with schizophrenia may perceive reality differently than others, experiencing some combination of the following symptoms.

Disordered thinking 

Disordered thoughts may range from chaotic thought patterns to difficulty organizing thoughts. Disorganized thinking typically manifests as disorganized speech in people with schizophrenia. For example, a person with schizophrenia may give unrelated or partial answers to questions, have difficulty communicating conversationally, and, in rare cases, string together words that are unrelated or fabricated. 

Abnormal behaviors

Schizophrenia symptoms typically include disorganized behaviors, like unpredictable distress with lucid intervals, notable childishness, and catatonic behaviors, such as a lack of response or appearing to "tune out" when engaged by others. Abnormal behaviors may include random movements, unusual body language, and a disregard for societal norms in public settings.  

Hallucinations

Schizophrenic hallucinations generally refer to sensory experiences that aren't real but seem extremely real to the person experiencing them. These hallucinations can affect any of the senses, but visual and auditory hallucinations tend to be the most common.  

Delusions

Many people with schizophrenia experience delusional thoughts or beliefs that aren't reality-based. For example, they may believe they can predict the future or read people's minds. They might think certain people, even total strangers, want to harm them or are in love with them.

Negative symptoms of schizophrenia

“Negative symptoms” can be seen as an umbrella term that usually refers to symptoms contributing to an individual's inability to function normally. For example, an individual may lack emotional expression, motivation, or the ability to experience pleasure. In addition, their personal hygiene, daily responsibilities, or relationships may fall into disrepair. 

Symptoms of schizophrenia typically vary between people based on several factors, such as age and environmental conditions. They may wax and wane or remain present, and while mood disturbances can occur in schizophrenia, they are usually not the primary feature of the disorder. 

Instead, mood disturbances may occur secondarily to psychotic symptoms or as symptoms of a comorbid condition, like anxiety or depression. 

To receive a clinical diagnosis for schizophrenia:

• The individual must present schizophrenic symptoms for a significant portion of the time for at least one month after the onset of the disturbance. 
• Levels of function must diminish markedly in one or more areas of daily life from the onset of the disturbance. These areas might include interpersonal relationships, work, school, or self-care.
• The individual must experience continuous signs of the disturbance for at least six months.
• Bipolar, depressive, and schizoaffective disorders with psychotic features must be ruled out. 
• The disturbance cannot be related to a medical condition or effects of medication, alcohol, or other substances. 

Schizoaffective personality disorder signs and symptoms

Schizoaffective disorder usually features symptoms of both schizophrenia and a mood disorder, such as major depressive or bipolar disorder. It can be grouped into two different types, depending on whether the individual presents a depressed mood, manic behavior, or both.

• Schizoaffective bipolar type: People with this type of schizoaffective disorder may present major mood episodes like extreme "highs" or elevated energy, sometimes alternating with major depression (periods of extremely low mood and energy). 
• Schizoaffective depressive type: People with this type of schizoaffective disorder usually only present major depressive symptoms. These might create significant barriers to daily productivity and severely impact one's self-esteem. 

Like schizophrenia, symptoms of schizoaffective disorder can vary between people according to their unique circumstances. To diagnose schizoaffective disorder, mental health professionals typically look for symptoms that persist for a significant portion of the time. 

These symptoms generally must include prominent mood symptoms (depression or mania) alongside psychotic symptoms for a substantial portion of the disturbance. These mood symptoms may occur even when psychotic symptoms are not present.

Schizoaffective disorder vs schizophrenia: Similarities and differences

In schizoaffective disorder, mood symptoms usually persist for a substantial portion of the illness, whereas in schizophrenia, mood disturbances are typically secondary to psychotic symptoms.

The prognosis for schizoaffective disorder can vary depending on the severity of both the psychotic and mood symptoms. 

Potential causes

The etiology of schizoaffective disorder and schizophrenia is still somewhat unclear. Individuals with the risk factors may not develop the disorder, and vice versa.

While research into schizoaffective disorder and schizophrenia is ongoing, scientists believe these disorders may develop due to a combination of the following:

• Genetics: Studies suggest that variations in specific genes may combine to increase the risk of developing the disorders. These genes may include some that help control chemical signals in the brain, that impact how nerve cells develop in the brain, and that regulate the body's circadian rhythms. 

Although many of the same genetic variations occur in both conditions, there may be some variations involved in the development of schizoaffective disorder that overlaps with bipolar disorder. 

• Inheritance: The role of heritability in schizoaffective disorder and schizophrenia is still unclear. However, studies indicate the risk tends to be more significant for first-degree relatives of affected individuals, and many with schizophrenia or schizoaffective disorder have relatives with other conditions, like bipolar and other mood disorders.
• Brain chemistry and structure: An individual's brain structure and function may be a risk factor for developing either condition. 
• Substance use: Studies suggest multiple factors might lead to a bi-directional relationship between substance use and schizophrenia. These factors may include dysfunction in the brain circuits involved in motivation and reward, genetic factors, and the age and frequency of substance exposure.
• Environmental factors: Although the research is somewhat inconclusive, studies suggest that environmental risk factors, such as brain infection, childhood trauma, and developmental complications in utero, may contribute to the development of schizophrenia and bipolar disorder. 

Treatment and management

Treatments for schizoaffective disorder and schizophrenia can be similar but are typically tailored to the individual's needs. Treatment plans may also change with time, depending on patient outcomes.

Medications 

Pharmaceutical treatments may include one or a combination of the following:

• Antipsychotic medications to treat delusions and hallucinations
• Antidepressants like SSRIs to address depressive symptoms for schizoaffective disorder treatment
• Mood stabilizers to target manic symptoms for patients with bipolar-type schizoaffective disorder

Do not start, stop, or change the way you take medication without consulting your doctor or psychiatrist. The information in this article is not a replacement for medical advice.

Psychotherapy and psychosocial interventions

As can be the case for many mental health disorders, individuals with schizoaffective disorder and schizophrenia may benefit from psychotherapy as well as psychosocial programs in some cases.

Individual therapy: Techniques like cognitive behavioral therapy (CBT) can help individuals better understand their thought processes to normalize them, reduce symptoms, and learn to cope with challenges in daily life. Individual therapy may also include a psychoeducational component to teach individuals about treatment and risk factors. 

Online therapy for mental health

While it might not be appropriate in all cases, virtual therapy could be a good option for individuals without local access to a therapist or who have trouble commuting to and from in-office appointments. Most online therapy platforms offer flexible scheduling options where one can attend appointments from the comfort of home via video, phone, or online chat. 

Online therapy is often more affordable than traditional treatment without insurance, and a growing body of research indicates it can be just as effective in supporting people with severe mental illness (SMI), such as psychotic disorders, schizophrenia, or schizoaffective disorder.

• Family/group therapy: Family therapy can educate loved ones to better understand the condition's signs, symptoms, and potential triggers so they may offer better support. Group programs can also provide support through shared experiences and connections among participants. 
• Skills training: Some people with schizophrenia and schizoaffective disorder may benefit from programs that teach practical skills. For example, they may learn social skills, conflict mediation strategies, goal-setting and management techniques, or vocational abilities. 

Schizophrenia spectrum disorders can be treatable

Learn more from a licensed therapist

Electroconvulsive therapy (ECT)

Although it's typically considered a last-resort treatment, multiple studies indicate that ECT can be beneficial in treating individuals in several situations. For example, it may be used for urgent or treatment-resistant cases, first-episode schizophrenia, adolescents with schizophrenia, and individuals with catatonia.