Schizoaffective Disorder

Schizoaffective disorder is one of the most frequently misdiagnosed mental health conditions because symptoms so closely resemble that of schizophrenia and a mood disorder. Doctors often have differing opinions on the best way to describe or diagnose the condition. One determining factor that can help doctors confirm a patient has schizoaffective disorder is that symptoms of both a mood disorder like bipolar disorder and symptoms of schizophrenia are present simultaneously for at least two weeks. Symptoms may present in a variety of ways.

Symptoms of mania:

• Sleeplessness
• Indiscretion, often sexually 
• Grandiosity⁴ or inflated self-esteem
• Paranoia 
• Decreased need for sleep
• Excessively talkative

Symptoms of depression:

• Loss of interest in usual activities
• A tendency to sleep or eat too little or too much
• Inability to concentrate
• Depressed mood
• Feelings of hopelessness or helplessness
• Changes in appetite or weight
• Thoughts of suicide or death

Symptoms of psychosis:

• Hallucinations
• Delusions
• Paranoia
• Inappropriate emotional reactions
• Decline in personal hygiene
• Social withdrawal
• Confused and disturbed thinking
• Abnormal movements

Symptoms typically first appear during adolescence or early adulthood. Untreated symptoms can negatively impact an individual’s social and functional well-being. For example, psychotic symptoms can make it difficult to socialize. Schizoaffective disorder may make it difficult for a person to maintain a job or properly care for themselves. They often experience isolation and may be at a higher risk of substance use disorders⁵ or problems. Research shows that up to 5% of individuals with a psychotic illness take their own life.

Along with these schizoaffective disorder symptoms, a few additional factors can help doctors determine if a patient has schizoaffective disorder. People with this disorder often have trouble watching a moving object, and the REM cycle of their sleep usually occurs early in their sleep cycle.

Researchers are still learning what exactly causes schizoaffective disorder, schizophrenia, and other psychotic disorders. A few different risk factors are thought to play a role in its development, including genetics, environmental factors, and brain chemical interactions with receptors. 

People with a first-degree relative (such as a sibling or parent) who has schizoaffective disorder symptoms are more likely to develop the condition as well. Having a relative with a mental health condition such as depression or bipolar disorder is also a risk factor. Schizoaffective disorder occurs more often in women than men. 

Environmental factors such as stress can also increase a person’s risk of developing schizoaffective disorder. Stress has the potential to trigger an episode of psychosis or a mood episode. Symptoms may initially begin when an individual experiences an extremely stressful event, such as a job loss, homelessness, or loss of a loved one. Childhood trauma, such as the loss of a parent or any type of abuse, may also be a risk factor for mental health conditions like schizophrenia spectrum disorder, schizoaffective disorder, and brief psychotic disorder.

Brain formation and chemistry may also be contributing factors. Some patients have been found to have abnormalities in their dopamine, norepinephrine, and serotonin. Decreased volume of the hippocampus and white matter abnormalities have also been noted in individuals with schizoaffective disorder.

Treatments for schizoaffective disorder include both medication and psychotherapy. The goal is often to help patients reduce or eliminate their symptoms of schizoaffective disorder to minimize the impact of the condition on their lives. 

Medication

Medication is the foundation of treatment for schizoaffective disorder. Approximately 93% of patients are prescribed an antipsychotic. Also, 19% are prescribed an antidepressant alongside the antipsychotic, and 20% receive a mood stabilizer along with the antipsychotic. 

• Antipsychotics may help decrease psychosis and aggressive behavior. They may also improve symptoms including delusions, hallucinations, and disorganized speech. Antipsychotics can help resolve symptoms as well. These medications may include paliperidone, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol.
• Mood stabilizers can decrease manic or hypomanic symptoms, such as distractibility, indiscretion, grandiosity, and a decreased need for sleep. Commonly prescribed mood stabilizers include lithium, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine.
  
• Antidepressants target periods of depression. Antidepressants may trigger a manic episode in some people with bipolar disorder, so it may be important to rule the condition out before giving them to a patient. Selective-serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine, are typically safer to prescribe than other types of antidepressants due to a lower risk of side effects.

Do not start, stop, or change a medication without consulting with your physician or other qualified health professional.

Other treatment options

Often considered a last resort, electroconvulsive therapy (ECT) may be used if a patient is experiencing catatonia or aggression. It’s proven to be effective in treating chronically hospitalized patients. Some experts now argue that ECT should be considered alongside medication in order to improve results.

It can also be beneficial to seek support outside of a patient’s immediate circle and medical team. In support groups, an individual can connect with peers who share a similar experience, finding both advice and a sense of community while learning how to navigate a somewhat isolating mental illness. Supported housing may also benefit individuals who need stable housing and long-term care.

Self-care

The mood problems associated with schizoaffective disorder are typically exacerbated by a lack of self-care, especially when a person isn’t sleeping enough. It can be important to maintain physical well-being in order to support mental and emotional health. A patient’s mental health typically benefits when they commit to taking care of their body. The following are some ways to enhance self-care:

• Follow a sleep schedule to get enough rest each night.
• Eat three well-balanced meals a day.
• Drink water to avoid dehydration.
• Participate in regular exercise or physical movement. 
• Spend time engaging in a favorite hobby to decrease stress levels.

If you or a loved one is living with schizoaffective disorder and you’re not sure what steps to take next, therapy may be a helpful place to get started. A mental health professional can work with you to design a treatment plan and connect you with other professionals, such as a social worker or psychiatrist. Using an online platform such as BetterHelp can make it easy to connect with a therapist at a time that’s most convenient for you. 

The National Alliance on Mental Illness (NAMI) facilitates support groups for both patients and their families. Many groups meet virtually, but there are also in-person support groups available across the U.S. You can also connect with a volunteer at the NAMI HelpLine by calling 1-800-950-6264, texting “HelpLine” to 62640, or emailing helpline@nami.org. NAMI also offers a number of other resources including online discussion groups, podcasts and webinars, and an extensive video resource library.

Mental Health America also has resources about various mental health conditions and ways to connect with others. The organization also has a unique resource on its website called “Changing Thoughts with an AI Assistant,” which uses artificial intelligence to help you reframe your negative thoughts and move past thinking traps.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

There is considerable debate between mental health professionals about how to describe and diagnose schizoaffective disorder. This often contributes to a delayed diagnosis of the condition. In one study, researchers examined the difference in patients who were diagnosed with schizophrenia and schizoaffective disorder. They found that patients with schizoaffective disorder had higher rates of suicidality and higher rates of anxiety. This highlights the need for a more detailed clinical characterization of patients so that therapists can provide more targeted treatment.

Because medication is typically considered the first line of treatment for patients with schizoaffective disorder, researchers have looked into what medicines are most effective in the treatment of this disorder. After studying the impact of various medications on more than 15,000 patients over an 11-year span, scientists in one study came to the conclusion that clozapine, long-acting injectable antipsychotics, and combination therapy with mood stabilizers resulted in the best outcome for patients.

Here are some key statistics on schizoaffective disorder:

• Schizoaffective disorder is relatively rare. Around 0.3% of the population will develop the condition at some point in their lives.
  
• People who experience psychotic episodes or schizophrenia-like symptoms are at a higher risk of developing substance use problems. In one study, researchers found that 37.9% of patients who had psychosis also had substance use problems. 
  
• It can be difficult at times to receive the proper treatment. According to the World Health Organization, only 31.3% of people with psychosis receive specialized mental health care.
• About 50% of individuals who develop a psychotic illness such as schizoaffective disorder have a favorable outcome. They experience minimal to no symptoms and/or are able to maintain employment.