Schizoaffective disorder in adults

buy fluoxetine 20 mg.gif

It is a mental condition that causes both loss of contact with reality (psychosis) and mood problems (depression or mania).

Schizoaffective disorder is part of a group of diagnoses called the schizophrenia spectrum and other psychotic disorders. Spectrum schizophrenia and other psychotic disorders are a group of psychiatric disorders that include:

  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder
  • Psychotic disorder caused by substances/drugs
  • Psychotic disorder caused by another medical condition
  • Catatonia
  • Schizotypal (personality) disorders
  • Brief psychotic disorder
  • Schizophreniform disorder

These disorders are characterized by symptoms that can be divided into two groups: positive and negative.

Positive symptoms include delusions, hallucinations, accelerated thinking (speech), and abnormally disorganized or abnormal motor behavior (including catatonia). Delusions are fixed beliefs that cannot be changed even in the face of contradictory evidence. Hallucinations are perceptions similar to normal experiences, but without external stimuli. Accelerated thinking/speech is characterized by discontinuity or loose associations in the individual’s speech pattern. Abnormally disorganized or abnormal motor behavior is difficulty maintaining purposeful behavior. It can manifest itself in a variety of ways, from infantile "silliness" To unpredictable agitation.

Negative symptoms include decreased emotional expression, abulia, impoverished thinking, and anhedonia. Negative symptoms are those associated with loss of normal function or experience. Decreased emotional expression is a decrease in facial expression, eye contact, voice intonation, and hand, head, and facial movements that usually give emotional emphasis to the voice. Abulia is a decrease in self-motivated intentional movement. Impoverished thinking manifests itself in decreased vocalization. Anhedonia is a disturbance in the ability to experience pleasure from normally pleasurable stimuli.

What is schizoaffective disorder?

Schizoaffective disorder is a neuropsychiatric disorder that includes clinical features common to both affective disorders and schizophrenia. Schizoaffective disorder is characterized by delusions, hallucinations, formal thought disturbances, or negative symptoms that occur with depressed mood with or without additional symptoms of mania.

In addition, delusions or hallucinations should occur in the absence of an underlying mood episode (depressive or manic), and mood symptoms should be present most of the time. These disorders do not have to be related to the use of psychoactive substances or medications.

There are two types of schizoaffective disorder:

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

The disorder can manifest itself in a variety of temporal forms. The following pattern is typical: the person may have severe auditory hallucinations and delusions of persecution for at least 2 months before the onset of a major depressive episode. Psychotic symptoms and a full major depressive episode have been present for at least 3 months. The person then fully recovers from the major depressive episode, but psychotic symptoms persist for at least another month before disappearing.

Causes

The exact cause of schizoaffective disorder is unknown. Changes in genes and brain chemicals (neurotransmitters) may play a role.

Schizoaffective disorder is thought to be less common than schizophrenia and mood disorders. Women may have the condition more often than men. The disorder tends to be rare in children.

Understanding schizoaffective disorder

Schizoaffective disorder is about a third more common than schizophrenia, which affects about 0.3% of adults. The onset of schizoaffective disorder usually occurs in early adulthood, although the onset can occur at any time from adolescence to old age.

Schizoaffective disorder of the bipolar type may be more common in young adults, and schizoaffective disorder of the depressive type in older adults. The incidence of schizoaffective disorder is higher in women than in men, mainly because of the higher prevalence of the depressive subtype among women.

Schizoaffective disorder is associated with social and occupational disability, but disability among people with schizoaffective disorder varies significantly. Schizoaffective disorder is associated with limited social contacts and difficulty with self-care, but negative symptoms may be less severe and less persistent than in schizophrenia. Misconceptions are common in schizoaffective disorder, but to a potentially lesser extent than in schizophrenia.

Schizoaffective disorder is often comorbid with other illnesses, particularly substance use disorders and anxiety disorders. It is often difficult to distinguish schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features.

Symptoms

The symptoms of schizoaffective disorder vary from person to person. People with this disorder often seek treatment because of problems with mood, daily functioning, or abnormal thoughts.

Psychosis and mood swings can occur simultaneously or separately. The course of this disorder may include cycles of severe symptoms followed by improvement.

Symptoms of schizoaffective disorder may include:

  • Changes in appetite and stamina
  • Disorganized and illogical speech
  • False beliefs (delusions), such as thoughts that someone is trying to hurt you (paranoia), or thoughts that special messages are hidden in ordinary places (directional delusions)
  • Lack of interest in hygiene or self-care
  • Being in too good a mood, depressed or irritable
  • Sleep problems
  • Problems with concentration
  • Sadness or hopelessness
  • Seeing or hearing things that are not there (hallucinations)
  • Social withdrawal
  • Speaks so fast that others do not have time to interrupt

How schizoaffective disorder is treated?

The schizoaffective disorder task force suggests that in the absence of established norms and rigorous treatment standards, definitive treatment recommendations would be premature.

However, evidence suggests that the choice of medications to treat schizoaffective disorder depends on the presence of a depressive or bipolar subtype, and that early psychopharmacological treatment combined with good premorbid functioning often improves outcomes. Antipsychotic medications are usually prescribed in combination with antidepressants or mood stabilizers, depending on whether the person has the depressive or bipolar subtype, respectively.

In addition, psychotherapeutic approaches are usually used in conjunction with medication to improve functioning.

Antipsychotics

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

Mood stabilizing drugs (bipolar subtype)

  • Lithium
  • Carbamazepine
  • Divalproex
  • Valproic acid

Taking antidepressants (depressive subtype)

  • Sertraline
  • Fluoxetine
  • Benzodiazepines (anxiety, insomnia, akathisia)
  • Antiepileptic drugs, such as Topiramate

When to see a medical professional

Call your doctor if you or someone you know is experiencing any of the following symptoms:

  • Depression with feelings of hopelessness or abandonment
  • Inability to meet basic personal needs
  • Increased energy and involvement in behaviors that are risky, unexpected, and abnormal for you (e.g., not sleeping and not feeling the need to sleep for days)
  • Strange or unusual thoughts or perceptions
  • Symptoms that worsen or do not improve with treatment
  • Suicidal thoughts or thoughts of harming others

Prognosis

People with schizoaffective disorder are more likely to return to their previous level of functioning than people with most other psychotic disorders. However, long-term treatment is often required, and results vary from person to person.

Possible complications

Complications are similar to those of schizophrenia and major affective disorder and include:

  • Substance abuse
  • Problems after therapy and medical treatment
  • Problems related to manic behavior (e.g., partying, excessive sexual behavior)
  • Suicidal behavior

Additional treatments to consider

Psychoeducation and family support: Helps improve family functioning, problem-solving and communication skills, and reduces relapse rates.

Cognitive behavioral therapy: Includes training in social skills, problem-solving strategies, and self-help skills.

Social skills training: Uses the principles of behavioral therapy to teach social skills, assertiveness, and other skills related to coping with illness and independent living.

Assertive treatment in the community: A multidisciplinary team approach to intensive case management that involves high frequency of patient contact (usually at least once a week), low patient-to-staff ratios, and community outreach, allowing the integration of medication management, rehabilitation, and social services, as well as individualization of patients.

Supported Employment: An approach to vocational rehabilitation for people with serious mental illness that emphasizes integration of employment and mental health services, rapid employment in the community, individual job development, and ongoing supported employment.

Cognitive Correction: These interventions aim 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.

Acceptance and Commitment Therapy: This therapy focuses on changing the relationship people have with their own thoughts, feelings, memories and physical sensations that cause fear or avoidance. Acceptance and mindfulness strategies are used to teach patients to reduce avoidance, attachment to cognitions, and increase focus on the present.

Cognitive coping training: This treatment teaches people with schizophrenia to use strategies that compensate for (or eliminate) the cognitive impairment associated with schizophrenia.

Disease Management and Recovery: This method of treatment emphasizes recovery by helping patients set and achieve meaningful personal goals. MRE combines 1) psychoeducation about mental illness, 2) cognitive behavioral approaches to medication treatment, 3) relapse prevention planning, 4) social skills training to strengthen social support, and 5) coping skills for the symptoms of mental illness.