eMedicine Specialties > Psychiatry > Adult

Schizoaffective Disorder: Differential Diagnoses & Workup

Author: Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Contributor Information and Disclosures

Updated: Jun 3, 2009

Differential Diagnoses

Amphetamine-Related Psychiatric Disorders
HIV Disease
Bipolar Affective Disorder
Hyperparathyroidism
Brief Psychotic Disorder
Phencyclidine (PCP)-Related Psychiatric Disorders
Cocaine-Related Psychiatric Disorders
Schizophrenia
Cushing Syndrome
Depression
Hallucinogens

Other Problems to Be Considered

Steroid use
Temporal lobe epilepsy
Complex partial seizure disorder
Neurosyphilis
Thyroid problems
Alcohol abuse or dependence
Metabolic syndrome
Delirium
Narcolepsy

Workup

Laboratory Studies

  • Sequential multiple analysis
  • Complete blood cell count
  • Rapid plasma reagent
  • Test of thyroid-stimulating hormone or thyroid function tests
  • Urine drug screen
  • Urine pregnancy test
  • Urinalysis
  • Lipid panel
  • HIV test

Imaging Studies

  • If the patient's neurologic findings are abnormal, CT or MRI rule out any suspected intracranial pathology may be appropriate.

Other Tests

  • Perform psychological testing to assist with diagnosis (eg, Structured Clinical Interview for Axis I DSM-IV Disorders [SCID-1]).
  • Several scales are available for rating the severity of disease in patients with schizophrenia or schizoaffective disorder.
    • These scales may be useful in assessing the patient's progress (eg, Positive and Negative Symptom Scale for Schizophrenia [PANSS]).
    • These scales include those for positive and negative symptoms and many for depression and bipolar rating (eg, Hamilton depression scale, Young mania scale). These tools can be used for baseline and outcome measurements.
    • The cut down, annoyed, guilty, and eye opener (CAGE) Questionnaire is useful to inquire about alcohol consumption in patients with schizoaffective disorder.
  • Perform electroencephalography, if indicated.

Histologic Findings

Findings include decreased amounts of cortical gray matter and increased fluid-filled spaces.

More on Schizoaffective Disorder

Overview: Schizoaffective Disorder
Differential Diagnoses & Workup: Schizoaffective Disorder
Treatment & Medication: Schizoaffective Disorder
Follow-up: Schizoaffective Disorder
References
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References

  1. Kaplan HI, Sadock BJ, eds. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 9th ed. New York, NY: Lippincott Williams & Wilkins; 2003:508-11.

  2. Perälä J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. Jan 2007;64(1):19-28. [Medline].

  3. Azorin JM, Kaladjian A, Fakra E. [Current issues on schizoaffective disorder]. Encephale. May-Jun 2005;31(3):359-65. [Medline].

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000:319-23.

  5. Addington DE, Pantelis C, Dineen M, et al. Efficacy and tolerability of ziprasidone versus risoeridone in patients with acute exacerbation of schizophrenia or schizoaffective disorder: an 8 week, double blind, multicenter trial. J Clin Psychiatry. 2004;65(12):1624-33. [Medline].

  6. Baethge C. Long-term treatment of schizoaffective disorder: review and recommendations. Pharmacopsychiatry. Mar-Apr 2003;36(2):45-56. [Medline].

  7. Baethge C, Gruschka P, Berghofer A, et al. Prophylaxis of schizoaffective disorder with lithium or carbamazepine: outcome after long-term follow up. J Affective Disord. 2004;79(1-3):43-50. [Medline].

  8. Basu R, Brar JS, Chengappa KN, et al. The prevalence of the metabolic syndrome in pateints with schizoaffective disorder - bipolar type. Bipolar Disord. 2004;6(4):314-8. [Medline].

  9. Bhatia T, Thomas P, Semwal P, Thelma BK, Nimgaonkar VL, Deshpande SN. Differing correlates for suicide attempts among patients with schizophrenia or schizoaffective disorder in India and USA. Schizophr Res. Sep 2006;86(1-3):208-14. [Medline].

  10. Bogan AM, Brown ES, Suppes T. Efficacy of divalproex therapy for schizoaffective disorder. J Clin Psychopharmacol. Oct 2000;20(5):520-2. [Medline].

  11. Brenner CA, Sporns O, Lysaker PH, O'Donnell BF. EEG synchronization to modualted auditory tones in schizophrenia, schizoaffective disorder, and schizotypal personality disorder. Am J Psychiatry. 2003;160(12):2238-40. [Medline].

  12. Brewerton TD. The phenomenology of psychosis associated with complex partial seizure disorder. Ann Clin Psychiatry. Mar 1997;9(1):31-51. [Medline].

  13. Centorrino F, Kelleher JP, Berry JM, et al. Pilot comparison of extented-release and standard preparations of divalproex sodium in patients with bipolar and schizoaffective disorder. Am J Psychiatry. 2003;160(7):1348-50. [Medline]. [Full Text].

  14. Ciapparelli A, Dell''Osso L, Bandettini di Poggio A, et al. Clozapine in treatment-resistant patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder: a naturalistic 48-month follow-up study. J Clin Psychiatry. Apr 2003;64(4):451-8. [Medline].

  15. Ciapparelli A, Dell''Osso L, Pini S, et al. Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: a 24-month naturalistic study. J Clin Psychiatry. May 2000;61(5):329-34. [Medline].

  16. Dietrich DE, Kropp S, Emrich HM. Oxcarbazepine in affective and schizoaffective disorders. Pharmacopsychiatry. Nov 2001;34(6):242-50. [Medline].

  17. Douglass AB. Narcolepsy: differential diagnosis or etiology in some cases of bipolar disorder and schizophrenia?. CNS Spectr. Feb 2003;8(2):120-6. [Medline].

  18. Emsley R, Rabinowitz J, Torreman M,. The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res. May 1 2003;61(1):47-57. [Medline].

  19. Etter M, Etter JF. Alcohol consuption and the CAGE test in outpatients with schizophrenia or schizoaffective disorder and in the general population. Schizophrenia Bull. 2004;30(4):947-56. [Medline].

  20. Evans JD, Heaton RK, Paulsen JS, et al. Schizoaffective disorder: a form of schizophrenia or affective disorder?. J Clin Psychiatry. Dec 1999;60(12):874-82. [Medline].

  21. Ghaemi SN, Goodwin FK. Use of atypical antipsychotic agents in bipolar and schizoaffective disorders: review of the empirical literature. J Clin Psychopharmacol. Aug 1999;19(4):354-61. [Medline].

  22. Gunasekara NS, Spencer CM, Keating GM. Spotlight on ziprasidone in schizophrenia and schizoaffective disorder. CNS Drugs. 2002;16(9):645-52. [Medline].

  23. Gunasekara NS, Spencer CM, Keating GM. Ziprasidone: a review of its use in schizophrenia and schizoaffective disorder. Drugs. 2002;62(8):1217-51. [Medline].

  24. Gunduz H, Woerner MG, Alvir JM, et al. Obstetric complications in schizophrenia, schizoaffective disorder and normal comparison subjects. Schizophr Res. Dec 21 1999;40(3):237-43. [Medline].

  25. Harrow M, Grossman LS, Herbener ES, Davies EW. Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms. Br J Psychiatry. Nov 2000;177:421-6. [Medline].

  26. Hirsch D, Orr G, Kantarovich V, et al. Cushing''s syndrome presenting as a schizophrenia-like psychotic state. Isr J Psychiatry Relat Sci. 2000;37(1):46-50. [Medline].

  27. Kane JM, Carson WH, Saha AR, et al. Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizoaffective disorder. J Clin Psychiatry. 2002;63(9):763-71. [Medline].

  28. Kohler CG, Pickholtz J, Ballas C. Neurosyphilis presenting as schizophrenialike psychosis. Neuropsychiatry Neuropsychol Behav Neurol. Oct 2000;13(4):297-302. [Medline].

  29. Lake CR, Hurwitz N. Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders. Psychiatry Res. Aug 30 2006;143(2-3):255-87. [Medline].

  30. Lasser R, Bossie CA, Gharabawi G, et al. Efficacy and safety of long-acting risperidone in stable patients with schizoaffective disorder. J Affect Disord. 2004;83(2-3):262-75. [Medline].

  31. Leucht S, McGrath J, White P, Kissling W. Carbamazepine for schizophrenia and schizoaffective psychoses. Cochrane Database Syst Rev. 2002;(3):CD001258. [Medline].

  32. Levinson DF, Umapathy C, Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms. Am J Psychiatry. Aug 1999;156(8):1138-48. [Medline]. [Full Text].

  33. Marneros A. Schizoaffective disorder: clinical aspects, differential diagnosis, and treatment. Curr Psychiatry Rep. 2003;5(3):202-5. [Medline].

  34. McClure RK. The visual backward masking deficit in schizoaffective disorder. Prog Neuropsychopharmacol Biol Psychiatry. Jul 1999;23(5):785-90. [Medline].

  35. McKinnon K, Rosner J. Severe mental illness and HIV-AIDS. New Dir Ment Health Serv. Fall 2000;(87):69-76. [Medline].

  36. Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res. Sep 1 2004;70(1):1-17. [Medline].

  37. Oquendo MA, Ellis SP, Greenwald S, Malone KM, Weissman MM, Mann JJ. Ethnic and sex differences in suicide rates relative to major depression in the United States. Am J Psychiatry. Oct 2001;158(10):1652-8. [Medline].

  38. Perkins D, Lieberman J, Gu H, et al. Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective, and schizophreniform disorders. Br J Psychiatry. 2004;185:18-24. [Medline]. [Full Text].

  39. Pharoah FM, Mari JJ, Streiner D. Family intervention for schizophrenia. Cochrane Database Syst rev. 2003;4:CD000088.

  40. Potkin SG, Saha AR, Kujawa MJ, et al. Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs placebo in patients with schiphrenia and schizoaffective disorder. Arch Gen Psychiatry. 2003;60(7):681-90. [Medline].

  41. Raja M, Azzoni A. Oxcarbazepine vs. valproate in the treatment of mood and schizoaffective disorders. Int J Neuropsychopharmacol. 2003;6(4):409-14. [Medline].

  42. Reid WH, Mason M, Hogan T. Suicide prevention effects associated with clozapine therapy in schizophrenia and schizoaffective disorder. Psychiatr Serv. Aug 1998;49(8):1029-33. [Medline].

  43. Smith TE, Hull JW, Huppert JD, Silverstein SM. Recovery from psychosis in schizophrenia and schizoaffective disorder: symptoms and neurocognitive rate-limiters for the development of social behavior skills. Schizophr Res. 2002;55(3):229-37. [Medline].

  44. Swainston Harrison T, Perry CM. Aripiprazole: a review of its use in schizophrenia and schizoaffective disorder. Drugs. 2004;64(15):1715-36. [Medline].

  45. Swoboda E, Conca A, Konig P, et al. Maintenance electroconvulsive therapy in affective and schizoaffective disorder. Neuropsychobiology. Jan 2001;43(1):23-8. [Medline].

  46. Tran PV, Tollefson GD, Sanger TM, et al. Olanzapine versus haloperidol in the treatment of schizoaffective disorder. Acute and long-term therapy. Br J Psychiatry. Jan 1999;174:15-22. [Medline].

  47. Vieta E, Goikolea JM, Corbella B, et al. Risperidone safety and efficacy in the treatment od bipolar and schizoaffective disorder: results from a 6-month, multicenter, open study. J Clin Psychiatry. 2001;62(10):818-25. [Medline].

  48. Volavka J, Czobor P, Sheitman B, et al. Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am J Psychiatry. 2002;159(2):255-62. [Medline]. [Full Text].

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Further Reading

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Keywords

mental illness, psychosis, mental disorder, hallucinations, delusions, schizophrenia, depression, mania, manic depressive, manic subtype, major depressive disorder, viral infection, malnutrition, birth complications, mood disorder, distorted thinking, bipolar disorder, antisocial personality traits, psychotherapy

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Contributor Information and Disclosures

Author

Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association
Disclosure: AstraZeneca Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Janssen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Medical Editor

Ronald C Albucher, MD, Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center
Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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