Schizoaffective Disorder 

  • Author: Guy E Brannon, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Feb 16, 2012
 

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 (ICD-10) 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.

To diagnosis schizoaffective disorder, one must complete the patient’s history review, medical and psychiatric records, and, if possible, obtain information from family members.[1, 2]

Men with schizoaffective disorder tend to exhibit antisocial personality traits.[3] 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 patient’s 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.

Go to Emergent Treatment of Schizophrenia, Childhood-Onset Schizophrenia, and Schizophreniform Disorder for complete information on these topics.

Next

Pathophysiology

The exact pathophysiology of schizoaffective disorder is unknown but may involve imbalance of neurotransmitters in the brain.[4] Abnormalities of the neurotransmitters serotonin, norepinephrine, and dopamine could play a role in this disorder.

In patients with schizoaffective disorder, reduced hippocampal volumes, thalamus, and white matter abnormalities have been noted.[5, 6, 7]

Previous
Next

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.

Previous
Next

Epidemiology

The lifetime prevalence of schizoaffective disorder is thought to be approximately 0.32%,[8] with a range of 0.5-0.8%.[9] 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.

Previous
Next

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.[10, 11, 12, 13]

The incidence of suicide is estimated at 10%. Also consider difference in suicide attempts among different ethnic groups.[14, 15] 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.[4]

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

Previous
Next

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:

Previous
Proceed to Clinical Presentation
 
 
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 Grant/research funds Other; Janssen Grant/research funds Other; Pfizer Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Eli Lilly Grant/research funds Other; Forrest Grant/research funds Other

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft 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.

Additional Contributors

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Kan JM. Performance improvement CME: Schizoaffective disorder. J Clin Psychitry. Jul 2011;72(7):e23.

  2. Kane JM. Strategies for making an accurate differential diagnosis of schizoaffective disorder. J Clin Psychiatry. 2010;71 Suppl 2:4-7. [Medline].

  3. Bottlender R, Strauss A, Möller HJ. Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission. Schizophr Res. Jan 2010;116(1):9-15. [Medline].

  4. 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.

  5. Radonic E, Rados M, Kalember P, Bajs-Janovic M, Folnegovic-Smalc V, Henigsberg N. Comparison of hippocampal volumes in schizophrenia, schizoaffective and bipolar disorder. Coll Antropol. Jan 2011;35 Suppl 1:249-52. [Medline].

  6. Antonius D, Prudent V, Rebani Y, et al. White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophr Res. May 2011;128(1-3):76-82. [Medline]. [Full Text].

  7. Smith MJ, Wang L, Cronenwett W, Mamah D, Barch DM, Csernansky JG. Thalamic morphology in schizophrenia and schizoaffective disorder. J Psychiatr Res. Mar 2011;45(3):378-85. [Medline]. [Full Text].

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

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

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

  11. 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].

  12. Perkins D, Lieberman J, Gu H, Tohen M, McEvoy J, Green A, et al. Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders. Br J Psychiatry. Jul 2004;185:18-24. [Medline].

  13. 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. Jun 1 2002;55(3):229-37. [Medline].

  14. 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].

  15. 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].

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

  17. 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].

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

  19. Evans JD, Heaton RK, Paulsen JS, McAdams LA, Heaton SC, Jeste DV. Schizoaffective disorder: a form of schizophrenia or affective disorder?. J Clin Psychiatry. Dec 1999;60(12):874-82. [Medline].

  20. 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].

  21. 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].

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

  23. Hirsch D, Orr G, Kantarovich V, Hermesh H, Stern E, Blum I. Cushing's syndrome presenting as a schizophrenia-like psychotic state. Isr J Psychiatry Relat Sci. 2000;37(1):46-50. [Medline].

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

  25. Kane JM. The differential diagnosis of schizoaffective disorder. J Clin Psychiatry. Dec 2010;71(12):e33. [Medline].

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

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

  28. Basu R, Brar JS, Chengappa KN, John V, Parepally H, Gershon S, et al. The prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar subtype. Bipolar Disord. Aug 2004;6(4):314-8. [Medline].

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

  30. Dodd S, Brnabic AJ, Berk L, et al. A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder. Compr Psychiatry. Sep-Oct 2010;51(5):504-9. [Medline].

  31. Williams JM, Steinberg ML, Zimmermann MH, et al. Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. J Subst Abuse Treat. Jun 2010;38(4):384-93. [Medline]. [Full Text].

  32. 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].

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

  34. Vieta E. Developing an individualized treatment plan for patients with schizoaffective disorder: from pharmacotherapy to psychoeducation. J Clin Psychiatry. 2010;71 Suppl 2:14-9. [Medline].

  35. Tidey JW, Rohsenow DJ. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophr Res. Dec 2009;115(2-3):310-6. [Medline]. [Full Text].

  36. Lindenmayer JP, Liu-Seifert H, Kulkarni PM, Kinon BJ, Stauffer V, Edwards SE, et al. Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. J Clin Psychiatry. Jul 2009;70(7):990-6. [Medline].

  37. Goff DC, Hill M, Freudenreich O. Treatment adherence in schizophrenia and schizoaffective disorder. J Clin Psychiatry. Apr 2011;72(4):e13. [Medline].

  38. Goff DC, Hill M, Freudenreich O. Strategies for improving treatment adherence in schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2010;71 Suppl 2:20-6. [Medline].

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

  40. Baethge C, Gruschka P, Berghöfer A, Bauer M, Müller-Oerlinghausen B, Bschor T, et al. Prophylaxis of schizoaffective disorder with lithium or carbamazepine: outcome after long-term follow-up. J Affect Disord. Apr 2004;79(1-3):43-50. [Medline].

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

  42. Centorrino F, Kelleher JP, Berry JM, Salvatore P, Eakin M, Fogarty KV, et al. Pilot comparison of extended-release and standard preparations of divalproex sodium in patients with bipolar and schizoaffective disorders. Am J Psychiatry. Jul 2003;160(7):1348-50. [Medline].

  43. Ciapparelli A, Dell'Osso L, Bandettini di Poggio A, Carmassi C, Cecconi D, Fenzi M, 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].

  44. Ciapparelli A, Dell'Osso L, Pini S, Chiavacci MC, Fenzi M, Cassano GB. 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].

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

  46. 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].

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

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

  49. Kane JM, Carson WH, Saha AR, McQuade RD, Ingenito GG, Zimbroff DL, et al. Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. Sep 2002;63(9):763-71. [Medline].

  50. Lasser RA, Bossie CA, Zhu Y, Gharabawi G, Eerdekens M, Davidson M. Efficacy and safety of long-acting risperidone in elderly patients with schizophrenia and schizoaffective disorder. Int J Geriatr Psychiatry. Sep 2004;19(9):898-905. [Medline].

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

  52. Potkin SG, Saha AR, Kujawa MJ, Carson WH, Ali M, Stock E, et al. Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs placebo in patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry. Jul 2003;60(7):681-90. [Medline].

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

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

  55. Tran PV, Tollefson GD, Sanger TM, Lu Y, Berg PH, Beasley CM Jr. Olanzapine versus haloperidol in the treatment of schizoaffective disorder. Acute and long-term therapy. Br J Psychiatry. Jan 1999;174:15-22. [Medline].

  56. Vieta E, Goikolea JM, Corbella B, Benabarre A, Reinares M, Martínez G, et al. Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: results from a 6-month, multicenter, open study. J Clin Psychiatry. Oct 2001;62(10):818-25. [Medline].

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

  58. Stip E, Tourjman V. Aripiprazole in schizophrenia and schizoaffective disorder: A review. Clin Ther. 2010;32 Suppl 1:S3-20. [Medline].

  59. Citrome L, Reist C, Palmer L, Montejano LB, Lenhart G, Cuffel B, et al. Impact of real-world ziprasidone dosing on treatment discontinuation rates in patients with schizophrenia or bipolar disorder. Schizophr Res. Dec 2009;115(2-3):115-20. [Medline].

  60. 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].

  61. Fitzgerald P, de Castella A, Arya D, Simons WR, Eggleston A, Meere S, et al. The cost of relapse in schizophrenia and schizoaffective disorder. Australas Psychiatry. Aug 2009;17(4):265-72. [Medline].

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

  63. Honer WG, Macewan GW, Gendron A, et al. A randomized, double-blind, placebo-controlled study of the safety and tolerability of high-dose quetiapine in patients with persistent symptoms of schizophrenia or schizoaffective disorder. J Clin Psychiatry. Jan 2012;73(1):13-20. [Medline].

  64. Gaebel W, Schreiner A, Bergmans P, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label, randomized clinical trial. Neuropsychopharmacology. Nov 2010;35(12):2367-77. [Medline]. [Full Text].

  65. Grootens KP, van Veelen NM, Peuskens J, et a;. Ziprasidone vs olanzapine in recent-onset schizophrenia and schizoaffective disorder: results of an 8-week double-blind randomized controlled trial. Schizophr Bull. Mar 2011;37(2):352-61. [Medline]. [Full Text].

  66. Stip E, Tourjman V. Aripiprazole in schizophrenia and schizoaffective disorder: A review. Clin Ther. 2010;32 Suppl 1:S3-20. [Medline].

  67. Gahr M, Kölle MA, Schönfeldt-Lecuona C, Lepping P, Freudenmann RW. Paliperidone extended-release: does it have a place in antipsychotic therapy?. Drug Des Devel Ther. Mar 11 2011;5:125-46. [Medline]. [Full Text].

  68. Canuso CM, Battisti WP. Paliperidone extended-release: a review of efficacy and tolerability in schizophrenia, schizoaffective disorder and bipolar mania. Expert Opin Pharmacother. Oct 2010;11(15):2557-67. [Medline].

  69. Canuso CM, Schooler N, Carothers J, et al. Paliperidone extended-release in schizoaffective disorder: a randomized, controlled study comparing a flexible dose with placebo in patients treated with and without antidepressants and/or mood stabilizers. J Clin Psychopharmacol. Oct 2010;30(5):487-95. [Medline].

  70. Canuso CM, Lindenmayer JP, Kosik-Gonzalez C, Turkoz I, Carothers J, Bossie CA, et al. A randomized, double-blind, placebo-controlled study of 2 dose ranges of paliperidone extended-release in the treatment of subjects with schizoaffective disorder. J Clin Psychiatry. May 2010;71(5):587-98. [Medline].

  71. Schoemaker J, Naber D, Vrijland P, Panagides J, Emsley R. Long-term assessment of Asenapine vs. Olanzapine in patients with schizophrenia or schizoaffective disorder. Pharmacopsychiatry. Jun 2010;43(4):138-46. [Medline].

  72. Correll CU. Understanding schizoaffective disorder: from psychobiology to psychosocial functioning. J Clin Psychiatry. 2010;71 Suppl 2:8-13. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.