Schizoaffective Disorder Treatment & Management

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

Consultations

Consult a neurologist to rule out neurologic disease.

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Long-Term Monitoring

For best results, patients require medication and psychotherapy.

When an inpatient who has schizoaffective disorder makes the transition to being an outpatient, stressing the importance of medication compliance is crucial.

Patients with schizoaffective disorder often lack judgment and insight into their illness. They commonly refuse to continue the medications started in the hospital after they are discharged. When patients begin to feel better as a result of their medications, they may think that they no longer need to take them; such thinking leads to the discontinuance of medication and typically results in a return to the hospital within the next several weeks or so. Noncompliance can also be due to adverse effects of the medication, such as sedation and weight gain.

If possible, select once-daily or long-acting medications, such as decanoate injections, to help with patient compliance. In addition, address the issue of compliance with a family member. Always discuss all the risks, benefits, adverse effects, and alternatives of each medication with the patient and family.

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Approach Considerations

Treatment consists of both pharmacotherapy and psychotherapy. Written informed consent must be obtained before pharmacologic therapy is started.

It is important to individualize the treatment plan for a particular patient to maximize benefits and adherence to treatment.[34]

If patients are suicidal, homicidal, or gravely disabled, admit them to an inpatient psychiatric unit. Inpatient treatment is mandatory for patients who are dangerous to themselves or others and for patients who cannot take care of themselves. If patients with schizoaffective disorder represent a danger to self or others or are gravely disabled and are unwilling to seek help on a formal voluntary basis, they may need to be committed for further evaluation and treatment.

Consider transfer to a medical surgical hospital, if needed. Also consider transfer to a residential or group home, if needed. Be familiar with local mental health laws.

Smoking cessation[35] and noncompliance with medications[36] are special concerns.

It is important to monitor treatment adherence for medications and other therapeutic activities.[37, 38]

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

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Pharmacologic Therapy

Several medications are used to treat schizoaffective disorder. Agent selection depends on whether the depressive or manic subtype is present. Early treatment with medication along with good premorbid function often improves outcomes.[39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57]

In the depressive subtype, combinations of antidepressants (eg, sertraline, fluoxetine) plus an antipsychotic (eg, haloperidol, risperidone, olanzapine, aripiprazole,[58] ziprasidone[59] ) are used. In refractory cases, clozapine has been used as an antipsychotic agent.[60] In the manic subtype, combinations of mood stabilizers (eg, lithium, carbamazepine, divalproex) plus an antipsychotic are used.

Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes of antidepressants. Because their adverse-effect profiles are less prominent than the profiles of other drugs, improved compliance is promoted. SSRIs do not have the cardiac dysrhythmia risk associated with tricyclic antidepressants. This risk is especially pertinent in overdose, and suicide risk must always be considered when one treats a child or adolescent with a mood disorder.

Physicians are advised to be aware of the following information and to use appropriate caution when they consider treatment with SSRIs in the pediatric population.

In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of depressive illness. After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except in the case of fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.

In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. The FDA asked that additional studies be performed because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.

Noncompliance with medications is a complication of therapy. If noncompliance with medications is an issue, one may seek a court order to force the patient to take medications (eg, in lieu of rehospitalization), which may help increase medication compliance.

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Psychotherapy and Psychoeducational Programs

Patients who have schizoaffective disorder can greatly benefit from psychotherapy, as well as psychoeducational programs.

They should receive therapy that involves their families, develops their social skills, and focuses on cognitive rehabilitation. Expressed emotions must be reduced in all areas of a patient’s life, including stress-reduction techniques employed to prevent relapse[61] and possible rehospitalization. Psychotherapies should include supportive therapy and assertive community therapy in addition to individual and group forms of therapy and rehabilitation programs.

Treatment includes education about the disorder and its treatment, family assistance in compliance with medications and appointments, and maintenance of structured daily activities (eg, a schedule of daily events) for the patient.

Family involvement is needed in the treatment of this particular disorder.[62] Family education is particularly important in this disorder secondary to the various mood and psychotic states. Families need information regarding the patient’s mediations and the dynamic nature of this illness.

For further information, families can contact the National Alliance on Mental Illness (NAMI) or Self-Help Association Regarding Emotions (SHARE; 1-800-832-8032).

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Dietary Measures

No specific diet is recommended for patients with schizoaffective disorder.

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Activity Restriction

Restrict activity if patients represent a danger to themselves or to others or if they are gravely disabled. Otherwise, encourage patients who are schizoaffective to continue their normal routines and strengthen their social skills whenever possible.

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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 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

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