Schizo-affective Disorder

There is some controversy as to whether schizoaffective disorder should be considered as a distinct disorder, as it shares features in common with both schizophrenia and bi-polar disorder, which can make diagnosis difficult. However, the International Classification of Diseases, amongst other bodies, categorises it as a disorder in its own right. According to the World Health Organisation, schizoaffective disorder is given a separate category as it 'occurs too frequently to be ignored'. Estimates vary, but it is likely that schizoaffective disorder develops in about 1 per 200 people at some point in their lives, with women being at slightly greater risk than men. A high proportion of mental health in-patients suffer this disorder. The condition tends to develop during adolescence or early adulthood, and rarely before the age of 13. Exact causes are unknown, but environmental factors such as highly stressful situations may trigger this disorder in people who have an inherent (e.g. genetic) vulnerability.

Schizoaffective disorder is an episodic disorder, in which both prominent mood disorder and schizophrenic symptoms co-occur within the same period of illness. There are two main subtypes of the condition. The depressive subtype features major depressive episodes only, whilst the bi-polar subtype is accompanied by manic episodes, either with or without depressive symptoms. In both types, psychotic symptoms will continue after the mood has stabilised (e.g. following a manic episode), thus differentiating them from bi-polar sufferers. In brief, schizophrenic symptoms include disturbances in the way a person thinks, acts and perceives reality; depression is characterised by feelings of sadness, hopelessness or suicidal thoughts, and bi-polar disorder manifests in cycling mood changes including extreme highs and lows. Individual sufferers will vary in terms of the exact nature and severity of their symptoms. For more details of symptoms please see the next section.

Schizoaffective disorder is a lifelong condition that can affect many areas of daily living, such as work and interpersonal relationships. People typically experience periods of wellness, interspersed with relapses. Whilst ill, individuals may become withdrawn and isolated; anxiety disorders and substance abuse are not uncommon. However, sufferers do tend to recover well from episodes of illness, particularly those of the manic type, and many symptoms can be controlled once a diagnosis has been reached, and effective medication(s) found that are suited to the needs of the individual. With the right treatment, such as a combination of medications and recovery-focused psychological therapies (please see Interventions section), many individuals with schizoaffective disorder may lead fulfilling and productive lives.

Symptoms & Behaviours

During periods of illness, symptoms of schizophrenia will be present, at times accompanied by depression, or mania, or both these mood disorders. (To be defined as schizoaffective disorder, psychotic symptoms must also occur during periods when these prominent mood symptoms are absent, such as after a manic phase).

Schizophrenic Symptoms

  • bizarre delusional ideas, for example that alien forces are trying to control you
  • hallucinations such as hearing voices
  • disorganised speech and thoughts
  • unusual or disturbed behaviour
  • slow movements or total immobility
  • lack of emotion in facial expressions and speech

Symptoms of Mania

  • elation
  • inflated self-esteem and grandiose ideas
  • excitability or irritability
  • over-activity, and little need for sleep
  • impaired concentration, and distraction
  • racing thoughts and rapid speech
  • agitation
  • self destructive or risk taking behaviour

Symptoms of Depression

  • feeling worthless or hopeless
  • suicidal thoughts
  • sleeping too much or too little
  • loss of energy
  • over or under eating
  • excessive restlessness
  • loss of interest in usual activities
  • guilt or self blame
  • problems in concentration

Common Associated Problems

  • impaired occupational functioning
  • disrupted interpersonal relationships
  • anxiety
  • substance misuse
  • difficulties managing daily activities
  • suicidal behaviour

Diagnosis & Assessment

If you suspect you have schizoaffective disorder, consult your GP who will complete a medical history and a physical examination. You may be referred to a psychiatrist specialising in mental health disorders. An evaluation will be made based on a specially designed interview and various assessment tools, which take into account the patient's self-reported experiences as well as observed behaviour. To arrive at a diagnosis of schizoaffective disorder, you must have had a period of uninterrupted illness, which has included either an episode of major depression, mania, or a mix of both, while also having symptoms of schizophrenia (i.e. both types of symptom must be prominent in the same period of illness). At least two of the primary symptoms of schizophrenia must be present over a period of at least one month. To complicate matters, there must also be evidence of a period of 2 weeks or more where psychotic symptoms existed in the absence of prominent mood symptoms (although mood symptoms will be present for a substantial part of the overall duration). An extended period of observation may be required to determine whether a diagnosis of schizoaffective disorder is more appropriate than one of either schizophrenia or mood disorder.

Interventions

Treatment for schizoaffective disorder typically consists of a combination of medication, psychotherapy, and skills training. These will focus on minimizing symptoms, and helping the person to cope with the disorder and improve their quality of life. Hospitalization may be necessary for a period of time to stabilize the condition, or if the person is in danger of hurting themselves or others.

Medication

Medication choice will depend on the mood disorder associated with the condition. Anti-depressants - such as Prozac - may be used, and/or a mood stabilizer, such as lithium, if manic symptoms are present. Neuroleptics (anti-psychotic drugs), such as risperidone, will also be used to treat the psychotic symptoms. There are several different options within each class of drug, and the psychiatrist will work with the individual to find the combination best suited for them, and their particular symptoms.

Psychological Therapy

Therapy will usually be conducted on an individual basis, within a supportive and client-centred setting. The aims will include improving the interpersonal, social and coping skills of the individual. Psychological therapy should be tailored to the needs of the individual and their particular life context, and help them find ways to gain structure in their life, and manage their emotions. It will be important that the client learns about their illness, as well as how to deal with the everyday problems associated with their condition. Relationship issues may also be focused upon.

Skills training will tend to take a problem solving approach in helping the sufferer develop coping skills, including work and social skills, home management, and day to day activity scheduling. Goal setting will be important, and therapy is likely to focus on relatively concrete issues, that the client can realistically achieve. It can be helpful to involve the client's family at some point during therapy, so that other family members are better equipped to understand, and to help, as well as learn how to predict when the sufferer may be likely to relapse. Good family communication can reduce stress for all concerned, and thus improve outcomes for the sufferer.

While there is no known cure for schizoaffective disorder, early diagnosis and treatment will be key, both to help avoid relapses, and to minimise the disruption to the person's day to day functioning. Most sufferers will need long-term therapy, combining both medications and psycho-social interventions as mentioned above, in order to achieve and maintain a good quality of life, and to make progress towards their goals.