What Is Schizoaffective Disorder?

What Is Schizoaffective Disorder?

Schizoaffective disorder is a chronic mental health condition that combines symptoms of psychosis (e.g., hallucinations and delusions) with symptoms of mood disorders (e.g., mania and/or depression). Depending on what type of mood symptoms are present, schizoaffective disorder is diagnosed as either bipolar type or depressive type.

The prevalence of schizoaffective disorder in the population is believed to be around 0.3%, which is less than for schizophrenia or mood disorders. Research suggests that women are slightly more prone to it, but men tend to develop the disorder at a younger age. It is usually first diagnosed between age 16 and 30 and is rare in children.

Whether you have been diagnosed with schizoaffective disorder or are worried that someone you know may have this disorder or has been recently diagnosed, it is important to understand the common symptoms, how a diagnosis is made, and how treatment can help to reduce symptoms and improve functioning in daily life.

Symptoms of Schizoaffective Disorder

Symptoms of schizoaffective disorder tend to be severe and vary for each individual. They can be broadly categorized into depressive symptoms, manic symptoms, and schizophrenia symptoms.

Depressive Symptoms

Depressive symptoms of schizoaffective disorder may be psychological or physical. Psychological symptoms include:

• Sadness
• Feeling worthless
• Hopelessness
• Restlessness
• Lack of energy
• Loss of interest in usual activities
• Trouble concentrating
• Guilt
• Self-blame
• Thoughts of death or suicide

Physical symptoms can include:

• Poor appetite
• Weight loss or gain
• Sleeping too much or too little

Manic Symptoms

People with bipolar type schizoaffective disorder may experience mania, which also has both psychological and physical symptoms.

Psychological symptoms can include:

• Risky or self-destructive behavior (e.g., spending sprees, reckless driving, risky sexual practices)
• Euphoria
• Irritable mood
• Racing thoughts
• Grandiosity
• Distractibility

Physical symptoms may include:

• Increased energy and/or activity (e.g., at work, socially, sexually)
• Talking more or faster than usual
• Reduced need for sleep

Psychotic Symptoms

Like the other groups of symptoms, psychotic symptoms may also be divided into psychological and physical effects.

Psychological symptoms can include:

• Paranoia
• Delusions
• Hallucinations
• Disorganized thinking
• Impaired communication
• Lack of emotion in facial expressions and speech (negative symptoms)
• Low motivation (avolition)

Physical symptoms include slow movements or no movement (catatonia) and poor personal hygiene.

While the psychotic symptoms listed above describe how schizoaffective disorder appears to an outsider, it is also helpful to learn what these symptoms feel like to a person with the disorder.

Disorganized Thinking

If you are experiencing disorganized thinking, you may feel like your thoughts are fuzzy or everything feels disconnected. When you speak, you may not be able to remember what you were talking about, so it's hard for people to follow what you say. You may also feel like your thoughts are not within your control.

Thinking You Are Being Controlled

You may think you are being controlled by outside forces like aliens, God, or the devil. You may feel someone is inserting thoughts into your head or that your thoughts are being removed. You might also feel like others can hear your thoughts or access them.

Hallucinations

You may hear one or more voices that sound real and seem to come from outside you but that nobody else can hear. You might start to talk to them or do things that they tell you to do. In fact, these voices are created by your brain and are not real. 

Delusions

Delusions are things you believe to be true but that are not thought to be real by everyone else. They may begin all of a sudden or form over time. Sometimes they are related to the voices that you hear and seem to explain them in some way.

Most often delusions are paranoid, such that you think people are plotting against you or spying on you. You might choose to avoid those people as it can feel very scary.

Suicidal Ideation

Suicidal ideation and behavior can also be a problem for some people with schizoaffective disorder. If someone you know is in danger of attempting suicide or harming another person, stay with that person while you call 911 or your local emergency number. The other alternative is to take the person to the nearest hospital emergency room if you believe that you can do so safely.

Complications of Schizoaffective Disorder

There are a number of potential complications of having schizoaffective disorder, including:

• Health problems
• Homelessness
• Impaired academic and occupational functioning
• Interpersonal conflicts
• Poverty
• Social isolation
• Substance use
• Suicidal thoughts and attempts
• Trouble adhering to treatment
  
• Unemployment
  

Diagnosis of Schizoaffective Disorder

Schizoaffective disorder overlaps with other conditions so it can be difficult to diagnose. Sometimes, it is incorrectly diagnosed as simply bipolar disorder or schizophrenia, which is why it is important for mental health professionals to have a full history of symptoms prior to making a diagnosis.

The first step in diagnosing schizoaffective disorder may be conducting a physical exam to rule out any potential medical contributions to the symptoms. Depending on the suspected diagnosis, this may mean undergoing blood testing and brain imaging.

Next, a psychiatrist or psychologist will conduct a clinical interview to determine whether symptoms meet the criteria outlined in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). This includes a period of major mood disorder (depression or mania) and at least two of the following schizophrenia symptoms (at least one of the first three is required):

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized or catatonic behavior
• Negative psychotic symptoms

In addition, delusions or hallucinations most occur for two or more weeks in the absence of a mood episode. The mood symptoms must also be present for most of the duration of the illness.

Causes of Schizoaffective Disorder

Researchers do not know precisely what causes schizoaffective disorder. However, some propose that it can result from a combination of risk factors that affect brain development prenatally and throughout childhood and adolescence. These include:

• Birth defects
• Brain chemistry and structure
• Genetics
  
• Life stressors (death in family, loss of job, end of marriage)
• Psychoactive or psychotropic drug use
• Viral infections including while in the womb
  

Related Conditions

People with schizoaffective disorder may also live with overlapping disorders such as attention-deficit hyperactivity disorder, post-traumatic stress disorder (PTSD), anxiety disorders, and substance and alcohol use.

A co-occurring disorder can exacerbate the symptoms of schizoaffective disorder and make a person less likely to follow their treatment plan. This is why proper diagnosis and integrated treatment is essential when it comes to managing and coping with a dual diagnosis.

Schizoaffective disorder is often confused with other mental illnesses, including schizophrenia and bipolar disorder. These are two distinct disorders, however, each with their own diagnostic criteria and treatment. While they do share many symptoms, the main difference is that there is a prominent mood component with schizoaffective disorder.

Treatment of Schizoaffective Disorder

Treatment can help people with schizoaffective disorder to live a more fulfilling life. Treatment may come in the form of medication, therapy, or hospitalization, depending on the particular symptoms.

Medication

Medications such as mood stabilizers (e.g., lithium), antipsychotics (e.g., paliperidone), and antidepressants (e.g., fluoxetine) may be prescribed for different aspects of schizoaffective disorder. Taking antipsychotic medication will help reduce hallucinations and delusions, lessen disorganized thinking, and soothe agitation.

Often, people with schizoaffective disorder need to take medication for the rest of their lives.

Therapy

Therapy such as cognitive-behavioral therapy (CBT), family therapy, group therapy, or skills training may be used to treat schizoaffective disorder.

During therapy, a person with schizoaffective disorder may learn about their illness, set goals, determine how to manage daily issues, develop skills to interact with others, look for a job, and practice life skills like managing finances, home maintenance, and personal grooming.

Family members can participate in therapy to learn how best to support their loved ones.

Hospitalization

In the event of an acute psychotic episode, suicidal ideation, or threats to others, treatment in a hospital may be necessary. There is, unfortunately, no cure for schizoaffective disorder and long-term treatment and management is often required.

However, medication and therapy can help to reduce symptom relapse and disruption to a person's life and the lives of those around them. This is why it is important for them to keep in contact with a psychiatrist to ensure that their treatment regimen is optimal.

When to Get Help

If someone you know is displaying symptoms of schizoaffective disorder, it can be hard to know how to help. While you can try to talk to your friend or relative, you also can't force them to seek treatment. Instead, try offering encouragement and practical advice such as looking up numbers of doctors to call or investigating avenues to receive treatment in the community.

In addition, people with this disorder may be disconnected from reality. In the event that the person is struggling with basic necessities of life such as food and shelter, or there are imminent safety concerns, you can call 911 and ask to have that person evaluated for treatment.

A Word From Verywell

If you have been diagnosed with schizoaffective disorder, it is important to learn to notice when your symptoms are worsening and that you may be entering another episode. Not being able to sleep or feelings of paranoia may be one signal that this is happening. In the event you notice symptoms increasing, it is important to reach out for help as soon as possible from your doctor or other mental health professional.