Schizoaffective Disorder

What Is Schizoaffective Disorder? What Causes Schizoaffective Disorder?

Schizoaffective disorder is characterized by a combination of schizophrenia and affective (mood) disorder symptoms - there is disagreement on whether it is a type of mood disorder or schizophrenia. However, most health care professionals (clinicians) agree it is mainly a form of schizophrenia; not all experts agree on whether it should be treated as a distinct disorder.

An individual diagnosed with schizoaffective disorder is said to have recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood that either occur together with or alternate with distortions of perception. Put simply - the individual experiences a combination of schizophrenia symptoms (hallucinations, delusions) and mood disorder symptoms (mania or depression).

This disorder typically affects cognition (thinking, knowing, remembering, judging and problem-solving) and emotion. The patient may experience auditory hallucinations (hearing hallucinations), bizarre delusions, paranoia, and may have disorganized speech and thinking with considerable social and occupational dysfunction (has problems socially and at work).

Diagnoses before the age of 13 are extremely rare. The vast majority of patients experience the onset of symptom during early adulthood.

According to the National Alliance on Mental Illness (NAMI), prevalence in the USA is between 2 to 5 in every 1,000 people.

According to Medilexicon's medical dictionary:

Schizoaffective Disorder is:

1. an illness manifested by an enduring major depressive, manic, or mixed episode along with delusions, hallucinations, disorganized speech and behavior, and negative symptoms of schizophrenia. In the absence of a major depressive, manic, or mixed episode, there must be delusions or hallucinations for several weeks.

2. a DSM diagnosis that is established when the specified criteria are met.
Clinicians will only diagnose schizoaffective disorder if the patient has at some point shown delusions or hallucinations for a minimum of two weeks with no symptoms of mood disorder.

The most common mood disorder to accompany the schizophrenia features is either: 
  • bipolar disorder - in such cases it will be termed bipolar-type schizoaffective.
  • depression - in such cases it will be termed depressive-type schizoaffective.
The following signs and symptoms may be present in an individual with schizoaffective disorder:
  • Delusions - fixed and/or false beliefs
  • Disorganized thinking - thoughts are confused and unclear
  • Hallucinations
  • Paranoid ideas and thoughts
  • Periods of depression
  • Strange perceptions
  • Strange thoughts
  • Manic mood, or an unexpected boost of energy and behaviors that are out of character
  • Poor temper control
  • Irritability
  • Incoherent speech
  • Irrelevant speech
  • Attention problems
  • Catatonic behavior - the patient hardly responds; there may be agitation that does not appear to be triggered by the environment
  • Lack of concern for his/her own physical appearance
  • Lack of concern for personal hygiene
  • Memory problems
  • Problems falling asleep
  • Problems staying asleep

What are the risk factors for schizoaffective disorder?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Experts say that schizoaffective disorder, like in schizophrenia, is caused by variations or delays in the way a human's brain develops during childhood - it is a neurodevelopmental disorder.

Genetics - people with a close relative who has schizoaffective disorder have a higher risk of developing the disorder themselves, compared to other individuals. The following factors may also increase the risk:
  • Having a relative with schizophrenia
  • Having a relative with a mood disorder
Age - the influence here is on the type of disorder. Older individuals tend to have depressive type schizoaffective disorder, while younger ones are more likely to have the bipolar type.

Parental age - advanced paternal age at the time of conception, a common cause of genetic mutations, has been linked to a higher risk of schizophrenia spectrum disorders, of which schizoaffective disorder is a part.

Fetal exposure and birth - some experts have speculated that perhaps fetal exposure to toxins or viral illness, or even birth complications, may play a role. However, there are no studies to back this up.

What are the causes of schizoaffective disorder?

We are not sure what causes the disorder - what exactly happens. A significant number of scientists believe an imbalance of serotonin and dopamine in the brain is a key cause - these are neurotransmitters; chemicals that help pass on electronic signals in the brain, as well as helping control mood.

Many different biological and environmental factors are thought to interact with the individual's genes in ways that can either increase or lower that individual's risk for developing the disorder.

The physiology of patients diagnosed with schizoaffective disorder appears to be similar but not identical to that of those diagnosed with schizophrenia and severe bipolar disorder.

Diagnosing schizoaffective disorder

Diagnosis is based on experiences reported by the patient, as well as behavior abnormalities reported by family members, friends and colleagues to a psychiatrist, psychiatric nurse, social worker or clinical psychologist in a clinical assessment. There is a list of criteria that must be met for an individual to be diagnosed with schizoaffective disorder - these depend on the presence and duration of specific signs and symptoms. The criteria are spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association - the criteria, known as DSM-IV-TR, includes:
  • Schizophrenia with mood symptoms
  • A mood disorder with schizophrenia symptoms
  • Both a mood disorder and schizophrenia
  • A non-schizophrenia psychotic disorder, as well as a mood disorder
  • (see further down for more details on DSM-IV-TR)
Diagnosis must be reached after ruling out the direct effects of a substance, or the result of a general medical condition. The symptoms may be mimicked by steroid use, Cushing's syndrome, HIV-related illness, temporal lobe epilepsy, neurosyphilis, thyroid or parathyroid problems, alcohol abuse, drug abuse, and metabolic syndrome.

There are no biological tests which confirm schizoaffective disorder. However, tests are often ordered to exclude medical illnesses and conditions which rarely may be linked to psychotic symptoms. The doctor may order the following diagnostic tests:
  • Blood tests - to measure TSH to exclude hypothyroidism or hyperthyroidism, basic electrolytes and serum calcium to exclude metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic (long-term) disease, and serology to exclude syphilis or HIV infection.
  • EEG (electroencephalography) - to rule out epilepsy.
  • CT (computed tomography) scan of the head - to rule out brain lesions.
The doctor needs to rule out a delirium, which can be distinguished by visual hallucinations, acute onset and varying levels of consciousness (indicating a medical illness).

DSM-IV-TR criteria for a diagnosis of schizoaffective disorder:

Criterion A - At least two of the symptoms below are present for most of a 1-month period (or a shorter period if symptoms improved with treatment:
  • Delusions
  • Hallucinations
  • Disorganized speech, such as frequent derailment (speech jumps from one topic to another unrelated topic (or only slightly related) in mid-sentence) or incoherence, which is a manifestation of formal thought disorder
  • Grossly disorganized behavior, such as dressing inappropriately, crying often, or catatonic behavior.
  • Negative symptoms, such as:

    • Affective flattening - diminishment of, or absence of, emotional expressiveness
    • Alogia - lack or decline in speech
    • Avolition - lack or drop in motivation
    • Anhedonia - inability to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction or sexual activities
Negative symptoms are not the same as depression symptoms.

If the delusions are deemed bizarre, or hallucinations consist of at least two voices talking to each other or just one voice participating in a running commentary of the patient's actions, then just that symptom is required to meet criterion A.

and at some point during the illness, there as at least one of the three listed below:
  • A major depressive episode
  • A manic episode
  • A mixed episode
Criterion B - delusions or hallucinations were present for at least two weeks during the illness, without major mood symptoms.

Criterion C - symptoms meeting criteria for a mood episode are present for a considerable part of the overall duration of both the active and residual period of the illness.

Criterion D - neither another medical condition, nor drug abuse, nor a medication(s) is causing the symptoms.

Subtypes - two schizoaffective disorder subtypes exist and may be noted in a diagnosis, bases on the mood constituent of the disorder:
  • Bipolar type - if a manic episode or a mixed episode is included.
Major depressive episodes commonly occur in the bipolar subtype (not always). However, they are not required for DSM-IV diagnosis.
  • Depressive type - this type is noted when major depressive episodes occur exclusively - if major depressive episodes (without manic or mixed episodes) are part of the presentation.
Distinguishing a schizoaffective disorder from schizophrenia and from mood disorder may be challenging. In schizoaffective disorder the mood symptoms are more prominent, and generally last much longer than in schizophrenia.

What are the treatment options for schizoaffective disorder?

The best treatment for schizoaffective disorder is a combination of medications, such as antipsychotics, antidepressants or mood stabilizers, and psychological interventions (counseling). Treatment specifics depends on various factors, including how severe symptoms are, as well as what subtype the patient may have (depressive-type or bipolar type).

The following medications may be used:
  • Antipsychotics (neuroleptics) - used to help with psychotic symptoms, which may include hallucinations, paranoia and delusions. Examples include clozapine (Clozaril), risperidone (Risperdal) and olanzapine (Zyprexa).
  • Mood stabilizers - these can smooth out the highs and lows of bipolar disorder (manic depression) which affect patients with the bipolar-type of schizoaffective disorder. Examples include lithium (Eskalith, Lithobid) and divalproex (Depakote).
  • Antidepressants - used when depression is the underlying mood disorder. These medications may help with such symptoms as hopelessness, concentration, insomnia and sadness. Examples include citalopram (Celexa), fluoxetine (Prozac) and escitalopram (Lexapro).
The following therapies may also be recommended:
  • Counseling and psychotherapy - a good psychotherapist/counselor can help the patient understand their condition and feel positive about the future. Sessions typically focus on real-life plans, relationships, and problems the patient encounters. The therapist may also introduce new behaviors for home and workplace settings.
  • Group therapy or family therapy - some patients respond well when they are able to talk about their problems with other people. During periods of psychosis these sessions can help as a reality check. Group therapy also helps the patient feel that he/she is not alone.
Experts say that patients with schizoaffective disorder tend to have a better prognosis than those with schizophrenia, while those with just mood disorders have a better prognosis than individuals with schizoaffective disorder.

What are the possible complications of schizoaffective disorder?

  • There is a higher risk of developing schizophrenia
  • There is a higher risk of having major depression
  • There is a higher risk of having bipolar disorder

With treatment, patients tend to have a better prognosis than do individuals with schizophrenia, but not as good as people who just have mood disorders.

What are the signs and symptoms for schizoaffective disorder?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Typically, a patient will have psychotic symptoms - including hallucinations, paranoid thoughts and disorganized thinking, as well as depression or manic moods (mood disturbance). Their antisocial behavior tends to leave them isolated. However, symptoms tend to vary from patient-to-patient.

Psychotic symptoms and mood disturbances either occur simultaneously or interchangeably. The individual will usually go through cycles of symptom severity.


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