Schizoaffective Disorder is a biological disorder thought to be brought on by an imbalance in brain chemicals, specifically dopamine. It is defined as “the presence of major depression, mania, or a mixture or alternative of depressive and manic symptoms for at least two weeks”, and a decline in social functioning for at least six months (problems with school or work, social relationships, or self-care). Schizoaffective is still sometimes diagnosed simply as a transition from Bipolar to Schizophrenia, since its symptoms are mainly a combination of the two. Even recent research still questions this disorder being separate since most diagnosed with this disorder are later diagnosed Schizophrenic with a mood disorder or Bipolar with a psychotic disorder. One person diagnosed strictly as Schizoaffective described the feeling as “dreaming when you are wide awake”; that it’s hard for the person to distinguish between fantasy and reality.
Characteristics and Diagnosis
This disorder affects young adults as early as late adolescence and early twenties. Past 30, the disorder is rare, and past 40 is extremely unlikely. The most serious characteristic of Schizoaffective is the likelihood of suicide. Schizoaffective patients know they have a disorder, unlike Schizophrenic patients, and therefore realize their behavior is due to the disorder and understand the social consequences of their actions. Diagnosis of Schizoaffective can only come from a clinical interview. It cannot be diagnosed through an X-ray, CAT scan, or blood work, only a sit down interview so that the clinician can discuss symptoms with the patient. In the interview, the diagnostician will also have to check to see if the patient is experiencing any physical problems that could result in symptoms of Schizoaffective, such as a brain tumor or alcohol or substance abuse.
One person diagnosed strictly as Schizoaffective described the feeling as “dreaming when you are wide awake”
Schizoaffective can be broken into five broad categories of symptoms: positive symptoms, negative symptoms, symptoms of mania, symptoms of depression, and other symptoms. These categories include symptoms of Bipolar, Unipolar Depression, and Schizophrenia.
Positive Symptoms -refer to thoughts, perceptions, and behaviors that are absent in the general population, but present in people with Schizoaffective Disorder.
- Hallucinations-false perceptions (hearing, seeing, feeling, or smelling things that are not there).
- Delusions-false beliefs; a belief which the patient holds, but which others can clearly see as not true.
- Thinking Disturbances-patient talks in a manner that is difficult to follow.
Negative Symptoms refer to the absence of thoughts, perceptions, and behaviors that are present in the general population, but absent in those diagnosed as Schizoaffective.
- Blunted Affect-diminished or restricted facial expressions, voice tone, and gestures.
- Apathy-lack of motivation, acts lethargic or sleepy, and trouble following through on even simple plans.
- Inattention-trouble paying attention and is easily distracted.
Symptoms of Mania describe an excess in behavioral activity, mood states, and self-esteem and confidence.
- Talkativeness-talking excessively, difficult to interrupt.
- Increased Goal Directed Activity-a great deal of time is spent pursuing goals: at work, school or sexually.
- Excessive Involvement in Pleasurable Activities with High Potential for Negative Consequences-spending sprees, sexual indiscretion, substance abuse, foolish business investments.
Symptoms of Depression -describes low mood and behavioral inactivity.
- Diminished Interest or Pleasure- few interests and gets little pleasure from anything.
- Change in Appetite/Weight Loss- evident loss of appetite (or weight) when not dieting, or increased appetite (and weight gain).
- Recurrent Thoughts about Death- thinking about death a great deal, contemplating (or even attempting) suicide.
Other Symptoms- patients are prone to alcohol or drug abuse. May do so due to their disturbing symptoms, to experience pleasure, or when socializing with others.
Genetics and Prevalance
There is very little evidence to suggest that Schizoaffective Disorder is a genetic disorder. However, if someone in your family has been diagnosed as Schizoaffective, Schizophrenic, or Bipolar, this diagnosis is more likely. Current statistics count Schizoaffective in only ½ % of the population (one in 200 people), but experts feel that this number is low due to Schizoaffective’s complexity in being diagnosed. Schizoaffective is more likely to occur in women than in men.
The best treatment for Schizoaffective Disorder is psychotherapy and effective medication. Psychotherapy will consist of individual treatment of the patient by a psychologist, social worker, and/or psychiatrist and will help with social skills training, vocational rehabilitation and supported employment, and intensive case management. The goal of psychotherapy is not recovery from the disorder; it is stable, long-term maintenance. Proper medication is also effective in helping control Schizoaffective. Antipsychotics combined with a mood stabilizer (usually lithium) are the most effective medications for this disorder. On occasion, if deemed necessary, an antidepressant or electroconvulsive therapy (ECT) can be used.
Tips for the Family
- Accept all the help, and support available to you.
- Keep a positive attitude, and a sense of humor.
- STAY OPTIMISTIC
- Learn as much as you can about Schizoaffective Disorder
- Develop realistic expectations for the patient and yourself.
- Recognize warning signs of a relapse.
- Find ways to handle symptoms.
- Be happy with slow progress, and allow patient to feel OK with even a little success.
- Get to know patient’s doctor(s).