Schizoaffective Disorder

Bipolar Disorder is characterized by intense mood swings that include extreme highs (hypomania or mania) and extreme lows (depression). These mood swings affect the daily mood as well as the functioning of an individual, which results in disrupted sleep schedules, low or high energy, increased levels of anxiety, and clouded judgment.

Schizophrenia is a condition characterized by delusions, hallucinations, disorganized thinking, incoherent speech, and social withdrawal. Individuals with schizophrenia find it difficult to function regularly as the condition affects their cognitive processes, which results in a problem in concentration and memory retention, and difficulty in problem-solving.

Schizoaffective Disorder is a combination of both; individuals with schizoaffective disorder have symptoms of bipolar disorder as well as schizophrenia.

What is Schizoaffective Disorder?

Schizoaffective Disorder is a condition that is characterized by the symptoms of bipolar disorder as well as schizophrenia. It hinders an individual’s daily functioning and could take a debilitating turn if left untreated. Individuals with the condition experience delusions, hallucinations, disorganized thinking, mania, and depression.

There are two types of schizoaffective disorder:

  • Bipolar Type- The Bipolar Type of schizoaffective disorder is characterized by manic episodes and some symptoms of major depressive disorder. Individuals experience elevated mood and irritability simultaneously, along with increased activity levels which results in manic episodes.
  • Depressive Type- The Depressive Type of schizoaffective disorder is characterized by major depressive episodes without manic episodes. Individuals experiencing this type of schizoaffective disorder might experience persistent feelings of hopelessness, helplessness, and extreme sadness.

One of the most common symptoms in both types is the lack of interest in doing something. Individuals with schizoaffective disorder lose interest in activities they once enjoyed and experience little- to no pleasure in pursuing their hobbies or favorite activities.

Symptoms of Schizoaffective Disorder

Since schizoaffective disorder is a combination of two different conditions (bipolar disorder and schizophrenia), it comprises the symptoms of both conditions. The symptoms of the condition could be categorized into two categories:

  • Psychotic Symptoms- Psychotic Symptoms are symptoms that distort an individual’s perception of reality and blur the line between what is real and what is not.
  • Mood Symptoms- Mood Symptoms are emotional symptoms that impact the daily functioning of an individual. These emotional symptoms might vary in intensity and therefore, affect the overall mood of the individual.

The following are the symptoms of schizoaffective disorder:

Psychotic Symptoms of Schizoaffective Disorder

The psychotic symptoms of schizoaffective disorder are as follows:

  • Hallucinations- Hallucinations are perceptions and ideas of things, people or objects that an individual experiencing schizoaffective disorder experiences, that are not real. These are characterized by auditory, visual, olfactory, gustatory, and somatic hallucinations.
  • Delusions- Delusions are conceptions and ideas that are not real but are perceived as the truth by those experiencing schizoaffective disorder. These are characterized by persecutory, grandiose, erotomania, folie a’ deux, bizarre, and non-bizarre delusions.
  • Disorganized Thinking- Disorganized Thinking is a symptom that affects the cognitive processes of an individual. Disorganized Thinking is when an individual is unable to connect two or more thoughts, has inappropriate or strange thoughts, and as a result, cannot form sentences, consequently, leading to incoherent speech.
  • Abnormal Physical Behavior- Abnormal Physical Behavior is one of the most common symptoms of schizoaffective disorder. This includes hyperactivity (intense/ high levels of activity), hypoactivity (reduced levels of activity), agitation, neglecting personal hygiene, impulsive behavior, and much more.
  • Negative Symptoms- Negative Symptoms of schizoaffective disorder are the negative symptoms of schizophrenia. These are basic functionalities that are absent in individuals with the condition. Some of these are catatonia, anhedonia (reduced ability to experience pleasure), avolition (lack of motivation), alogia (disruption in speech/ incoherent speech), flat affect (lack of emotional expressions), social withdrawal, and much more.
  • Cognitive Impairment- Cognitive Impairment refers to the disruption of cognitive processes of an individual experiencing schizoaffective disorder. Cognitive impairment leads to problems in concentration, attention deficit, difficulty in memory retention, poor problem-solving skills, and much more.

Most of the psychotic symptoms of schizoaffective disorder are major symptoms of schizophrenia. Therefore, an early consultation is suggested for a correct diagnosis.

Mood Symptoms of Schizoaffective Disorder

Following are the mood symptoms of schizoaffective disorder:

Depressive Symptoms

  • Persistent Sadness- Persistent Sadness is one of the most common symptoms of bipolar disorder and major depressive disorder. This could lead to feelings of hopelessness, helplessness, despair, and loneliness.
  • Loss of Interest- Constant mood swings could lead to a lack of interest in doing things. For instance, an individual with schizoaffective disorder might lose interest in hobbies they enjoy.
  • Changes in Appetite or Weight- One of the main changes an individual experiences during this phase is weight loss or weight gain. This could also result in changed eating habits or an overall change in appetite.
  • Sleep Disturbances- Due to a disorganized sleep schedule, individuals may experience either insomnia or sleep excessively, with both being signs of depression.
  • Inconstant Physical Movement- Individuals experiencing the depressive symptoms of schizoaffective disorder may experience constant restlessness and agitation. This could also lead to slowed movements.
  • Loss of Energy- Individuals with schizoaffective disorder may constantly feel tired or have little to- no- energy, which could lead to fatigue.
  • Feelings of Guilt- Schizoaffective Disorder could cause individuals to feel excessive or inappropriate guilt. They could also be overwhelmed with feelings of worthlessness.
  • Difficulty Concentrating- People with the condition may face difficulty focusing, making decisions, or remembering things. This proves that schizoaffective disorder affects the cognitive processes.
  • Suicidal Thoughts- Although unfortunate, suicidal thoughts are common in depressive disorders. Individuals with schizoaffective disorder may have thoughts of death or suicide, or even contemplate about suicide attempts.

Manic Symptoms

  • Increased Energy- Mania involves heightened emotions. Individuals experiencing manic symptoms may unusually feel energized or revved up.
  • Decreased Need for Sleep- Schizoaffective Disorder may make individuals think that they are well-rested and do not require extra sleep when in reality, they function on much less sleep than usual.
  • Elevated Mood- Due to intense emotions (mania), individuals may feel overly happy or elated.
    Grandiosity- Grandiosity is one of the most common delusions of schizoaffective disorder. Individuals experiencing the symptoms may have an inflated sense of self-esteem or importance.
  • Rapid Speech- One distinct symptom of the condition is rapid speech. Talking more quickly than usual is what individuals with schizoaffective disorder do.
  • Racing Thoughts- Individuals with manic symptoms may quickly jump from one idea to another. This is also known as disorganized thinking and it is one of the most common symptoms of schizoaffective disorder.
  • Distractibility- Due to attention deficit and concentration problems, people get easily distracted.
  • Increased Goal-Directed Activity- Individuals experiencing the symptoms of the condition may engage in multiple activities at once with a sense of urgency.
  • Risk-Taking Behavior- Individuals with manic symptoms may engage in activities that hold potential for harmful consequences. This stems from a state of hyperactivity (increased levels of activity).

Causes of Schizoaffective Disorder

Although the real cause of schizoaffective disorder is not established, following are the causes that contribute to the condition:

  • Family History- Individuals with a family history of schizoaffective disorder, schizophrenia, or mood disorders are at a higher risk of developing the condition. Family history is an important factor in the risk of developing schizoaffective disorder and could indicate a genetic predisposition to the condition.
  • Brain Structure and Function- Multiple abnormalities in brain structure and function have been identified in individuals with schizoaffective disorder, which may explain some of the symptoms associated with the condition. Abnormalities in brain structure and function, such as changes in the size or activity of certain brain regions, may be involved.
  • Stressful Life Events- Stressful life events can play an imperative role in the development and exacerbation of schizoaffective disorder. These events can act as triggers for the onset of symptoms in individuals who are already genetically or biologically vulnerable to the disorder.
  • Trauma and Abuse- Trauma and abuse are notable risk factors in the development of schizoaffective disorder and other mental health conditions. These experiences can have profound and long-lasting effects on an individual’s mental and emotional well-being.
  • Hormonal Changes- Hormonal changes can have a profound impact on the development and progression of mental health disorders, including schizoaffective disorder. While these are not typically considered a direct cause of schizoaffective disorder, hormonal fluctuations could affect the mood and exacerbate psychiatric symptoms in individuals with existing mental health conditions.
  • Physical Illness or Injury- Physical illness or injury, while not typically identified as a direct cause of schizoaffective disorder, can sometimes play a part in triggering or exacerbating symptoms in susceptible individuals.

Can Alcohol Cause Schizoaffective Disorder?

Although not directly linked to schizoaffective disorder, constant and excessive alcohol use could lead to the development of the condition. Alcohol could also exacerbate the existing symptoms that might complicate the diagnosis and management of the condition.

Alcohol use could have the following effects on an individual with schizoaffective disorder:

  • Exacerbation of Psychotic Symptoms- Excessive alcohol use could worsen the psychotic symptoms of the condition. It could lead individuals to experience delusions, hallucinations, paranoia, catatonia, avolition, anhedonia, and much more.
  • Exacerbation of Mood Symptoms- Constant use of alcohol could exacerbate the mood symptoms of schizoaffective disorder. It could trigger the onset of manic and depressive episodes that include hyperactivity, hypoactivity, intense emotions and feelings of sadness, hopelessness, and helplessness, respectively.
  • Cognitive Impairment- Excessive alcohol use could affect the cognitive functioning of an individual with the condition and worsen the problem of cognitive impairment. This includes problems with attention, concentration, difficulty in focusing, and poor problem- solving skills.
  • Dual Diagnosis- Psychiatrists and medical professionals could have a hard time diagnosing schizoaffective disorder as alcohol use could contribute to substance- abuse disorder as well, which could result in a dual diagnosis, when in reality, that might not be the case.
  • Social Factors- Alcohol abuse could result in social, occupational, and relational problems, which could contribute to overall stress and anxiety, and potentially exacerbate psychiatric symptoms.
  • Interaction with Medicines- Alcohol could interfere with the effectiveness of medications used to treat the condition. It could also increase the risk of side effects from these medications.

Can Drug Use Cause Schizoaffective Disorder?

Drug use, especially those of psychoactive drugs could exacerbate the psychiatric symptoms of schizoaffective disorder. Abusing substances like amphetamines, cocaine, and hallucinogens (e.g., LSD, PCP) could induce hallucinations, delusions, paranoia, and trigger manic or psychotic episodes.

Following are some effects of drug use on individuals with schizoaffective disorder:

  • Exacerbation of Psychotic Symptoms- Drug use could worsen the psychotic symptoms of schizoaffective disorder. Individuals abusing drugs like LSD or PCP could experience hallucinations, delusions, and paranoia.
  • Exacerbation of Mood Symptoms- Substance- abuse could lead to intense mood symptoms which could result in mania or depressive episodes, and further exacerbate the symptoms.
  • Stress Response- Drug use could cause profound stress on the body and brain, potentially triggering the onset of psychiatric symptoms in individuals predisposed to mental illnesses.
  • Potential for Misdiagnosis- Substance- abuse disorder shares the same psychiatric symptoms as schizoaffective disorder. This increases the possibility of a misdiagnosis since psychiatrists may find it difficult to distinguish between the two. It is therefore suggested to assess the individual during a period of abstinence to distinguish between the symptoms of substance- abuse disorder and any other underlying psychiatric condition.
  • Aggression and Agitation- Aggression and agitation are two of the most common symptoms of schizoaffective disorder, and substance abuse could make these worse. This could result in intense rage, restlessness, irritability, and violent tendencies.
  • Physical Health Deterioration- Drug use could result in poor physical health, which could have an indirect effect on mental health. It could also increase the risk of medical conditions like liver disease, cardiovascular problems, and infectious diseases, which could exacerbate psychiatric symptoms.

Can PTSD Cause Schizoaffective Disorder?

Post- Traumatic Stress Disorder is a distinct condition that triggers fear and stress inducing memories of stressful or traumatic situations in individuals experiencing it. While PTSD has not been directly linked to schizoaffective disorder, it could exacerbate the symptoms of the condition.

Following are the effects of PTSD on individuals with schizoaffective disorder:

  • Psychotic Symptoms- Severe trauma as a result of PTSD could display dissociative symptoms that may resemble psychotic symptoms. This could complicate the diagnosis of schizoaffective disorder.
  • Mood Symptoms- PTSD often includes symptoms of depression and anxiety, which are also the mood symptoms of schizoaffective disorder, potentially exacerbating the overall condition.
  • Trauma-Related Triggers- Individuals with schizoaffective disorder who also have PTSD may feel that their symptoms are exacerbating or experience severe psychotic or mood symptoms when confronted with past memories of trauma or stressors that trigger their PTSD.
  • Emotional Dysregulation- PTSD could lead to emotional dysregulation, which may complicate the management of mood symptoms in schizoaffective disorder.
  • Chronic Stress- Chronic stress from PTSD symptoms could have debilitating effects on mental health, potentially making the symptoms of schizoaffective disorder more difficult to manage.
  • Environmental Stressors- Trauma- inducing experiences could act as significant stressors that might trigger the onset of psychiatric symptoms in individuals with schizoaffective disorder.

DSM 5 Diagnostic Criteria for Schizoaffective Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM- 5), the diagnostic criteria for schizoaffective disorder is as follows:

A. An uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to criterion A for schizophrenia; the major depressive episode must include depressed mood.

Criterion A for schizophrenia is as follows:

Two or more of the following presentations, each present for a significant amount of time during a 1- month period (or less if successfully treated). At least one of these must be from the first three below.

  • Delusions
  • Hallucinations
  • Disorganized speech (e.g., frequent derailment or incoherence)
  • Grossly disorganized or catatonic behavior
  • Negative symptoms (i.e., diminished emotional expression or avolition)

B. Hallucinations and delusions for two or more weeks in the absence of a major mood episode (manic or depressive) during the entire lifetime duration of the illness.

C. Symptoms that meet the criteria for a major mood episode are present for most of the total duration of both the active and residual portions of the illness.

D. The disturbance is not the result of the effects of a substance (e.g., a drug of misuse or a medication) or another underlying medical condition.

The following are specifiers based on the primary mood episode as part of the presentation.

  • Bipolar type- includes episodes of mania and sometimes major depression.
  • Depressive type- includes only major depressive episodes.

Individuals experiencing the symptoms of the condition must meet the criteria for A-D above to be diagnosed with schizoaffective disorder.

Treatment for Schizoaffective Disorder

There are multiple viable treatment options available for individuals experiencing schizoaffective disorder. Following are some treatment options:

  • Psychotherapy- Psychotherapy involves one- on- one sessions of patients with their therapists, where they work on managing their emotions, coming up with coping mechanisms or strategies, and identifying root issues to resolve any conflicts.
  • Support Services- There are support services available for individuals with a mental health condition to help them reintegrate into society. This gives them an opportunity to find a job, get married, do things that an average person does, and live their lives like everyone else.
  • Support Groups- Support Groups help individuals with similar mental health conditions get together and share their experiences with everyone in the group. This group activity builds compassion, sympathy, and overall camaraderie, and helps individuals come up with coping mechanisms.
  • Emotional Support Animal- An Emotional Support Animal (ESA) is different from a pet. An ESA encourages an individual to follow a structured daily routine, which could be beneficial for the management of mood symptoms. It also provides unconditional love and companionship and helps reduce feelings of sadness and loneliness.
  • Yoga- Yoga helps individuals with schizoaffective disorder manage their mood symptoms. It encourages them to practice mindfulness and helps improve disorganized sleep schedules, which could prove to be beneficial for emotional dysregulation.
  • Medication- Medication is an integral part of the treatment procedure. Professional psychiatrists may prescribe different medications to individuals, based on the severity of their symptoms. Some of the medications for schizoaffective disorder are Aripiprazole, Risperidone, Olanzapine, and Quetiapin.

Therapy for Schizoaffective Disorder

An alternative treatment option is therapy. There are various types of therapies available for individuals with schizoaffective disorder. Here are some of them:

  • Cognitive Remediation Therapy (CRT)- Cognitive Remediation Therapy aims to improve cognitive functioning that includes attention, memory, problem-solving, and decision-making skills, which may be impaired in individuals with schizoaffective disorder.
  • Dialectical Behavioral Therapy (DBT)- Dialectical Behavioral Therapy combines cognitive-behavioral techniques with mindfulness practices and helps individuals manage intense emotions, which could be beneficial for mood symptoms of the condition, and enhance interpersonal relationships.
  • Cognitive Behavioral Therapy (CBT)- Cognitive Behavioral Therapy helps individuals identify and change negative thought patterns and behaviors that contribute to mood symptoms. It focuses on understanding the connections between thoughts, feelings, and behaviors, and helps individuals come up with coping skills.
  • Integrated Psychological Therapy (IPT)- Integrated Psychological Therapy integrates various therapeutic approaches to address the intricate needs of individuals with schizoaffective disorder.
  • Psychoeducation- Psychoeducation involves educating individuals and their families about schizoaffective disorder, its symptoms, causes, risk factors, treatment options, and strategies for managing the condition.
  • Supportive Therapy- Supportive therapy involves a professional therapist providing emotional support and encouragement to their patient, validating their feelings and emotions, and helping them cope with the challenges of living with schizoaffective disorder.

Schizoaffective disorder is one of the spectrum disorders of schizophrenia that has multiple treatment options available for it. If you or anyone you know is experiencing the symptoms of schizoaffective disorder, consider reaching out to a professional to get an early diagnosis.

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References

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