What is Schizoaffective Disorder?

It’s easy to confuse Schizoaffective Disorder with Schizophrenia because of the similarity in the names, and this confusion can go all the way through to diagnosis as well.

Schizoaffective disorder is a serious mental health condition and is so called because it features the psychotic symptoms of schizophrenia: the ‘affective’ element in the name means it affects mood, energy levels and behaviour.

Less is known about schizoaffective disorder and because the condition shares some of the symptoms with both schizophrenia and bipolar disorder, a professional diagnosis from a psychiatrist is always essential. Sufferers may also have other mental health problems, dependency issues or substance abuse problems, so treatment can be wide-ranging and complex to reflect all of these potential issues.

How common is schizoaffective disorder?

The answer is, not very, once it has been accurately diagnosed and not confused with another similar condition. The rate of schizoaffective disorder is low across the population at only 0.3%, so this is not a common condition; perhaps one of the reasons why less is known about it and also potentially the reason why schizoaffective disorder shares treatment options with similar conditions and disorders on the same spectrum.

Some reports suggest that the rate of occurrence is even across the genders, whereas other organisations like Mental Health UK find that schizoaffective disorder is more common in women than in men.

One differentiating factor in incidence rates is that men seem to develop the illness at an earlier point in life compared to women, and the most common time for schizoaffective disorder to appear is during the teens and early adulthood.

What causes schizoaffective disorder?

Schizoaffective disorder is one of those conditions which doesn’t have one easy and convenient trigger point, instead it is usually a mixture of factors which gives rise to this rare condition.

Patients with schizoaffective disorder will have a chemical imbalance in the brain and this can be caused by a variety of different reasons including:

• Genetics – Healthcare professionals can see that there is a trait of schizoaffective disorder in certain families, so genetic predisposition is relevant, and this can stretch into the extended family.
• Stress – A trigger for so many health problems, a stressful event can trigger this illness, particularly childhood traumas, but stress can also occur in adulthood with worry over money problems or relationships, redundancy and bereavement plus stress associated with frontline work such as the emergency services or the armed forces.
• Substance abuse – Specifically drugs like LSD or marijuana which are psychoactive have a connection to schizoaffective disorder.
• Brain chemistry – Brain chemistry and structure are as individual as a fingerprint; how the brain functions varies from person to person and depends on numerous factors. People with schizoaffective disorder may have an imbalance in their brain chemistry, with chemicals called neurotransmitters disrupting how the nerve cells in the brain communicate with one another. Some people with schizoaffective disorder have abnormalities in the size of different parts of the brain, for instance the thalamus or hippocampus.

What are the signs and symptoms of schizoaffective disorder?

Schizoaffective disorder is a chronic rather than an acute mental health condition (although episodes can be intense for some people) and one which shares many of the symptoms of schizophrenia. Symptoms can be severe and vary according to the specific type of schizoaffective disorder.

• Depressive schizoaffective disorder – Symptoms will include feelings of sadness and emptiness, feeling worthless, constant low mood or negative thoughts. Sufferers feel de-energised and constantly tired and sluggish with a loss of interest in things which usually make you happy. Some people exhibit catatonic behaviour where they appear dazed and unable to move. Sleep is often disrupted and appetite affected as well, with either loss of interest in food or, conversely, a desire to eat too much. It is not uncommon for people with depressive schizoaffective disorder to feel suicidal or think about their own death.
• Bipolar schizoaffective disorder – This type of schizoaffective disorder can produce manic episodes characterised by over activity, restlessness and an excess of energy. Rapid speech and jumping around from one idea to another may be noticed by work colleagues and friends and family. A sufferer of this type of schizoaffective disorder may be irrationally positive even when they are in a difficult situation. Sleep is disrupted by racing thoughts and close family and friends may see a person who is more irritable and argumentative than usual. Taking unusual risks such as making high value purchases, gambling or being promiscuous in their sex life is another feature of this type of schizoaffective disorder. Hallucinations and delusions are not uncommon either.

For both types of schizoaffective disorder, the symptoms can occur at the same time or within weeks of each other, in a sequence. Episodes can last for different periods of time and vary each time for a sufferer. Many people feel well and happy between episodes and some people only suffer from them occasionally, whereas for others, the frequency is much more intense.

The different types of schizoaffective disorder

There are three key types of schizoaffective disorder: one is depression based, one is linked to bipolar and the third is a mixture of the two.

The type of schizoaffective disorder will determine the symptoms and diagnosis and is usually based on the symptoms which are presenting.

• Manic type schizoaffective disorder – A person suffering with manic type schizoaffective disorder will have symptoms of mania and schizophrenia at the same time.
• Depressive type schizoaffective disorder – This type of schizoaffective disorder combines depression and schizophrenia simultaneously during an episode.
• Mixed type schizoaffective disorder – This type combines depression, mania and schizophrenia during any one episode.

Can schizoaffective disorder be prevented?

There is no way to prevent schizoaffective disorder from occurring, however, awareness of a genetic propensity can help people look out for the disorder if there is a combination of other factors such as stress or trauma. Most families who have a member with a diagnosis of schizoaffective disorder are aware of how it presents and can spot the early signs in other people.

Early treatment is the next best thing to prevention and can help minimise symptoms and reduce episodes in frequency and severity and periods of time spent in hospital, as well as disruption to daily life and close relationships.

Diagnosing schizoaffective disorder

Diagnosis must be undertaken by a skilled psychiatrist usually following referral from a GP or other healthcare professional. It is easy to confuse schizoaffective disorder with other conditions like depression, bipolar disorder and schizophrenia, hence the need for a really skilled diagnosis.

A psychiatrist will use two sets of parameters to assess the patient as part of the diagnostic process; these are:

• Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association.
• The World Health Organization’s (WHO) International Classification of Diseases (ICD-11).

Some people experience a combination of psychotic and bipolar symptoms, and for a diagnosis to be confirmed, the symptoms should be present for a minimum period of fourteen days.

A psychiatrist will usually expect to see the following symptoms to confirm a diagnosis of schizoaffective disorder:

• The symptoms that satisfy the criteria for a major mood episode are present throughout the illness and do not disappear and reappear.
• A period of time in which there is a major mood disorder which can be either depression or mania based is present at the same time as the schizophrenic symptoms.
• There are delusions or hallucinations for a continuous period of two weeks apart from a major mood episode which should not be present at this time.
• That there is no abuse of substances which could account for the symptoms.

Diagnosis for schizoaffective disorder is based on a person’s symptoms and medical history. There is no blood test or X-ray or scan which can definitively identify this condition, although sometimes other physical diagnostic tools are used to rule out different illnesses and diseases. Diagnosis is often based on the results following a series of assessment sessions rather than just one appointment.

What are the treatments available for someone diagnosed with schizoaffective disorder?

Schizoaffective disorder is treated and managed in three key ways:

• Medication – Medication is used to stabilise mood; patients are also treated with anti-psychotic medicines and antidepressants.
• Psychotherapy – Talking therapies such as CBT and family intervention.
• Self-management strategies and techniques.

Most treatment pathways follow a combination of therapies, and CBT (Cognitive Behavioural Therapy) is a very popular resource on the NHS. CBT teaches people about the links between their thoughts and feelings and how they act.

CBT will specifically target a sufferer’s belief system and perceptions and teaches self-awareness and coping techniques during a schizoaffective disorder episode. The goal of psychotherapy is for the person to learn about and understand their illness and to set management targets so they can learn how to deal with everyday problems which the illness causes.

Family therapy is used with the patient’s family where a mental health professional helps the person with schizoaffective disorder to manage their close relationships. Sessions can be group or individual and are as much about enabling the patient’s family as they are about helping the person who is diagnosed.

Skills training is a different type of support which can be used very effectively to help people with mental health problems and depression of all types including schizoaffective disorder. This therapy helps people manage their day-to-day lives and routines like hygiene, money management, social skills and daily tasks around family and work.

Medication is prescribed specifically for each particular patient’s mix of symptoms and depends on which schizoaffective disorder diagnosis they have. Depressive type schizoaffective disorder is usually managed with antidepressants and mood stabilisers, whereas manic type schizoaffective disorder is treated with antipsychotic drugs in addition to mood stabilisers. Acute episodes of either type may be managed with antipsychotic medication as well as sleeping tablets.

Antipsychotic medication is the main medicine used to treat schizoaffective disorder and covers symptoms like disorganised and irrational thinking, hallucinations and delusions. An antidepressant like lithium is popular for treating mood-related symptoms – many people are treated with both.

The goal with all treatment plans is to manage symptoms initially, which can be severe, and then look at longer-term solutions which are not medication dependent. All medication carries side effects, and patients on treatment plans for any of the three types of schizoaffective disorder will require close monitoring by their GP and psychiatrist.

Lithium in particular causes side effects like hand tremors, dizziness, loss of appetite and nausea. Antidepressants also cause side effects which vary according to the type of medication being used but can include headaches, sleeping problems, weight gain or weight loss, constipation or diarrhoea and sexual problems like erectile dysfunction.

It is not unusual for people with schizoaffective disorder to have other mental health conditions such as PTSD (Post-Traumatic Stress Disorder) or ADHD (Attention-Deficit Hyperactivity Disorder), as well as substance abuse problems, so treatment has to be managed holistically.

People with schizoaffective disorder can lead fulfilling and reasonably normal lives providing their condition is managed and closely monitored. For some, the condition only surfaces occasionally, and self-awareness and lifestyle support programmes are enough to manage episodes, with medication only being needed in acute episodes. Other people have much more frequent and continuous symptoms and need targeted and constant support with regular monitoring of their medication.

The NHS have an Early Intervention in Psychosis team, or EIT, which can help people experiencing acute psychosis, particularly for the first time. EIT aim to see people within fourteen days and are useful for people who have recently developed schizoaffective disorder and are having their first acute episode.

Hospitalisation is not normally necessary as most people attend health sessions either at their GP surgery or as an outpatient with a psychiatric service – treatment for schizoaffective disorder becomes something interwoven into their lives using a mix of different support services based around their Community Mental Health Team (CMHT), although there are also other NHS support teams which target different sectors of people suffering with this condition.