SCHIZOAFFECTIVE DISORDER

Schizoaffective Disorder is a chronic psychiatric condition characterized by symptoms of both schizophrenia (such as hallucinations, delusions, and disorganized thinking) and mood disorders (either depression or bipolar-type mania). It is considered a bridge disorder, combining features of psychotic and affective (mood-related) illness, and is classified under the Schizophrenia Spectrum and Other Psychotic Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

To meet criteria for schizoaffective disorder, the following must be present:

  1. An uninterrupted period of illness during which the individual experiences a major mood episode (either major depressive or manic) concurrent with symptoms of schizophrenia (e.g., delusions, hallucinations, disorganized speech or behavior, negative symptoms).

  2. Psychotic symptoms (delusions or hallucinations) must occur for at least two weeks in the absence of a major mood episode, to distinguish it from a mood disorder with psychotic features.

  3. Mood symptoms must be present for the majority of the total duration of the illness.

Types:

  • Bipolar type: Includes episodes of mania and possibly depression.

  • Depressive type: Only major depressive episodes are present alongside psychotic symptoms.

Symptoms May Include:

  • Psychotic features: Hallucinations (often auditory), delusions, disorganized thinking

  • Mood symptoms:

    • Depression: Low mood, lack of energy, feelings of worthlessness, suicidal thoughts

    • Mania: Elevated or irritable mood, increased energy, impulsivity, decreased need for sleep

  • Cognitive impairments and social withdrawal

  • Functional decline in occupational or social settings

Etiology and Risk Factors:

The precise cause of schizoaffective disorder is unknown, but contributing factors include:

  • Genetic vulnerability (family history of schizophrenia, bipolar disorder, or depression)

  • Neurobiological abnormalities

  • Environmental stressors, including trauma or substance use

Management typically involves a multimodal approach, including:

  • Pharmacotherapy:

    • Antipsychotic medications (e.g., paliperidone, which is FDA-approved for schizoaffective disorder)

    • Mood stabilizers (e.g., lithium, valproate) for bipolar symptoms

    • Antidepressants for depressive symptoms

  • Psychotherapy:

    • Cognitive-behavioral therapy (CBT)

    • Psychoeducation and skills training

    • Family therapy or support

  • Social and vocational support:

    • Case management, supported employment, and housing assistance

Schizoaffective disorder often follows a chronic and fluctuating course. Prognosis is generally intermediate between schizophrenia (more severe) and mood disorders (less severe). Early diagnosis, treatment adherence, and social support significantly improve long-term outcomes.