A disorder that includes features of both schizophrenia ( hallucinations , delusions, and deteriorating function) and a mood disorder (either bipolar disorder "manic depression" or major depressive disorder) in which the symptoms are so intertwined that a distinction between the two problems cannot be made.

Causes, incidence, and risk factors

People with this condition often seek treatment for mood problems (mania, depression, symptoms of both simultaneously or rapidly alternating) which shifts towards symptoms of schizophrenia or may display symptoms of both conditions simultaneously, although the schizophrenic symptoms dominate. To be diagnosed with this disorder, someone must experience psychotic symptoms (hallucinations and delusions) for at least 2 weeks in the absence of mood disorder. The exact cause of the condition is unknown, but factors that affect the development of both schizophrenia and affective disorders may play a role, including a strong genetic component and other biochemical factors. Risk factors include a family history of schizophrenia or affective disorder. It is not known how commonly schizoaffective disorder occurs, but it is believed to be less common than schizophrenia or mood disorders. Women may be affected more often than men. While mood disorders are relatively common in children, schizophrenia is not. Therefore schizoaffective disorder tends to be rare in children.

Signs and tests

psychological evaluation for identification of symptoms

history of current behavior and symptoms

The combination of psychotic and affective symptoms seen in schizoaffective disorder can be seen in other illnesses, particularly in episodes of bipolar disorder with psychotic features. In these illnesses, as well as in schizoaffective disorder, the mood disturbance is a prominent part of the illness. However, in schizoaffective disorder, the psychotic symptoms do not necessarily remit with effective treatment of the mood symptoms as they do in mood disorders with psychotic features. Also, they usually persist for at least two weeks without symptoms of mania or major depression. Any medical, psychiatric, or drug related condition that causes psychotic or mood symptoms must be considered. Patients undergoing treatment with steroids, abusers of cocaine, amphetamines and phencyclidine (PCP), and some patients with temporal lobe epilepsy are particularly likely to have concurrent schizophrenic and mood disorder symptoms.

Treatment

The treatment of people with schizoaffective disorder varies, but generally involves agents to stabilize mood and to treat psychosis. Neuroleptic medications (antipsychotics) are used to treat psychotic symptoms. These medications may take up to three weeks to relieve symptoms. Lithium may be used to manage mania and to stabilize mood. Anti-seizure medications such as valproic acid and carbamazepine are effective mood stabilizers. Usually the combination of antipsychotic and mood-stabilizing medication controls both depressive and manic symptoms, but antidepressants may need to be used in some cases.

Expectations (prognosis)

People with schizoaffective disorder may have a fairly favorable prognosis, with more likelihood of returning to a previous level of functioning than schizophrenics. However, this severe and persistent disorder requires long-term treatment and may have variable outcomes.

Complications

Complications are similar to those for schizophrenia and major affective disorders. These include:

problems complying with therapeutic regimens

risk of developing substance use problems in an attempt to self-medicate symptoms

problems resulting from manic behavior (for example, spending sprees, sexual indiscretions)

risk of suicidal behavior due to depressive and/or psychotic symptoms

Calling your health care provider

Call your health-care provider or mental health professional if you or someone you know is experiencing any of the following:

strange or unusual thoughts or perceptions

inability to care for basic personal needs

bouts of depression; feelings of hopelessness and/or helplessness

increase in energy and involvement in risky behavior that is sudden in onset and out of character. This often includes going days without sleeping and feeling no need for sleep.

symptoms worsening or not improving with treatment

feelings and thoughts of suicide