Schizoaffective disorder

Schizoaffective disorder symptoms may vary from person to person. People with the condition experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder — either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression).

Although the development and course of schizoaffective disorder may vary, defining features include a major mood episode (depressed or manic mood) and at least a two-week period of psychotic symptoms when a major mood episode is not present.

Signs and symptoms of schizoaffective disorder depend on the type — bipolar or depressive type — and may include, among others:

• Delusions — having false, fixed beliefs, despite evidence to the contrary
• Hallucinations, such as hearing voices or seeing things that aren't there
• Impaired communication and speech, such as being incoherent
• Bizarre or unusual behavior
• Symptoms of depression, such as feeling empty, sad or worthless
• Periods of manic mood, with an increase in energy and a decreased need for sleep over several days, and behaviors that are out of character
• Impaired occupational, academic and social functioning
• Problems with managing personal care, including cleanliness and physical appearance

When to see a doctor

If you think someone you know may have schizoaffective disorder symptoms, talk to that person about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help find a qualified doctor or mental health professional.

If your loved one can't provide his or her own food, clothing or shelter, or if the safety of your loved one or others is a concern, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

Suicidal thoughts or behavior

Talk of suicide or suicidal behavior may occur in someone with schizoaffective disorder. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

The exact causes of schizoaffective disorder are still being investigated, but genetics are likely a factor.

Factors that increase the risk of developing schizoaffective disorder include:

• Having a close blood relative — such as a parent or sibling — who has schizoaffective disorder, schizophrenia or bipolar disorder
• Stressful events that may trigger symptoms
• Taking mind-altering drugs, which may worsen symptoms when an underlying disorder is present

People with schizoaffective disorder are at an increased risk of:

• Suicide, suicide attempts or suicidal thoughts
• Social isolation
• Family and interpersonal conflicts
• Unemployment
• Anxiety disorders
• Alcohol or other substance use problems
• Significant health problems
• Poverty and homelessness

Diagnosis of schizoaffective disorder involves ruling out other mental health disorders and concluding that symptoms are not due to substance use, medication or a medical condition. Determining a diagnosis of schizoaffective disorder may include:

• Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
• Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. In certain situations, the doctor may also request imaging studies, such as an MRI or CT scan.
• Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use and potential for suicide. This also includes a discussion of family and personal history.
• Diagnostic criteria for schizoaffective disorder. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association.

People with schizoaffective disorder generally respond best to a combination of medications, psychotherapy and life skills training. Treatment varies, depending on the type and severity of symptoms and whether the disorder is the depressive or bipolar type. In some cases, hospitalization may be needed. Long-term treatment can help to manage the symptoms.

Medications

In general, doctors prescribe medications for schizoaffective disorder to relieve psychotic symptoms, stabilize mood and treat depression. These medications may include:

• Antipsychotics. The only medication approved by the Food and Drug Administration specifically for the treatment of schizoaffective disorder is the antipsychotic drug paliperidone (Invega). However, doctors may prescribe other antipsychotic drugs to help manage psychotic symptoms such as delusions and hallucinations.
• Mood-stabilizing medications. When the schizoaffective disorder is bipolar type, mood stabilizers can help level out the mania highs and depression lows.
• Antidepressants. When depression is the underlying mood disorder, antidepressants can help manage feelings of sadness, hopelessness, or difficulty with sleep and concentration.

Psychotherapy

In addition to medication, psychotherapy, also called talk therapy, may help. Psychotherapy may include:

• Individual therapy. Psychotherapy may help to normalize thought patterns and reduce symptoms. Building a trusting relationship in therapy can help people with schizoaffective disorder better understand their condition and learn to manage symptoms. Effective sessions focus on real-life plans, problems, relationships and coping strategies.
• Family or group therapy. Treatment can be more effective when people with schizoaffective disorder are able to discuss their real-life problems with others. Supportive group settings can also help reduce social isolation, provide a reality check during periods of psychosis, increase appropriate use of medications and develop better social skills.

Life skills training

Learning social and vocational skills can help reduce isolation and improve quality of life.

• Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities. New skills and behaviors specific to settings such as the home or workplace can be practiced.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizoaffective disorder prepare for, find and keep jobs.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic personal care.

Electroconvulsive therapy

For adults with schizoaffective disorder who do not respond to psychotherapy or medications, electroconvulsive therapy (ECT) may be considered.

Schizoaffective disorder requires ongoing treatment and support. People with schizoaffective disorder can benefit from:

• Learning about the disorder. Education about schizoaffective disorder may help the person stick to the treatment plan. Education can also help friends and family understand the disorder and be more compassionate.
• Paying attention to warning signs. Identify things that may trigger symptoms or interfere with carrying out daily activities. Make a plan for what to do if symptoms return. Contact the doctor or therapist if needed to prevent the situation from worsening.
• Joining a support group. Support groups can help make connections with others facing similar challenges. Support groups may also help family and friends cope.
• Asking about social services assistance. These services may be able to help with affordable housing, transportation and daily activities.

Also, avoid recreational drugs, tobacco and alcohol. These can worsen schizoaffective symptoms or interfere with medications. If necessary, get appropriate treatment for a substance use problem.

If you think you may have schizoaffective disorder or that your loved one may have it, take steps to prepare for the appointment, whether it's with a primary care doctor or a mental health professional, such as a psychiatrist.

If the appointment is for a relative or friend, offer to go with him or her. Getting the information firsthand will help you know what you're facing and how you can help your loved one.

What you can do

To prepare for the appointment, make a list of:

• Any symptoms you've noticed, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any family history of mental health disorders, any major stresses or recent life changes
• All medications, vitamins, herbal preparations and any other supplements, and the dosages
• Questions to ask the doctor to help you make the most of your time

Some basic questions to ask include:

• What is likely causing the symptoms?
• Are there any other possible causes?
• How will you determine the diagnosis?
• Is this condition likely temporary or long term?
• What treatments do you recommend?
• What are the alternatives to the primary approach you're suggesting?
• What are the side effects of the medication you're prescribing?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask any other questions during the appointment.

What to expect from your doctor

Your doctor is likely to ask several questions, such as:

• What symptoms have you noticed?
• When did you start noticing symptoms?
• Have symptoms been continuous or occasional?
• Have you thought about or attempted suicide?
• How are you functioning in daily life — are you eating regularly, bathing regularly, going to work, school or social activities?
• Have other family members or friends expressed concern about your behavior?
• Have you been diagnosed with any other medical conditions?
• Has anyone else in your family been diagnosed with or treated for mental illness?

Be ready to answer these questions so you'll have time to go over any other points you want to focus on.