Schizoaffective disorder is a mental health issue on the schizophrenia spectrum. Like people who have schizophrenia, people with schizoaffective disorder have psychotic symptoms (such as delusions and hallucinations). They may also have other symptoms of schizophrenia, such as disorganized speech. But schizoaffective disorder differs from schizophrenia in one main way. It involves mood symptoms—mania or depression—along with schizophrenia symptoms.
Schizoaffective disorder often appears in young adulthood, but symptoms could begin in adolescence or later in life. People who don’t get treatment may have trouble at school, work, or home. They are often more likely to have health issues, relationship difficulties, thoughts of suicide, and substance abuse issues. They can also be at a higher risk of homelessness, unemployment, and isolation.
But help is available. The support of a qualified mental health professional can improve the outlook for this condition. Treatment generally includes medication and counseling. If you or a loved one has symptoms of schizoaffective disorder, consider reaching out to a counselor right away.
What Is Schizoaffective Disorder?
As it involves symptoms of two separate mental health conditions, schizoaffective disorder is less understood and not as clearly defined as some other mental health conditions. The pattern of symptoms can be very different from one person to the next. This is one reason why schizoaffective disorder may be less defined than other conditions.
This condition is not common, according to diagnostic rates. It only occurs in about 0.3% of the population, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This makes it only about a third as common as schizophrenia. But misdiagnosis of the condition could mean it occurs more frequently than statistics suggest.
The DSM-5 lists four main criteria for the condition.
- A period of poor mental health that includes a mood episode (depression or mania) at the same time as schizophrenia symptoms.
- A stretch of two weeks in which a person has delusions or hallucinations but not mood symptoms. In other words, a person needs to have psychotic symptoms outside of a major mood episode.
- Since the condition’s onset, the person has had mood symptoms most of the time. In other words, a person who experiences schizophrenia symptoms consistently and mood symptoms from time to time would likely not be diagnosed with schizoaffective disorder.
- The symptoms are not better explained by a health condition or side effects of a medication or other substance.
Schizoaffective Disorder Symptoms
Schizoaffective disorder can be divided into two categories: depressive type and bipolar type. The type depends on what kind of mood symptoms a person has.
Schizoaffective disorder, bipolar type, is characterized by schizophrenia symptoms that occur with bipolar symptoms. For diagnosis, it’s necessary to have experienced a manic episode. But a person with bipolar type might also have depression symptoms. The bipolar type tends to appear more often in younger adults.
According to the DSM-5, some symptoms of bipolar that might happen during a period of mania include:
- Racing thoughts
- Flight of ideas (rapid speech, being unable to stop talking)
- Sleeplessness, not needing sleep
- An increase in goal-directed activity
- Risk-taking or impulsive behavior
- Becoming agitated and distracted easily
Schizoaffective disorder, depressive type, is more common in women and older adults. Depression symptoms include:
- Persistent low mood
- Loss of energy or lack of interest in usual activities
- Appetite loss and/or weight changes
- Sleep issues
- Difficulty concentrating
- Feeling hopeless or suicidal
Both types of schizoaffective disorder involve symptoms of schizophrenia. These may include:
- Hallucinating (hearing and seeing things no one else can)
- Delusions (beliefs that aren’t grounded in reality yet aren’t given up in the face of contradicting evidence)
- Moving slowly or being unable to move at all
- Incoherent, disorganized, or confused thoughts and speech
- Lacking motivation
- Blunted affect (being unable to express emotions in the face or voice)
Is it Schizoaffective Disorder, Schizophrenia, or a Mood Issue?
Because schizoaffective disorder is similar to schizophrenia in many ways, it may not always be easily recognized. People are often misdiagnosed with schizophrenia or bipolar, especially when symptoms first appear.
Mental health experts continue to debate whether schizoaffective disorder is truly a distinct diagnosis or if it is a subtype of schizophrenia, bipolar, or depression. Existing research is limited. According to a Frontiers in Human Neuroscience article from 2010, much of the research that exists is inconsistent. This may be in part because schizophrenia and schizoaffective disorder are often studied together.
The DSM criteria try to make diagnosis clear by stating that delusions and hallucinations must be present for two weeks while the person is not also having a mood episode. This criterion distinguishes the schizoaffective disorder from depression or bipolar. It is possible to experience psychosis with bipolar or major depression, but any psychotic symptoms are usually confined to the mood episodes. Typically someone with depression or bipolar will not have hallucinations or delusions when their mood symptoms are in remission, but someone with schizoaffective disorder could.
Mood symptoms are the main difference between schizophrenia or schizoaffective disorder. A diagnosis of schizoaffective disorder requires mood symptoms to be present most of the time. Yet schizophrenia generally does not involve persistent depression or mania.
What Causes Schizoaffective Disorder?
Research hasn’t yet discovered a clear cause of schizoaffective disorder. Experts believe the condition may develop from a combination of factors.
The condition may be inherited. Having a close relative who has schizophrenia, bipolar, or schizoaffective disorder can increase one’s lifetime risk of developing this condition. A study from 2014 reports strong evidence of familial overlap between bipolar and schizophrenia spectrum conditions. Identical twin studies show if one twin has schizoaffective disorder, the other twin has a 40% chance of also developing the condition.
It’s believed that brain chemistry contributes to the development of mood issues as well as schizophrenic spectrum conditions. When people have an imbalance of brain chemicals called neurotransmitters, certain signals in the brain may not be sent or received properly. Because neurotransmitters like serotonin and dopamine can affect mood, imbalances can lead to symptoms.
Environmental stressors can also increase risk. A person with a higher genetic risk for schizoaffective disorder may be more likely to develop the condition if they experience a stressful event such as divorce or job loss.
Using hallucinogenic drugs, such as LSD, may increase symptoms of schizoaffective disorder or increase one’s risk of developing it. Some people might use these drugs to help relieve symptoms, but they often make symptoms worse.
Prognosis for Schizoaffective Disorder
There’s no cure for schizoaffective disorder, but treatment can help. Research suggests almost half of affected individuals see their symptoms go into remission after five years. About 25% of people are able to function well socially for two-year stretches. Developing a treatment plan with a qualified mental health professional and following this plan can make it more likely symptoms will improve or go away.
When compared to schizophrenia, schizoaffective disorder tends to have a better chance for improvement. People with this condition are more likely to be able to return to their previous level of function with treatment. This does depend on other factors though, including:
- How a person functioned before being diagnosed.
- How severe and persistent symptoms are.
- How much support the person has from family and friends.
- How well the person follows their treatment plan.
The psychotic symptoms of schizoaffective disorder make this condition more difficult to treat than bipolar or depression. Because delusions and hallucinations accompany mood symptoms, it’s often harder for people to work, interact with others, and perform necessary self-care.
Related Mental Health Issues
Anxiety and substance abuse are common in people who have schizoaffective disorder. It’s important to talk about these symptoms with a counselor. Treatment is most effective when it addresses all symptoms, particularly substance use, since this can make psychotic symptoms worse.
People with schizoaffective disorder have a 5% lifetime risk for suicide. Depression symptoms increase this risk, so it’s important for people with this condition to get help.
Schizoaffective disorder can be difficult to manage, but it is treatable. This condition is lifelong, so being diagnosed may be discouraging and distressing. But know that recovery, even long-term remission, is possible. A trained mental health counselor can provide support and guidance on the best treatment for each unique pattern of symptoms. Reach out today. You are not alone.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
- Cardno, A. G., & Owen, M. J. (2014, February 24). Genetic relationships between schizophrenia, bipolar disorder, and schizoaffective disorder. Schizophrenia Bulletin, 40(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984527
- Mathalon, D. H., Hoffman, R. E., Watson, T. D., Miller, R. M., Roach, B. J., & Ford, J. M. (2010, January 29). Neurophysiological distinction between schizophrenia and schizoaffective disorder. Frontiers in Human Neuroscience, 3(1), 70. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816168
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