Schizoaffective disorder

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1 Schizoaffective disorder Dr.Varunee Mekareeya,M.D.,FRCPsychT Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered thought processes and abnormal emotional responses. Common symptoms include delusions,hallucinations,disorganized speech,and bizarre behaviors,as well as mood problems. Schizoaffective disorder is divided into two mood disorder types : bipolar or depressive. Symptoms of schizoaffective disorder usually begin in young adulthood. In DSM-5 and ICD-10,schizoaffective disorder is in the same diagnostic class as schizophrenia,but not in the same class as mood disorders. Epidemiology Schizoaffective disorder appears to be about one-third as common as schizophrenia. Lifetime prevalence of schizoaffective disorder is uncertain,but probably less than 1 percent,in the range of 0.5 to 0.8 percent. The incidence of the disorder is higher in females than in males,mainly due to an increased incidence of the depressive type among females. The typical age at onset of schizoaffective disorder is early adulthood,although onset can occur anywhere from adolescence to late in life. Etiology Genetic,neurobiology,early and current environment,behavioral,social,and experiential components appear to be important contributory factors. Biological and environmental factors interact with an individual s genes in ways which may increase or decrease the risk for developing schizoaffective disorder. Schizophrenia spectrum disorders,of which schizoaffective disorder is a part,have been increasingly linked to advanced paternal age at the time of conception,a known cause of genetic mutations. Among people with schizophrenia,there may be an increased risk for schizoaffective disorder in first degree relatives. The risk for schizoaffective disorder may be increased among patients who have a first degree relative with schizophrenia,bipolar disorder,or schizoaffective disorder. The physiology of persons with schizoaffective disorder appears to be not identical to that of those with schizophrenia and bipolar disorder. Clinical features Schizoaffective disorder is distinguished by mood disorder free psychosis in the context of a long term psychotic and mood disorder. Psychosis may include delusions,hallucinations,disorganized speech,thinking or behavior and negative symptoms. Negative symptoms include a lack of spontaneous speech,reduced intensity of outward emotional expression,loss of motivation,and inability of experience pleasure. Negative symptoms can be more lasting and more debilitating than positive symptoms.

2 Mood symptoms are of mania,hypomania,mixed state or depression,and tend to be episodic rather than continuous. Symptoms of mania include elevated or irritable mood,inflated self esteem,agitation,risk taking behavior,decreased need for sleep,poor concentration,rapid speech,and racing thoughts. Symptoms of depression include low mood or apathy loss of pleasure in activities which the individual once enjoyed changes in appetite or weight disturbances in sleep changes in motor activity or decreased energy fatigue guilt or worthlessness and suicidal thinking difficulty making decisions and concentrating Diagnosis Diagnosis is based on mental health clinician s observation of patient s behavior while the patient is experiencing active symptoms. Diagnosis is also based on the patient s self reported experiences,behavioral abnormalities reported by family members,friends or co workers. The criteria for diagnosis depend on both the presence and duration of certain signs and symptoms. The most widely used criteria for diagnosing schizoaffective disorder are from the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Diagnostic Criteria A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1:Depressed mood. B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness. D. The disturbance is not attributable to the effects of a substance (e.g.,a drug of abuse, a medication) or another medical condition. Specify whether: Bipolar type : This subtype applies if a manic episode is part of the presentation. Major Depressive episodes may also occur. Depressive type : This subtype applies if only major depressive episodes are part of the presentation.

3 Associated Features Supporting Diagnosis Occupational functioning is frequently impaired. People with schizoaffective disorder have restricted social contact and difficulties with self-care. They also have less severe and less negative symptoms than schizophrenic patients. Individuals with schizoaffective disorder may be at increased risk for later developing episodes of major depressive disorder or bipolar disorder. There may be associated alcohol and other substance-related disorder. Differential Diagnosis A wide variety of psychiatric and medical conditions can manifest with psychotic and mood symptoms that must be considered in the differential diagnosis of schizoaffective disorder. These include psychotic disorder due to another medical condition delirium major neurocognitive disorder substance / medication-induced psychotic disorder bipolar disorders with psychotic features major depressive disorder with psychotic features depressive or bipolar disorders with catatonic features schizotypal,schizoid,or paranoid personality disorder brief psychotic disorder schizophreniform disorder schizophrenia delusional disorder other specified and unspecified schizophrenia spectrum and other psychotic disorder psychotic disorder due to another medical condition Distinguishing schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features is often difficult. Criteria C is designed to separate schizoaffective disorder from schizophrenia,and Criteria B is designed to distinguish schizoaffective disorder from a depressive or bipolar disorder with psychotic features. Comorbidity Many patients with schizoaffective disorder are also diagnosed with other mental disorders,especially substance use disorders and anxiety disorders. The incidence of medical conditions is increased in schizoaffective disorder.

4 Treatment People with schizoaffective disorder generally respond best to a combination of medical treatment and long-term psychosocial and social supports. Medical treatment Medication Medications are chosen to reduce psychotic symptoms and stabilize mood symptoms. Electroconvulsive therapy Electroconvulsive therapy (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to medications. Psychosocial Treatment Cognitive behavioral therapy is helpful. Building a trusting relationship in therapy can help patients with schizoaffective disorder better understand their condition and feel helpful about their future. Effective sessions focus on real-life plans,problems and relationships. Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment,and improve social functioning. High quality psychiatric rehabilitation is very important for recovery from schizoaffective disorder. Psychiatric rehabilitation consists of eight main areas: Psychiatric (symptom management) Health and Medical (maintaining consistency of care) Housing (safe environments) Basic Living skills (hygiene,meals,safety,planning,chores) Social (relationships,family,boundaries,communications & community integration) Vocational and/or Educational (coping skills, motivation) Financial (personal budget) Community and Legal (resources) Complication The following complications are more prevalent in outpatient treatment. Difficulty following medical treatment. Substance use,misuse,abuse and addiction. Serious side effects and adverse effects from long-term use of prescribed medication,including obesity,types diabetes and metabolic syndrome. Problems resulting from untreated or undertreated manic behavior. Suicide due to mixed episode,severe depression,or psychosis.

5 Reference 1. Schizoaffective disorder. [Internet]. Available from: 2. American Psychiatric Association. Diagnostic and statistical Manual of Mental Disorders,fifth edition. Arlington,VA: American Psychiatric Association ; 2013.p Schizoaffective disorder. [Internet]. Available from: 4. Schizoaffective disorder.[internet]. Available from: https://www.rethink.org/../schizoaffective_disorder_ Factsheet.pdf

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