Schizoaffective Disorder

Schizoaffective disorder was first described in the 1930s. This psychiatric condition has features of both schizophrenia and mood disorders e.g. depression.

Schizoaffective disorder is less common than schizophrenia - there are no figures on the incidence and prevalence in the United Kingdom.

It commonly presents in early adulthood and women are more often affected.

• Schizoaffective disorder occurs when during the same illness there is major depressive, manic or a mixed episode. This occurs along with the symptoms of schizophrenia.
• Delusions or hallucinations need to be present for at least 2 weeks when the mood symptoms are not present.
• Symptoms of mood disturbance are present for a significant length of the illness.
• The disturbance is not due to other causes e.g. organic illness, substance misuse, medication (see below).

The schizoaffective illness can be described as:

1. Bipolar Type - when a manic or a mixed episode occurs.
2. Depressive Type - the illness has mainly depressive episodes.

This can be divided in to major depressive episode, manic episode, mixed episode and schizophrenia.¹

It is important to ascertain that the disorder is not caused by any underlying process. Main groups of differentials include:

• Substance misuse e.g. cannabis
• Organic illness e.g. hypothyroidism, delirium
• Medication side effects
• For depressive episode need to ensure it can not be explained by recent life events e.g. recent bereavement or loss of employment
• Other psychiatric illness e.g. dementia, delusional disorder

This will mainly be to rule out underlying causes and may include:

• Baseline bloods: FBC, renal and liver function, thyroid function tests
• Urine or plasma toxicology
• CXR to exclude pneumonia in elderly.
• Other imaging if clinically indicated e.g. elderly patient with recent head injury will require CT scanning

Patients affected by schizoaffective disorder can also have a number of other problems. These can include:

• Learning difficulties
• Abnormal personality e.g. antisocial or dependent
• Psychosis

• Poor social integration and function
• Difficulties with relationships
• Substance misuse e.g. alcohol
• Suicidal behaviour

Treatment of schizoaffective disorder requires medical therapies such as antipsychotics combined with psychological therapies. The mainstay of treatment is similar to that for schizophrenia i.e. antipsychotics.

Treatments can be divided as:²

• Treatment of an acute exacerbation of schizoaffective disorder - antipsychotics are useful and it may be that atypical antipsychotics have some qualities superior to typical antipsychotics e.g. risperidone or olanzapine.
• Long-term treatment of schizoaffective disorder - this involves the use of antipsychotics with psychological treatments. Antipsychotics improve patients with schizoaffective disorder, being more efficacious in those with bipolar type. Atypical antipsychotics may be more effective in schizoaffective disorders but more research is required here.
• Treatment of ongoing depressive symptoms in schizoaffective disorder - in this situation a trial of antidepressants is warranted and these may need to continue for longer periods of time. Occasionally electroconvulsive therapy may be required.
• Carbamazepine, as a mood stabiliser, has been used in schizoaffective disorder with some good results.
• Use of lithium in schizoaffective disorder - lithium has been investigated but the results are confusing. Some studies have shown that patients on lithium and haloperidol do better than those taking haloperidol alone³ and in others there was an increased relapse rate in the lithium group compared with fluphenazine.⁴

Psychological treatments involve - cognitive-behavioural therapy, family interventions and counselling and supportive psychotherapy. This is similar to the treatment of schizophrenia.

The bipolar type of schizoaffective disorder has a better prognosis than the depressive type as the latter usually results in long-term mood disturbance.