Schizoaffective disorder: definition, causes, symptoms, and treatments

Schizoaffective disorder is a type of psychotic disorder that is characterized by symptoms of schizophrenia and a mood disorder. It is one of the most misdiagnosed mental health conditions due to its complexity.

The causes of schizoaffective disorder include a combination of factors involving genetics, brain structure and function, environment, and drug use.

Symptoms of schizoaffective disorder include psychosis i.e., hallucinations and delusions as well as other symptoms such as impaired communication and speech, symptoms of depression, impaired occupational, academic, and social functioning, and poor hygiene and grooming habits.

There are two types of schizoaffective disorder: bipolar and depressive type. The bipolar type includes mania or major depression, whereas the depressive type involves depressive symptoms only. In these cases, symptoms of schizophrenia occur together with mania or depression, depending on the type.

Treatments for schizoaffective disorder include medications, psychotherapy, and hospitalization in severe cases. Patients can also benefit from training to improve their social and vocational skills.

What is schizoaffective disorder?

Schizoaffective disorder is a type of mental illness that combines symptoms of schizophrenia and symptoms of a mood disorder such as mania or depression. That’s exactly what its name stands for. Here, schizo refers to psychotic symptoms of schizophrenia, whereas affective stands for mood disorder symptoms.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association categorizes this mental illness among psychotic disorders.

Not all cases of schizoaffective disorder are the same; there are two types. Bipolar type includes symptoms of schizophrenia and mania (or depression sometimes). On the other hand, the depressive type is indicated by symptoms of schizophrenia and major depression.

When left unmanaged, the schizoaffective disorder can lead to various complications, such as significant health problems, anxiety, interpersonal conflicts, unemployment, substance abuse, financial problems, and suicidal thoughts or tendencies.

Schizoaffective disorder is not a modern-day disease. Throughout history, psychiatrists have been interested in unique cases where patients have both psychosis and depression. However, the term schizoaffective psychosis was first used in 1933 by the American psychiatrist Jacob Kasanin. He used this term to describe an episodic psychotic condition with affective symptoms. At the time, people with psychotic and affective symptoms were considered to have “good prognosis” schizophrenia. Kasanin theorized emotional conflicts were behind the schizoaffective disorder and claimed many of them were sexual.

Several decades before Kasanin, in 1863, a German psychiatrist Karl Khalbaum described the schizoaffective disorder as a separate group of mental illnesses. In 1920, another German psychiatrist Emil Kraepelin reported a significant volume of cases that exhibited characteristics of both groups of psychoses that he distinguished as two separate illnesses. These are just some examples that show the great interest of some of the most notable psychiatrists in a specific condition indicated by the presence of psychosis and mood disorder – schizoaffective disorder.

How common is schizoaffective disorder?

Schizoaffective disorder is uncommon. The lifetime prevalence of the schizoaffective disorder is 0.3%, National Alliance on Mental Illness (NAMI) California reports. More precisely, one in every 300 people will develop a schizoaffective disorder at some point.

At this point, there are no estimates regarding the prevalence of the schizoaffective disorder in children and adolescents. However, younger patients tend to develop a schizoaffective disorder, bipolar type, whereas older adults usually get a schizoaffective disorder, depressive type.

The prevalence of the schizoaffective disorder in children and teens could be lower than that of schizophrenia. While rare in childhood, schizophrenia affects 0.4% of children and 0.23% of adolescents, according to a review from the Greek journal Psychiatriki.

Numbers show that schizoaffective disorder affects 0.14% of older adults. In fact, older adults have more severe symptoms, a higher risk of suicide, and increased treatment resistance compared to younger patients, Psychiatric Times reported.

Schizoaffective disorder is slightly more common in women than in men. In a study led by Dr. Iris E. Sommer from the Department of Biomedical Sciences of Cells and Systems in Groningen, Netherlands and published by the journal Schizophrenia, the disorder was diagnosed in 31.2% of women and 17.5% of men. However, males tend to develop symptoms earlier.

What are the causes of schizoaffective disorder?

The causes of schizoaffective disorder have multiple contributing factors as listed below:

• Genetics
• Brain structure and function
• Environment
• Drug use

1. Genetics

Genetics indicates schizoaffective disorder may be hereditary due to gene variations. Parents may pass down gene mutations to children and thereby increase their susceptibility to developing schizoaffective disorder. A paper, authored by Dr. Alastair G. Cardno from the University of Leeds and Michael J. Owen at Cardiff University, and published in the Schizophrenia Bulletin explained there is a familial overlap between schizoaffective disorder and both schizophrenia and bipolar disorder. Multiple genes and their variations are involved in the development of schizoaffective disorder. Although genetics may contribute to the onset of symptoms, it’s not the sole cause of this mental illness.

2. Brain structure and function

Abnormalities in brain structure and function can contribute to the development of a mental illness. Evidence confirms that could be the case with schizoaffective disorder. For example, a paper by Amann et al, from the Acta Psychiatrica Scandinavica, reported that patients with schizoaffective disorder and people with schizophrenia display widespread and overlapping areas of notable volume reduction. Reduced gray matter volume in men and women with this mental illness is similar to that observed in schizophrenia.

Schizoaffective disorder is also associated with abnormalities in neurotransmitters such as dopamine, serotonin, and norepinephrine. White matter abnormalities in several brain regions are present, too. These brain areas include the right lentiform nucleus, left temporal gyrus, and right precuneus, according to a post published on the website of the National Library of Medicine by Tom Joshua P. Wy from University Hospital/HCA and Abdolreza Saadabadi from Western University/Kaweah Delta. The right lentiform nucleus takes part in functions that regulate cognition, movement, and emotions. The left temporal gyrus is involved in memory processing, sensory functions, and speech comprehension. The right precuneus participates in the recollection of memory, perception of the environment, and cue reactivity, among other functions.

Abnormalities in these specific brain areas can contribute to symptoms of psychosis and problems with behavior, memory, and perception of reality.

Additionally, schizoaffective disorder is linked to deformations in medial and lateral thalamic regions, which are involved in executive functions and motor control respectively.

3. Environment

Environmental factors can trigger the onset of schizoaffective disorder. The environment is primarily a major contributor to the development of this mental illness in people who are at higher risk due to their genetics. More precisely, environmental factors tend to work in combination with other causes, such as heredity. Cleveland Clinic reports environmental causes of schizoaffective disorder may include highly stressful situations, exposure to viral infections in the womb, and experiencing emotional trauma.

The underlying mechanisms through which the environment influences the development of schizoaffective disorder are unclear. It could be due to the inability to cope with trauma or stress in a healthy manner, which leads to an altered perception of reality. Exposure to viral infections or toxins in the womb could affect brain development and its structure and function.

4. Drug use

The use of drugs, especially illicit substances, can contribute to the development of mental illnesses. Psychoactive drugs such as cannabis can lead to the onset of schizoaffective disorder. Drugs and other substances, including alcohol, act on the brain and may contribute to abnormalities in its functioning.

For example, they may negatively affect neurotransmitters and their transmission. That way, drugs, and alcohol can lead to symptoms of schizoaffective disorder, especially in people who are already at a higher risk of developing this mental illness.

In people who are already diagnosed with schizoaffective disorder, drug use can make the symptoms more severe. Schizoaffective disorder can lead to drug abuse. For example, a person may start drinking alcohol or using drugs in order to cope with symptoms of schizoaffective disorder.

What are the symptoms of schizoaffective disorder?

Symptoms of schizoaffective disorder may vary from one patient to another. This mental illness manifests itself through symptoms of psychosis and mood disorder symptoms. A person with schizoaffective disorder bipolar type exhibits symptoms of psychosis and mania or depression sometimes, whereas a person with depressive type has symptoms of psychosis and depression. The symptoms of schizoaffective disorder are listed below:

• Hallucinations
• Delusions
• Impaired communication and speech
• Symptoms of depression
• Impaired occupational, academic and social functioning
• Poor hygiene and grooming habits

1. Hallucinations

Hallucinations are defined as perceptions that occur in the absence of an external stimulus that has the qualities of real perceptions. In other words, hallucinations are false sensory experiences. People may hear, see, or feel things that seem real, but they aren’t. While hallucinations can involve any of the five senses, people with the schizoaffective disorder usually experience auditory hallucinations, i.e., hearing sounds or voices other people don’t. Visual hallucinations are also common.

The physical effects of hallucinations are usually associated with the consequences of stress and social withdrawal or bizarre behaviors. A person may have problems with the sleeping pattern, which leads to weight gain and a high risk of health problems.

The behavioral effects of hallucinations are aggressiveness, argumentative behavior, social withdrawal, and a high risk of self-harm.

2. Delusions

Delusions are defined as false beliefs that indicate the presence of abnormality in a person’s content of thought. In a nutshell, a person firmly believes in something despite no evidence to confirm those claims. Delusions aren’t accounted for by the person’s religious or cultural background or their level of intelligence. They come in many forms or types such as persecutory delusions, erotomanic, grandiose, jealous, somatic, and mixed or unspecified delusions. The most common type of delusion that people have is persecutory, which causes a person to believe that someone wants to harm them. In other words, people have paranoid thoughts and feel threatened even when there’s no reason for it.

Physical effects of delusions occur indirectly as a consequence of too much stress and lack of self-care. A person with delusions may gain weight, develop dental problems, and have a high risk of health problems linked to excess weight gain.

Behavioral effects of delusions include aggressiveness, anger, irritability, social withdrawal, reduced performance at work or school, conflicts with family or friends and coworkers, and bizarre or erratic behaviors or attitudes.

3. Impaired communication and speech

Impaired communication and speech refer to all cases where a person experiences difficulties comprehending or using language to express oneself. A person with schizoaffective disorder may speak incoherently or give unrelated answers to questions. They may say things that are illogical and make no sense. People with this mental illness tend to jump from one topic to another, a completely unrelated subject.

This symptom doesn’t have specific physical effects other than those that may occur as a consequence of high-stress levels. Stress depletes energy, causes insomnia, may contribute to weight gain, and jeopardize a person’s health.

Behavioral effects of impaired communication and speech include irritability, mood swings, argumentativeness, frustration, and social isolation.

4. Symptoms of depression

People with schizoaffective disorder develop symptoms of mood disorder in addition to psychosis. For that reason, they experience symptoms of depression. As one of the most common mental health problems, depression is indicated by a persistent feeling of sadness, worthlessness, helplessness, loss of interest in activities once enjoyed, and inability to experience pleasure.

Physical effects of depression include weight changes, chronic pain, headaches, cramps, gastrointestinal problems, fatigue, psychomotor activity changes, a higher risk of heart or kidney disease and diabetes, and hormonal imbalances.

Behavioral effects of symptoms of depression include social isolation, difficulty making decisions, refusal to engage in activities that a person once liked, lack of self-care, angry outbursts, irritability, frustration, and suicidal thoughts and tendencies.

5. Impaired occupational, academic and social functioning

Schizoaffective disorder negatively affects the way a person functions in different aspects of their life. For that reason, people experience problems such as poor performance and low productivity at work or home. They may also experience social functioning problems i.e. their relationships with friends, coworkers, and even family members suffer. This happens due to symptoms of psychosis that often lead to bizarre behaviors, false accusations, and other problems that jeopardize one’s social life.

Physical effects of this symptom mainly involve poor quality of sleep, disrupted executive function, faster cognitive decline, poor immune system function and problems with cardiovascular health.

Behavioral effects include social withdrawal, angry outbursts, and violent behavior.

6. Poor hygiene and grooming habits

Patients with schizoaffective disorder often fail to engage in regular hygiene practices such as brushing and flossing teeth, taking showers, and keeping their hair, nails, and other parts of the body clean. As a result, they often have a messy appearance, bad odor, greasy hair, and other problems associated with a lack of hygiene and grooming.

Physical effects of poor hygiene and grooming include tooth decay, gum disease, body or head lice, infections, the accelerated aging process, and a higher risk of cardiovascular diseases.

Behavioral effects mainly include frustration and anger when family or friends suggest taking care of your body or health, being reluctant to spend time with others, neglecting responsibilities, and having pessimistic attitudes.

Who is affected by schizoaffective disorder?

People in their late adolescence or early adulthood are usually affected by schizoaffective disorder. This psychotic disorder can affect men and women up to 30 years of age. It is not as common in the elderly population and children. Additionally, women are more frequently affected than men. Persons who abuse drugs and those who have experienced something traumatic may also be affected by schizoaffective disorder.

What are the risk factors for schizoaffective disorder?

Risk factors for the schizoaffective disorder are associated with main causes such as genetics, environment, and factors that influence brain function. Schizoaffective disorder is a complex mental illness. Several factors are involved in its development, usually combined. The biggest risk factors for schizoaffective disorder are listed below:

• Family history of schizoaffective disorder, other psychotic disorder, or mental illness
• Taking mind-altering drugs such as cannabis
• History of major life stress or trauma, such as being a victim of abuse and neglect
• Personal history of mental health disorders
• Prenatal exposure to toxins or viruses and illnesses
• Developmental delays
• Traumatic brain injury
• Malnutrition before or during birth

How is schizoaffective disorder diagnosed?

Schizoaffective disorder is diagnosed after ruling out physical conditions, substance abuse, and other mental health disorders, Mayo Clinic explains. Everything starts with a visit to a doctor’s office and a thorough describing the symptoms that occur.

The doctor will start by performing a physical exam to rule out health problems that may cause the symptoms. To get a complete insight into a patient’s physical health, the doctor may order blood tests, urine tests, and imaging tests such as CT and MRI. Not only do blood and urine tests give information about a patient’s physical health, but they also reveal whether a person has alcohol or drugs in their system.

If these tests show nothing specific, the healthcare professional recommends psychiatric evaluation. The primary objective of psychiatric evaluation is to get a closer insight into a patient’s mental status. The psychiatrist does so by asking questions about symptoms and observing their behavior, appearance, and demeanor. Patients are asked to talk about their experience with psychosis, mainly with hallucinations or delusions they may have. The psychiatric evaluation also includes a discussion about personal and family medical history.

Upon thorough psychiatric evaluation, the psychiatrist uses DSM-5 to ensure the patient’s symptoms meet the diagnostic criteria for schizoaffective disorder, explained the post on the website of the National Library of Medicine. Diagnostic criteria for schizoaffective disorder include uninterrupted duration of illness during which there is a major mood episode (depressive or manic) in addition to criterion A for schizophrenia, the major depressive episode needs to include depressed mood. Criterion A for schizophrenia indicates a person must have at least two of five symptoms present for a significant amount of time during one-month period. At least one of the symptoms should be delusions, hallucinations, or disorganized speech. Other two symptoms are disorganized behavior and negative symptoms.

Diagnostic criteria for schizoaffective disorder also indicate that a patient should have delusions or hallucinations for two or more weeks in the absence of a major mood episode during the entire duration of illness. Additionally, mood episode symptoms should be present for most part of the active or residual phase of the illness.

The symptoms shouldn’t be a result of underlying medical condition or substance abuse.

How to prevent schizoaffective disorder?

It’s impossible to prevent schizoaffective disorder, similar to most other psychotic disorders. However, it is possible to delay the progression of this mental illness and prevent complications that affect a person’s quality of life.

In order to achieve that, a person with symptoms of schizoaffective disorder should see a doctor to get an accurate diagnosis and adhere to a treatment protocol. It also helps to manage stress and reduce disruptions in personal life.

While there is no foolproof prevention method, it could help to seek help to cope with trauma. Avoid drugs and alcohol, especially when at a high risk of developing schizoaffective disorder.

What are the treatments for schizoaffective disorder?

Treatments for the schizoaffective disorder are listed below:

• Medications: patients with the schizoaffective disorder usually receive a prescription for medications that will relieve their symptoms or reduce their intensity. The most common medications prescribed for patients with this disorder are antipsychotics. The only FDA-approved antipsychotic medication for patients with this mental illness is paliperidone (Invega). That said, a doctor may prescribe other types of antipsychotics to tackle hallucinations and delusions. Antipsychotics work by inhibiting dopaminergic transmission in the brain. Paliperidone blocks receptors for both dopamine and serotonin thereby normalizing the activity of the brain. That way, this medication reduces symptoms. Symptoms may improve in a matter of hours or days, but it can take several weeks to experience the best effects.
• Psychotherapy: since medications only work to relieve symptoms, patients with schizoaffective disorder also need therapy. Therapy, such as cognitive-behavioral therapy (CBT), aims to normalize a person’s thought pattern and reduce their symptoms in the process. Patients also understand their condition better and learn to identify unhealthy or negative thoughts to replace them with more realistic alternatives. Therapy also serves for helping patients focus on real-life problems and coping strategies. Individual therapy is the cornerstone of psychotherapy for patients with schizoaffective disorder. Family or group therapy is also helpful. The number of sessions depends on the severity of the symptoms. Patients usually need between 12 and 20 sessions with ongoing booster sessions.
• Hospitalization: not every person with schizoaffective disorder needs hospitalization. A healthcare professional will recommend hospitalization in the presence of severe symptoms. The goal is to prevent self-harm and malnutrition and improve a patient’s level of care.
• Life skills training: since schizoaffective disorder has a major impact on a person’s quality of life, learning social and vocational skills can be helpful. That way, people can help prepare for jobs or learn to function in teams. Persons with jobs learn how to maintain their position and improve productivity. Social and vocational skills training enables a patient to function better at home and work and improves their social life at the same time.

Do schizoaffective disorders have a cure?

No, schizoaffective disorder doesn’t have a cure. While it cannot be eliminated entirely, it’s possible to keep the mental illness under control. In order to manage schizoaffective disorder properly, patients need to follow the treatment program. That means they need to take medications as instructed, attend therapy sessions regularly, manage stress, and make healthy lifestyle choices. As a result, they can significantly improve their quality of life and lower the risk of complications such as hospitalization, the U.S. Pharmacist explains.