Mental Health Conditions

Schizoaffective Disorder

Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.

Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia. Because schizoaffective disorder is less well-studied than the other two conditions, many interventions are borrowed from their treatment approaches. 

Schizoaffective is relatively rare, with a lifetime prevalence of only 0.3%. Men and women experience schizoaffective disorder at the same rate, but men often develop the illness at an earlier age. Schizoaffective disorder can be managed effectively with medication and therapy. Co-occurring substance use disorders are a serious risk and require integrated treatment.

Symptoms

The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:

  • Hallucinations, which are seeing or hearing things that aren’t there.
  • Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence.
  • Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated.
  • Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression.
  • Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.

Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.

  • Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.
  • Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.
  • Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.
  • Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.

Diagnosis

Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: bipolar type and depressive type. To be diagnosed with schizoaffective disorder a person must have the following symptoms.

  • A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.
  • Delusions or hallucinations for two or more weeks in the absence of a major mood episode.
  • Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the illness.
  • The abuse of drugs or a medication are not responsible for the symptoms.

Treatment

Schizoaffective disorder is treated and managed in several ways:

  • Medications, including mood stabilizers, antipsychotic medications and antidepressants
  • Psychotherapy, such as cognitive behavioral therapy or family-focused therapy
  • Self-management strategies and education

Related Conditions

A person with schizoaffective disorder may have additional mental health conditions:

People with schizoaffective disorder are often treated with a combination of medications and psychotherapy. How well treatment works depends on the type of schizoaffective disorder, its severity and its duration.

Medications

Doctors and other mental health professionals will often prescribe medications to relieve symptoms of psychosis, stabilize mood and treat depression. The only medication approved by the FDA to treat schizoaffective disorder is the antipsychotic drug paliperidone (Invega).

However, some medications approved for the treatment of other mental health conditions may be helpful for schizoaffective disorder. These medications include:

  • Antipsychotics. A health care provider will prescribe antipsychotics to relieve symptoms of psychosis, such as delusions and hallucinations.
  • Antidepressants. When schizoaffective disorder is depressive-type antidepressants can alleviate feelings of sadness, despair and trouble concentrating.
  • Mood stabilizers. When bipolar disorder is the underlying mood disorder, mood stabilizers can help stabilize the highs and lows.

Psychotherapy

Family involvement, psychosocial strategies, self-care peer support, psychotherapy and integrated care for co-occurring substance use disorders can all be part of an individual support plan.

  • Cognitive behavioral therapy (CBT) helps change the negative thinking and behavior associated with feelings of depression. The goal of this therapy is to recognize negative thoughts and to teach coping strategies. With conditions like schizoaffective disorder that have symptoms of psychosis, additional cognitive therapy is added to basic CBT (CBTp). CBTp helps people develop coping strategies for persistent symptoms that do not respond to medicine.

Alternative Treatment Options

For cases where medication and psychotherapy do not work for a person with schizoaffective disorder, ECT may be worth considering. ECT involves transmitting short electrical impulses into the brain. Although ECT is a highly effective treatment for severe depression, it is not the first choice in treating schizoaffective disorder.

Cultural Considerations

Research has shown that African Americans and Latinos are more likely to be misdiagnosed with schizoaffective disorder, so people who have been diagnosed should make sure that their mental health professional understands their background and shares their expectations for treatment.

If you or a family member or friend is struggling with schizoaffective disorder, there is help. NAMI is there to provide you with support for you and your family and information about community resources.

Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org if you have any questions about schizoaffective disorder or finding support and resources.

Helping Yourself

If you have schizoaffective disorder, the condition can control your thoughts, interfere with relationships and if not treated, lead to a crisis. Here are some ways to help manage your illness.

Pinpoint your stressors and triggers. Are there specific times when you find yourself stressed? People, places, jobs, and even holidays can play a big role in your mood stability. Symptoms of mania and depression may start slow, but addressing them early can prevent a serious episode. Feelings of mania may feel good at first, but they can spiral into dangerous behavior such as reckless driving, violence or hypersexuality. Depression may begin with feeling tired and being unable to sleep.

Avoid drugs and alcohol. Substance use can disturb emotional balance and interact with medications. Both depression and mania make drugs and alcohol attractive options to help you “slow down” or “perk up,” but the potential damage can block your recovery.

Establish a routine. Committing to a routine can help you take control and help prevent depression and mania from taking control. For example, to keep the energy changes caused by depression and mania in check, commit to being in bed only eight hours a night and up and moving the rest of the time.

Form healthy relationships. Relationships can help stabilize your moods. An outgoing friend might encourage you to get involved with social activities and lift your mood. A more relaxed friend may provide you with a steady calm that can help keep feelings of mania under control.

Self-management strategies and education. Learning strategies to manage the symptoms of your disorder are critical. Coping strategies may also include work-and-school rehabilitation and social skills training. 

If you live with a mental health condition, learn more about managing your mental health and finding the support you need.

Helping A Family Member Or Friend

Recognize early symptoms. You may be able to prevent a serious episode of the illness before it happens. Symptoms of mania and depression often have warning signs. The beginnings of mania typically feel good and that means your family member may not want to seek help. Identify signals such as lack of sleep and speaking quickly that signal impending mania. A deep depression often only begins with a low mood, feeling fatigued or having trouble sleeping.

Communicate. Not everyone enjoys confronting problems head on, but doing so is critical to healthy communication. Make time to talk about problems, but know that not just any time is right. For example, if your family member has bipolar II and becomes angry, it might be safe to try and talk through the situation. But if your friend with bipolar I becomes angry, your reaction may need to be different. It’s more likely that this anger will turn to rage and become dangerous, including physical violence.

React calmly and rationally. Even in situations where your family member or friend may “go off,” ranting at you or others, it’s important to remain calm. Listen to them and make them feel understood, then try to work toward a positive outcome.

NAMI’s Family-to-Family support groups. These groups can increase family and community support. Peer support and connection can also be valuable to people with the disorder and their families.