What Are Schizoaffective Disorders, and What Causes Them?
Schizoaffective disorder is listed in the category of Schizophrenia Spectrum and Other Psychotic Disorders by the American Psychiatric Association (APA).
Psychotic disorders are generally identified by the presence of a severe loss of reality. These disorders most often present with a number of different types of hallucinations (where the person either sees, hears, or otherwise senses things that are not really there, such as people, voices, etc.) or delusions (very fixed false beliefs that are extreme).
What Is Schizoaffective Disorder?
Schizoaffective disorder is a chronic psychiatric disorder that is differentiated from schizophrenia by having both the presence of psychotic behavior (hallucinations and/or delusions) and symptoms of either major depressive disorder or bipolar disorder.
According to APA, the disorder is diagnosed when:
- The individual has an uninterrupted period where they present with symptoms of a major depressive disorder (must have depressed mood) and/or mania along with the presence of schizophrenic symptoms, including delusions, hallucinations, disorganized speech, disorganized behavior, or negative symptoms, such as a lack of emotional expression or lack of motivation.
- The person must also have delusions or hallucinations that occur for a period of two or more weeks without depression or mania at some point.
- The depression or mania is present for the majority of the duration of the illness.
- The individual’s symptoms cannot be better explained by drug abuse, some other mental health disorder (e.g., schizophrenia), and/or a medical condition, such as a stroke.
Schizoaffective disorder is a disorder that is not well understood because of its mix of different types of symptoms. The disorder often occurs in cycles of very severe symptoms followed by cycles of more improved functioning. Some other accompanying symptoms include:
- Marked fluctuations in energy level
- Marked fluctuations in appetite
- Periods of paying very poor attention to personal hygiene
- Periods where the individual appears to have difficulty concentrating or maintaining focus
- Periods where the individual becomes very isolated
Individuals are given a subtype diagnosis, such that if they present with psychotic behavior and major depression, they are diagnosed with schizoaffective disorder depressed type; or if they present with manic behavior in addition to the psychotic behavior, they are diagnosed with schizoaffective disorder bipolar type.
Like most of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, there are no formal medical tests or biological signs that can be used to diagnose schizoaffective disorder. Instead, mental health workers take a full history of the individual and ascertain their symptoms from the report of the individual and friends or family members. The diagnosis is made according to the findings of a number of different interviews and ancillary tests, such as self-report surveys, questionnaires, personality inventories, etc., if they are used.
Individuals with this disorder often have a number of functional issues, including difficulty holding down a job, difficulty maintaining relationships, and a tendency to remain isolated and have very few friends. These individuals are often viewed as moody and odd by others, and they just cannot seem to fit in.
The disorder is extremely rare. It is believed to occur in less than one-third of a percent of individuals in the United States.
Schizoaffective disorder is typically first diagnosed in late adolescence or early adulthood. According to a recent article in the journal Bipolar Disorders, there are a number of different presentations of the disorder, but typically, individuals who are eventually diagnosed with schizoaffective disorder first have auditory hallucinations and delusions of persecution (false beliefs that they are being persecuted or targeted by others) around two months before they begin to experience depression. Then, individuals will typically experience the psychotic disorder symptoms and the depression together for a period of around three months. Because depressive symptoms often wax and wane, individuals will often recover from the depressive symptoms, but the psychotic symptoms may remain.
For many individuals, this cycle of psychosis, psychosis and depression, followed by psychosis alone will last about six months. However, depressive or manic symptoms can occur before the psychosis, during the psychosis, or even afterward. The outcome for individuals diagnosed with this disorder is a little bit better than it is for individuals diagnosed with schizophrenia.
As mentioned above, schizoaffective disorder is a bit of an enigma to mental health researchers. There is not quite as much information on this disorder as there is on other disorders, such as schizophrenia, bipolar disorder, and major depressive disorder. The cause of schizoaffective disorder has not been identified. Like most of the psychiatric/psychological disorders listed in the DSM series, the causes of these disorders are most likely due to a combination of the following:
- Genetic factors: Schizoaffective disorder, like most mental health disorders, tends to run in families. Having a first-degree relative with the disorder increases the risk that one will develop it; however, there is no guarantee that one will develop the disorder. In addition, people who have first-degree relatives diagnosed with schizophrenia or bipolar disorder also appear to be at a greater risk to develop schizoaffective disorder; however, again, there is no guarantee that this will happen.
- Neuroanatomical factors: As is the case with most of the mental health disorders that are identified by APA, there is probably a relationship between an individual’s neuroanatomy and brain functioning, and the development of the disorder. However, there are no reliable identified differences in brain structure that can be used to diagnose schizoaffective disorder in anyone.
- Environmental factors: Environmental factors probably interact with heredity and other factors to increase the probability of developing the disorder. For instance, individuals who experience early stressors, such as the loss of a parent or abuse, are at a greater risk to develop any mental health disorder; however, experiencing trauma or stress is no guarantee that anyone will develop any type of mental health disorder.
- Substance abuse: Interestingly, there is a link between the use of certain hallucinogenic drugs, such as LSD, and the diagnosis of schizoaffective disorder. It is not understood if this relationship is causal, such that using these drugs results in an individual being more likely to develop schizoaffective disorder or if individuals who actually have schizoaffective disorder are more likely to use this type of drug.
Schizoaffective disorder is most likely caused by the interaction of inherent factors, such as genetics, brain chemistry, etc., and environmental factors, such as stress and other personal experiences.
Even though there may be a link between the use of certain hallucinogenic drugs and the development of schizoaffective disorder, it is also established that individuals who have schizoaffective disorder are prone to the development of substance use disorders, particularly alcohol use disorders.
Treating Schizoaffective Disorders
The treatment of schizoaffective disorder typically follows three combined interventions that include:
- Medications: When a person is diagnosed with schizoaffective disorder, they are typically placed on appropriate medications given their symptom presentation. Most often, this may include a mood stabilizer for individuals who present with mania, antidepressant medications for individuals who present with depression, and antipsychotic drugs for the hallucinations and delusions that often occur in the disorder.
- Psychotherapy: Psychotherapy can be useful in helping individuals with depression to learn coping strategies, in assisting individuals with manic symptoms to adhere to medication treatment strategies, and in assisting in the treatment of psychotic symptoms and helping an individual adjust. Psychotherapy is typically not a standalone treatment for schizoaffective disorder in the same way that it is typically not considered to be a standalone treatment for schizophrenia. Psychotherapy helps individuals adhere to medical treatment regimes, learn strategies for adjustment, and assists them in dealing with issues like stress that can exacerbate their symptoms. Often, individuals with schizoaffective disorder can benefit from family therapy and other forms of group therapy.
- Psychoeducation: Because of the mix of symptoms that individuals with schizoaffective disorder often experience, basic educational interventions can assist these individuals to better identify the pre-existing conditions that may signal the approach of certain types of symptoms, such as depression, mania, or psychotic symptoms. In addition, psychoeducation develops a solid foundation for an individual to be able to adhere to treatment and to request additional interventions when necessary. For example, individuals with co-occurring schizoaffective disorder and substance use disorders can learn to recognize the symptoms of a substance use disorder and request additional intervention for that.
The best course of action that one should use if they suspect a loved one may be suffering from a psychotic disorder, such as schizoaffective disorder, is to immediately get the person to a licensed mental health professional, such as a psychiatrist, psychologist, or social worker, and have a full assessment performed on the individual. The assessment should include a physical examination performed by a physician in order to rule out potential medical conditions that might be producing the behaviors of concern.
Show the person concern, care, and genuine empathy regarding their experiences. For instance, if someone says they are hearing voices, this does not automatically mean that the person has a psychotic disorder. It is important to inquire about how the person is feeling and then gently convince them that they need to see someone to discuss these feeling and experiences. Cases where individuals are extremely suspicious or even paranoid may require more firm approaches to persuade them to see a mental health professional. When in doubt, call a local psychiatrist, community mental health center, or other treatment resource that can assist.