| Schizoaffective disorder is a combination of a thought disorder, mood disorder, and anxiety disorder characterized by features of both schizophrenia and a significant emotional disturbance resembling either major depression (depressive type) or mania (bipolar type). The psychotic aspects (fixed, untrue beliefs [delusions]), hearing voices or seeing visions (hallucinations), disorganized speech, disorganized behavior, or severely diminished emotions, speech, or activity are present continuously, with the mood disturbance present for a significant portion of that time.
Manic episodes are associated with sudden elation, euphoria, or extreme irritability. Depressive episodes are characterized by sadness, feeling worthless or hopeless, loss of pleasure and interest in life with thoughts of death or suicide attempts. With this illness there is often impairment of occupational and social functioning and basic self-care.
For a diagnosis of schizoeffective disorder, DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision) criteria require an uninterrupted period of illness with symptoms meeting criterion for schizophrenia (2 or more of the following): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as flat or bland emotional affect. During that time, delusions or hallucinations must be present for at least 2 weeks in the absence of prominent mood symptoms. At some time during the illness, there must be either a major depressive episode, manic episode, or mixed episode meeting DSM-IV-TR criteria as described. Symptoms must not be due to the direct effects of a substance such as drugs or alcohol or a general medical condition such as endocrine disease.Risk: Onset can be any at age from adolescence onward. Schizoaffective disorder affects more women than men. Incidence and Prevalence: Schizoaffective disorder has a prevalence of approximately 0.5% to 0.8%, which is based on approximations since no real studies have been conducted (Brannon). It is difficult to estimate international prevalence because of changes in what features need to be present to make that diagnosis; however, it is thought to be from 2% to 2.9% (Brannon). |
Source: Medical Disability Advisor
| History: Individual has a continuous illness with psychotic features combined with an emotional disturbance (mania, major depression or mixed episode) present for a significant part of the overall illness. Delusions or hallucinations are noted for at least 2 weeks, separate and distinct from the mood disturbance. A typical history consists of hearing voices for 2 months, becoming severely depressed for the next 3 months while still hearing the voices, then recovering from depression but continuing to have auditory hallucinations. Physical exam: The exam does not contribute significantly to the diagnosis other than to rule out neurological abnormalities that may suggest another diagnosis. Some individuals with this disorder may have abnormal eye movements (optokinetic nystagmus) when asked to count the stripes on a rotating drum or cloth moved before the eyes. Observation of the individual's orientation, attire, mannerisms, behavior, and content of speech provide essential signs to diagnose the illness. Tests: Tests are not needed to establish this diagnosis, although personality testing such as the Minnesota Multiphasic Personality Inventory (MMPI or MMPI-2) may be helpful. Other laboratory tests that may be helpful include urinalysis; complete blood count; thyroid function test; urine toxicology screen; rapid plasma reagin (RPR), a test for syphilis; and an EEG. A head CT or MRI maybe helpful to rule out any brain lesions. |
Source: Medical Disability Advisor
| During the acute psychotic episodes, psychiatric hospitalization is often needed to protect individuals from their own loss of reality, judgment, and impulse control. The manic (bipolar) type of schizoaffective disorder is treated with antipsychotic medications and mood stabilizers such as lithium. With the depressive form of schizoaffective disorder, antidepressant medications and antipsychotics are given. As very few individuals with schizoaffective disorder tend to remain on their oral medications after the first year of treatment, long-acting antipsychotics given by injections deep into the muscle, spaced 2 to 4 weeks apart are often needed.
Benzodiazepines may also be given for anxiety and insomnia in the acute stages. Anti-parkinsonian drugs are commonly given to treat side effects of the traditional antipsychotic drugs but are rarely needed with the newer antipsychotic agents. Shock therapy (electroconvulsive therapy) is rarely used and is not generally effective.
Psychotherapy and strengthening of family, social, and occupational support is useful. Social and occupational rehabilitation therapy may help overcome the unemployment, homelessness, and poverty often associated with this disorder. Step-down treatment after hospitalization may include day treatment and residing in a halfway house. |
Source: Medical Disability Advisor
| Outcome is highly variable. The illness may later evolve into schizophrenia, bipolar disorder, or major depression. |
Source: Medical Disability Advisor
| There is an increased risk of suicide during depressive episodes. Alcohol and drug abuse can occur. Break with reality secondary to psychotic symptoms can lead to accidental injury, death, homicide, or injury to others. Poor impulse control and lack of judgment during manic episodes may lead to loss of employment, financial or legal problems, divorce, or other problems in society and relationships. |
Source: Medical Disability Advisor
| Temporary work accommodations may include reducing or eliminating activities where the safety of self or others is contingent upon a constant and/or high level of alertness, such as driving a motor vehicle, operating complex machinery, or handling dangerous chemicals; introducing the individual to new or stressful situations gradually under individually appropriate supervision; allowing some flexibility in scheduling to attend therapy appointments (which normally should occur during the employee's personal time); promoting proactive management of identified problem areas; and offering timely feedback on job performance issues. It will be helpful if accommodations are documented in a written plan designed to promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has a diagnosis of schizoaffective disorder been confirmed?
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Have conditions with similar symptoms been ruled out?
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Have conditions directly due to physiological effects of a substance or general medical conditions been identified or ruled out?
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If diagnostic criteria for schizoaffective disorder dictates that the illness has a mixture of both schizophrenia and bipolar disorder symptoms, does individual's diagnosis need to be readdressed?
Regarding treatment:
- Has drug therapy, including antidepressants and lithium, been effective?
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Were antipsychotic (neuroleptic) drugs used while the individual was in a psychotic state? With what response?
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If antipsychotic drugs are causing unpleasant side effects, what alternatives exist?
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Can individual change medications at this point in treatment?
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What long-term therapy regime has physician planned for this individual?
Regarding prognosis:
- If experiencing acute psychotic episodes, is psychiatric hospitalization warranted to protect the individual loss of reality, judgment, and impulse control?
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Would individual benefit from supervised step-down treatment after hospitalization, such as day treatment or residing in a halfway house?
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What is individual's current level of occupational functioning?
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To what extent is social dysfunction obvious?
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Is individual having trouble communicating with co-workers or other family members?
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Is individual experiencing difficulties with self-care such as cooking and personal grooming?
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Is individual demonstrating increased risk of suicide?
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Is rehabilitation focused on helping individual regain confidence for self-care and living a fuller life? What more can be done to meet these needs?
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Does individual have an effective support system in place?
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Is individual and/or family involved in a psychotherapy experience that helps both individual and family members better understand this illness and share coping problems?
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Source: Medical Disability Advisor
| Brannon, Guy E. "Schizoaffective Disorder." eMedicine. Eds. Ronald C. Albucher, et al. 17 Jun. 2004. Medscape. 28 Dec. 2004 <http://emedicine.com/med/topic/3514.htm>.Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor
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