Schizoaffective Disorder

Its's true that in medicine there are many names for different conditions that sound very similar and this can be confusing. One of the more confusing and even controversial disorders in the field of psychiatry is schizoaffective disorder.

Although it sounds similar and even shares some sypmtoms, this is not the same thing as schizophrenia.

Schizoaffective disorder is characterized by both mood symptoms and psychotic symptoms. Individuals with this condition experience psychotic hallmarks such as hallucinations and delusions, but they also experience mood symptoms like depression or mania.

What distinguishes this disorder from conditions like bipolar disorder (which can also have both psychotic and mood symptoms), is that in schizoaffective disorder the psychotic symptoms persist even after the mood has stabilized. These individuals need to continue taking an antipsychotic medication as well as mood stabilizing treatment.

Many individuals with schizoaffective disorder are first diagnosed with bipolar disorder or schizophrenia because of the similarities between the conditions. However, bipolar disorder is only the correct diagnosis if the person's delusions or hallucinations go away once the mood has returned to normal. The diagnosis therefore requires assessment of the course of the illness and not just the symptoms at one point in time.

This means that at the time of the first episode it would actually be impossible to make the correct diagnosis. The diagnosis requires observation over time. If psychotic symptoms continue, a diagnosis of schizoaffective disorder may be appropriate.

Misdiagnosis is common with this complicated and controversial disorder and some psychiatrists even question the existence of this as a separate disorder. The debate is not helped by the relatively little amount of research available on this specific illness. What we know comes mainly from clinical experience and from the application of research findings from schizophrenia and bipolar disorder.

In practical terms, however, there are patients who appear very much like bipolar patients but in whom psychotic symptoms recur in the absence of either mania or depression and who therefore require ongoing antipsychotic medication, which is not usually typical in bipolar patients. If onoly antipsychotic medication is used they will get recurrent depression taht requires an antidepressant and may respond to antidepressants with mania.

The prognosis of individuals being treated for schizoaffective disorder is generally a little more positive than for schizophrenia, but not quite as positive as for bipolar disorder.

It is important to be aware of these distinctions because they have practical consequences in terms of what to expect with respect to prognosis and required treatment.

A better understanding of why some people have this combination of symptoms will likely not be possible until the genetics of all three disorders have been elucidated. We already know that there is some overlap in the genes responsible for schizophrenia and bipolar disorder. In the meantime, we will continue to rely on careful observation and history taking, which have always been the cornerstones of diagnosis in psychiatry.


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