Schizoaffective disorder
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| ICD-9 | 295.70 |
|---|
Schizoaffective disorder is a psychiatric diagnosis describing a situation where both the symptoms of mood disorder and psychosis are present. The disorder usually begins in early adulthood, and is more common in women.
There are two sub-types of schizoaffective disorder: the bipolar type type and the depressive type. The bipolar type has a better prognosis than the depressive type, which can have a residual defect with the passing of time. Bipolar schizoaffective disorder is more similar to bipolar disorder than schizophrenia. People with bipolar disorder may also suffer from isolated episodes of psychotic symptoms.
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[edit] Signs and Symptoms
The following are the criteria for a diagnosis of schizoaffective disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):
A. Two (or more) of the following symptoms are present for the majority of a one-month period:
- delusions
- hallucinations
- disorganized speech (e.g., frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms (i.e., affective flattening, alogia, or avolition)
Note: Only one of these symptoms is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
AND at some time there is either a
B. During the same period of illness, there have been delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms.
C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
[edit] Subtypes
Two subtypes of Schizoaffective Disorder may be noted based on the mood component of the disorder:
Bipolar Type - if the disturbance includes
- manic episode
- mixed episode
- manic and major depressive episodes
- mixed and major depressive episode
This subtype applies if a Manic Episode or Mixed Episode is part of the presentation. Major Depressive Episodes may also occur.
Depressive Type - if the disturbance includes major depressive episodes exclusively.
This subtype applies if only Major Depressive Episodes are part of the presentation.
[edit] Etiology & Pathogenesis
Although the causes of schizoaffective disorder are unknown, it is suspected that this diagnosis represents a heterogeneous group of patients, some with atypical forms of schizophrenia and some with very severe forms of mood disorders. There is little evidence for a distinct variety of psychotic illness. It follows then that the etiology is probably identical to that of schizophrenia in some cases or to mood disorders in others.
[edit] Epidemiology
Estimates of the prevalence of schizoaffective disorder vary widely, but schizoaffective manic patients appear to comprise 3-5% of psychiatric admissions to typical clinical centers. At one point it was widely believed that schizoaffective disorder was associated with increased risk of mood disorders in relatives. This may have been because of the number of patients with psychotic mood disorders who were included in schizoaffective study populations. The current diagnostic criteria define a group of patients with a mixed genetic picture. They are more likely to have schizophrenic relatives than patients with mood disorders but more likely to have relatives with mood disorders than schizophrenic patients.
[edit] Treatment
The psychiatric treatment for schizoaffective disorder is a combination of therapy and medicine. A licensed psychiatrist will prescribe different combinations of medicine to the patient in order to find the combination that works. Each person responds differently to medicine.
Common medicines prescribed to treat schizoaffective disorder:
Combining lithium, carbamazepine, or valproate with a neuroleptic has been shown to be superior to neuroleptics alone in schizoaffective patients with manic symptoms. The degree of benefit for an individual patient should be considered carefully, as each of these agents carries an additional set of risks. Lithium-neuroleptic combinations may produce severe extrapyramidal reactions or confusion in some patients. Carbamazepine or valproate are frequently employed when lithium is not effective or well tolerated. Granulocytopenia can occur during the first few weeks of carbamazepine treatment, and neuroleptic blood levels may be increased substantially due to hepatic enzyme induction. Valproate can cause liver toxicity and platelet dysfunction, although those problems are uncommon. More recently, the anticonvulsants lamotrigine and gabapentin have shown promise in the treatment of manic symptoms, although there have been no systematic studies of their use in schizoaffective disorder at this time. Calcium channel blockers such as verapamil may also be an effective treatment for manic symptoms but are seldom prescribed for that purpose. Benzodiazepines such as lorazepam and clonazepam are effective adjunctive treatment agents for acute manic symptoms, but long-term use may result in dependency.
Often a sleeping pill will initially be prescribed to allow the patient rest from his or her anxiety or hallucinations.
[edit] Cannabis
In addition to pharmaceutical medications, some who suffer from schizoaffective disorder have claimed to benefit from medicinal marijuana (cannabis). This claim, however, has not been substantiated by clinical trials and there is no available clinical literature on effective dosage levels.[1] Additionally, psychiatrists report that with patients who are heavy cannabis users, it is often difficult to separate the symptoms of the disorder from those due to the cannabis.[2]
[edit] Expectations (prognosis)
People with schizoaffective disorder have a greater chance of returning to a previous level of functioning than patients with other psychotic disorders. However, long-term treatment may be necessary and individual outcomes will vary.
[edit] Complications
Complications are similar to those for schizophrenia and major mood disorders. These include:
- Problems following medical treatment and therapy
- Abuse of drugs in an attempt to self-medicate
- Problems resulting from manic behavior (for example, spending sprees, sexual indiscretions)
- Suicidal behavior due to depressive or psychotic symptoms
[edit] See also
[edit] Sources
[edit] References
Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:126-127.
Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 48.
