Schizoaffective Disorder

Q: What is schizoaffective disorder?

A: Schizoaffective disorder is an illness in which there

are both severe mood swings (mania and/or depression),

and some of the psychotic symptoms of schizophrenia.

Most of the time mania or depression mix with psychotic

symptoms, but there must be at least one two-week period in

which there are only psychotic symptoms without any symptoms of

mania or depression.

Many individuals with schizoaffective disorder are originally diagnosed

with manic depression. If the person experiences delusions or

hallucinations that go away in less than two weeks when the mood

is "normal," bipolar disorder may be the proper diagnosis. Someone who

experiences psychosis for three or four weeks while in a manic phase does

not have schizoaffective disorder.

However, if delusions or hallucinations continue after the mood has

stabilized and are accompanied by other symptoms of schizophrenia such as

catatonia, paranoia, bizarre behavior, or thought disorders, a diagnosis of

schizoaffective disorder may be appropriate. Accurate diagnosis is easier

once the acute psychotic episode is under control.

Distinguishing between bipolar disorder and schizophrenia can be

particularly difficult in an adolescent, since at that age psychotic

features are especially common during manic periods.

Because schizoaffective disorder is so complicated, misdiagnosis is common.

Some people may be misdiagnosed as having schizophrenia. Others may be

misdiagnosed as having bipolar disorder. And those diagnosed as having

schizoaffective disorder may actually have schizophrenia with prominent mood

symptoms. Or they may have a mood disorder with symptoms similar to those of

schizophrenia.

Schizophrenia is also not a "split personality." It also is not caused by

bad upbringing, personal weakness, or laziness. Schizophrenia is a disease

with a physical cause, like cancer or heart disease.

Q: What are the symptoms of schizoaffective disorder?

A: People with schizophrenia can have a variety of symptoms.

Sometimes, these symptoms come on suddenly. Usually, though, the illness

develops slowly over months or even years. At first, the symptoms may not be

noticed or may be confused with those of other conditions. For example,

people with schizophrenia may feel tense, be unable to concentrate, or have

trouble sleeping. They often become increasingly isolated and withdrawn as

their grip on reality loosens. They do not make or keep friends. They may

stop caring about the way they look. Dropping out of school or doing badly

at work are other early signs of schizophrenia.

As the illness progresses, symptoms of psychosis develop. The person starts

to act strangely and talk nonsensically. People with schizophrenia may

develop hallucinations; that is they may see, feel, smell, or hear things

that are not really there. They may have physical symptoms, like frowning or

unusual movements, and may stand or sit in strange positions. Some people

become almost motionless. Others move around constantly.

The severity of symptoms varies from one person to another. The symptoms

also tend to worsen and improve. When the symptoms are improved, the person

may appear to behave relatively normally, but usually there will be repeated

episodes of the illness (relapses) that will cause symptoms to reappear.

During the depressed state the following symptoms may be present:

poor appetite, weight loss, insomnia, agitation, general slowing down,

loss of interest in usual activities, lack of energy or fatigue, feelings of

worthlessness, self-reproach, guilt, inability to think or concentrate,

or thoughts of death or suicide.

During the manic state the following symptoms may occur:

increase in social, work or sexual activity, increased talking,

rapid or racing thoughts, grandiosity, little need for sleep, agitation, inflated

self-esteem, distractibility and self-destructive activities.

Psychotic symptoms may include delusions, hallucinations, incoherence,

disorganized speech or thinking, grossly disorganized behavior, total immobility,

or lack of facial expression, speech or motivation.

Q: What causes schizoaffective disorder?

A: The cause is unknown, but we think it stems from a mixture of biological,

genetic and environmental factors.

Even the experts are not sure exactly what causes it. Some doctors think

that the brain may not be able to process information correctly. In the next

section, we will discuss some of the structural and chemical abnormalities

that cause the brains of people with schizophrenia to get overloaded by too

much information from the outside world. People without schizophrenia

usually filter out unneeded information: for example, the sound of a train

whistle in the background or a dog barking next door. People with

schizophrenia, however, cannot always filter out this extra information.

One possible cause of schizophrenia may be heredity, or genetics. Experts

think that some people inherit a tendency to schizophrenia. In fact, the

disorder tends to "run" in families, but only among blood relatives.

People who have family members with schizophrenia may be more likely to get

the disease themselves. If both biologic parents have schizophrenia, there

is nearly a 40% chance that their child will get it, too. This happens even

if the child is adopted and raised by mentally healthy adults. In people who

have an identical twin with schizophrenia, the chance of schizophrenia

developing is almost 50%.

In contrast, children whose biologic parents are mentally healthy - even if

their adoptive parents have schizophrenia - have about a 1% chance of

getting the disease. That is about the same risk as for the general

population shown below.

General population 1%

Brother or sister has schizophrenia 8%

One parent has schizophrenia 12%

Fraternal twin has schizophrenia 14%

Both parents have schizophrenia 39%

Identical twin has schizophrenia 47%

Schizophrenia is not passed on directly, like eye or hair color. Other

conditions are necessary because other factors are involved. Otherwise,

schizophrenia would always develop in both identical twins, since they have

the same heredity.

Some researchers believe that events in a person' environment trigger

schizophrenia. Some studies have shown that influenza infection or

improper nutrition during pregnancy and complications during birth may

increase the risk that the baby will develop schizophrenia later in life.

Many researchers believe schizophrenia is likely caused by a complex

combination of gene and environmental factors. Certain people are born with

a tendency to develop the disease. But the disease only appears if these

people are exposed to unusual stresses or traumas.

Q: What happens to people with schizoaffective disorder?

A: Schizoaffective disorder is a lifelong illness for most people. The exact

course of the illness varies from person to person, but most people have a

flare-up of symptoms periodically in times of stress. These periods of

increased symptoms are called relapses. They may be severe enough

to limit functioning and may make hospitalization necessary. After a relapse,

there is usually a gradual return to the prior level of functioning.

Between relapses, most people have mild, if any, symptoms.

People with schizophrenia may have a chemical imbalance in the brain. They

may either be very sensitive to or produce too much of a substance called

dopamine. Dopamine is one of several brain chemicals (neurotransmitters)

that allow nerve cells to send messages to each other. Researchers have

found several types of dopamine receptors in different parts of the brain.

Other neurotransmitters and their receptors also may be affected in people

with schizophrenia.

Researchers have used modern techniques to show the differences between

the brains of people with schizophrenia and those of mentally healthy

people. Specialized tests that produce images (scans) of the inside of the

brain show differences in the size and shape of certain brain structures in

people with schizophrenia compared with those of mentally healthy people.

For example, in people with schizophrenia, there is enlargement of the fluid-

filled cavities of the brain called ventricles. Similarly, there is a

decrease in the size of the part called the hippocampus. Other tests have

shown that in the brains of people with schizophrenia there is less activity

in the prefrontal cortex, the part of the brain that governs thought and

higher mental functions.

Q: What is the treatment of schizoaffective disorder?

A: Treatment usually consists of therapy, medicine and skills training.

The medicines used to treat schizoaffective disorder include antipsychotic

medicines, antidepressants, and/or mood stabilizers. Often several

medicines are combined to get the best results. Psychiatrists often

treat this disorder with an anti-psychotic medication and lithium, or with

carbamazepine (an anticonvulsant medication) and lithium.

As a practical matter, differentiating between schizophrenia, bipolar

disorder, and schizoaffective disorder is not absolutely critical, since

antipsychotic medication is recommended for all three. If a mood problem is

suspected, lithium or an antidepressant should be added. Therapy is most

helpful when the patient and therapist work together to learn about the

illness, to establish and work on the patient's goals, and to manage

everyday problems. Skills training may focus on social skills, grooming and

hygiene, managing money, grocery shopping, looking for a job, cooking, and so on.

Q: What can I do to make the best possible recovery?

A: Accept that you have a prolonged illness. Identify your strengths and

limitations. Make clear, realistic goals. After a relapse, go slowly and

gradually back to your responsibilities. Plan a regular, consistent, predictable

daily routine. Make your home as quiet, calm and relaxed as you can.

Identify and reduce stress. Make only one change in your life at a time.

Work toward an active and trusting relationship with the staff involved in your

care. Take your medicines regularly, as prescribed. Identify early signs of

relapse. Make your own early warning list. Get involved with a group of people

you feel comfortable with. Avoid street drugs. Whether or not you drink

alcohol is a very personal decision you should make with your prescriber.

Eat a well-balanced diet. Get enough rest. Get regular exercise. If

you're not sure whether your feelings or fears are based in reality,

ask someone you trust or compare your behavior with others. Accept that

there may be setbacks from time to time.

Q: Once the symptoms are in control, what can I do to help

keep them in control?

A: During a well period, the patient and therapist should make a written

plan for what to do if signs of relapse appear. A friend or family member

can also be involved.

The plan should include:

Specific warning signs of relapse.

Calling the therapist right away when warning signs of relapse appear.

Notifying friends and family who can help limit stress and stimulation.

Specific ways to decrease stress and stimulation and increase structure.

Q: Where can I learn more about this illness?

A: There are some written materials about schizoaffective disorder

and its treatment, and several organizations that provide support, advice

and information. Your nurse can give you a list of these resources.

For information or referral, call 1-888-694-5700

To keep up with the latest advances in schizophrenia call 1-800-829-8289

and leave your name and mailing address.