Schizoaffective disorder
Schizoaffective disorder (SZA, SZD) is a mental disorder characterized by abnormal thought processes and an unstable mood.[4][5] This diagnosis requires symptoms of both schizophrenia (psychosis) and a mood disorder: either bipolar disorder or depression.[4][5] The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms.[5] Schizoaffective disorder can often be misdiagnosed[5] when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. many people with schizoaffective disorder have other mental disorder including anxiety disorders[5][6]
Schizoaffective disorder
- harm to self or other, social isolation, cognitive issues
16–30 years of age
Unknown[3]
- Genetics
- brain chemistry and structure
- stress
- drug use[3]
- Psychotic depression
- bipolar disorder with psychotic features
- schizophreniform disorder
- schizophrenia
Depends on the individual, medication response, and therapeutic support available
0.3%
There are three forms of schizoaffective disorder: bipolar (or manic) type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).[4][5][7] Common symptoms include hallucinations, delusions, and disorganized speech and thinking.[8] Auditory hallucinations, or "hearing voices", are most common.[9][10] The onset of symptoms usually begins in adolescence or young adulthood.[11] On a ranking scale of symptom progression relating to the schizophrenic spectrum, schizoaffective disorder falls between mood disorders and schizophrenia in regards to severity.[12]
Genetics (researched in the field of genomics); problems with neural circuits; chronic early, and chronic or short-term current environmental stress appear to be important causal factors.[13][14][15] No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of tetrahydrobiopterin (BH4), dopamine, and glutamic acid in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.[16]
While a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,[17] it is considered a common diagnosis among psychiatric disorders.[18] Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them.
The main current treatment is antipsychotic medication combined with either or both of mood stabilizers and antidepressants. There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder. When there is risk to self or others, usually early in treatment, hospitalization may be necessary.[19] Psychiatric rehabilitation, psychotherapy, and vocational rehabilitation are very important for recovery of higher psychosocial function. As a group, people diagnosed with schizoaffective disorder using DSM-IV and ICD-10 criteria (which have since been updated) have a better outcome,[4][5] but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.[5][20] Outcomes for people with DSM-5 diagnosed schizoaffective disorder depend on data from prospective cohort studies, which have not been completed yet.[5] The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;[19] that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV prevalence estimates were less than one percent of the population, in the range of 0.5–0.8 percent;[21] newer DSM-5 prevalence estimates are not yet available.
Signs and symptoms[edit]
Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder.[5] Psychosis must meet criterion A for schizophrenia which may include delusions, hallucinations, disorganized speech and behavior and negative symptoms.[5] Both delusions and hallucinations are classic symptoms of psychosis.[22] Delusions are false beliefs which are strongly held despite evidence to the contrary.[22] Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although auditory hallucinations (or "hearing voices") are the most common. Negative symptoms include alogia (lack of speech), blunted affect (reduced intensity of outward emotional expression), avolition (lack of motivation), and anhedonia (inability to experience pleasure).[22] Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.
Mood symptoms are of mania, hypomania, mixed episode, or depression, and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.[22] Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and suicidal thinking.
DSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.[4]
Mechanisms[edit]
Though the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.[37] White matter and grey matter reductions in the right lentiform nucleus, left superior temporal gyrus, and right precuneus, and other areas in the brain are also characteristic of schizoaffective disorder.[37][38] Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.[38] Due to its role in emotional regulation, researchers believe that the hippocampus is also involved in the progression of schizoaffective disorder.[39] Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.[39] Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.[37]
Epidemiology[edit]
Compared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.[88] Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.[89] 30% of cases occur between the ages of 25 and 35.[90] It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.[91] Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.[11][92]