Schizoaffective Disorder
Schizoaffective Disorder
Table of Contents
Most people are familiar with the term schizophrenia, but many people have never heard of schizoaffective disorder. Though the two disorders sound alike and can be mistaken for each other, they’re not the same illness.
What is Schizoaffective Disorder?
Schizoaffective disorder (SZA) is a chronic psychiatric illness consisting of symptoms similar to schizophrenia and mood disorders — mania, depression, hallucinations, and delusions. Misdiagnosis occurs often because SZA shares the same symptoms as other mental health conditions. There are two types of schizoaffective disorder:1
Bipolar Type
Schizoaffective disorder bipolar type includes alternating “highs” and “lows.” Like bipolar disorder, people who have the bipolar type of schizoaffective disorder have very energetic periods called “manic episodes” and low energy periods called “depressive episodes.”
During the manic episodes, a person can be intensely exuberant and filled with energy, often talking quickly and moving from topic to topic. They may feel restless, have racing thoughts, and engage in risky behaviors.
Depressive episodes include periods of intense hopelessness and low energy. During this time, an individual might have trouble completing everyday tasks like bathing and changing their clothing. They may even feel extreme sadness without reason and may experience suicidal thoughts.
Depressive Type
People who have the depressive type of SZA only experience depressive symptoms rather than alternating manic and depressive periods. For people with this type of schizoaffective disorder, life may consist of daily feelings of hopelessness and despondency. Activities like cooking and cleaning can be too overwhelming for an individual with depressive type SZA.
Other Signs and Symptoms
People who have schizoaffective disorder, whether the bipolar or depressive type, also share other symptoms. They may experience:- Psychosis
- Disordered thinking
- Problems functioning in school and work
Causes of Schizoaffective Disorder
According to the National Alliance on Mental Illness (NAMI), the cause of SZA may stem from a combination of factors. The exact cause, however, remains unknown.2
Genetics and Inheritance
There appears to be a genetic component to SZA found running through families. People with relatives who have this disorder are much more likely to develop the illness.
Stress
Traumatic and distressing events, like a death or loss of a job, can trigger the start of psychotic disorders such as schizoaffective disorder.Brain Structure and Chemistry
Brain scans indicate that brain function may impact schizophrenia or schizoaffective disorder. Brain alterations are often found in the scans of people with these types of disorders. Research remains ongoing in this area.3
Drug Use
Drug combinations and chronic substance abuse can induce hallucinations and impair social function. Psychoactive drugs, like LSD, are thought to trigger symptoms of SZA.4
Diagnosing Schizoaffective Disorder
Diagnosing schizoaffective disorder correctly is challenging as it is often initially mistaken for schizophrenia or bipolar disorder. Unfortunately, there are no SZA tests like blood tests or scans.5
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) provides clinicians a resource to categorize and diagnose psychiatric disorders. Schizoaffective disorder DSM-5 diagnosis requires that:
- Schizophrenia symptoms like delusions and hallucinations must appear at the same time as a mood disorder, like depression or mania.
- SZA occur for two or more weeks without a significant mood episode.
- Mood episode symptoms occur for the majority of the illness.
- Substance abuse or medication are not the cause of the symptoms.
Although there are no schizoaffective disorder tests, this criteria provides a means for a correct diagnosis. A schizoaffective disorder DSM-5 diagnosis allows clinicians to target their treatments for the right symptoms. The disorder is listed in the World Health Organization’s International Statistical Classification of Diseases as schizoaffective disorder ICD-10-F25. A formal DSM-5 diagnosis allows for legal, medical, and fiscal documentation of schizoaffective disorder ICD-10 as F25.5
Treating Schizoaffective Disorder
Treatment for SZA includes a combination of medication and psychotherapy.
Medication
Most psychotic disorders, like schizophrenia, require antipsychotic medication to manage symptoms. When it comes to medication treatments, however, schizoaffective interventions differ from the medications treatments used for schizophrenia.
Medications for schizoaffective disorder, especially schizoaffective disorder bipolar type, requires antipsychotics paired with antidepressants or mood stabilizers. Finding the right combination can take some trial and error, but medications are needed to address the disordered thinking and delusions that can accompany the disorder.6
Psychotherapy and Psychosocial Rehabilitation
Psychotherapy can help people understand their illness, learn positive coping skills to manage symptoms, and set life goals. Clinicians may prescribe different types of psychotherapy, like cognitive-behavioral therapy (CBT), depending on the needs of the client.
Individuals with SZA may experience disordered thinking and poor social skills. Psychosocial rehabilitation programs teach interpersonal skills and life coaching to address these issues. Learning how to appropriately dress, perform activities of daily living, and carry out hygiene becomes necessary when schizoaffective disorder symptoms are severe.
Other Therapies
In rare cases, some individuals with SZA may require hospitalization to keep themselves safe and be assisted with care and treatment. In other cases, doctors might recommend electroconvulsive therapy (ECT) if medications and psychosocial therapies don’t work.6
The Link Between Schizoaffective Disorder and Addiction
According to the National Institutes on Drug Abuse, research indicates that substance use disorder (SUD) and mental illnesses – which include SZA – occur together at high rates. Individuals with mental illness are at a higher risk for drug abuse. Subsequently, individuals with a substance use disorder are more likely to have a mental illness.7
The links between drug addiction and schizoaffective disorder, along with other mental illnesses, occur due to a variety of factors. In some cases, a genetic component may increase the risk for both illnesses. Brain chemistry may also be a factor because mental illness and substance abuse both impact the chemical reward circuits in the brain.
Drug use, particularly in adolescence, may start as an unknowing attempt to self-medicate and manage symptoms of the disorder. In addition, impulse control and exposure to trauma — which may occur with mental illness — can also influence SUD. When a mental illness occurs simultaneously with a substance use disorder, the condition is called a dual diagnosis or co-occurring disorder.7
Treating Addiction and Schizoaffective Disorder as a Dual Diagnosis
Detoxification
Detoxification is typically the first step in treating dual diagnosis patients. Detox allows time for the body to eliminate drugs from the system and offers a supportive and safe environment to do so. The detox process may take anywhere from 24 hours to a week.8
Inpatient and Outpatient Rehabilitation
Inpatient rehabilitation provides around-the-clock care for a person undergoing recovery. The person resides at the facility for a period, and medical and mental health care staff are available for on-site for treatment. Psychotherapy is usually a large part of an effective treatment plan. In particular, cognitive-behavioral therapy (CBT) helps people with a dual diagnosis learn how to cope and change ineffective patterns of thinking that lead to substance abuse.8
Outpatient rehabilitation enables a person to reside off-grounds and engage in treatments services at the facility during scheduled times. For many individuals, inpatient rehabilitation occurs first and leads to a gradual transition to outpatient rehabilitation.
Medications
Clinicians may prescribe medications to treat both the cravings associated with addiction and schizoaffective disorder. A person with SZA may need mood stabilizers as well as antipsychotics. Because each person is unique, medications are prescribed according to every patient’s individual needs.
Supportive Housing and Support Groups
After rehabilitation, a supportive housing environment like a sober house or group home helps transition people back into the community. Support groups also allow individuals to talk about shared experiences and problem solve amongst each other.8
It’s possible to live a full and happy life with SZA. However, obtaining appropriate diagnosis and treatment is essential for managing the disorder. Substance use disorder combined with SZA can bring another layer of challenges, but the proper intervention recovery is more than possible.
Resources
- https://medlineplus.gov/genetics/condition/SZA
- https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/SZA
- https://www.researchgate.net/publication/341175424_The_Neurobiology_of_SZA
- https://www.jneurosci.org/content/38/14/3603
- https://icd.who.int/browse10/2014/en#!/F22.9
- https://www.uspharmacist.com/article/an-overview-of-SZA
- https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
- https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders
