Schizoaffective Disorder

Schizoaffective disorder is a chronic mental health condition characterized by a mix of symptoms from two separate mental illnesses: schizophrenia, a neuropsychiatric disorder that alters a person’s perception of reality, and a mood disorder, which causes drastic shifts in mood, energy levels, and motivation. 

The exact prevalence of schizoaffective disorder is unknown, as it is frequently misdiagnosed as schizophrenia, bipolar disorder, or major depressive disorder with psychotic symptoms. Current research suggests that it’s relatively rare, affecting around 0.3% of the population [1]. Females are thought to be affected slightly more often than males, but males may experience symptoms at an earlier age. 

Most people with schizoaffective disorder are diagnosed in young adulthood; an estimated 30% of cases occur from the ages of 25 to 35 [2]. Children and people older than 50 are rarely diagnosed with the disorder.

Co-Occurring Addiction

For a variety of reasons, people with schizoaffective disorder are more likely to develop a substance use disorder than people without the condition. This may be due to an increased tendency to self-medicate or structural changes in the brain that make people with the condition more susceptible. 

Drug or alcohol dependency can make the symptoms of schizoaffective disorder worse and may trigger symptoms when an individual is otherwise stable. Substance use can also greatly complicate the diagnosis and treatment processes. To effectively treat schizoaffective disorder when co-occurring addiction is present, both conditions must be addressed simultaneously within an integrated treatment plan. 

1. Perälä, Jonna, et al. “Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population.” Archives of General Psychiatry, vol. 64, no. 1, 1 Jan. 2007, p. 19, https://doi.org/10.1001/archpsyc.64.1.19.
2. Joshua, Tom, and Abdolreza Saadabadi. “Schizoaffective Disorder.” Nih.gov, StatPearls Publishing, 2023, www.ncbi.nlm.nih.gov/books/NBK541012/

Both types of schizoaffective disorder can cause positive or negative symptoms of schizophrenia. Each type has different mood-related symptoms.  

Symptoms of Schizophrenia

Positive symptoms

• Hallucinations (seeing, hearing, smelling, tasting or feeling things that aren’t real)
• Delusions (false beliefs that persist even when they’re disproven with clear evidence)
• Disorganized thinking and speech (speaking incoherently, using made-up words, repeating words)
• Abnormal movements and behaviors (repetitive rocking or pacing, sitting still for hours, laughing, grimacing, or giggling at inappropriate times)

Negative symptoms

• Diminished emotional expression (muted or absent physical gestures and facial expressions, monotone speaking voice)
• Lack of motivation (difficulty engaging in goal-directed activities like personal hygiene)
• Poverty of speech (using fewer words when speaking, speaking less often)
• Decreased ability to feel joy or pleasure
• Social isolation

Symptoms of Schizoaffective Disorder, Bipolar Type

• Positive or negative symptoms of schizophrenia
• Always: Mania/hypomania (periods of noticeably increased energy, euphoria or irritability, lack of sleep, racing thoughts and rapid speech, risky or impulsive behavior) 
• Sometimes: Depressive episodes (periods of noticeably low energy and mood, decreased ability to feel joy or pleasure, social withdrawal, sleep disturbances, thoughts of self harm)

Symptoms of Schizoaffective Disorder, Depressive Type

• Positive or negative symptoms of schizophrenia
• Depressive episodes

People with schizoaffective disorder are often misdiagnosed with bipolar disorder with psychotic features or major depressive disorder with psychotic features. The key differences between the conditions is the presence and duration of psychotic symptoms. In both bipolar disorder with psychotic features and MDD with psychotic features, psychosis is only present during manic or depressive episodes. In schizoaffective disorder, psychosis is present for at least two weeks in the absence of any mood symptoms. 

Experts can’t point to a single confirmed cause of schizoaffective disorder. 

Possible risk factors for developing or triggering the condition include: 

• Having a close blood relative with schizoaffective disorder, schizophrenia, or bipolar disorder
• Being assigned female at birth
• Experiencing extreme stress or trauma in childhood
• Using psychoactive drugs like LSD

There is no universally effective treatment for schizoaffective disorder. Each person experiences the disorder differently and may have unique symptoms and treatment challenges based on their medical history, personal history, and co-occurring conditions. Multidisciplinary treatment (a combination of psychotherapy, social support, family programming, and medication) is thought to be most effective for the long-term management of the disorder.

Psychotherapy (Talk Therapy)

Cognitive behavioral therapy (CBT) is frequently used in the treatment of schizoaffective disorder to help people address, understand, and cope with their symptoms. 

Dialectical behavior therapy (DBT) is a research-backed therapy for schizophrenia that helps individuals with schizoaffective disorder regulate and cope with their emotions. 

Mindfulness-based interventions and other mind-body therapies can help individuals with the disorder manage the stress and anxiety caused by their symptoms and develop a deeper awareness and understanding of how the disorder affects them.  

Medications

The majority of people with schizoaffective disorder (both types) are treated with prescription antipsychotic medications. Antipsychotics work to relieve symptoms of psychosis associated with schizophrenia. 

Depending on the severity of mood symptoms associated with the disorder, antipsychotic medications may be combined with mood stabilizers and/or antidepressants. 

Family/social support

Family therapy and support groups can be critical to the long-term management of schizoaffective disorder. Family programs can help educate families on the symptoms and challenges of the disorder and provide them with tools and resources for supporting their loved one. Likewise, social support groups provide a social outlet and community where individuals can share their experiences and hold one another accountable.