Center for Schizoaffective Disorder Education and Information
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Center for Schizoaffective Disorder Education and Information

Information

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Schizoaffective disorder is due to defects in genes and regulatory regions that alter brain structure and function. Neuroimaging studies show abnormalities in the brain structure of people with schizoaffective disorder. These neurological abnormalities manifest as a particular set of symptoms, a combination of schizophrenia, depression and/or mania. Environmental factors may also play a role.

There are two types of schizoaffective disorder: bipolar type and depressive type. The bipolar type of schizoaffective disorder is characterized by the illness including at least one manic episode. The depressive type of this illness involves having only major depressive episodes as the mood disorder part of the illness. The disorder can only be diagnosed by a clinical interview.

The symptoms of schizoaffective disorder:

  1. Delusions – beliefs that have no basis in reality

  2. Disorganized thinking and speech – incoherence, thoughts and speech are out of order

  3. Abnormal motor behavior

  4. Severely limited movement, speech or range of emotion

  5. Suicidal thoughts

  6. Racing thoughts – thoughts moving rapidly and out of your control

  7. Impairments of memory

  8. Hallucinations can occur but are rare

To be diagnosed with schizoaffective, a person must

  1. Have psychosis as a constant symptom

  2. Have mania and/or depression that reappears periodically throughout life

From the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, you must meet the following diagnostic criteria:

  1. An uninterrupted period of illness that includes either a major depressive disorder or a manic episode along with at least two active symptoms of schizophrenia (hallucinations, delusions, disorganized speech, severely disorganized or catatonic behaviors, negative symptoms like decreased emotional expression or movement)

  2. Delusions (for example, paranoia, erotomania, grandiosity, delusional jealousy, persecutory or somatic delusions) or hallucinations occur for at least two weeks without major depressive or manic symptoms at some time during the illness.

  3. The major mood symptoms occur for most of the duration of the illness.

  4. The illness is not the result of a medical condition or the effects of alcohol, other drugs of abuse, a medication or exposure to an environmental toxin.

There is no cure for schizoaffective disorder. However, there are effective treatments. Medications used to treat the disorder include antipsychotics, mood stabilizers and antidepressants. Risperdal, Geodon, Lexapro, Lithium and others have shown to be effective for those with schizoaffective disorder, the combination used depends on whether symptoms include depression and/or mania. Herbal and other alternative treatments have not been shown to be effective for schizoaffective disorder. Research into new medications is ongoing.

Medication adherence is a problem for those with schizoaffective disorder. Hospitalization and rehospitalization is more likely if medications are not used or are used intermittently. Long acting injectable antipsychotics are available for those who stop taking medication or take it not as prescribed.

Problems with psychiatric diagnoses

In clinical practice and research, schizoaffective disorder has a comparatively low diagnostic reliability.  Diagnostic reliability is how accurate symptoms and test results can be in the identification of disease.

About 50 percent of patients diagnosed with schizoaffective disorder have been diagnosed with other disorders previously, including schizophrenia and bipolar. About 40 percent of those diagnosed as schizoaffective later receive a different diagnosis.

Problems with psychiatric diagnoses include:

  1. Patient factors such as memory problems and anxiety

  2. Change in symptoms over time

  3. Open ended interview style

  4. Constraints on interviewers and patients time

  5. Disagreements on definition of psychiatric symptoms

Notwithstanding the problems with accuracy of diagnoses, a patient must make a point of informing their doctor of all symptoms.

Studies on schizoaffective disorder

There is overlap and difference between schizoaffective, schizophrenia and bipolar disorder. Resting-state functional magnetic resonance imaging has been used to differentiate schizoaffective, schizophrenia and bipolar disorder. Findings from these and other studies include:

  1. In structural gray matter brain abnormalities, schizoaffective disorder resembles schizophrenia more than bipolar disorder.

  2. Persons with schizoaffective disorder tend to have smaller brain volumes compared to the general population, particularly in certain areas of the brain.

  3. Hippocampal volume is decreased in schizoaffective and schizophrenia, but not in bipolar disorder.

  4. Dorsolateral prefrontal cortex alterations found in schizophrenics are not found in schizoaffectives.

  5. Abnormalities in the cortical inhibitory-excitatory balance have been found in schizoaffectives, bipolar type.

  6. Schizoaffectives show a failure of de-activation in the medial frontal gyrus.

  7. Schizoaffectives, along with schizophrenics, show abnormality in the anterior cingulate cortex, which regulates social functioning.

  1. Persons with schizoaffective disorder show gray matter abnormalities in the frontal and temporal lobes, striatum, fusiform, cuneus, precuneus, lingual and limbic regions.

  2. Persons with schizoaffective disorder show white matter abnormalities in the corpus callosum, superior and inferior longitudinal fasciculi, anterior thalamic radiation, uncinate fasciculus and cingulum bundle.

  3. The neurocognitive and neuroimaging abnormalities found in those with schizoaffective disorder are thus far seen more in schizophrenia than in bipolar disorder. This is suggestive for schizoaffective disorder being a subtype of schizophrenia.

 

Citations

Santelmann H, Franklin J, et al, (2016). Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies. Bipolar Disorders, 18 (3), 233-246. Doi 10.1111/bdi. 12388.

Tondo, L, Vazquez GH, et al, (2016). Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study. Acta Psychiatrica Scandanavica, 133(1), 34-43. Doi 10.1111/acps. 12447.

Amann, BL, Canales-Rodriquez, EJ, et al, (2016). Brain structural changes in schizoaffective disorder compared to schizophrenia and bipolar disorder. Acta Psychiatrica Scandanavica,133(1), 23-33. Doi 10.1111/acps. 12440.

Madre, M, Canales -Rodriguez EJ, et al, (2016). Neuropsychological and neuroimaging underpinnings of schizoaffective disorder: a systematic review, Acta Psychiatrica Scandanavica, 134(1), 16-30. Doi 10.1111/acps. 12564.

Brealy JA, Shaw A, Richardson H, et al, (2015). Increased visual gamma power in schizoaffective bipolar disorder. Psychological Medicine, 45(4), 783-94. Doi 10.1017/ S0033291714001846.

Merce M, Radua J, Amann BL, (2015). Neuropsychological and Brain Functional Changes Across the Different Phases of Schizoaffective Disorder. European Psychiatry, 38(1), 1490.

Nelson BD, Bjorkquist OA, Olsen EK, Herbener ES, (2015). Schizophrenia symptom and functional correlates of anterior cingulate cortex activation to emotion stimuli: An fMRI investigation. Psychiatry Research Neuroimaging, 234(3), 285-91, doi: 10.1016/j.pscychresns.2015.11.001.

Landin-Romero R, Canales-Rodriguez EJ, Kumfor F, et al, (2016). Surface-based brain morphometry and diffusion tensor imaging in schizoaffective disorder. Australia and New Zealand Journal of Psychiatry, Feb 16, pii: 0004867416631827.

Mansuri Z, Shambu S, Yadav P, et al, (2016). Trends of hospitalization for schizoaffective disorder (SD) in USA: A nationwide analysis. European Psychiatry, (33), S103, pii/S0924933816000870.