Schizoaffective disorder is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania.
The two types of schizoaffective disorder — both of which include some symptoms of schizophrenia — are:
- Bipolar type, which includes episodes of mania and sometimes major depression
- Depressive type, which includes only major depressive episodes
Schizoaffective disorder may run a unique course in each affected person.
Untreated schizoaffective disorder may lead to problems functioning at work, at school and in social situations, causing loneliness and trouble holding down a job or attending school. People with schizoaffective disorder may need assistance and support with daily functioning. Treatment can help manage symptoms and improve quality of life.
Schizoaffective disorder symptoms may vary from person to person. People with the condition experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder — either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression).
Although the development and course of schizoaffective disorder may vary, defining features include a major mood episode (depressed or manic mood) and at least a two-week period of psychotic symptoms when a major mood episode is not present.
Signs and symptoms of schizoaffective disorder depend on the type — bipolar or depressive type — and may include, among others:
- Delusions — having false, fixed beliefs, despite evidence to the contrary
- Hallucinations, such as hearing voices or seeing things that aren’t there
- Impaired communication and speech, such as being incoherent
- Bizarre or unusual behavior
- Symptoms of depression, such as feeling empty, sad or worthless
- Periods of manic mood, with an increase in energy and a decreased need for sleep over several days, and behaviors that are out of character
- Impaired occupational, academic and social functioning
- Problems with managing personal care, including cleanliness and physical appearance
Diagnosis of schizoaffective disorder involves ruling out other mental health disorders and concluding that symptoms are not due to substance use, medication or a medical condition. Determining a diagnosis of schizoaffective disorder may include:
- Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
- Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. In certain situations, the doctor may also request imaging studies, such as an MRI or CT scan.
- Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use and potential for suicide. This also includes a discussion of family and personal history.
- Diagnostic criteria for schizoaffective disorder. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association.
People with schizoaffective disorder generally respond best to a combination of medications, psychotherapy and life skills training. Treatment varies, depending on the type and severity of symptoms and whether the disorder is the depressive or bipolar type. In some cases, hospitalization may be needed. Long-term treatment can help to manage the symptoms.
In general, doctors prescribe medications for schizoaffective disorder to relieve psychotic symptoms, stabilize mood and treat depression. These medications may include:
- Antipsychotics. The only medication approved by the Food and Drug Administration specifically for the treatment of schizoaffective disorder is the antipsychotic drug paliperidone (Invega). However, doctors may prescribe other antipsychotic drugs to help manage psychotic symptoms such as delusions and hallucinations.
- Mood-stabilizing medications. When the schizoaffective disorder is bipolar type, mood stabilizers can help level out the mania highs and depression lows.
- Antidepressants. When depression is the underlying mood disorder, antidepressants can help manage feelings of sadness, hopelessness, or difficulty with sleep and concentration.