Schizoaffective Disorder (cont.)
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Schizoaffective disorder facts
- What is schizoaffective disorder?
- What are the different types of schizoaffective disorder?
- What are causes and risk factors for schizoaffective disorder?
- What are symptoms and signs of schizoaffective disorder?
- What tests do health care professionals use to diagnose schizoaffective disorder?
- What are criteria for diagnosis of schizoaffective disorder?
- What is the treatment for schizoaffective disorder? Are there home remedies for schizoaffective disorder?
- What are complications of schizoaffective disorder?
- What is the prognosis of schizoaffective disorder?
- Is it possible to prevent schizoaffective disorder?
- Are there support groups for schizoaffective disorder?
- Where can people find more information on schizoaffective disorder?
- Find a local Psychiatrist in your town
What are criteria for diagnosis of schizoaffective disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in order to be diagnosed with schizoaffective disorder, an individual must meet the following diagnostic criteria:
- 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)
- 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.
- The symptoms of major mood disorders occur for most of the duration of the illness.
- 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.
What is the treatment for schizoaffective disorder? Are there home remedies for schizoaffective disorder?
Given the potentially serious impact that schizoaffective disorder has on the lives of sufferers, home remedies are not thought to be appropriate to address its symptoms. Treatment for people living with this condition tends to be symptom-based rather than distinctly different based on the illness itself. In terms of medication treatment, individuals with the bipolar type of the disorder seem to respond best to treatment with an antipsychotic drug combined with a mood-stabilizer drug or treatment with an antipsychotic drug alone. For people with the depressive type of schizoaffective disorder, combining an antipsychotic medication with an antidepressant medication tends to work best. Since consistent treatment is important for the best outcome, psychoeducation of the person with the illness and their loved ones, as well as using long-acting medications can be important aspects of their care.
For people who don't respond to multiple trials of treatment, electroconvulsive therapy (ECT) may be an option. Treatment for people who suffer from both schizoaffective disorder and a substance-abuse disorder (dual diagnosis) tends to be most effective when both conditions are specifically addressed.
Antipsychotic medications have been shown to be effective in treating acute psychosis and reducing the risk of future psychotic episodes. The treatment of schizoaffective disorder thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to alleviate psychotic and severe mood disorder symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in medication dosage may help prevent a relapse.
Even with continued treatment, some patients have relapses. By far, though, the highest relapse rates are seen when medication is discontinued. Most patients experience substantial improvement when receiving antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them. Since it is difficult to predict which patients will fall into what groups, it is essential to have long-term follow-up, so that the treatment can be adjusted and any problems addressed in a timely manner.
Medication treatment for schizoaffective disorder
Antipsychotic medications are the cornerstone in the management of schizoaffective disorder. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a health care professional who is well trained and experienced in treating severe mental illness. The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), loxapine (Loxitane), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorder, loose associations, ambivalence, or emotional lability), they can also alleviate severe anxiety that people with schizoaffective disorder may suffer. However, they cause side effects, many of which affect the neurologic (nervous) system. Since 1989, a new class of antipsychotics (atypical antipsychotics) has been introduced. At clinically effective doses, very few of these neurological side effects, which often affect the extrapyramidal nerve tracts (which control such things as muscular rigidity, painful muscle spasms, restlessness, or tremors) are observed.
The first of the new class, clozapine (Clozaril), is not associated with extrapyramidal side effects, but it can produce other side effects, including a possible decrease in the number of white blood cells to the point of being dangerous, so the blood needs to be monitored every week during the first six months of treatment and then every two weeks to detect this side effect early if it occurs. Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel and Seroquel-XR), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), paliperidone (Invega), lurasidone (Latuda), and brexpiprazole (Rexulti). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizoaffective disorder. That some neuroleptic medications can either be injected into muscle (for example, haloperidol, fluphenazine, risperidone, and aripiprazole) or melt once placed under the tongue (for example, asenapine) can further help the schizoaffective disorder sufferer maintain critical compliance with their care.
Although more effective and better tolerated, the use of atypical antipsychotic drugs is also associated with side effects, and current medical practice is developing better ways of understanding and minimizing these effects, identifying people at risk, and monitoring for the emergence of complications.
Mood-stabilizer medications like lithium (Lithobid), valproic acid or divalproex (Stavzor or Depakote), carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of mania as well as preventing return of such symptoms in schizoaffective disorder. Some studies have also found that oxcarbazepine (Trileptal) may also be a helpful addition to other medications that treat schizoaffective disorder. These medications may take a bit longer to work compared to the neuroleptic medications, and some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, while some can be associated with birth defects when taken by pregnant women. Since people with schizoaffective disorder often have depression as part of the illness, medications that address that symptom may be of great benefit, as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil or Pexeva), citalopram (Celexa), escitalopram (Lexapro), vilazodone (Viibryd), and vortioxetine (Trintellix) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for treatment of schizoaffective disorder include venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and bupropion (Wellbutrin).
Most of these medications take several weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, or another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).
Non-medication psychotherapeutic treatments for schizoaffective disorder
In spite of successful antipsychotic treatment, many patients with schizoaffective disorder have difficulty with maintaining motivation, activities of daily living, relationships, and communication skills. Therefore, psychosocial treatments are also important, and many useful treatment approaches have been developed to complement the medications in assisting people suffering from this illness:
- Individual psychotherapy: This involves regular therapy sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with schizoaffective disorder become able to understand more about the illness, to learn about themselves, and to better handle the problems of their daily lives. The goals of therapy often include helping the person with schizoaffective disorder become better able to distinguish between what is real and, by contrast, what is not and to acquire beneficial problem-solving skills.
- Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social-skills training, nutrition, and education in money management. Thus, patients learn skills required to live with the illness through successful reintegration into their community following discharge from the hospital and to minimize or eliminate the need for psychiatric hospitalizations.
- Family psychoeducation and family therapy: Research has consistently shown that people with schizoaffective disorder who have involved families with an understanding of their illness have a better prognosis than those who battle the condition alone.
- Self-help groups: Outside support for family members of those with schizoaffective disorder often is necessary and desirable.
Non-medication medical treatments for schizoaffective disorder
As with other schizophrenia spectrum and other psychotic disorders, people with schizoaffective disorder who do not receive enough relief of psychotic symptoms (like hallucinations or delusions) from medication and psychotherapy treatments may benefit from non-medication medical interventions like transcranial magnetic stimulation (TMS) or electroconvulsive treatment (ECT). TMS is a treatment that involves applying a magnetic field through the scalp to a small area of the brain to provide repeated stimulation. The treatment course is usually completed over about six weeks, with each treatment session taking about 20 minutes. TMS tends to have few negative effects and is considered to be quite safe.
ECT involves the use of electrical current passed through the brain using electrodes on one side of the brain through the scalp for the purpose of inducing seizures. It is done while the person is sedated under generalized anesthesia. While its effectiveness in treating psychotic symptoms when used alone does not seem to be established, it is thought to be helpful when used in addition to prescribed antipsychotic medication. Due to side effects of decreased memory and risks associated with generalized anesthesia, ECT is considered to be a treatment of last resort for schizophrenia spectrum and other psychotic disorders
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