- What is schizoaffective disorder?
- How many people have schizoaffective disorder?
- Treatment and support
- Physical health
People who have a diagnosis of schizoaffective disorder can experience symptoms of both bipolar disorder and schizophrenia. During an episode, a person can have ‘affective’ symptoms i.e. symptoms of their mood – mania or depression as well as the ‘negative’ and ‘positive’ schizophrenia symptoms all at once, or over a few days.
The APA (American Psychiatric Association) has published a disease classification manual – the Diagnostic and Statistical Manual of Mental Disorders, the DSM. This describes schizoaffective disorder as an entirely separate condition from schizophrenia and bipolar disorder. The WHO’s (World Health Organisation’s) ICD – International Classification of Diseases – states the same.
There is, however, some debate over whether or not the condition is entirely separate or whether it is a type of bipolar disorder or schizophrenia. It has been called into question whether doctors are giving this diagnosis when a patient’s symptoms aren’t categorically one condition or the other.
There is the theory that those who have a schizoaffective disorder diagnosis belong in two groups – one group has bipolar disorder but also has schizophrenia symptoms and the other has schizophrenia with symptoms of mania and/or depression. There is a different theory that people who have schizoaffective disorder have both bipolar disorder and schizophrenia.
There has been a lot of research on a ‘psychosis continuum’ that suggests that the same risk factors and same genes contribute to all types of mental illness that involve some form of psychosis symptoms but that other life experiences and other genes are responsible for determining the severity and type of the symptoms. Some scientists believe that schizoaffective disorder occupies a place between bipolar disorder and schizophrenia on the continuum.
Since those who have bipolar disorder can experience psychosis symptoms and as people who have schizophrenia can experience depression, psychiatrists will often have difficulties making a definite schizoaffective disorder diagnosis. Also, any given diagnosis could change. Research has shown that as few as 36% of people with a schizoaffective disorder diagnosis are still given the same diagnosis two years later at reassessment. At this point, 42% of people go on to be diagnosed with schizophrenia instead. A different research study showed that more than half of people with a schizoaffective disorder diagnosis were later given a diagnosis of bipolar disorder.
Some researchers believe that medics give schizoaffective disorder as a diagnosis when they are not sure whether a patient has bipolar disorder with psychosis symptoms or schizophrenia and depression.
When the DSM was updated in 2013 by the American Psychiatric Association there was a slight change in the criteria for making a schizoaffective disorder diagnosis. Some say that this makes it easier to distinguish between patients with bipolar disorder having psychosis symptoms, people with schizophrenia also experiencing depression and people with schizoaffective disorder. The 5th update of the DSM – DSM-5, describes the condition of schizoaffective disorder as a diagnosis for life – it is a condition that is chronic with recurring episodes.
This manual is used by insurance companies and doctors in the United States. Psychiatrists in the UK prefer to use the ICD (the International Classifications of Diseases), produced by the World Health Organisation (WHO).
Both of these classification systems also include schizoaffective disorder ‘sub-types’. These include ‘depressive type’ and ‘bipolar type’ in DSM-5 and ‘mixed type’ and ‘depressive type’ in the ICD.
Since it is difficult to diagnose schizoaffective disorder, it is also difficult to know just how many people have it. In general, researches and doctors think that schizoaffective disorder is less common than bipolar disorder and schizophrenia. There was some research that took place between the year 1950 and the year 2009 in England that showed that every year there were about 4 people in every 1000 that had a mental illness involving psychosis symptoms such as schizophrenia. Schizophrenia is the most common of severe mental illnesses. About one person in every one hundred has bipolar 1 disorder.
There are fewer men than women who are given a schizoaffective disorder diagnosis and, just like schizophrenia and bipolar disorder, symptoms typically begin in the late teens or early 20s.
The NICE (National Institute for Health and Care Excellence) guidance about schizophrenia and psychosis treatment uses the terminology ‘psychosis’ to describe the psychotic symptoms of those with schizoaffective disorder as well as delusional disorder and schizophreniform disorder. It does not, however, specify treatments only for schizoaffective disorder and doesn’t address the medications and combinations that are typically prescribed for patients with this diagnosis.
Those who have a schizoaffective disorder diagnosis usually take antipsychotic drugs for the symptoms associated with schizophrenia as well as mood stabilisers like lithium and carbamazepine to treat bipolar disorder symptoms. The antipsychotic drug olanzapine is occasionally prescribed as it is licensed for both bipolar disorder and schizophrenia. The exact combination of medication prescribed depends on an individual’s symptoms and they may also be given antidepressants.
There has not been a lot of research on testing treatments for schizoaffective disorder. There was a research report from 2010 that looked into 33 studies, most of which tested medication. The researchers weren’t able to establish whether any drug was better than another, however. There were no trials that tested talking therapies for this condition either. In spite of this, there have been trials researching how effective talking therapies like CBT (Cognitive Behavioural Therapy) and family therapy are for schizophrenia, within which those with a schizoaffective disorder diagnosis will have been included. This means that it is likely that these treatments will help them too alongside medication.
The NICE guidelines from 2014 recommend talking therapies for psychosis and schizophrenia and should also be offered to those with a schizoaffective disorder diagnosis. There are CBT and family therapy sessions specialised for psychosis. Mental health workers should consider art therapy too. That said, these therapies are not available widely throughout the United Kingdom.
NICE also recommends ‘peer support’ whereby a patient is supported by someone who has had psychosis symptoms themselves and has received training to become a peer support worker. As an alternative, NICE recommends mental health professionals consider offering patients a place on a programme of self-management that is led by a health care or social care professional. Both self-management and peer-support have the aim of helping people to understand their diagnosis and symptoms, their treatment and medication, what to do should they have a crisis and how to stay well.
People who have a mental illness diagnosis such as schizoaffective disorder are much more likely to have problems with their physical health. This includes high blood pressure, heart disease, diabetes and weight gain. These physical problems are caused by lifestyle changes because of the symptoms of their illness or because of the drug side effects.
In NICE’s 2014 schizophrenia and psychosis guidelines, it is recommended that people have a physical health check before they start taking their first lot of antipsychotic drugs. People should also be checked for side effects for the first 3 months of taking them.
Those with a diagnosis of schizoaffective disorder should have a physical health exam annually with their GP. This should check their blood sugar levels, cholesterol levels, blood pressure and weight. Patients should be treated as per NICE recommendations for all physical health problems and are encouraged to discuss these with their doctor.
Patients also should be advised with regards to eating healthily and taking regular exercise as well as advice on how to stop smoking.