What is Schizoaffective Disorder?

When our new psychologist mentioned schizoaffective disorder I only had a vague recollection of it's existence. My first question was - "Isn't that a personality disorder?" I was met with dissent. The way the doctor explained it to me was that when you have psychosis and bipolar symptoms the diagnosis is bipolar with psychotic features (S's current diagnosis) if the psychosis is dependent on the state of the mood. The diagnosis is schizoaffective disorder if the psychosis is not dependent on the mood fluctuations. Those of you who have been reading my blog for any length of time know that when life throws me a curveball I go to the research. This is what I found on schizoaffective disorder. I hope it helps you. 

Schizoaffective disorder is when an individual presents with both a mood disorder, either unidepression or bipolar, in addition to paranoid schizophrenic symptoms (Harvard Mental Health Letter, 2004). It is characterized by three main components. 1) The individual must have both a mood disorder and schizophrenic symptoms. 2)The delusions and paranoia must consist outside of a manic or depressive episode. 3) Mood symptoms are most always present (Harvard Mental Health Letter, 

2004). Schizoaffective disorder runs the risk of being misdiagnosed because of the overlap of psychosis or mood symptoms during specific periods of a course of either schizophrenia or bipolar (Cascade, Kalali, & Buckley, 2009; Harvard Mental Health Letter, 2004).  However schizoaffective disorder requires a life history of both psychosis and mood symptoms (Harvard Mental Health Letter, 2004).

The actual diagnosis of schizoaffective disorder is controversial and inconsistent. There is a large lack of agreement over the diagnosis of individuals exhibiting both psychotic and mood symptoms (Pagel, Baldessarini, Franklin, & Baethge, 2013). Some studies have found that individuals who meet the requirements of having both a mood disorder and schizophrenia are more appropriately categorized under schizophrenia (Kotev et al., 2013; Pagel, Baldessarini, Franklin, & Baethge, 2013). However, research also indicates that there are distinct difference between individuals diagnosed with schizoaffective disorder as opposed to schizophrenia or bipolar disorder (Pagel, Baldessarini, Franklin, & Baethge, 2013). 

Current research suggest that there is some overlap in genetic predisposition to both schizophrenia and bipolar, but that there are also unique risk between the two disorders (Cardno & Owen, 2014). There is also the suggestiong in the research that there is a unique risk for the development of schizoaffective disorder bipolar subtype (Cardno & Owen, 2014). However to fully understand the relationship more research still needs to be done.

History and Treatment

Schitzoaffective disorder was first identified in the 1930s, however it was not more widely accepted until 1980 (Harvard Mental Health Letter, 2004).  Even now very little is known about how the disorder manifests both mood and schizophrenic symptoms, although brain structure does seem to more closely resemble individuals with schizophrenia (Harvard Mental Health Letter, 2004). Like bipolar disorder, schizoaffective disorder seems to affect women as often, or slightly more often, than men (Cascade, kalali, & Buckley, 2009; Pagel, Baldessarini, Franklin, & Baethge, 2013).

Schizoaffective disorder is treated through medication management. Nearly all individuals with schizoaffective disorder are given an antipsychotic medication, and about half also take an antidepressant or mood disorder treatment (Cascade, Kalali, & Buckley, 2009). 

Childhood

While the research available on adults with schizoaffective disorder is basic, and inconclusive, the research on children with schizoaffective disorder is even more limited. Most of the research has 

focused on the difference between schizophrenia and schizoaffective disorder, or the intellectual and social prognosis. For example, it was found that children who exhibited greater difficulty in adjusting socially were more likely to be diagnosed with schizoaffective disorder as compared with schizophrenia (Tarbox, Brown, & Haas, 2012). However, if the social disturbance did not appear until adolescence individuals were less likely to be diagnosed with schizoaffective disorder (Tarbox et al., 2012). 

Hooper and colleagues (2010) assessed children between the ages of 8 and 19 with either schizoaffective disorder or schizophrenia. They found that both groups had academic and intellectual challenges. However, children with schizoaffective disorder were slightly above their peers in spelling ability (Hooper et al., 2010).  Individuals in both groups who preformed better on the academic and intellectual testing showed increased ability in adaptive behaviors such as daily living skills, social skills, and working memory then their lower performing peers (Hooper et al., 2010) It is interesting that they found that the younger a child was diagnosed with either schizoaffective disorder of schizophrenia the higher their IQ (Hooper et al., 2010). This could be a result of a different course of the illness or perhaps it is related to children getting interventions earlier, which then improves their intellectual capacity. 

The research is really uncertain about whether schizoaffective disorder is even a distinct disorder. Most evidence seems to point that, at least cognitively, individuals with schizoaffective disorder are more similar to individuals with schizophrenia.  However, this could be based on the unspecific diagnostic criteria of the DSM. Either way, no research has adequately explained if schizoaffective disorder is a unique disorder, a subset of schizophrenia, or comorbid mood disorder and schizophrenia. 

References

Cardno, A. G., & Owen, M. J. (2014). Genetic relationships between schizophrenia, bipolar disorder, and schizoaffective disorder. Schizophrenia Bulletin, 40(3), 504-515.

Cascade, E., Kalali, A. H., & Buckley, P. (2009). Treatment of Schizoaffective Disorder. Psychiatry(Edgemont), 6(3), 15-17

Hooper, S. R., Giulianao, A. J., Youngstrom, E. A., Breiger, D., Sikich, L. . .Lieberman, J. A. (2010). Neurocognition in early-onset schizophrenia and schizoaffective disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 49(1), 52-60.

Kotov, R., Leong, S. H., Mojtabai, R., Eckardt Erlanger, A. C., Fochtmann, L., Constantino, E. . .Bromet, E. J. (2013). Boundaries of schizoaffective disorder revisiting Kraepelin. JAMA Psychiatry, 70(12), 1276-1286.

Pagel, T., Baldessarini, R. J., Franklin, J., & Baethge, C. (2013). Characteristics of patients diagnosed with schizoaffective disorder compared with schizophrenia and bipolar disorder. Bipolar Disorders, 15, 229-239

Schizoaffective disorder. (2004). Harvard Mental Health Letter, 20(12), 3-5

Tarbox, S. I., Brown, L. H., & Haas, G. L. (2012). Diagnostic specificity of poor premorbid adjustment: Comparison of schizophrenia, schizoaffective disorder, and mood disorder with psychotic features. Schizophrenia Research, 141, 91-97.