Schizoaffective disorder is characterized by significant mood symptoms, psychosis, and other symptoms of schizophrenia. It is differentiated from schizophrenia by occurrence of ≥ 1 episodes of depressive or manic symptoms.
Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate motor behavior (including catatonia) that indicate loss of contact with reality.
Schizoaffective disorder is considered when a psychotic patient also demonstrates mood symptoms. The diagnosis requires that significant mood symptoms (depressive or manic) be present for a majority of the total duration of illness, concurrent with ≥ 2 symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms).
The prognosis is somewhat better than that for schizophrenia but worse than that for mood disorders.
Because schizoaffective disorder often leads to long-term disability, comprehensive treatment (including drugs, psychotherapy, and community support) is often required.
For treatment of the manic type, antipsychotics combined with lithium, carbamazepine, or valproate may be more effective than antipsychotics alone.
For treatment of the depressive type, a 2nd-generation antipsychotic is given first. Then, once positive psychotic symptoms are stabilized, an antidepressant should be introduced; SSRIs are preferred because of their safety profile.
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