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 psychosis and mood symptoms coexist. The diagnosis requires that significant mood symptoms (depressive or manic) be present for > 50% of the total duration of illness, concurrent with ≥ 2 symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms).
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, a 2nd-generation antipsychotic may be sufficient but if not, it may help to add lithium, carbamazepine, or valproate.
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 if depression requires treatment; selective serotonin reuptake inhibitors (SSRIs) are preferred because of their safety profile.