Merck Manual

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Schizoaffective Disorder

By

Carol Tamminga

, MD, UT Southwestern Medical Dallas

Last full review/revision May 2020| Content last modified May 2020
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Schizoaffective disorder is characterized by psychosis, other symptoms of schizophrenia, and significant mood symptoms. It is differentiated from schizophrenia by occurrence of 1 episode of depression or mania in a person's lifetime.

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).

Differentiating schizoaffective disorder from schizophrenia and mood disorders may require longitudinal assessment of symptoms and symptom progression.

Treatment

  • Often a combination of drugs, psychotherapy, and community support

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.

Drugs Mentioned In This Article

Drug Name Select Trade
TEGRETOL
LITHOBID
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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