The presentation varies from patient to patient but there are a few items that are commonly assessed in majority of patients with this disorder [6]. Depending on the subtype of the disorder, all or some of the symptoms may be clearly manifested in no particular combinations:

• Eye contact (may be increased, decreased or appropriate)
• Facial expression (may be sad, euphoric or angry. Rarely neutral)
• Motor (possible psychomotor agitation or retardation)
• Appearance (ranges from well-groomed to dishevelled)
• Cooperativeness (patient may be cooperative or uncooperative)
• Mood (may be depressed, euthymic or manic)
• Affect (ranges from appropriate to flat)
• Speech (ranges from poor to lack of ideas or feeling under pressure)
• Suicidal ideation (may be seen or not)
• Homicidal ideation (may or may not be presented)
• Delusions (having false, fixed beliefs)
• Hallucinations (such as hearing of voices)

• Antipsychotic Agent

  Although growing research indicates that the atypical antipsychotic agent clozapine is effective in patients with schizophrenia, little is known about the efficacy of clozapine in patients with schizoaffective disorder or psychotic mood disorders. [ncbi.nlm.nih.gov]

  Antipsychotic agents may affect libido and may produce difficulty in achieving and maintaining erection. Inability to reach orgasm or ejaculation and retrograde ejaculation have been reported. [psychcentral.com]

  If both manic episodes and depressive episodes are evident, the medications used are likely to include antipsychotic agents and mood stabilizers. [coloradorecovery.com]

  agents For consumers: dosage, interactions, side effects For professionals: Prescribing Information olanzapine Off Label Rx C N X 46 reviews 6.0 Generic name: olanzapine systemic Drug class: atypical antipsychotics For consumers: dosage, interactions [drugs.com]

• Falling

  CONCLUSIONS: Regarding unipolar affective disorder this study confirms what we have shown for bipolar disorders in earlier studies: schizoaffective disorder falls between schizophrenia and affective disorders, and there are relevant quantitative differences [ncbi.nlm.nih.gov]

  They can be broadly categorized into those that fall under depressive symptoms, manic symptoms, and schizophrenia symptoms. [verywellmind.com]

  Inability to express feelings Paranoia, hallucinations or delusions Disorganized thinking, lack of concentration and confusion Suicidal or homicidal thoughts Behavioral Symptoms Some common behavioral symptoms of schizoaffective disorder include: Trouble falling [therecoveryvillage.com]

  ‘My anxiety would get out of control, I wouldn't know how to deal with it, as a result I would fall into these dark places.’ ‘Self-advocacy is about learning to stand up for yourself. .. It's building your confidence and self-esteem.’ [sane.org]

• Delusion

  Clinical ratings of delusions were made using the Scale for the Assessment of Positive Symptoms. RESULTS: For the sample as a whole, individuals with higher levels of attention to emotion tended to have more severe delusions. [ncbi.nlm.nih.gov]

  At least two weeks of hallucinations and delusions - Chris has had his hallucinations and delusions for over a month, so he fits this criterion, too. [study.com]

  […] episode along with delusions, hallucinations, disorganized speech and behavior, and negative symptoms of schizophrenia. [medical-dictionary.thefreedictionary.com]

  With regards to medication, antipsychotics are usually necessary to control the psychotic symptoms (e.g., delusions or hallucinations). [schizophrenic.com]

• Euphoria

  Mania is characterized by hyperactivity, euphoria and insomnia. [news-medical.net]

  […] common symptoms of a thought disorder: Visual/Auditory hallucinations Incoherence Disorders of movement Diminished interaction with others Monotonous voice Low energy Increased energy Restlessness Poor judgment/insight Increased/decreased sex drive Euphoria [lifeskillssouthflorida.com]

  If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania. [nami.org]

  Basically, bipolar is a combination of states of severe depression (sadness, anger, sorrow, irritability, numbness), and states of severe mania (delusion, euphoria, extreme elation). [vantagepointrecovery.com]

• Auditory Hallucination

  We found visual hallucinations differentiated the groups to a greater degree over the 20year course than did auditory hallucinations. [ncbi.nlm.nih.gov]

  The following is a typical pattern: An individual may have pronounced auditory hallucinations and persecutory delusions for 2 months before the onset of a prominent Major Depressive Episode. [health.am]

  The person may also experience auditory hallucinations, bizarre delusions, paranoia, disorganized speech and thought. [parkroyalhospital.com]

• Suicidal Ideation

  ideation Suicide attempts Death as a result of suicide Co-Occurring Disorders Schizoaffective disorder and co-occurring disorders Adolescents and adults who are diagnosed with schizoaffective disorder often struggle with the symptoms of other mental [southcoastbehavioral.com]

  Suicidal Ideation and Prevention Suicidal ideation and behavior can also be a problem for some people with schizoaffective disorder. [verywellmind.com]

  ideation (may be seen or not) Homicidal ideation (may or may not be presented) Delusions (having false, fixed beliefs) Hallucinations (such as hearing of voices) In most cases, workup may include psychological testing, diagnostic imaging (CT, MRI or [symptoma.com]

  SA differed from both BDp and SZ in 9/12 factors: SA and BDp were similar in education and suicidal ideation or acts; SA and SZ were similar in education, onset stressors, and substance abuse. [ncbi.nlm.nih.gov]

• Psychiatric Symptoms

  (Brief Psychiatric Rating Scale, Center for Epidemiologic Studies Depression Scale, Scale for the Assessment of Negative Symptoms), medical severity (Charlson comorbidity index), and acute service use. [ncbi.nlm.nih.gov]

  The authors’ observations Divalproex is a commonly used FDA-approved treatment for a variety of neurologic and psychiatric conditions including acute bipolar mania.1-3 It also is used for off-label control of various psychiatric symptoms. [mdedge.com]

  Resources BOOKS American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000. Fuller, Mark and M. Sajatovic. [minddisorders.com]

• Confusion

  Schizoaffective disorder (SAD) represents one of the most confusing and controversial concepts in psychiatry. Prevalence is less than 1%, but despite that it has a major influence on an individual and community. [ncbi.nlm.nih.gov]

  Schizoaffective Disorder Schizoaffective disorder is a confusing, and often frightening mental illness. [reintegration.com]

  CASE Disoriented and confused Mr. [mdedge.com]

  Instead, it has most likely generated confusion with respect to epidemiological and clinical data. [doi.org]

  […] with the diagnosis of a mood disorder like bipolar disorder or depression, or be confused with the diagnosis of schizophrenia. [healthyplace.com]

• Irritability

  RESULTS: At baseline, 54% of participants were irritable. [ncbi.nlm.nih.gov]

  Of the full sample, 54% of the participants was irritable. [psychiatryadvisor.com]

  Diagnostic Guidelines There must be a prominent elevation of mood, or a less obvious elevation of mood combined with increased irritability or excitement. [mhreference.org]

  Deep depressions or periods of arrogant irritability. These are just a few of the symptoms of a thought disorder, which includes schizoaffective disorder, schizophrenia, and psychosis. [lifeskillssouthflorida.com]

• Agitation

  However, he remained severely agitated and psychotic with continuous threats of harm to others. [ncbi.nlm.nih.gov]

  Those who suffer from a depression type schizoaffective disorder often notice: Agitation (being very restless) Inability to concentrate Inappropriate emotional reactions Bizarre thinking Confusing thoughts Manic type In this diagnosis, people suffer from [mentalhealthcenter.org]

  If the patient’s psychotic symptoms are acute and accompanied by agitation, a number of different antipsychotics can be used to terminate the flare-up of acute agitated psychosis. [encyclopedia.com]

  Psychomotor agitation or retardation. Fatigue. Feelings of guilt or worthlessness. Decreased concentration. Recurrent thoughts of death or suicidal notions. Manic episode Persistently elevated or irritable mood for at least one week. [patient.info]

  Most concerning for his family was his agitation/anger, paranoia and apathy. Agitation episodes were directed toward his wife, grandchildren and other drivers and were exaggerated in comparison to the associated anger trigger. [consultqd.clevelandclinic.org]

• Catatonia

  The initial admitting team continues aripiprazole, increased divalproex extended release to 1,000 mg in the morning/1,500 mg at night, held mirtazapine, and started lorazepam, 2 mg, 3 times daily, for catatonia. [mdedge.com]

  Catatonia is currently a diagnosis that is made clinically; however, due to the varied clinical presentations of catatonia, underdiagnosis is common. We describe an unusual presentation of catatonia in a female patient with schizoaffective disorder. [ncbi.nlm.nih.gov]

  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. [msdmanuals.com]

• Seizure

  Dyke-Davidoff-Masson syndrome, or cerebral hemiatrophy, is a pre- or perinatally acquired entity characterized by predominantly neurologic symptoms, such as seizures, facial asymmetry, contralateral hemiplegia, and mental retardation. [ncbi.nlm.nih.gov]

  When diagnosing schizoaffective disorder many other disorders have to be ruled out, like: 2 Bipolar disorder Major depressive disorder Schizophrenia Substance abuse Seizure disorder And others Persons with schizoaffective disorder may be of a bipolar [healthyplace.com]

  […] a suicide plan, and the means to carry out the plan Have trouble breathing Are very confused Are very drowsy or have trouble awakening Faint or loss of consciousness Have a rapid heart rate, very low heart rate, or a new irregular heart rate Have a seizure [fairview.org]

  Anticonvulsant medication can also help treat mood disorder symptoms electroconvulsive therapy (ECT) - is used to treat depression by inducing controlled seizures via small electrodes placed at specific locations on the head psychological therapy - which [betterhealth.vic.gov.au]

  For example, psychotic or mood disorder symptoms can occur in people who: Use cocaine, amphetamines, or phencyclidine (PCP) Have seizure disorders Take steroid medicines Treatment can vary. [medlineplus.gov]

In most cases, workup may include psychological testing, diagnostic imaging (CT, MRI or EEG) and selected laboratory tests [7].

Laboratory studies that may be performed include the following:

• Sequential multiple analysis
• Complete blood count (CBC)
• Lipids
• Rapid plasma reagent
• Thyroid-stimulating hormone (TSH) level 
• Urine drug screen
• Urine pregnancy test
• Urinalysis

Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. [ncbi.nlm.nih.gov]

Treatment of someone with this disorder is often challenging and rarely boring for the treatment team. [psychcentral.com]

Treatment may include multiple hospitalizations and multiple psychotropic medications ( 3, 4 ). [doi.org]

Treatment is based largely on the treatment of schizophrenia. [ 1 ] Antipsychotics are the mainstay of treatment, sometimes combined with psychological therapies. [patient.info]

However, with respect to the long-term outcome ICD-10 schizoaffective disorders had a prognosis similar to that of affective disorders. [ncbi.nlm.nih.gov]

Prognosis There is no cure for this disorder so prognosis is poor. [allpsych.com]

Patients have a better prognosis than patients with schizophrenia but a worse prognosis than patients with mood disorder. [online.epocrates.com]

The exact cause of schizoaffective disorder remains unknown [2]. A combination of factors may however, contributes to its development. Some of these factors include genetic predisposition, brain chemistry, brain development variations or delays and exposure of fetus to viral illnesses, toxins or birth complications.

The frequency of schizoaffective disorder worldwide is rather difficult to determine because the diagnostic criteria has continued to evolve over the last few years [3]. A study in Finland says the estimated lifetime prevalence of schizoaffective disorder is about 0.32% while a French study puts it at 0.5-0.8%. These numbers are however very rough estimates.

The bipolar subtype of schizoaffective disorder is seen most of the time in young people while older people often have the depressive subtype.

Overall, the condition is more common in women than in men. This is probably due to the fact that women have the depressive subtype instead of the bipolar subtype. Men with schizoaffective disorder often tend to exhibit antisocial traits and behaviour. This is in contrast to other personality traits. Additionally, the age of onset varies in both sexes as it is seen earlier in men. There have not been any observed racial differences.

On the contrary, convergent evidence purports overlap across current diagnostic boundaries in the heritability and pathophysiology of psychotic and affective disorders. However, there are some disorder-specific findings. [ncbi.nlm.nih.gov]

However, since its introduction, schizoaffective disorder has proven to be a problematic diagnosis and one that has provided little insight into the pathophysiology of psychotic disorders. [doi.org]

Pathophysiology and Etiology The exact pathophysiology of schizoaffective disorder is unknown but may involve neurotransmitter imbalances in the brain. [6] Abnormalities of the neurotransmitters serotonin, norepinephrine, and dopamine could play a role [emedicine.medscape.com]

There is no prevention of the disease as the root cause is still unclear but reoccurrence of symptoms can be prevented using the right medications [10].

1. Kane JM. Performance improvement CME: Schizoaffective disorder. J Clin Psychiatry. Jul 2011;72(7):e23.
2. Kane JM. Strategies for making an accurate differential diagnosis of schizoaffective disorder. J Clin Psychiatry. 2010;71 Suppl 2:4-7. 
3. Bottlender R, Strauss A, Möller HJ. Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission. Schizophr Res. Jan 2010;116(1):9-15. [Medline].
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000:319-23.
5. Kaplan HI, Sadock BJ, eds. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 9th ed. New York, NY: Lippincott Williams & Wilkins; 2003:508-11.
6. Becker T, Kilian R. Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?. Acta Psychiatrica Scandinavica 2006 Supplement 113 (429): 9–16
7. Jäger M, Bottlender R, Strauss A, Möller HJ. Fifteen-year follow-up of ICD-10 schizoaffective disorders compared with schizophrenia and affective disorders. Acta psychiatrica Scandinavica 2004 109 (1): 30–7.
8. Ben Amar M, Potvin S. Cannabis and psychosis: what is the link?. Journal of Psychoactive Drugs 2007 39 (2): 131–42.
9. Kumar S, Kodela S, Detweiler JG, Kim KY, Detweiler MB. Bupropion-induced psychosis: folklore or a fact? A systematic review of the literature. General hospital psychiatry 2011 33 (6): 612–7.
10. Stahl, Stephen M. Essential Psychopharmacology of Antipsychotics and Mood Stabilizers. Cambridge University Press 2002. p. 70. ISBN 0521-89074-8.