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)

• Cutaneous Manifestation

  Argyria is a rare cutaneous manifestation of silver deposits in the skin, characterized by a grayish blue discoloration, particularly in sun-exposed areas. [ncbi.nlm.nih.gov]

• Photosensitivity

  Photosensitivity reactions are most common with chlorpromazine; vulnerable patients should wear protective screens on their exposed skin. Pigmentary retinopathy is associated with thioridazine and may impair vision if not detected. [psychcentral.com]

• Hypertelorism

  Phenotypical abnormalities are short stature, depressed nasal bridge, hypertelorism and slender shoulders. Paracentric inversion of chromosome 9 is a rare chromosome aberration. [ncbi.nlm.nih.gov]

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

  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]

• Withdrawn

  Sometimes a neuroleptic is combined with lithium or an antidepressant and then gradually withdrawn, to be restored if necessary. The few studies on drug treatment of this disorder suggest that antipsychotic drugs are most effective. [mhanational.org]

  Trial Phase, Sponsor Type and End point status The report reviews top companies involved and enlists all trials (Trial title, Phase, and Status) pertaining to the company The report provides all the unaccomplished trials (Terminated, Suspended and Withdrawn [gii.co.jp]

  At times, people with this disorder may seem withdrawn, listless, and remote. They may also have extreme mood swings. They may feel intensely happy for a time. Later, they may be very depressed. [muschealth.staywellsolutionsonline.com]

  You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. [nhs.uk]

• Flight of Ideas

  Flight of ideas and racing thoughts. Easily distracted. Increase in goal-directed activity with psychomotor agitation. Excessive involvement in high-risk activities - eg, shopping sprees. [patient.info]

  Below are some examples of such symptoms: Disorganized thought processes, as manifested in speech or behavioral disorganization Flight of ideas or tangential thinking Poor memory Reduced processing speed Poor judgment or decision-making Depressive symptoms [keystonetreatment.com]

  Flight of ideas or subjective experience that thoughts are racing. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli). [psychnet-uk.com]

• Schizoid Personality Disorder

  People with pre-existing cases of certain personality disorders-including borderline personality disorder, schizoid personality disorder, paranoid personality disorder and schizotypal personality disorder-may have increased risks for the onset of schizoaffective [promises.com]

  These two conditions are not the same as schizoid personality disorder or schizotypal disorder, which are personality disorders that also impact thinking and the ability to relate to others. [verywellmind.com]

  Cain, Schizoid Personality Disorder, Encyclopedia of Personality and Individual Differences, 10.1007/978-3-319-28099-8_626-2, (1-9), (2017). [doi.org]

• Euphoric Mood

  Mood Depressed Mood Somatic/Sexual Dysfunction Hyperactivity Guilt/Obsession Odd/Eccentric/Suspicious Personality Anxious/Fearful/Dependent Personality Dramatic/Erratic/Antisocial Personality Differential Diagnosis Psychotic Disorder Due to a General [schizoaffective.org]

  Mood Depressed Mood Somatic/Sexual Dysfunction Hyperactivity Guilt/Obsession Odd/Eccentric/Suspicious Personality Anxious/Fearful/Dependent Personality Dramatic/Erratic/Antisocial Personality DIFFERENTIAL DIAGNOSIS Psychotic Disorder Due to a General [obad.ca]

  A trial of tricyclic antidepressant drugs resulted in a euphoric mood accompanied by pressured speech, insomnia, and poor judgment. [health.am]

• Retrograde Ejaculation

  Inability to reach orgasm or ejaculation and retrograde ejaculation have been reported. Antipsychotics also may cause amenorrhea, lactation, hirsutism, and gynecomastia. [psychcentral.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]

  Manic episode Persistently elevated or irritable mood for at least one week. Three of the following need to be present (or four if the patient has an irritable mood): Inflated self-esteem or grandiosity. Reduced need for sleep. Pressure of speech. [patient.info]

  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]

  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]

  A manic type schizoaffective disorder person may be: Compulsively talkative Extremely agitated Susceptible to buying sprees Experiencing drastic mood changes Suffering from sleeplessness Reference [mentalhealthcenter.org]

  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 [symptoma.com]

  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. [minddisorders.com]

• Catatonia

  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]

  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]

  […] 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 [merckmanuals.com]

• Abnormal Involuntary Movement

  She complained of anticholinergic adverse effects and had abnormal involuntary movements in the oral/buccal region. [ncbi.nlm.nih.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

• Neurophysiologic Abnormalities

  We hypothesized that inhibitory deficits would be present in both subjects with schizophrenia and subjects with bipolar disorder, but differences in the pattern of neurophysiological abnormalities between the two groups might separate the two, in accordance [doi.org]

• Flattened T Wave

  Other Side Effects: Depressed S-T segments, flattened T-waves, U-waves, and prolonged Q-T intervals may be caused by antipsychotic drugs. [psychcentral.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.

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.