Schizoaffective disorder is a mental health condition characterized by features of schizophrenia and affective disorder.
The presentation varies from patient to patient but there are a few items that are commonly assessed in majority of patients with this disorder . 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)
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 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]
Face, Head & Neck
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]
Sometimes a neuroleptic is combined with lithium or an antidepressant and then gradually withdrawn, to be restored if necessary.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and Status) pertaining to the company The report provides all the unaccomplished trials (Terminated, Suspended and Withdrawn [gii.co.jp]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]
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]
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]
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 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 .
Laboratory studies that may be performed include the following:
- Sequential multiple analysis
- Complete blood count (CBC)
- Rapid plasma reagent
- Thyroid-stimulating hormone (TSH) level
- Urine drug screen
- Urine pregnancy test
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]
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 . 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 . 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.  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 .
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