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]

• Epilepsy

  […] motivation to leave the house social difficulties in communicating with people Before making a diagnosis, the doctor must rule out other general medical conditions with similar symptoms, including: Cushing’s syndrome HIV-related illnesses temporal lobe epilepsy [medicalnewstoday.com]

  The symptoms must not be due to the direct physiological effects of a substance (e.g., cocaine) or a general medical condition (e.g., hyperthyroidism or temporal lobe epilepsy) ( Criterion D ). [health.am]

  PubMed Google Scholar Sato M: Long-lasting hypersensitivity to methamphetamine following amygdaloid kindling in cats: the relationship between limbic epilepsy and the psychotic state. Biol Psychiatry. 1983, 18 (5): 525-536. [biomedcentral.com]

• Asymptomatic

  A bipolar person may experience psychotic symptoms like hallucinations and delusions only in extreme cases of depression and mania; the person is almost asymptomatic in the normal mood phases. [trialx.com]

  Amphetamine psychosis High doses of amphetamines can produce psychotic behavior indistinguishable from schizophrenia in asymptomatic schizophrenics and in some healthy human subjects. 190, 191 The Diagnostic and Statistical Manual of Mental Disorders, [doi.org]

  J., “Cost-Effectiveness of Screening for Asymptomatic Carotid Atherosclerotic Disease,” Stroke, vol. 27, pp. 1944-1950, 1996. 144. [federalregister.gov]

• Developmental Delay

  It has also been reported that people who have brain developmental delays may run the risk of developing the disorder as well. [ohiohospitalforpsychiatry.com]

  Individuals with BPD are vulnerable to mood swings not because there are necessarily differences with their brain chemistry, but instead because they possess rather fragile, developmentally-delayed and under-developed emotional coping skills. [mentalhelp.net]

  delays Prenatal exposure to certain toxins or illnesses, such as drugs or alcohol Statistics on Schizoaffective Disorder Research has shown that the lifetime rate for schizoaffective disorder has been estimated at 0.3 percent. [therecoveryvillage.com]

• Anorexia

  They can produce euphoria, induce anorexia, and be used to treat narcolepsy and attention deficit/hyperactivity disorder (ADHD). [biomedcentral.com]

• Loss of Appetite

  […] of motivation and interest, fatigue, concentration difficulties, physical complaints such as headache or stomach ache, low self-esteem, suicidal thoughts, loss of appetite, insomnia. [betterhealth.vic.gov.au]

  […] of appetite It may sound strange to diagnose “happiness” as a symptom of mental illness, but this isn’t your usual kind of joy. [vantagepointrecovery.com]

  The most common drug-related effects are loss of appetite, insomnia, emotional lability, nervousness and fever. 23 The American Academy of Pediatrics 24 also lists jitteriness and social withdrawal as common side effects of amphetamines in children. [doi.org]

• Anxiety Disorder

  Author information 1 a Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil. 2 b Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia, Salvador, BA, Brazil. 3 c Department of Life Sciences, State [ncbi.nlm.nih.gov]

  Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 2011; 131: 233-42. 14. [content.sciendo.com]

  Daniel's diagnoses include: schizoaffective disorder, borderline personality disorder, CPTSD, depression, anxiety disorder and traumatic brain injury. [youtube.com]

  […] strategies and education Related Conditions A person with schizoaffective disorder may have additional mental health conditions: Anxiety disorders Posttraumatic stress disorder (PTSD) Attention-deficit hyperactivity disorder (ADHD) Substance use disorders [nami.org]

  […] may also live with overlapping disorders such as attention-deficit hyperactivity disorder, anxiety disorders, post-traumatic stress disorder (PTSD), anxiety disorders, and substance and alcohol abuse. [verywellmind.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]

• 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]

• 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]

• 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]

• Insomnia

  The most common adverse events were akathisia (11.1%), injection-site pain (10.6%), and insomnia (10.0%). [ncbi.nlm.nih.gov]

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

  Insomnia or hypersomnia. Psychomotor agitation or retardation. Fatigue. Feelings of guilt or worthlessness. Decreased concentration. Recurrent thoughts of death or suicidal notions. [patient.info]

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.