Schizoaffective Disorder: Understanding Symptoms, Causes and Treatment

Introduction

Schizoaffective disorder falls under the category of Schizophrenia spectrum and other psychotic disorders according to current diagnostic classification. However, it is difficult to establish whether the disorder falls into the subtype of schizophrenia or mood disorder or simultaneous expression of both. Early intervention can be helpful for patients’ well-being.

Schizoaffective Disorder

Schizoaffective disorder is a mental health condition characterized by features comprising both schizophrenia and mood disorders (depression or mania). The lifetime prevalence has been found to be 0.3%. [1] Research shows that 30% of cases occur between the ages of 25 – 35 years, and it occurs more frequently in women. [2,3] It can be diagnosed if the patient with schizophrenia has mood symptoms, the patient with mood disorder has symptoms of schizophrenia, or the patient has symptoms of both schizophrenia and mood disorder. The disorder is usually difficult to diagnose as it presents with a wide variety of signs and symptoms, sometimes overlapping between both psychiatric disorders. During illness, it also results in social impairment, dysfunction in work-life balance, emotional lability, and cognitive disturbances (decreased attention span, lack of concentration), which is difficult for the patient and the family members. Prompt intervention is a must to improve the quality of life of the patient.

Symptoms of Schizoaffective Disorder

Symptoms of Schizophrenia include: 

1. Hallucinations (Auditory, tactile) 
2. Delusions (persecutory, jealousy, self-reference)
3. Bizarre behavior (aggression, inappropriate clothing, or sexual behavior)
4. Unchanging facial expression
5. Disorganised thought and speech
6. Social withdrawal

Symptoms of Mood disorder include:

1. Sad mood or euphoric mood
2. Decreased energy 
3. Hopelessness, worthlessness, helplessness
4. Pessimistic ideas
5. Suicidal thoughts or behaviour
6. Pressured speech
7. Disturbed sleep
8. Decreased or increased appetite
9. Easy distractibility

Causes of Schizoaffective Disorder

There is no exact cause known for schizoaffective disorder. [4] However, genetic factors play an important role in the aetiology. Sometimes, causes of schizophrenia and mood disorder overlapping can also lead to this disorder. 

Genetic factors include:

1. Parents or siblings who have schizophrenia, depression, or any mental disorder
2. A first-degree relative who is suffering from schizophrenia or mood disorder
3. Identical twins have a higher probability of having an illness than non-identical twins.
4. Alterations in Gene markers that code for GABA neurotransmitter [5]

Neurobiological factors include:

1. Abnormalities in dopamine, norepinephrine, and serotonin [6]
2. White matter abnormalities in the right lentiform nucleus left temporal gyrus, and right precuneus [7]
3. Reduced hippocampal volumes [8]

Environmental factors include:

1. Stressful life situations
2. Emotional trauma
3. Use of illicit substances 
4. Living in poverty
5. Poor family dynamics
6. Neglect

How can Family and Friends Support Someone with Schizoaffective Disorder?

Schizoaffective disorder can take a toll on patients as well as family members. 

1. The first thing, if someone is feeling disturbed or having the above symptoms, should try to speak about it. 
2. If a family member or friend observes something unusual, then they should encourage the patient to visit a healthcare provider. 
3. Early diagnosis and intervention can reduce the symptoms and improve the quality of life. 
4. Family and friends should follow the doctor’s treatment instructions all throughout the course of illness.
5. Family members must motivate the patient to be compliant with treatment.
6. They can attend the therapy sessions with the patients.
7. They must be in touch with the health care provider.
8. Family members must try to make the home environment loving, so that patient do not feel ill or burden on the family.

Treatment of Schizoaffective Disorder

There is no specific laboratory test to diagnose the disorder. It is purely done based on history and mental status examination. The management of the disorder includes pharmacotherapy and psychotherapy.

Pharmacotherapy:

1. Antipsychotics, including first-generation (haloperidol, trifluoperazine, chlorpromazine) and second-generation (olanzapine, risperidone, quetiapine), are used for aggressive behavior and for treating schizophrenia-like symptoms.
2. Mood stabilizers treat euphoric mood, easy distractibility, aggression, and grandiosity. These includes lithium, sodium valproate, carbamazepine, oxcarbazepine. It should be considered in patients with a history of mania or hypomania.
3. Antidepressants target depressive symptoms in patients with schizoaffective disorder. Selective serotonin reuptake inhibitors (SSRI) like fluoxetine, escitalopram, sertraline, paroxetine, and selective norepinephrine reuptake inhibitors (SNRI) like venlafaxine, desvenlafaxine, duloxetine can be considered.

Psychotherapy:

1. Individual therapy: It aims to understand the disorder and help to reduce symptoms 
2. Family therapy: It involves family education regarding medications and compliance with medications.
3. Group therapy: It helps in the improvement of social skills among the patients
4. Psychoeducation programs: To help patients and relatives acknowledge the illness, its symptoms, and how to manage it.

Conclusion

Schizoaffective disorder is indeed a challenging psychotic disorder. It is difficult to diagnose the illness, but early detection and prompt intervention can help in improving the quality of life and overall well-being of the patient. If not treated, it impairs social functioning and daily living activities. 

References

1. Laursen TM, Munk-Olsen T, Nordentoft M, Bo Mortensen P. A comparison of selected risk factors for unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia from aDanishh population-based cohort. J Clin Psychiatry. 2007 Nov;68(11):1673-81. Doi: 10.4088/jcp.v68n1106. PMID: 18052560.
2. Marneros A, Deister A, Rohde A. Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course. Acta Psychiatr Scand. 1990 Nov;82(5):352-8. doi: 10.1111/j.1600-0447.1990.tb01400.x. PMID: 2281805.
3. Abrams DJ, Rojas DC, Arciniegas DB. Is schizoaffective disorder a distinct categorical diagnosis? A critical review of the literature. Neuropsychiatr Dis Treat. 2008 Dec;4(6):1089-109. doi: 10.2147/ndt.s4120. PMID: 19337453; PMCID: PMC2646642.
4. Wy TJP, Saadabadi A. Schizoaffective Disorder. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541012/
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6. Meltzer HY, Arora RC, Metz J. Biological studies of schizoaffective disorders. Schizophr Bull. 1984;10(1):49-70. doi: 10.1093/schbul/10.1.49. PMID: 6422546.
7. Antonius D, Prudent V, Rebani Y, D’Angelo D, Ardekani BA, Malaspina D, Hoptman MJ. White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophr Res. 2011 May;128(1-3):76-82. doi: 10.1016/j.schres.2011.02.020. Epub 2011 Mar 22. PMID: 21429714; PMCID: PMC3085627.
8. Radonić E, Rados M, Kalember P, Bajs-Janović M, Folnegović-Smalc V, Henigsberg N. Comparison of hippocampal volumes in schizophrenia, schizoaffective and bipolar disorder. Coll Antropol. 2011 Jan;35 Suppl 1:249-52. PMID: 21648342.