Schizoaffective Disorder DSM-5 295.70 (F25.0 or F25.1)
DSM-5 Category: Schizophrenia Spectrum and Other Psychotic Disorders
Introduction
Mood symptoms and psychosis are prominent features of schizoaffective disorder (American Psychiatric Association, 2013). Hallmarks of schizoaffective disorder include depression and mood disorders, hallucination, and delusion. Concisely defining schizoaffective disorder has been a rather complex issue fraught with disagreement over whether or not it should be diagnosed as a distinct psychiatric disorder (Pagel et al., 2013). The broad consensus, however, is that schizoaffective disorder may be classified as a disorder in its own right, and the American Psychiatric Association (2013) has laid out the criteria that together constitute schizoaffective disorder. For a psychiatric disorder to be diagnosed as schizoaffective, it must be characterized by a bout of illness during which a significant mood episode is manifested. Hallucinations and delusions must also be present in a time span of 2 weeks in order for a diagnosis of schizoaffective disorder to be accurately made. Importantly, drugs or medications must not be the cause of these mood symptoms, hallucinations, and delusions. Furthermore, difficulty in an occupational setting is often seen in schizoaffective disorder, but it is not a requisite condition for a diagnosis of schizoaffective disorder.
The DSM-5 states that schizoaffective disorder can be broken down into two principle subgroups: bipolar type and depressive type. Bipolar type is typified by depressive and manic episodes, whereas manic episodes are not found in depressive type schizoaffective disorder.
The severity of schizoaffective disorder is indicated by the strength and frequency of hallucinations, delusions, faulty psychomotor function, and speech deficits. The degree of severity is measured by a scale from 0 to 4, where 4 is the most severe level of schizoaffective disorder.
Symptoms of Schizoaffective Disorder
Symptoms of schizoaffective disorder are not limited to psychosis and manic episodes, although the DSM-5 emphasizes that these are the most prominent features of the disorder. While these are the more obvious signs of schizoaffective disorder, other symptoms exist that raise the possibility that an individual has schizoaffective disorder. Night eating syndrome, wherein the individual recurrently indulges in late-night episodes of binge eating, is a symptom that may be associated with schizoaffective disorder (Palmese et al., 2013). A corollary to this is that night eating occurrences is frequently accompanied by insomnia. Another symptom of schizoaffective disorder is a lack of organized speech and thought patterns, as well as suicide ideation (American Psychiatric Association).
The National Institute of Health has identified several other symptoms that characterize schizoaffective disorder. Paranoia, for instance, is a symptom of schizoaffective disorder, as well as a neglect of hygiene and personal appearance. Moreover, difficulties in concentrating might signal the presence of schizoaffective disorder. Mood swings, too, are a common feature of schizoaffective disorder; in this case, the affected individual’s mood range from one of melancholy to one of exuberance. An additional symptom of schizoaffective disorder is the tendency to speak rapidly, such that one’s peers are unable to interrupt. Finally, isolation in social settings may occur when one has schizoaffective disorder.
Here it should be pointed out, however, that these symptoms are in no way exclusive to schizoaffective disorder since they may also be indicative of other disorders. Nevertheless, when many of these symptoms are present, it is reasonable to suspect that schizoaffective disorder has manifested itself.
Risk Factors and Causes
Individuals with biological relatives who are affected by schizophrenia or bipolar disorder generally have a higher than average probability for schizoaffective disorder (DSM-5), pointing to a common genetic link between schizophrenia, bipolar, and schizoaffective disorder. There are, to be sure, molecular genetic mechanisms that underlie schizoaffective disorder, and indeed, schizoaffective disorder is classified as a psychiatric illness that is distinct from schizophrenia and bipolar disorder precisely because the biological factors responsible for schizoaffective disorder are not entirely the same as those that result in schizophrenia and bipolar disorder (Cosgrove and Suppes, 2013). One study, for example, found that a lowered level of arrestin – a critical protein component involved in cell signaling regulation – was correlated with schizophrenia but not schizoaffective personality (Bychkov et al., 2011). Furthermore, the crucial differences in the mechanisms behind schizophrenia and schizoaffective disorder are not only molecular, but also anatomical. Studies of brain morphology of patients with schizoaffective disorder and schizophrenia have detected unique morphological features for each of these disorders (Smith et al., 2011).
Despite an impressive accumulation of genomic data, the genes that trigger schizoaffective disorder have not been entirely ascertained (Cosgrove and Suppes, 2013). This being said, however, several lines of research have shed light on possible genome dynamics that cause schizoaffective disorder. Domschke (2013) reviewed the current literature on the subject, and identified a number of genes that might possibly be implicated in the etiology of schizoaffective disorder (and related psychotic illnesses).
Treatment of Schizoaffective Disorder
While there are a host of medications available for treating schizoaffective disorder (see the DSM-5), many of these have negative side effects that make them undesirable for some patients. Thus, other treatment methods have been explored and analyzed in the peer-reviewed literature. Cognitive behavioral therapy has been experimentally demonstrated to be effective in reducing “auditory verbal hallucinations” in patients with schizoaffective disorder (Zanello et al., 2014). The experiment began with a questionnaire which the patients answered before being provided with intervention strategies. Other approaches utilizing cognitive behavioral therapy have also been employed: Lysaker et al. (2009) structured a cognitive behavioral intervention strategy specifically suited for those whose occupational performance had been disrupted by schizophrenia spectrum disorders, including schizoaffective disorder. This approach proved to be successful in producing better work performance from the affected individuals.
Cognitive behavioral therapy methods are not the sole therapies used in the treatment of schizoaffective disorder, however. Psychotherapy has been used – with some success – in treating the psychotic symptoms of patients with schizoaffective disorder (Restek-Petrovic et al., 2012). In particular, group psychotherapy – wherein patients could interact with individuals with the same disorder in a safe context – provided the patients with a deeper understanding of their own nature. In a similar vein, Steggles (2012) discusses the case of a young woman suffering from schizoaffective disorder who was able to make a complete recovery after several years of psychotherapy with a psychoanalyst. This psychotherapy allowed her to gain a deeper comprehension of her own mind, and thus proved to be helpful in her recovery. Therefore, therapy beyond medications offers potential for treating this debilitating disorder.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bychkov, E.R., Ahmed, M.R., Gurevich, V.V., Benovic, J.L., Gurevich, E.V. (2011). Reduced expression of G protein-coupled receptor kinases in schizophrenia but not in schizoaffective disorder. Neurobiology of Disease, 44(2), 248-258.
Cosgrove, V.E., Suppes, T. (2013). Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia. BMC Medicine, 11, 127.
Domschke, K. (2013). Clinical and molecular genetics of psychotic depression. Schizophrenia Bulletin, 39(4), 766-775.
Lysaker, P.H., Davis, L.W., Bryson, G.J., Bell, M.D. (2009). Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders. Schizophrenia Research, 107(2-3), 186-191.
Pagel, T., Baldessarini, R.J., Franklin, J., Baethge, C. (2013). Characteristics of patients diagnosed with schizoaffective disorder compared with schizophrenia and bipolar disorder. Bipolar Disorders, 15(3), 229-239.
Palmese, L.B., Ratliff, J.C., Reutenauer, E.L., Tonizzo, K.M., Grilo, C.M., Tek, C. (2013). Prevalence of night eating in obese individuals with schizophrenia and schizoaffective disorder. Comprehensive Psychiatry, 54(3), 276-281.
Restek-Petrovic, B., Mihanovic, M., Grah, M., Molnar, S., Bogovic, A., Agius, M., Kezic, S., et al. (2012). Early intervention program for psychotic disorders at the psychiatric hospital "Sveti Ivan". Psychiatria Danubina, 24(3), 323-332.
Smith, M.J., Wang, L., Cronenwett W., Mamah, D., Barch, D.M., Csernansky, J.G. (2011). Thalamic morphology in schizophrenia and schizoaffective disorder. Journal of Psychiatric Research, 45(3), 378-385.
Steggles, G.R. (2012). The process of recovery of a schizoaffectively disordered mind: a psychoanalytic theory of the functional psychoses, the psychodynamic pentapointed cognitive construct theory. BMJ Case Reports, doi: 10.1136/bcr-2012-006683.
Zanello, A., Mohr, S., Merlo, M.C., Huguelet, P., Rey-Bellet, P. (2014). Effectiveness of a Brief Group Cognitive Behavioral Therapy for Auditory Verbal Hallucinations: A 6-Month Follow-up Study. The Journal of Nervous and Mental Disease, 202(2), 144-153.
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