Facts about Schizoaffective Disorder

What is Schizoaffective Disorder?
Schizoaffective disorder is a major psychiatric disorder that is quite similar to schizophrenia.  The disorder can affect all
aspects of daily living, including work, social relationships, and self-care skills (such as grooming and hygiene).  People
with schizoaffective disorder can have a wide variety of symptoms, including problems with their contact with reality
(hallucinations and delusions), mood (such as marked depression), low motivation, inability to experience pleasure, and
poor attention.  The serious nature of the symptoms of schizoaffective disorder sometimes requires clients to be
hospitalized at times for treatment.  The experience of schizoaffective disorder can be described as similar to "dreaming
when you are wide awake"; that is, it can be hard for the person with the disorder to distinguish between reality and
fantasy.

How Common Is Schizoaffective Disorder?
About one in every two hundred people (1/2 percent) develops schizoaffective disorder at some time during his or her
life.  Schizoaffective disorder, along with schizophrenia, is one of the most common serious psychiatric disorders.

How Is the Disorder Diagnosed?
Schizoaffective disorder can only be diagnosed by a clinical interview.  The purpose of the interview is to determine
whether the client has experienced specific "symptoms" of the disorder, and whether these symptoms have been
present long enough to merit the diagnosis.  In addition to conducting the interview, the diagnostician must also check
to make sure the client is not experiencing any physical problems that could cause symptoms similar to schizoaffective
disorder, such as a brain tumor or alcohol or drug abuse.
     Schizoaffective disorder
cannot be diagnosed with a blood test, an X ray, a CAT scan, or any other laboratory test.  
An interview is necessary to establish the diagnosis.

The Characteristic Symptoms of Schizoaffective Disorder
The diagnosis of schizoaffective disorder requires that the client experience some decline in social functioning for at
least a six-month period, such as problems with school or work, social relationships, or self-care.  In addition, some
other symptoms are commonly present.  The symptoms of schizoaffective disorder can be divided into five broad
classes:  p
ositive symptoms, negative symptoms, symptoms of mania, symptoms of depression, and other symptoms.  A
person with schizoaffective disorder will have some (but not all) of the symptoms described below:

     
Positive Symptoms
     Positive symptoms refer to thoughts, perceptions, and behaviors that are ordinarily absent in people in the general
population, but are present in persons with schizoaffective disorder.  These symptoms often vary over time in their
severity, and may be absent for long periods in some clients.

Hallucinations.  Hallucinations are "false perceptions"; that is, hearing, seeing, feeling, or smelling things that are not
actually there.  The most common type of hallucinations are auditory hallucinations.  Clients sometimes report hearing
voices talking to them or about them, often saying insulting things, such as calling them names.  These voices are
usually heard through the ears and sound like other human voices.

Delusions.  Delusions are "false beliefs"; that is, a belief that the client holds, but that others can clearly see is not
true.  Some clients have paranoid delusions, believing that others want to hurt them.  Delusions of reference are
common, in which the client believes that something in the environment is referring to him or her when it is not (such as
the television talking to the client).  Delusions of control are beliefs that others can control one's actions.  Clients hold
these beliefs strongly and cannot usually be "talked out" of them.

Thinking Disturbances.  The client talks in a manner that is difficult to follow, an indication that he or she has a
disturbance in thinking.  For example, the client may jump from one topic to the next, stop in the middle of the sentence,
make up new words, or simply be difficult to understand.

    
 Negative Symptoms
     Negative symptoms are the opposite of positive symptoms.  They are the absence of thoughts, perceptions, or
behaviors that are ordinarily present in people in the general population.  These symptoms are often stable throughout
much of the client's life.

Blunted Affect.  The expressiveness of the client's face, voice tone, and gestures is diminished or restricted.  
However, this does not mean that the person is not reacting to his or her environment or having feelings.

Apathy.  The client does not feel motivated to pursue goals and activities.  The client may feel lethargic or sleepy and
have trouble following through on even simple plans.  Clients with apathy often have little sense of purpose in their lives
and have few interests.

Anhedonia.  The client experiences little or no pleasure from activities that he or she used to enjoy or that others
enjoy.  For example, the person may not enjoy watching a sunset, going to the movies, or a close relationship with
another person.

Poverty of Speech or Content of Speech.  The client says very little, or when he or she talks, it does not amount to
much.  Sometimes conversing with the client can be unrewarding.

Inattention.  The client has difficulty attending and is easily distracted.  This can interfere with activities such as work,
interacting with others, and personal-care skills.

     
Symptoms of Mania
     In general, the symptoms of mania involve an excess in behavioral activity, mood states (in particular, irritability or
positive feelings), and self-esteem and confidence.

Euphoric or Expansive Mood.  The client's mood is abnormally elevated; for example, he or she is extremely happy
or excited (euphoria).  The person may tend to talk more and with greater enthusiasm or emphasis on certain topics
(expansiveness).

Irritability.  The client is easily angered or persistently irritable, especially when others seem to interfere with his or her
plans or goals, however unrealistic they may be.

Inflated Self-Esteem or Grandiosity.  The client is extremely self-confident and may be unrealistic about his or her
abilities (grandiosity).  For example, the client may believe he or she is a brilliant artist or inventor, a wealthy person, a
shrewd business-person, or a healer when he or she has no special competence in these areas.

Decreased Need for Sleep.  Only a few hours of sleep are needed each night (such as less than four hours) for the
client to feel rested.

Talkativeness.  The client talks excessively and may be difficult to interrupt.  The client may jump quickly from one
topic to another (called flight of ideas), making it hard for others to understand.

Racing Thoughts.  Thoughts come so rapidly that the client finds it hard to keep up with them or express them.

Distractibility.  The client's attention is easily drawn to irrelevant stimuli, such as the sound of a car honking outside on
the street.

Increased Goal-Directed Activity.  A great deal of time is spent pursuing specific goals, at work, school, or sexually.

Excessive Involvement in Pleasurable Activities with High Potential for Negative Consequences.  Common
problem areas include spending sprees, sexual indiscretions, increased substance abuse, or making foolish business
investments.

    
 Symptoms of Depression
     Depressive symptoms reflect the opposite end of the continuum of mood from manic symptoms, with a low mood
and behavioral inactivity as the major features.  

Depressed Mood.  Mood is low most of the time, according to the client or significant others.

Diminished Interest or Pleasure.  The client has few interests and gets little pleasure from anything, including
activities previously found enjoyable.

Change in Appetite or Weight.  Loss of appetite (and weight), when not dieting, or increased appetite (and weight
gain) are evident.

Change in Sleep Pattern.  The client may have difficulty falling asleep or staying asleep, or may wake early in the
morning and not be able to get back to sleep.  Alternatively, the client may sleep excessively (such as over twelve hours
per night), spending much of the day in bed.

Change in Activity Level.  Decreased activity level is reflected by slowness and lethargy, in terms of both the client's
behavior and his or her thought processes.  Alternatively, the client may feel agitated, "on edge," and restless.

Fatigue or Loss of Energy.  The client experiences fatigue throughout the day, or there is a chronic feeling of loss of
energy.

Feelings of Worthlessness, Hopelessness, Helplessness.  Clients may feel they are worthless as people, that
there is no hope for improving their life, or that they are helpless to improve their unhappy situation.

Inappropriate Guilt.  Feelings of guilt may be present about events that the client did not even cause, such as a
catastrophe, a crime, or an illness.

Recurrent Thoughts about Death.  The client thinks about death a great deal and may contemplate (or even
attempt) suicide.

Decreased Concentration or Ability to Make Decisions.  Significant decreases in the ability to concentrate make it
difficult for the client to pay attention to others or complete rudimentary tasks.  The client may be quite indecisive about
even minor things.

     
Other Symptoms
     Clients with schizoaffective disorder are prone to alcohol or drug abuse.  Clients may use alcohol and drugs
excessively either because of their disturbing symptoms, to experience pleasure, or when socializing with others.

How is Schizoaffective Disorder Distinguished from Schizophrenia and Affective (Mood) Disorders?
Many persons with a diagnosis of schizoaffective disorder have had, at a prior time, diagnoses of schizophrenia or
bipolar disorder.  Frequently, this previous diagnosis is revised to schizoaffective disorder when it becomes clear, over
time, that the person has sometimes experienced symptoms of mania or depression but on other occasions has
experienced psychotic symptoms such as hallucinations or delusions even when his or her mood is stable.

What Is the Course of Schizoaffective Disorder?
The disorder usually begins in late adolescence or early adulthood, often between the ages of sixteen and thirty.  The
disorder is lifelong, although the symptoms tend to improve gradually over the person's life.  The severity of symptoms
usually varies over time, at times requiring hospitalization for treatment.  However, most clients have at least some
symptoms throughout their lives.

What Causes Schizoaffective Disorder?
The cause of schizoaffective disorder is not known, although many scientists believe it is a variant of the disorder of
schizophrenia.  Schizoaffective disorder (and schizophrenia) may actually be several disorders.  Current theories
suggest that an imbalance in brain chemicals (specifically, dopamine) may be at the root of these two disorders.  
Vulnerability to developing schizoaffective disorder appears to be partly determined by genetic factors and partly by
early environmental factors (such as subtle insults to the brain of the baby in the womb or during birth).

Are There Factors That Might Increase the Likelihood of Relapse?
Factors that tend to increase the likelihood of a psychotic episode include a significant life change (good or bad), use of
stimulant drugs such as amphetamines or cocaine, and stopping prescribed medications against the doctor's advice.

How is Schizoaffective Disorder Treated?
Many of the same methods used to treat schizophrenia are also effective for schizoaffective disorder.  Antipsychotic
medications are an effective treatment for schizoaffective disorder for most, but not all, persons with the disorder.  
These drugs are not a "cure" for the disorder, but they can reduce symptoms and prevent relapses among the majority
of people with the disorder.  Antidepressant medications and mood stabilizing medications (such as lithium) are
occasionally used to treat affective symptoms (depressive or manic symptoms) in schizoaffective disorder.  Other
important treatments include social-skills training, vocational rehabilitation and supported employment, and intensive
case management.  Family therapy helps reduce stress in the family and teaches family members how to monitor the
disorder.  In addition, individual supportive counseling can help the person with the disorder learn to manage the
disorder more successfully and obtain emotional support in coping with the distress resulting from the disorder.




Recommended Readings

Dearth, N., Labenski, B.J., Mott, M.F., & Pellegrini, L.M. (1986), Families Helping Families:  Living with Schizophrenia.  
New York: Norton.

Gottesman, I.I. (1991),
Schizophrenia Genesis: The Origins of Madness.  New York: W.H.  Freeman and Company.

Keefe, R.S.F. & Harvey, P.D. (1994),
Understanding Schizophrenia.  New York: Free Press.

Mueser, K.T. & Gingerich, S.L. (1994),
Coping with Schizophrenia: A Guide for Families.  Oakland, CA: New Harbinger.

Torrey, E.F. (1995),
Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (Third Edition).  New
York: Harper & Row.

*Note:  This handout is taken from the book
Behavioral Family Therapy for Psychiatric Disorders (1999) by Kim T.
Meuser and Shirley M. Glynn, published by New Harbinger Publications.  Used with permission.
Consult a mental health professional (such as a psychiatrist, social worker, or
psychiaric nurse) about any questions you have concerning this handout.