Schizoaffective Disorder - Anatomy of Psych

What is schizoaffective disorder?

Schizoaffective disorder is a psychotic disorder whereby a major mood episode occurs at the same time as symptoms of schizophrenia. Its lifetime prevalence is 0.3%, and it is more often seen in women than in men.

What does schizoaffective disorder look like?

DSM-5 Criteria

Criterion A. An uninterrupted period of illness during which where there is a major mood episode (depressive or manic) concurrent with Criterion A of schizophrenia. Note: the major depressive episode must include Criterion A1: Depressed mood.

Criterion B. Delusions or hallucinations for at least 2 weeks in the absence of a major mood episode during the lifetime duration of the illness

Criterion C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

Criterion D. The disturbance is not attributable to the effects of a substance or another medical condition.

Subtypes & Specifiers

Subtypes:

Bipolar type: applies if a manic episode is part of the presentation; major depressive episodes may also occur
Depressive type: applies if only major depressive episodes are part of the presentation

Specifiers:

First episode, currently in acute episode
First episode, currently in partial remission
First episode, currently in full remission
Multiple episodes, currently in acute episode
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous
Unspecified

Differential Diagnosis

Schizophrenia
Major depressive disorder with psychotic features
Bipolar disorder

How is schizoaffective disorder investigated?

Labwork: CBC, lipids, TSH, infections (e.g. HIV)
Urine drug screen
Neuroimaging if there are any neurological deficits

How is schizoaffective treated?

There is limited evidence-based guidelines for schizoaffective disorder

For depressive subtype: antipsychotic + antidepressant
For bipolar subtype: antipsychotic + mood stabilizer

Nursing Management

See nursing management for schizophrenia, major depressive disorder, and bipolar I disorder.

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Jäger, M., Becker, T., Weinmann, S., & Frasch, K. (2010), Treatment of schizoaffective disorder – a challenge for evidence-based psychiatry. Acta Psychiatrica Scandinavica, 121(1), 22-32.

[4] Schnitzer, K., Beckmann, D., & Freudenreich, O. (2020). Schizoaffective disorder: Treatment considerations. Psychiatric Annals, 50(5), 200-204.

[5] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.