Schizoaffective Disorder-History and Theorist
Schizoaffective disorder was initially introduced by Dr. Jacob Kasanin in 1933. His belief was different from the thinking of the time, that delusions and hallucinations were exclusive to schizophrenia. He recognized the role of mood disorders and for the first time established a connection between the mood disorders and schizophrenia, stating that they weren’t mutually exclusive (Lake & Hurwitz, 2006b). The idea of mutual exclusivity had previously been championed by Emil Kraepelin in the late 1890s. He referred to the two distinct disorders as dementia praecox (a term first used by Arnold Pick in 1891) and manic-depressive insanity, and the two together composed what was known as the Kraepelinian dichotomy. Dementia praecox was later named schizophrenia in 1911 by Eugen Bleuler and manic depressive insanity came to be known as bi-polar disorder (Lake, 2008).
Schizoaffective Disorder- DSM-IV Diagnosis
According to the DSM-IV-TR, as well as information on the Mayo Clinic website, schizoaffective disorder is currently described as a condition in which a person experiences a combination of schizophrenia symptoms—such as hallucinations or delusions—and of mood disorder symptoms, such as mania or depression. These mood symptoms are what distinguish the schizoaffective personality from the schizophrenic one (Mathalon et al., 2010). The DSM-IV-TR criteria require, in addition to a mood disorder, at least a two-week period of delusions or hallucinations without prominent mood symptoms.
Schizoaffective Disorder Behavioral Symptoms
Schizoaffective disorder typically includes delusions, auditory hallucinations, speech and thinking that is disorganized, paranoia, depression, and/or mania. People suffering from schizoaffective disorder are, without treatment, usually dysfunctional in social and occupational settings. These symptoms, however, may vary among affected individuals and, most of the time, manifest themselves between late adolescence and early adulthood (Maier et al., 2006).
Schizoaffective Disorder Prevalence
The prevalence of schizoaffective disorder is difficult to determine, since it shares symptoms with other disorders, such as depression, anxiety, substance use, paranoia, hallucinations, etc. and may be misdiagnosed. It is considered rare in the general population, approximately one-fourth as common as schizophrenia. However, schizoaffective disorder patients comprise about 24% as compared to 32% of schizophrenics as users of mental health services. Within community hospitals the diagnosis of schizoaffective disorder is higher than that of schizophrenia. In one study, schizoaffective disorder patients had a younger mean age and were more likely to be white and female than their schizophrenic counterparts (Olfson et al., 2009).
Schizoaffective Disorder- Causes
It has been difficult to determine the cause of schizoaffective disorder, due to the scarcity of research in this area. And the research that has been done combines schizoaffective and schizophrenia patients into the same group (Mathalon et al., 2009). Although what causes this disorder is not known, there does appear to be some genetic link involving many different genes (Maier et al., 2006). Other experts believe that it may involve an imbalance of dopamine and serotonin, chemicals in the brain that act as neurotransmitters.
Schizoaffective Disorder Treatment
The treatment of schizoaffective disorder must include both medications and psychotherapy. Drug therapy is usually targeted to the specific symptoms being manifested, whether they be psychotic or mood-related (Nasrallah et al., 2010). The pharmacologic regimen may include antidepressants, mood-stabilizers, antipsychotics, and anti-convulsants. Psychotherapy, such as Cognitive Behavioral Therapy, would be warranted to help with depression, stress, loneliness, anxiety, improvement of social skills, etc. Also, there is generally a need for family and occupational counseling, as the patients may be estranged from family, experiencing family discord, and/or out of work.
References
Cheniaux, E., Landeira-Fernandez, J., & Versiani, M. (2009). The diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder and unipolar depression: Interrater reliability and congruence between DSM-IV and ICD-10 (Abstract). Psychopathology, 42(5). doi: 10.1159/000228838
Frueh, B. C., Grubaugh, A. L., Cusack, K. J., Kimble, M. O., Elhai, J. D., & Knapp, R. G. (2009). Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: A pilot study. Journal of Anxiety Disorders, 23(5), 665-675. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737503/
Lake, C. R. (2008). Disorders of thought are severe mood disorders: The selective attention defect in mania challenges the Kraepelinian dichotomy—A review. Schizophrenia Bulletin, 34(1), 109-117.
Lake, C. R. & Hurwitz N. (2006a). Schizoaffective disorders are psychotic mood disorders: There are no schizoaffective disorders (Abstract). Psychiatry Research, 143(2), 255-287. doi:10.1016/j.psychres.2005.08.012
Lake, C. R. & Hurwitz N. (2006b). When psychosis clouds mood symptoms, mismatched medication can worsen patients’ course. Journal of Family Practice, 5(3). Retrieved from http://www.jfponline.com/Pages.asp?AID=3921
Maier, W., Zobel, A., & Wagner, M. (2006). Schizophrenia and bipolar disorder: Differences and overlaps (Abstract). Current Opinion in Psychiatry, 19(2), 165-170.
