Schizoaffective Disorder

Schizoaffective disorder is a mental illness that has symptoms of both schizophrenia and bipolar disorder. This factsheet aims to provide information on the condition and possible causes and treatments.

Schizoaffective disorder is a condition with symptoms of schizophrenia and bipolar disorder (also known as manic depression). It involves a combination of symptoms of psychosis and mania and/or depression. Because of the close overlap with bipolar disorder and schizophrenia, the diagnosis can be changeable. The cause of the condition is still unknown. However, it seems that there are genetic and environmental links. Schizoaffective disorder is often treated with medication. There are a variety of types of medication that may be used. Talking therapies are also helpful in treatment, such as Cognitive Behavioural Therapy (CBT).

This factsheet covers 1. 2. 3. 4. What is schizoaffective disorder? What causes schizoaffective disorder? How is schizoaffective disorder treated? Risk associated with schizoaffective disorder?

1. What is schizoaffective disorder? Schizoaffective disorder is a condition in which there are symptoms of bipolar disorder (depression and/or mania) and schizophrenia. Diagnosis 1

is not a clear cut process so this diagnosis can be changeable. This is also due to the overlap of schizoaffective disorder with schizophrenia and bipolar disorder. More women than men tend to suffer from schizoaffective disorder, with symptoms usually beginning at the age of early adulthood. About 1 in 200 (0.5%) people develop schizoaffective disorder at some time during their life.1 Some people believe that this low statistic does not represent the true level of the condition, and that many people are misdiagnosed with something else. One study interviewed a group of people with psychosis and around 30% were given a diagnosis of schizoaffective disorder. Of these people, around 40% already had a current schizoaffective disorder diagnosis.2 Most of the time symptoms of mania or depression occur at the same time as psychotic symptoms, but there must be at least one two-week period in which there are only psychotic symptoms without any symptoms of mania or depression. The symptoms below are typical of mania, depression and psychosis Mania Elevated or irritable mood, inflated sense of self-importance, decreased need for sleep, being more talkative, racing thoughts, being easily distracted, being over-involved in activities for pleasure that can have very negative consequences (e.g. sexual behaviour or spending sprees), increased activity. Depression Lasting sad or empty mood, feeling hopeless and worthless, loss of pleasure in activities once enjoyed, disturbed sleep, changes in weight and appetite, thoughts of suicide, decreased energy, difficulty making decisions and concentrating. Psychosis Delusions (fixed false beliefs), hallucinations (sensing something that is not there, which can affect all of the senses), confused or disturbed thoughts and speech, change in behaviour, becoming withdrawn. People with psychosis can often be unaware of being unwell and believe that what they are experiencing is real.

Top 2. What causes schizoaffective disorder? The causes of schizoaffective disorder are unknown but it is thought that both genetic and environmental factors are involved. It seems that in people with schizoaffective disorder there may be a chemical imbalance in the chemical messengers of the brain (neurotransmitters). However, it is unclear as yet whether that is caused by the environment or as a result of a genetic predisposition. 2

Genetic causes Schizoaffective disorder occurs more often in families where other members have been diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder.3 This suggests that genetics have a role to play in the development of schizoaffective disorder, although no single gene has been identified as being responsible. Environmental causes Stress seems to play a key role in triggering schizoaffective disorder and subsequent relapses.4 It is important for people with schizoaffective disorder to live in an environment with a low degree of stress and to monitor the types of stress that cause relapses. Top

3. How is schizoaffective disorder treated? Drug and psychosocial therapies (such as talking treatments) are often necessary to successfully treat schizoaffective disorder. As with many other forms of mental illness, schizoaffective disorder is often accompanied by social problems such as unemployment, poverty and homelessness and as such drug therapy alone is often insufficient. Drug therapy can usually stop someones psychosis, but often only social and occupational rehabilitation therapies can overcome the associated problems. Medication There is no specific treatment for schizoaffective disorder. It is often treated with medication to treat the symptoms of schizophrenia and bipolar disorder.5 This may include a combination of antipsychotics, antidepressants, mood stabilisers and anti-anxiety medication.6 There are some points regarding medication that are worth noting Some people given oral antipsychotic medication may not take the medication regularly or at all in some cases. In these situations, long acting depot injections can be helpful. Antidepressants can often be used as part of the medication treatment. The newer Selective Serotonin Reuptake Inhibitor SSRI antidepressants are generally used, with the tricyclic and Monoamine Oxidase Inhibitor (MAOI) antidepressants usually avoided. Antidepressant use should be monitored carefully as they can trigger manic episodes, known as switching.7

For further information on medication, please see the Rethink Advice & Information Services factsheets Antipsychotics, Antidepressants, Mood 3

stabilisers and Benzodiazepenes (anti-anxiety medication). It has also produced a medication guide called Only the Best, which has information on antipsychotic and mood stabiliser medication. The Rethink Advice & Information Service can provide you with a copy of these (contact details at the end of the factsheet) or they can be downloaded for free from www.rethink.org. Psychosocial treatments NICE (National Institute for Health and Clinical Excellence) produces guidelines about how particular conditions should be treated in the NHS. Its guideline on schizophrenia states that people with schizoaffective disorder should be offered the psychological intervention of Cognitive Behavioural Therapy (CBT). A review has found that CBT can reduce the rate of going back to hospital, and hospital stays tend to be shorter. 8 Research has found that group CBT may not be effective in treating the symptoms of schizoaffective disorder (such as hallucinations and delusions). However, it did find that group therapy can improve peoples negative feelings of themselves and help with low self-esteem.9 The NICE guidelines also recommend that family interventions should also be offered when the family lives with or are in close contact with the person. Family therapy has been found to possibly reduce the risk of relapse and also possibly reduce hospital admission.10 NICE guidance recommends that supportive psychotherapy and counselling arent offered routinely as specific interventions. Ho wever, peoples preferences should be taken into account as well as the availability of other treatments such as CBT. When a patient with schizoaffective disorder is no longer experiencing psychosis, behaviour therapy can successfully teach necessary social and occupational skills. Self help groups, in which family members of schizoaffective patients discuss and share issues, may also be helpful.

For further information about talking treatments, please see the Rethink Advice & Information Services factsheet Talking treatments and psychological therapies. Top 4. Risk associated with schizoaffective disorder: Between 30-40% of people with schizoaffective disorder will attempt suicide during their lifetime and 10% of them will succeed.11 Clozapine is a type of antipsychotic medication that is used in treating schizophrenia. It is recommended to be used when other antipsychotics havent been effective.12 Should it be appropriate, treatment with clozapine can reduce the chance of suicide in people with schizoaffective disorder. 13 Symptoms in schizoaffective disorder may be improved with a combination 4

treatment of clozapine and lithium.14 Lithium is a mood stabilising medication. Top The Hearing Voices Network provides support and understanding for those who hear voices and their significant others. HVN, 79 Lever Street, Manchester, M1 1FL Helpline - 0845 122 8642 (Open Tuesday, 1pm 4pm) Email - info@hearing-voices.org Web - www.hearing-voices.org

Mental Health Care. Schizoaffective disorder [Online] Available at: http://www.mentalhealthcare.org.uk/schizoaffective_disorder [Accessed 12 February 2010] 2 Canuso, C. et al., (2008) Frequency of schizoaffective disorder diagnosis in patients with psychotic disorders using the mini-international neuropsychiatric interview. Schizophrenia Research, 98, p.67-68 3 Laursen, T.M. et al (2005) Family history of psychiatric illness as a risk factor for schizoaffective disorder:a Danish register-based cohort study. Archive of General Psychiatry, 62(8), p.841-848 4 Nuechterlein, K.H. et al (1994) The vulnerability/stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatrica Scandinavica. 89 (s382), p.58-64 5 Mental Health Care. Schizoaffective disorder [Online] Available at: http://www.mentalhealthcare.org.uk/schizoaffective_disorder [Accessed 12 February 2010] 6 Taylor, D., Paton C., & Kapur, S., 2009. The Maudsley Prescribing Guidelines. 10th ed. Informa Healthcare. 7 Taylor, D., Paton C., & Kapur, S., 2009. The Maudsley Prescribing Guidelines. 10th ed. Informa Healthcare. 8 National Institute of Health and Clinical Excellence. Core interventions in the treatment and management of schizophrenia in primary and secondary care (update). Clinical Guidance 82, http://www.nice.org.uk. 2009. 9 Barrowclough, C. et al (2006). Group cognitive-behavioural therapy for schizophrenia. The British Journal of Psychiatry. 189, p.527-532 10 Pharoah, F. et al. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 4 11 Mental Health Foundation. Schizoaffective disorder [Online] Available at: http://www.mentalhealth.org.uk/information/mental-health-az/schizoaffective-disorder/ [Accessed 12 February 2010] 12 National Institute of Health and Clinical Excellence. Core interventions in the treatment and management of schizophrenia in primary and secondary care (update). Clinical Guidance 82, http://www.nice.org.uk. 2009. 13 Reid, W.H. et al. (1998) Suicide prevention effects associated with clozapine therapy in schizophrenia and schizoaffective disorder. Psychiatric Services, 49, p.1029-1033 14 Small et al. (2003) Tolerability and efficacy of clozapine combined with lithium in schizophrenia and schizoaffective disorder. Journal of Clinical Psychopharmacology, 23, p.223-228 5

The content of this product is available in Large Print (16 point). Please call 0300 5000 927.
RET0111 Rethink Mental Illness 2011 Last updated July 2011 Next update July 2013

Last updated 01/10/2010