General psychopathology Tushnik Ghosh

E- Schizoaffective disorder

SECTION E

SCHIZOAFFECTIVE DISORDERS (F25): Schizoaffective disorder comes between schizophrenia and

affective psychosis. Signs of the disorder contain psychic attacks of bright affect (mania and depression)
and schizophrenia. During the onset of the emotional disorder of mania type the patient may show high
self-appraisal, grandiose ideas, sometimes combined with irritation and agitation and aggression. In
depressive condition observed decreased interest, disorder of sleep, ideas of guilt, low self-appraisal and
hopelessness. Duration of psychosis prolongs from a few weeks to few years. Recurrent attacks are not
rare. In ' some patients attacks are provoked by exogenous and psychological factors (symptomatic
lability). On the whole, the attacks are characterized by bright affect, onset of acute affective delusion, and
less frequently catatonic symptoms. Remission is very much different from the other types of ' psychiatric
diseases. Absence of defect (change in personality) after the 1st attack allows us to consider about
intermission. Gradually the defect forms. This defect is characterized by asthenia or hypersthenia,
increased work capability with simultaneously decreased creative activity (lack of productivity), and mild
impoverishment of emotions. Generally these changes are found after 3rd or 4th ' attack. After 4th attack
attacks occur less frequently and the defect stands at the same point. ' At this stage the patient develops
insight and he is able to distinguish the healthy and diseased state of his condition clearly. Work
capability of this patient (when not in psychosis) is secured (little decreased as compared to a normal
person taking consideration that the patient is having change in personality of asthenic type). Prognosis
is good, but we must keep in mind that the patient in depressive state may develop a suicidal idea. In this
case a special watch must be given on the patient. It is actually very difcult to differentiate
schizoaffective disorder from paranoid schizophrenia and MDP. I will give three case examples to show
the basic differences among them. Case example 1: Mrs B was a married woman with 3 children. She was
reported be a happy woman. When her 3rd child was 15 months old, she complained of trouble in
sleeping. Her husband noticed that she is sometimes irritable and other times euphoric. One night her
husband received a phone ' call informing that his wife is in jail. She had secretly left the house, gone to
local pub, ' and initiated a ght with a female cop. Cop thought that she was acting wildly and suspected
her of drug abuse. She was taken to psychiatric clinic where urine test informed the absence of drug in
the body. She was admitted there and was treated by benzodiazepine, and lithium. After 2 weeks she was
asymptomatic. Her diagnosis is bipolar I disorder, manic type. Case example 2: Mrs B was a married
woman with 3 children. She was reported be a happy woman. When her 3rd child was 15 months old, she
complained of trouble in sleeping. Her husband noticed that she was becoming increasingly isolated and
was not able to take care of the children. One night her husband received a phone call informing that his
wife is in jail. She had secretly left ' the house, gone to local pub, and initiated a ght with a female cop.
Cop thought that she was acting wildly and suspected her of drug abuse. She was taken to psychiatric
clinic where urine test informed the absence of drug in the body. At that time she told the cop and the
psychiatrist that she is sure about the fact that somebody is using her social security number and
consuming the benet she would need when she was older. She had gone to pub because a man s voice
told her that the person, who uses her number, was in the pub. This voice was with her over year and even
sometimes commented on her looks and actions. The patient was admitted to ' hospital and was treated
with resperidone. After 2 weeks she was asymptomatic. Her diagnosis was paranoid schizophrenia. Case
example 3: Mrs B was a married woman with 3 children. She was reported be a happy woman. When her
3rd child was 15 months old, she complained of trouble in sleeping. Her husband noticed that she was
irritable, sometimes euphoric, becoming increasingly isolated and was not able to take care of the
children. One night her husband received a phone call informing that his wife is in ' jail. She had secretly
left the house, gone to local pub, and initiated a ght with a female cop. Cop thought that she was acting
wildly and suspected her of drug abuse. She was taken to psychiatric clinic where urine test informed the
absence of drug in the body. At that time she told the cop and the psychiatrist that she is sure about the
fact that somebody is using her social security ' number and consuming the benet she would need when
she was older. She had gone to pub because a man s voice told her that the person, who uses her number,
was in the pub. At the same time ' she also told them that she was one of 10 smartest persons in the
world. She insisted to see the ' head of the department as she thought that the investigation team cannot
recognize her. She was treated with resperidone and lithium. After 2 weeks she was asymptomatic. A year
later she was brought back to hospital. Her husband conrmed that she was taking medicines as
prescribed and was compliant, which was now lithium alone and was doing well. During the last one
month she was complaining ' that some one had again stolen her security card. During consultation she
was depressive, thinking herself worthless, and complained that the man s voice had returned. She was
given resperidone and 2 weeks later was asymptomatic. Her diagnosis was schizoaffective disorder
bipolar type.

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