preparation for placement in the mental health sector

The information below has been reproduced with the kind permission of Schizophrenia Fellowship Australia

 

The term schizoaffective disorder was coined by Dr Jacob Kasanin in 1933. Since that time the definition of the disorder has changed a number of times making research into it difficult and confusing both people with the disorder and doctors. Schizoaffective Disorder is a perplexing but chronic mental illness characterised by a combination of symptoms. It is a disorder in which mood swings, similar to those found in bipolar disorder are present together with symptoms of schizophrenia (delusions, hallucinations, disorganised speech, disorganised behaviour and negative symptoms). The way it presents can change, at times appearing more to be schizophrenia, at other times more like bipolar disorder. As a consequence, schizoaffective disorder can seem confusing to both patients and doctors alike. It is often difficult to diagnose, manage and treat because there is increasing uncertainty whether it is a distinct variety of psychotic illness. It is not unusual for people living with schizoaffective disorder to be originally misdiagnosed with schizophrenia, bipolar disorder or acute depression.

 

 

 

Is it the same as Schizophrenia?

 

No. While schizoaffective disorder is now widely recognised as a ‘variant’ of schizophrenia, it is currently recognised an illness where symptoms are prevalent from both bipolar disorder and schizophrenia such that a diagnosis with either of these two illnesses alone is eliminated. It is a disorder in which mood swings, similar to those found in bipolar disorder are present together with symptoms of schizophrenia (delusions, hallucinations, disorganised speech, disorganised behaviour and negative symptoms).

 

 

 

What are the symptoms of Schizoaffective disorder?

 

The symptoms of schizoaffective disorder combine features of both mood disorders and schizophrenia. Symptoms usually emerge in early adulthood and these can often be misinterpreted as features of other conditions. Schizoaffective disorder will affect cognition, behaviour and emotion.

During an episode with depressive features, symptoms may include poor appetite, weight loss, insomnia, agitation, general slowing down, loss of energy and interest in usual activities, feelings of worthlessness, guilt, difficulties with concentration, and suicidal thoughts. During an episode with manic features, symptoms may include an increase in work, social and sexual activity, racing thoughts and talking, inflated self-esteem, grandiosity, reduced need for sleep, and self-destructive behaviours.

Importantly at some stage during the illness, psychotic symptoms such as delusions, hallucinations, disorganised speech, disorganised behaviour, total immobility, lack of facial expression, and loss of motivation should be present without mood related symptoms for at least 2 weeks.

 

 

What causes Schizoaffective disorder?

 

The cause of schizoaffective disorder is unknown, although many now view this disorder as a variant of schizophrenia. As with schizophrenia, likely causes of schizoaffective disorder are linked to a combination of biological and environmental/social factors. Current theories suggest that predisposing genetic factors, probably from a range of many genes, coupled with other predisposing environmental factors, such as illness during the first or second trimester of a life, maternal starvation or obstetric complications then combine with later life stressors such as substance abuse or migration. No one stressor appears to be enough in itself. These factors and their effects upon a person are similar to those found in severe bipolar disorder and schizophrenia.

 

 

 

How is Schizoaffective disorder treated?

 

The fact that people living with schizoaffective disorder can have symptoms from across a wide spectrum of illnesses (such as schizophrenia and bipolar disorder) also makes treatment and finding the right medication a fraught process. A biopsychosocial approach that uses medication, but also acknowledges and treats the psychological and social aspects, is the most effective method in the treatment of schizoaffective disorder.

Medications used to treat schizoaffective disorder include anti-psychotic medications, and anti-depressants and/or mood stabilisers. Antipsychotic medications are effective for most people in reducing psychotic symptoms. Typically an antipsychotic medication is started first, but it may be combined with antidepressants, mood stabilisers or electroconvulsive therapy.

As the acute symptoms begin to subside, the psychosocial aspect of treatment should be encouraged. These treatments range from therapy for depression and mood instability, to programs that aim to build social skills, enhance cognitive function and family function so that people regain confidence, and make friends and social connections. Importantly they should also address essential problems such as accommodation and social services. In combination, a coordinated biopsychosocial approach will reduce the morbidity caused by the illness (such as social isolation, poverty from unemployment and loss of social skills).