In March 2018 the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate medicines in the womb. Under the new restrictions, valproate medicines are contraindicated in bipolar disorder during pregnancy due to the high risk of congenital malformations and developmental problems in the child. The EMA did not comment specifically on use of valproate during pregnancy in schizoaffective disorder, but it is reasonable to extrapolate that this is also contraindicated.
Valproate medicines must not be used in female patients of childbearing potential unless there is a pregnancy prevention programme in place and certain conditions are met. These include:
an assessment of the patient’s potential for becoming pregnant
pregnancy tests before starting and during treatment as needed
counselling about the risks of valproate treatment and the need for effective contraception throughout treatment
a review of ongoing treatment by a specialist at least annually
a risk acknowledgement form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.
The EMA said the new measures were put in place because of evidence suggesting that information on the risks of valproate use in pregnancy was still not getting through to women despite earlier steps aimed at ensuring this.See Management: approach See Management: treatment algorithm
Schizoaffective disorder has features of both schizophrenia and mood disorders.
The lifetime prevalence is in the range of 0.32% to 1.1%.
The depressive type of schizoaffective disorder is more common in older patients, whereas the bipolar type is more common in younger patients.
Patients have a better prognosis than patients with schizophrenia but a worse prognosis than patients with mood disorder.
Patients tend to have a non-deteriorating course and better response to mood stabiliser medications than patients with schizophrenia.
Patients with schizoaffective disorder are a heterogeneous group with a variable predominance of schizophrenia and affective disorder symptoms.
Schizoaffective disorder is an illness defined by a course that combines significant affective and psychotic symptoms. The Diagnostic and statistical manual of mental disorders (DSM) definition requires the presence of schizophrenia symptoms concurrent with the mood symptoms (depression or mania), and lasting for a considerable part of a 1-month period. Schizoaffective disorder is further classified as manic type (when manic symptoms are prominent) or depressive type (when only schizophrenia and major depressive symptoms have been present). 
The WHO International statistical classification of diseases and related health problems, 10th revision (ICD-10) definition requires the presence of prominent affective and psychotic symptoms, either at the same time or within a few days of each other.  A schizoaffective episode is diagnosed only when the patient does not meet criteria for either schizophrenia or a depressive or manic episode. Schizoaffective disorder is further classified as manic type when manic or mixed symptoms are prominent; or a depressive type when only schizophrenia and depressive symptoms have been present.
Associate Clinical Professor of Psychiatry
University of California
RGB declares that he has no competing interests.
Health Sciences Professor
Department of Psychiatry and Human Behavior
University of California, Irvine School of Medicine
AP declares that he has no competing interests.
Professor of Psychiatry
University of Missouri Kansas City
KS declares that he has no competing interests.
Associate Professor of Psychiatry
University of Maryland School of Medicine
WTR declares that he has no competing interests.
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