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 nondeteriorating course and to have better response to mood stabilizer 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 bipolar type (when manic symptoms are prominent; major depressive episodes may also occur) or depressive type (when only schizophrenia and major depressive symptoms have been present).
The World Health Organization International statistical classification of diseases and related health problems, 11th revision (ICD-11) 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.
History and exam
Key diagnostic factors
- positive symptoms
- negative symptoms
- disorder of perception
- disturbances in emotions
- incongruent affect
- disorders of stream and form of thought
- cognitive abnormalities
- deficit symptoms
- major depressive episodes
- manic episodes
Other diagnostic factors
- neurologic deficit
- family history
- functional impairment
- disorders of behavior
- family history of schizophrenia
- substance use
- age of the father at patient's birth
- psychological stress
1st investigations to order
- urine drug screen
- sexually transmitted disease screening
- complete blood count
- thyroid function tests
Investigations to consider
- laboratory studies to exclude organic causes
- CT/MRI head
- electroencephalogram (EEG)
acute psychotic episode
- Substance-induced psychotic disorder
- Dementia with psychosis
- Diagnostic and statistical manual, 5th edition, text revision (DSM-5-TR)
- International statistical classification of diseases and related health problems, 11th revision (ICD-11)
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