Schizoaffective disorder

Schizoaffective disorder is a mental health condition that causes both a loss of contact with reality (psychosis) and mood problems (depression or mania).

It can be thought of as a mix of mental health conditions.

There can be a wide range of symptoms that occur and, for each person, the experience will be unique. Often, people with schizoaffective disorder will see their doctor for problems with mood, daily functioning, or abnormal thoughts.

Schizoaffective disorder is difficult to accurately diagnose as it contains so many elements of other mental health conditions. Regular and thorough checks with your doctor over time are important to help build a picture of any difficulties you may be experiencing.

If you think you have schizoaffective disorder, or you are worried about a loved one, it’s important to talk to your doctor or counsellor, or someone else you can trust, as a first step to getting the important help you or they need.

It’s important to get diagnosis and treatment as early as possible.

With treatment over a period of time there is evidence to show that many people with schizoaffective disorder who have good family or friends support, can greatly improve their quality of life.

Without support, the journey can be more difficult as people with schizoaffective disorder can have difficulties with attending school, maintaining jobs and relationships and may need supported living environments.

The risk of suicide in people who experience schizoaffective disorder is significant.

It is important that if you are having any suicidal thoughts you seek help immediately by dialing 111.

What causes schizoaffective disorder?

The exact cause of schizoaffective disorder is unknown. Different causes may operate in different people. This may be why there is wide variation in its symptoms and the way it develops.

Schizoaffective disorder is thought to be less common than schizophrenia and mood disorders. It's important to remember that it is not your fault or your family’s fault you experience a mental health problem.

Signs to look for (symptoms)

There are numerous signs that you or a loved one may be experiencing schizoaffective disorder.

If you experience psychosis, the symptoms could resemble schizophrenia, and those symptoms are listed below. The mood problems may mean experiencing feelings of depression and/or manic episodes.

It’s important to remember that the symptoms of schizoaffective disorder can vary between individuals and, over time, within an individual.

Psychotic symptoms

These symptoms are not there all the time and may only occur when you are having a severe or acute episode.

They include the following:

• Delusions – an unusual belief that seems quite real to you, but not to those around you. A delusional person is convinced their belief is true. 
• Thought disturbances – how you process thoughts or your ability to concentrate and maintain a train of thought may be affected. For example, you may feel like your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted, or you may laugh at irrational times. Your speech may become quite disorganised, and you may use made up words that only you understand.
• Hallucinations – this is when someone hears, sees, feels or smells something that is not there. Hearing voices that others cannot hear or when there is no-one else in the room is very typical of psychosis. Sometimes these voices will talk about or to you. They will sometimes command you to do things. For some, these voices can be inside their head; occasionally they may seem to come from within their body, or come from the radio or television.

Mood symptoms

These could include:

• Loss of motivation, interest or pleasure in things. Everyday tasks such as washing up become difficult. 
• Mood changes – you'll tell friends you're feeling great or never better. However, your behaviour will be recognised as excessive by friends or family. You may also be quite unresponsive and be unable to express joy or sadness.
• Social withdrawal – people may notice that you become very careless in your dress and self-care, or have periods of seeming to do little and periods of being extremely active. 

Other symptoms include subtle difficulties with tasks like problem solving or you may show signs of depression – commonly experienced by people with schizophrenia.

Symptoms of mania

If you experience mania, you won't complain of problems. You may feel fantastic, creative and energised.

It’s others around you who see you aren't yourself. 

Your elevated mood can be infectious and it's as though you're the life of the party.Or, you could be irritable and experience rapidly changing emotions from laughter to tears to anger and back.

You may also find you need less sleep or won't sleep for days, yet be full of energy and have an increased appetite for food, sex or other pleasurable past times. Or you might have a sudden need to spring clean the house, mow the lawn and paint a wall – all in one morning. 

Experiencing mania can also change how you process thoughts, or your ability to concentrate. For example, you may feel like your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted.

With these changes comes an increased sense of self-importance that may start out as increased self-confidence. But then, you start to lose touch with reality. For example, you might borrow money and start a business in a field where you have no experience.

If the mania is severe, you may lose touch with reality, believing perhaps, that you have a special relationship with God, Jesus or the Queen, or that you have special powers.

How the doctor determines if you have schizoaffective disorder (diagnosis)

People experiencing schizoaffective disorder often see their doctor for other reasons, such as feeling depressed, or anxious, or maybe about a drug or alcohol problem.

Once you’ve spent some time talking to your doctor, they will refer you to a mental health professional qualified to diagnose and treat people with this condition.

A diagnosis for schizoaffective disorder is made when the doctor confirms that you are experiencing symptoms of both schizophrenia and an "affective" (mood) disorder — depression or bipolar disorder.

Treatment options

Treatment of schizoaffective disorder can involve a number of aspects, each of which will be tailored to meet your individual needs. Many of the strategies used to treat both schizophrenia and depression/bipolar conditions can be used.

These include medications, family involvement, and therapy, problem solving training, psychotherapy and treatment for any other problems, such as drug or alcohol abuse (when appropriate).

Talking therapies and counselling

These therapies involve a trained professional who uses clinically researched talking therapies to assess and help people to make positive changes in their lives. They may involve the use of specific therapies such as cognitive-behavioural therapy (CBT), which largely focuses on overcoming unhelpful beliefs. These are the most effective, but must be continued over a significant period of time, often ongoing.

Counselling: This may include some techniques referred to above, but is mainly based on supportive listening, practical problem solving and information giving. 

Problem solving/skills training: This is often part of an overall approach, but can also be learnt in skills training groups. It aims to help you learn more effective ways of dealing with problem situations.

All types of therapy/counselling should be provided to you and your family/whānau in a manner that is respectful of you, and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medicines

Medicines are most often used for making your mood more stable (anti-psychotics) and for helping with depression (anti-depressants).

If you're prescribed medication, you are entitled to know the names of the medicines; what symptoms they are supposed to treat; how long it will be before they take effect; how long you will have to take them for and understand the side effects.

Finding the right medication can be a matter of trial and error. There is no way to predict exactly how medicines will affect you.

If you're breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It is also really important to look after your physical wellbeing. Make sure you get an annual checkup with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, registered psychologist, for reviewing this content. Date last reviewed: November 2014