What is Schizoaffective Disorder?

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Schizoaffective disorder is a disorder of the mind that affects your thoughts and emotions, and may affect your actions. You may experience episodes that are combinations of ‘psychotic‘ symptoms and ‘bipolar disorder‘ symptoms. These symptoms are clearly present for most of the time over a period of at least two weeks.

Schizoaffective Disorder manic type

In this type, an individual has both psychotic and manic symptoms, occurring within one episode.

Schizoaffective Disorder depressive type

In this type, an individual has both psychotic and depressive symptoms, occurring within one episode.

Schizoaffective Disorder mixed type

In this type, an individual has psychotic symptoms with both manic and depressive symptoms. However, the psychotic symptoms are independent and not necessarily related to the bipolar disorder symptoms.

The exact cause is not known, but we do know that there is a chemical imbalance in people affected by schizoaffective disorder.

Genes

Research has shown that the same genes may be responsible for Schizophrenia, Schizoaffective Disorder and Bipolar Disorder. People with this Disorder are more likely to have family members who have been diagnosed with these conditions.

Stress

Stress can contribute to the start of an episode of Schizoaffective Disorder, such as a bereavement, physical illness, car accident or family/relationship problems. In particular, traumatic experiences in childhood can increase the chances of developing this condition in the future.

Thought disorder/muddled thinking

Thought disorder and muddled thinking include individuals finding it hard to concentrate as their thoughts seem fuzzy, muddled, bizarre and/or disconnected. An individual with these symptoms may be unable to finish a book that they have been reading or follow a TV programme.

Muddled thinking may affect an individual’s speech, so a person may jump from one topic to another and after a while, they may not be able to remember what they were trying to say in the first place. This makes it difficult for people to follow conversation.

An individual with these symptoms may believe that their thoughts are being interfered with, such as that someone or something is able to insert thoughts in their mind or that a particular thought does not belong to them. A person may also feel like someone or something is taking certain thoughts out of their mind, such as that their thoughts are disappearing.

Individuals with these symptoms may feel that other people can hear their thoughts or have access to them in some way.

Beliefs that you are being controlled

An individual with this symptom may insist that outside forces like aliens, spirits, God or the devil are controlling how they feel, think and behave. A person may feel like a robot whose remote control is in someone else’s hand. They might be distressed if they feel that someone else is making them think certain things, or that they have no control on a particular behaviour of theirs because an outside force controls it.

Hallucinations

A person with hallucinations may hear sounds or voices, or see and smell things that are not there. Sometimes they can feel that someone is touching them or hitting them, but they can’t see anyone. The most common type of hallucination is hearing voices.

What is hearing voices like?

These voices sound real. Unlike thoughts which come from one’s own mind, these voices seem to come from outside they person experiencing them and no one else can hear them. There can be one voice or several different voices which may be commenting on what the person is doing.

How do people react to these voices?

Because these voices sound real, the person experiencing them may start talking back to them. The person may try to do things that these voices tell them to do, or they may be able to ignore them.

Where do these voices come from if no-one else can hear them?

In Schizoaffective Disorder, there is a chemical imbalance in the brain. As a result, the brain can create the voices which a person with the Disorder can hear but no one else can.

Delusions

Delusions are beliefs or ideas which a person believes in 100 per cent, without a single doubt, and which nobody else seems to accept. These beliefs or ideas cannot be explained as part of one’s culture, religion or background. Other people may find these ideas strange, unrealistic or even bizarre.

How do delusions start?

      • They can start suddenly when an idea or belief comes out of the blue.
      • They may form after weeks or months of feeling that something strange is happening that can’t be identified. This is called ‘delusional mood’.
      • Sometimes they help a person to understand their hallucinations. For example if you hear voices talking amongst themselves about you, then your mind may explain that your neighbours are plotting against you or the spirit world has made contact with you. This is called a ‘delusional idea’.

The most common type of delusion is paranoid delusion.

These are ideas which convince an individual that others might harm them, are plotting against them or are spying on them. Feeling persecuted can be very scary and upsetting for those people who an individual with paranoid delusions feels are against them. A person with paranoid delusions may want to stay away from people or protect themselves from the persecutors.

  • A sense of extreme physical and mental well-being, excessive energy and elation of mood, which is also called feeling ‘high’.
  • Not sleeping much, and subsequently poor concentration.
  • Fast talking, often jumping from one topic to another.
  • Having very optimistic ideas which can be unrealistic or bizarre. For example, you may believe that you have special abilities and powers.
  • In later stages, speech may become incomprehensible; a person may become irritable and neglect their health and safety.

Manic symptoms can affect relationships and make it difficult for an individual to carry on working.

  • Not only feeling sad all the time, but losing interest in activities that were once previously enjoyed.
  • Lost motivation and energy.
  • Affected sleeping and eating patterns.
  • Loss of the ability to concentrate on a book or TV programme.
  • Intense feelings of guilt, worthlessness and hopelessness.

Less than 1 in 100 people are likely to have Schizoaffective Disorder in their lifetime. Schizoaffective manic patients make up 3% to 5% of all patients admitted to a psychiatric hospital.

More women than men are affected by Schizoaffective Disorder. It tends to develop at a later age in women than men and is more likely to the depressive type. The depressive type is also more common in older people, while the bipolar type is more common in younger people. Symptoms usually begin in early adulthood.

Some people feel that Schizoaffective Disorder sits in the middle of a spectrum, with Schizophrenia at one end and Bipolar Disorder at the other. However, Schizoaffective Disorder is recognised as a separate condition to Schizophrenia, both in clinical practice and in the research literature.

The treatment of these disorders depends on the type. Treatment includes medication which is usually started and monitored by a psychiatrist, along with talking therapies.

Medication

How can medication help?

Taking medication regularly can help to control the most distressing symptoms of Schizoaffective Disorder. They can help a person to feel calmer by weakening delusions and gradually reducing the frequency and intensity of hallucinations.

While taking medications a person’s thinking becomes clearer and they may feel well enough to look after themselves, their home, re-start their studies or work, and concentrate on other aspects of life which are important to them.

If these medications are taken regularly, they can prevent a person with Schizoaffective Disorder from having another episode. It is important to continue to take these medications, even if you feel well.

How long will I have to take the medication?

Usually these medications will need to be taken for the rest of your life.

In some cases, the medication can be gradually reduced and stopped. However, this must be done under the supervision of a doctor.

What will happen if I stop the medication?

If a person has diabetes and stops taking their medication, they may become unwell. Similarly with Schizoaffective Disorder, if you stop taking your medication, you too may become unwell. This may not happen immediately, but may take 3 to 6 months.

Types of medication

An acute episode of Schizoaffective Disorder may benefit from antipsychotics. Atypical antipsychotics include Olanzapine, Risperidone, Quetiapine and Amisulpride.

In the treatment of depressive symptoms, medication may include antidepressants. There are many different types of antidepressants and you may be started on one of the newer one, a SSRI (Selective Serotonin Reuptake Inhibitor), such as Sertraline or Citalopram.

In the treatment of manic symptoms, mood stabilisers such as lithium, sodium valproate and carbamazapine may be useful.

The long-term treatment of Schizoaffective Disorder involves the use of antipsychotics with psychological (talking) treatments.

For the manic type, often a combination of a mood stabiliser and an antipsychotic are prescribed.

For the depressive type, a mood stabiliser and an antidepressant is preferred.

The effects and side-effects of these medications should be fully explained to you and your carer(s).

Talking therapies

Cognitive Behavioural Therapy (CBT)

With CBT, people are helped to monitor their thoughts, feelings and actions. The therapist will help them to find out the unhelpful thoughts and behaviours which may be contributing to their distress. These thoughts could be linked to delusions, and behaviours to hallucinatory experiences. The therapist will help to work out helpful ways of thinking and reacting and then to put these positive thoughts and behaviours into real situations.

CBT is recommended if someone are suffering from psychotic symptoms as it can help them cope with troublesome delusions and hallucinations. It equips individuals with various coping strategies so that they are able to solve their issues and problems.

Family meetings

This is especially helpful if the person with Schizoaffective Disorder lives with their family or are in close contact with them. Family therapy will help a family to understand the person’s problems and how best to support them.

Supportive Psychotherapy and Counselling

People are able to discuss their problems and issues with a professional in detail and gain support from telling their story to someone who will listen.

Art Therapy

Some people may have difficulty talking about their emotions. Art therapy can help these individuals to express your emotions through art.

Self-help groups

This is an opportunity to meet other people with the same illness and to discuss alternative coping strategies, recognising early signs that they may be starting to feel unwell again.

Community Mental Health Services

These services are important in keeping people with Schizoaffective Disorder out of hospital or in managing a gradual return back into the community after being discharged from hospital. Specialist services may be needed, including community psychiatric nursing, social services and occupational therapy as well as support in managing domestic and financial affairs.

There are different teams that can òffer support in the community:

  • Early Intervention Team: provides intensive support to young people who have recently been diagnosed with Schizophrenia or Schizoaffective Disorder.
  • Assertive Outreach Team: provides extensive help and support for people who have had a diagnosis of Schizophrenia or Schizoaffective Disorder for quite some time, especially for people who find it difficult to work with other services or have not been able to take their medications regularly for various reasons.
  • Crisis Resolution Home Treatment Team: can help at home, prevent a hospital admission and provide intensive support after a hospital admission.
  • Vocational Rehabilitation: includes day centres, day hospital or community health centres. These facilities offer different creative activities such as back-to-work courses, education, art and cooking.

Care Programme Approach (CPA) (England and Wales only)

This is a way of making sure that individuals get the right care and support. Individuals may be given a care co-ordinator who is responsible for organising different parts of their treatment. These include regular meetings every 6 to 9 months which can include family or carer(s). A plan will be made about what to do in an emergency, including what has helped in the past. Plans are amended at each CPA meeting to take into account what individuals and their family/carer(s) would like to happen.

Self-help

If you think you are becoming unwell or need help:

  • Call your local mental health team/care co-ordinator.
  • Call the local Crisis Team or Emergency out-of-hours phone numbers .
  • Go to your local Emergency Department if the situation is such that it cannot be dealt with at home.
  • Learn to recognise the early signs that you may be getting unwell, such as not being able to sleep, feeling persecuted or anxious. Some people may start hearing voices or whispers when no one is around. It is important to get help as soon as possible, for example by calling your care co-ordinator.
  • Exercise regularly and eat a healthy balanced diet.
  • Learn to talk to someone you trust in your family or a friend.
  • Learn relaxation techniques.

Try not to:

  • Use illicit drugs as they can cause another episode.
  • Drink too much alcohol – remember the safe alcohol drinking limits of 21 units per week for a man and 14 units per week for a woman.
  • Get stressed.
  • Smoke cigarettes – 30 to 40 people out of a 100 with mental health problems smoke. They may help you to relax and focus your thoughts in the short-term but interferes with your medication and is very harmful to your body in the long-term.

What will happen without treatment?

The symptoms may get worse and you may have more frequent and longer episodes. There is also a risk of suicide.

If you or someone you know is affected by any of the issues raised in this article, you can get help by phoning the free Pieta House 24-hour suicide helpline on 1800 247 247 or, alternatively, by phoning the Samaritans at Freephone 116123.

For more resources on psychiatry and mental illness, click here.