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Schizoaffective Disorder

Practice Essentials

Schizoaffective disorder is a perplexing mental illness that has both features of schizophrenia and features of a mood disorder. The coupling of symptoms from these divergent conditions makes diagnosing and treating schizoaffective patients difficult.

Signs and symptoms

The first step in evaluation is to obtain a complete medical history, keeping in mind the diagnostic criteria for schizoaffective disorder.

Several scales are available for rating the severity of disease (eg, PANSS). The Questionnaire is useful for investigating alcohol consumption in patients with schizoaffective disorder.

The next step is to perform a complete mental status examination (MSE), physical examination, and neurologic examination to assist with the evaluation and rule out other disease processes. The MSE typically includes assessment of the following:

Appearance

Eye contact

Facial expression

Motor

Cooperativeness

Mood

Affect

Speech

Suicidal ideation (should be inquired about at every visit)

Homicidal ideation

Orientation

Consciousness

Concentration and attention

Reading and writing

Memory

Delusions

Hallucinations

Insight

Judgment

See Presentation for more detail.

Diagnosis

The diagnosis of schizoaffective disorder is made when the patient has features of both schizophrenia and a mood disorder but does not strictly meet diagnostic criteria for either alone. Ongoing reevaluation over the course of the illness is important for confirming the diagnosis.

Laboratory studies that may be performed include the following:

Sequential multiple analysis

Complete blood count (CBC)

Rapid plasma reagent

Thyroid-stimulating hormone (TSH) level or thyroid function tests

Urine drug screen

Urine pregnancy test

Urinalysis

Lipid panel

HIV test

Psychological testing (eg, The Structured Clinical Interview for DSM-5 [SCID-5]) is warranted to assist with diagnosis.

Additional studies that may be helpful include the following:

Computed tomography (CT)

Magnetic resonance imaging (MRI)

Electroencephalography (EEG)

See Workup for more detail.

Management

Management principles include the following:

Treatment approaches include both pharmacotherapy and psychotherapy (as well as psychoeducational programs)

The treatment plan must be individualized for each patient

Inpatient treatment is mandatory for patients who are dangerous to themselves or others and for patients who cannot take care of themselves

Transfer to a medical surgical hospital or to a residential or group home should be considered if appropriate

Smoking cessation and noncompliance with medications are special concerns

Selection of medications to treat schizoaffective disorder depends on whether the depressive or manic subtype is present. In the depressive subtype, combinations of antidepressants plus an antipsychotic are used. In the manic subtype, combinations of mood stabilizers plus an antipsychotic are used.

Antipsychotics used to treat schizoaffective disorder include the following:

Haloperidol

Risperidone

Olanzapine

Aripiprazole

Ziprasidone

Quetiapine

Clozapine

Iloperidone

Paliperidone

Asenapine

Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes of antidepressants in this setting. They include the following:

Sertraline

Fluoxetine

Paroxetine

Fluvoxamine

Citalopram

Escitalopram

Mood stabilizers used in this setting are as follows:

Lithium

Valproic acid

Carbamazepine

Oxcarbazepine

See Treatment and Medication for more detail.

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