Schizoaffective disorder is a mental health condition in which psychotic symptoms, such as hallucinations or delusions, occur alongside the symptoms of a mood episode, either mania or depression. It sits between schizophrenia and the mood disorders, and is recognised as a diagnosis in its own right.
Key points
- Psychotic symptoms and the symptoms of a mood episode, mania or depression, occur in the same illness.
- Timing sets it apart from bipolar disorder or depression with psychosis: psychosis is also present when prominent mood symptoms are absent.
- Two types are recognised: bipolar type and depressive type.
- The diagnosis is less stable than schizophrenia or bipolar disorder and changes for a sizeable minority.
- NICE has no guideline for it alone, so UK care draws on the psychosis and bipolar disorder guidelines together.
Symptoms
- Psychotic: hallucinations, most often hearing voices; delusions; disorganised speech; negative symptoms such as reduced expression.
- Manic (bipolar type): elevated or irritable mood, racing thoughts, needing much less sleep, impulsive decisions.
- Depressive: persistent low mood and hopelessness, loss of interest, thoughts of death or suicide.
Causes and risk factors
- A first-degree relative with schizophrenia, bipolar disorder or schizoaffective disorder raises risk.
- Differences in dopamine, noradrenaline and serotonin activity; childhood adversity; stressful events.
Treatment
- Psychosis component: oral antipsychotic medication with CBT for psychosis (at least 16 sessions) and family intervention.
- Mood component: for mania, haloperidol, olanzapine, quetiapine or risperidone; for bipolar depression, a psychological intervention plus medication; lithium as first-line long-term.
- Trial evidence specific to schizoaffective disorder is thin, since trials tend to recruit people with schizophrenia or bipolar disorder instead.
When to speak to a professional
- You have been hearing or seeing things others do not for more than a few days, or hold beliefs others find strange that are causing distress.
- Your mood has been very low or unusually high for two weeks or more, or symptoms have returned after a period of stability.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.