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Schizoaffective Disorder
The document provides a comprehensive overview of schizoaffective disorder, detailing its DSM-5 definition, pathophysiology, epidemiology, symptoms, prognosis, and treatment approaches. It emphasizes the coexistence of major mood episodes with schizophrenia symptoms and outlines the demographic prevalence, key symptoms, and treatment options for different subtypes. Additionally, it highlights critical factors affecting diagnosis and prognosis, including neurotransmitter imbalances and the incidence of suicide.
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Schizoaffective Disorder
- 1. SCHIZOAFFECTIVE DISORDER Amelie Kanovsky AllSaints University School of Medicine, MD4 Dr. Daniel Martinez President: Comprehensive Clinical Services
- 2. Overview Definition (DSMV) Pathophysiology & Etiology Epidemiology Symptoms Prognosis Treatment 2
- 3. Definition (DSM 5)-1 A. An uninterrupted period of illness during which there is a Major Mood Episode (Major Depressive or Manic) concurrent with Criterion A of Schizophrenia. Note: The Major Depressive Episode must include Criterion A1. B. Depressed mood. Delusions or hallucinations for 2 or more weeks in the absence of a Major Mood Episode (Depressive or Manic) during the lifetime duration of the illness. C. Symptoms that meet criteria for a Major Mood Episode are present for the majority of the total duration of the active and residual portions of the illness. D. The disturbance is not attributable to the effects of a substance or another medical condition 3 Esan, Oluyomi. "DSM-5 schizoaffective disorder: will clinical utility be enhanced?." Social psychiatry and psychiatric epidemiology (2015): 1-2.
- 4. Definition (DSM 5)-2 Major Affective Disorder (MDD/BPD) + Symptoms of Schizophrenia + >2 weeks of Psychosis without Mood Symptoms 4 Esan, Oluyomi. "DSM-5 schizoaffective disorder: will clinical utility be enhanced?." Social psychiatry and psychiatric epidemiology (2015): 1-2.
- 5. Pathophysiology & Etiology Neurotransmitter imbalance: DA, NE, 5-HT Reduced hippocampal volumes Thalamic abnormalities White-matter abnormalities 5 Zeng, Ruifan, et al. "Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder." Psychiatry Research (2015).
- 6. Epidemiology Life-time prevalence:0.5 – 0.8% (approximation) Females > Males No race-based differences Young patients: Mania; Elderly patients: Depression Incidence of Suicide: 10% (Caucasians > AA) 6 http://www.mdguidelines.com/schizoaffective-disorder
- 7. Symptoms - Schizophrenia PositiveSymptoms Delusions - fixed false idiosyncratic belief Hallucinations – perception without an existing external stimulus Disorganized speech Bizarre behavior Thought disorder Negative Symptoms Flat effect Decreased emotional reactivity Poverty of speech Lack of purposeful actions Anhedonia 7 Schennach, R., et al. "What are depressive symptoms in acutely ill patients with schizophrenia spectrum disorder?." European Psychiatry 30.1 (2015): 43-50.
- 8. Symptoms – Mania& Depression Mania (DIG FAST) Distractibility Insomnia Grandiosity Flight of ideas Activities/psychomotor Agitation Sexual indiscretions Talkativeness/pressured speech Depression (SIG E CAPS) Sleep Interest Guild Energy Concentration Appetite Psychomotor agitation/retardation Suicidal ideation 8 Tao, L., et al. ”First Aid for the USMLE Step 2CK." Mac Graw Hill, 8th edition (2012) 399-401.
- 9. Diagnosis Psychosis – Symptomof exclusion: Lab: TSH, electrolytes (Ca2+), CBC + ESR, VDRL/RPR, HIV, UA, serum toxicology CT/MRI, EEG 9 Schennach, R., et al. "What are depressive symptoms in acutely ill patients with schizophrenia spectrum disorder?." European Psychiatry 30.1 (2015): 43-50.
- 10. Prognosis - 1 Subjects (n=118) Standardized Medication Algorithm prospectively Fluphenazine, Haloperidol, Haloperidol + Lithium, Loxapine, Clozapine + Mood Stabilizers, SSRI (Lithium, Sertraline) + S/E (Propanolol, Benztropine, Lorazepam) Full recovery = S/S remission + adequate social/vocational fxn 10 Robinson, Delbert G., et al. "Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder." (2014).
- 11. 11 Robinson, Delbert G.,et al. "Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder." (2014).
- 12. Treatment Depressive Subtype:SSRI (Sertraline, Fluoxetine) + Antipsychotic (Haloperidol, Resperidone, Paliperidone palmitate, Olanzapine) Refractory cases: Clozapine (CBC/week) Manic Subtype: Mood Stabilizers (Lithium, VA, Carbamazepine)+ Antipsychotic 12 Conley, Robert R., and Ramy Mahmoud. "A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder." American Journal of Psychiatry 158.5 (2001): 765-774.
- 13. Thank you! Danke!Gracias! 13