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.

1. SCHIZOAFFECTIVE DISORDER
Amelie Kanovsky
All Saints University School of Medicine, MD4
Dr. Daniel Martinez
President: Comprehensive Clinical Services

2. Overview
 Definition (DSM V)
 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
Positive Symptoms
 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 – Symptom of 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!
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