Schizoaffective disorder is characterized by the combination of schizophrenia symptoms and major mood episodes, with various onset patterns and prevalence rates. Diagnosis is based on DSM-5 criteria, requiring mood episodes concurrent with psychotic symptoms while ruling out other medical causes. Treatment involves biological interventions like antipsychotics and mood stabilizers, and psychological therapies to improve social functioning and cognitive skills.

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SCHIZOAFFECTIVE
DISORDER
YASIN KHATRI (MD, MUHAS 2025)
@med.tutor.tz/@health.gramm on Instagram

2. 08/11/2024
What is Schizoaffective Disorder?
 Schizo  schizophrenia
 Affect expression of mood
 A combination of schizophrenia and a mood
disorder (manic/depressive)
 Either of the component can come first,
variable temporal relationship

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Epidemiology
 0.3x as schizophrenia
 Lifetime prevalence = 0.3%
 Age of onset later in females
 For bipolar subtype, M=F and more likely to
present in young than old individuals
 For depressive subtype, F>M and more likely to
present in old than young individuals

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Etiology and Risk Factors
 Same as schizophrenia, as per the
biopsychosocial model.
 Genetically, if the first degree relative has
schizophrenia/bipolar than the client is at risk
due to involvement of DISC1 gene in
chromosome 1q42 (also affected in
schizophrenia and bipolar).

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Diagnostic Criteria (DSM-5 TR)
 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: Depressed mood.

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Diagnostic Criteria (DSM-5 TR)
 B. 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.

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Diagnostic Criteria (DSM-5 TR)
D. The disturbance is not attributable to
the effects of a substance (e.g., a drug of
abuse, a medication) or another medical
condition.

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Diagnostic Criteria (DSM-5 TR)
Specifier Features
Bipolar Type This subtype applies if a manic episode is
part of the presentation. Major
depressive episodes may also occur.
Depressive
Type
This subtype applies if only major
depressive episodes are part of the
presentation
With Catatonia At least 3 of the 12 catatonia features

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Diagnostic Criteria (DSM-5 TR)
 Other specifiers (require at least 1y duration):
-First episode/multiple episodes/continuous
currently in acute episode/partial remission/full
remission
 Unspecified
 Severity

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Associated Features
 Antisocial behavior
 Difficulties with self-care
 Though have less severe and less persistent negative
symptoms, and less anosognosia (poor insight) than
schizophrenia
 ± Substance related disorders
 Suicide risk (5% especially if depressive episodes)
 Social and occupational dysfunction

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Investigations
R/O Organic
Causes
-RFT, LFT
-RPR, HIV test
-UDS, UPT
-CT head, MRI
brain
-EEG
Baseline
-CBC
-RBG
-Lipid panel
-TFT, TSH

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Management
A. Biological
i. Antipsychotics
ii. Mood stabilizers
-If bipolar type
-E.g Carbamazepine
iii. Antidepressants
-If depressive type

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Management
-SSRI are safe to use, but can opt for TCA if
associated with agitation/insomnia
iv. ECT
-As indicated

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Prognosis
B. Psychological
i. Family Therapy
-Reduction of expressed emotion, criticism, hostility,
overprotection
ii. Behavioral Therapy (social skills training)
iii. Cognitive Rehabilitation
-Restoring lost cognitive skills such as memory retraining,
attention training, problem solving exercises

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Prognosis
 Poor indicators:
-Poor premorbid hx
-Insidious onset
-Absence of precipitating
factors
-Predominant psychosis
-Negative symptoms
-Early onset
-Unremitting course
-Family hx of
schizophrenia/bipolar

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Prognosis
 Good indicators similar to schizophrenia
 Difficult to predict the overall outcome, previous
studies suggest the final prognosis closely
resembles schizophrenia than a mood disorder
with psychotic features.

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References
1. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and
Sadock's synopsis of psychiatry: Behavioral sciences/clinical
psychiatry (11th ed.). Wolters Kluwer Health.
2. American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders. 5th ed., Text Revision, American
Psychiatric Publishing, 2022,
https://doi.org/10.1176/appi.books.9780890425787.
3. Schizoaffective Disorder: Practice Essentials, Background, Pa