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Schizoaffective Disorder 5/4/2018 Schizoaffective Disorder Roseanna Parkhurst-Gatewood MSN FNP-BC, PMHNP-BC Schizoaffective disorder • DSM-5 diagnostic criteria for schizoaffective disorder3 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. 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. D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. • 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 Schizoaffective Disorder 1 5/4/2018 Schizoaffective disorder • Schizoaffective disorder symptoms may vary from person to person. People with the condition experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder — either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression). • The course of schizoaffective disorder usually features cycles of severe symptoms followed by periods of improvement with less severe symptoms Schizoaffective Disorder • Positive psychotic symptoms: Hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviors. • Negative symptoms: A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure. • Disorganization symptoms: Confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements. • Impaired cognition: Problems with attention, concentration, memory and declining educational performance Schizoaffective Disorder • There are two major subtypes of Schizoaffective disorder: • 1. Bipolar type • 2. Depressive type 2 5/4/2018 Schizoaffective disorder Schizoaffective Disorder often features cycles of severe symptoms which include: • Manic behaviors: Euphoria, Racing thoughts, Risky behaviors- sexual and financial, or sudden increased energy and behaviors that are out of character. • Depressed mood: Depressed type, people can experience feelings of worthlessness. • sadness, and depression. • Impaired functioning: Occupational, academic , social. • Problems managing personal care: Physical appearance, cleanliness, self care (brushing teeth, hair) • Delusions: False, fixed beliefs Schizoaffective Disorder • Causes • The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder. • Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness. • Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Neurotransmitter imbalances, reduced hippocampal volumes, thalamic abnormalities, and white matter abnormalities could be involved. • Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness. • Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder Schizoaffective disorder • Epidemiology • The frequency of schizoaffective disorder worldwide is difficult to determine, because the diagnostic criteria have changed over the past few years. • The lifetime prevalence of schizoaffective disorder to be about 0.32%. • Young people with schizoaffective disorder tend to have the bipolar subtype, whereas older people tend to have the depressive subtype. • Overall, the disorder affects more women than men, probably in part because more women have the depressive subtype as opposed to the bipolar subtype. Men with schizoaffective disorder tend to exhibit antisocial traits and behavior in contrast to other personality traits. In addition, the age of onset is later for women than for men. No race-based differences in frequency have been observed. 3 5/4/2018 Schizoaffective disorder • Diagnostic Considerations • The diagnosis is made when the patient has features of both schizophrenia and a mood disorder but does not strictly meet diagnostic criteria for either alone. Unfortunately, it is often difficult to determine whether a patient has 1 of the 2 illnesses (schizophrenia or a mood disorder), a combination of the 2 (schizophrenia with a mood disorder), or perhaps even another separate illness. Schizoaffective disorder • Differential Diagnoses: Steroid use Temporal lobe epilepsy Complex partial seizure disorder Neurosyphilis Thyroid problems –Hyperparathyroidism, Cushing's Alcohol abuse or dependence, Cocaine/Amphetamine related Psychosis Metabolic syndrome, Delirium Bipolar affective disorder Schizophrenia Schizoaffective Disorder • Schizoaffective disorder is treated and managed in several ways: • Medications, including mood stabilizers, antipsychotic medications and antidepressants • Psychotherapy, such as cognitive behavioral therapy or family-focused therapy. Group therapy helps decrease social isolation. • Self-management strategies and education, Life training skills help reduce isolation and improve quality of life. • ECT: severe depression 4 5/4/2018 • Prognosis • The prognosis for patients with schizoaffective disorder is thought to lie between that of patients with schizophrenia and that of patients with a mood disorder. That is, the prognosis is better than that of schizophrenia alone but worse than that of a mood disorder alone. • Individuals with the bipolar subtype are thought to have a prognosis similar to those with bipolar type I, whereas the prognosis of people with the depressive subtype is thought to be similar to that of people with schizophrenia. • The overall incidence of suicide is estimated to be about 10%. • A poor prognosis in patients with schizoaffective disorder is generally associated with a poor premorbid history, an insidious onset, an absence of precipitating factors, a predominant psychosis, negative symptoms, an early onset, an unremitting course, or having a family member with schizophrenia Schizoaffective disorder Schizoaffective Disorder Hospitalization Individuals who are suffering from an acute psychotic episode during this disorder usually require immediate hospitalization to stabilize them on an antipsychotic medication Bressler, S. (2018). Schizoaffective Disorder Treatment. Psych Central. Retrieved on May 2, 2018, from https://psychcentral.com/disorders/schizoaffective-disorder-treatmentSchizophrenia http://www.webmd.com/schizophrenia/guide/mental-health-schizoaffective- disorder[9/5/2013 12:06:17 PM] Alexopoulos GS, Katz IR, Reynolds CF 3rd, Carpenter D, Docherty JP, Ross RW. J Psychiatr Pract. 2001 Nov;7(6):361-76. Bora E, Yucel M, Fornito A, et al. Major psychoses with mixed psychotic and mood symptoms: Are mixed psychoses associated with different neurobiological markers? Acta Psychiatr Scand. 2008;118(3):172–187. [PubMed Pierre J. Deconstructing schizophrenia for DSM-V: challenges for clinical and research agenda. Clin Schizophr Related Psychoses. 2008;2:166–174 5.
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