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Schizoaffective Disorder?

Schizoaffective Disorder?

WHAT IS ?

BASIC FACTS • SYMPTOMS • FAMILIES • TREATMENTS

RT P SE A Mental Illness Research, Education and Clinical Center E C I D F

I A C VA Desert Pacific Healthcare Network

V

M

R E E Long Beach VA Healthcare System N T T N A E L C IL L LN A E IC S IN Education and Dissemination Unit 06/116A S R CL ESE N & ARCH, EDUCATIO 5901 E. 7th street | Long Beach, CA 90822 2 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 someone withnofamilyhistory ofthesedisorders. disorder,schizoaffective developing to compared of risk increased at are disorder schizoaffective or disorder, bipolar , with sibling) or parent (e.g., relative degree first a with dividuals In- men. in than woman in common more is disorder zoaffective Schi- 0.5%. to 0.2% from ranges it that estimate experts clear, not fulfilling lifegoals. ing relationships with other people, and achieving meaningful and encouragement can lead to experiencing fewer symptoms, improv- and assistance provide to supports and illness, one’s managing in education therapies, helpful of combination A possible! is covery tioning and relieve func- many symptoms improveof schizoaffective disorder.help Re- that treatments are There help. for others on rely they so themselves, for caring or a job holding difficulty have disorder schizoaffective with people Many performance. school or well. Symptoms may result in poor social functioning and poor job In betweentheseextremes, theperson’smoodmaybenormal. months. or weeks, days, hours, for last can in Changes time. to time from experience people most that downs and ups normal the from different very are disorder schizoaffective with someone by experienced downs and ups The symptoms. of types both ence experi- others , or of symptoms experience only fective disorder also experience mood episodes. While some people decision-making abilility. and ,, their in impairments some have disorder In schizoaffective with people relationships.all nearly symptoms, these to addition social in interest an show not do and , lack expressiveness, have low also , are unable to experience illness this with individuals Some agitated. become and/or withdraw them make and illness the with people terrify can ences experi- These them. harm to plot or thoughts, their control minds, their read can people other that believing as such suspicions, and thoughts unusual have may They hear. don’t people other voices hear may They them. around reality the understanding difficulty have they when periods have illness this with people Therefore, . and of features prominent its of because school, socialrelationships, andself-care. work, including living, daily of aspects all impact can and haviors atric disorder that can affect a person’s thinking, , and be- psychi- disorder.a bipolar is or depressionIt in seen those as such symptoms, mood 2) schizophreniaand in seen those as such toms, symp- psychotic 1) of combination a by characterized is It illness. basic facts Although the exact prevalence of schizoaffective disorder is disorder schizoaffective of prevalence exact the Although Families and society are affected by schizoaffective disorder as In addition to psychotic symptoms, individuals with schizoaf- disorder apsychotic is considered disorder Schizoaffective psychiatric treatable and chronic a is disorder Schizoaffective Schizoaffective disorderischaracterizedbyacombinationof Less than1%ofthepopulationwill developschizoaffective psychotic andmoodsymptomscanaffectaperson’s thinking, emotions,andbehaviors. disorder intheir lifetime. schizophrenia-spectrum disorders. with associated also are abuse, sexual or physical and separation, or loss parental early conflict, family as such events, life Stressful been identified as a risk factor in developing psychotic symptoms. and substance use. use, especially before age 15, has also or exposure to toxins before birth, obstetric complications, poverty, cluding schizoaffective disorder, are malnutrition, maternal illness tors believed to be linked to schizophrenia-spectrum disorders, in- fac- environmental the of disorder. Some schizoaffective develop will someone whether in role key a plays also environment that in schizoaffectivedisorder isunclear. the brain throughoutand body. However, information the exact role of these are communicate that Neurotransmitters chemicals disorder. brain schizoaffective to linked is also and , glutamate, , mitters the strongest andmostconsistentriskfactorsforthedisorder. of one is disorder bipolar or schizophrenia, disorder, zoaffective schi- of history family a and families, in run does disorder fective disorder.the develop will However, schizoaf- shown that have studies relatives other or children mean necessarily not does order environmentaland factors. Aschizoaffective dis- of history family biological with together acting genes of influence the from sults vironmental stressors, andstressful lifeevents. disorder,disorder,schizophrenia,bipolar or en- factors, biological schizoaffective of history family or genetic a include order.dis- These the of onset the in part a play factors several because order Causes long, symptomstendtoimprove overtheperson’s life. life- often is disorder the Although illness. the of course milder a severehave individuals Some time. over and symptoms are more chronically ill and maintain a steady level of moderate to ence experi- periods of symptom exacerbation people and , while others Most hospitalization. require may and siderably alone appearstobemore commoninolderadults. symptoms depressive with disorder schizoaffective while adults, young in common more be to appears symptoms manic with der before or after the onset of mood symptoms. Schizoaffective disor present might they and gradual, or abrupt be may symptoms ic psychot- of onset the greatly– vary disordercan the of symptoms initial The 30. and 16 of ages the between often adulthood, early Course ofIllness dlho. ot epe xeine eid o smtm exacerbation symptom of periods orearly experience people Most lateadolescence adulthood. in begins usually disorder Schizoaffective factors, includingafamilyhistoryofpsychoticorbipolardisorders, Scientists believethatschizoaffectivedisorderiscausedbyseveral biological factors,environmental factors, and stressful lifeevents. n diin o eei ad ilgcl atr, tes believe others factors, biological and genetic to addition In neurotransthe of imbalance an factors, biological of terms - In re- disorder schizoaffective of risk the that shows Research dis- schizoaffective causes what to answer simple no Thereis The course of schizoaffective disorder over time varies con- varies time over disorder schizoaffective of course The or adolescence late in begins usually disorder Schizoaffective and remission, whileothersare more chronically ill. - TV, radio,orother media. the through them to communicated being are messages personal special if as seem may her, it or or him at directed specifically are lieve that certain gestures, comments, or other environmental cues be- may person The this. confirm to information no is there when sonal meaning to actions of others or to various objects and events per special attaches individual an When delusions: Referential • on, threatened, attacked, ordeliberatelyvictimized. spied against, discriminated or plotted being is them) to close one • Delusions of persecution: The belief that the individual (or some include: examples Some themes. of variety a include may delusions the of content The them. of out” “talked be cannot usually and strongly beliefs these hold People them. against evidence overwhelming 2) • Gustatoryexperiences:Tasting thingsthatare notthere. smelling thesamethingthatotherpeopledosmell. • Olfactory: Smelling things that other people cannot smell, or not something istouchingone’sskinthatnotthere. • Tactile: Feeling things that other people do not feel or feeling like not see. can- people other that thereor areVisual:not that • things Seeing most commontypeofhallucination. warn or things, them do of danger. Sometimes the to voices talk to each other. them This is the order behavior, their about person the to talk may voices The voices. hear disorder this with people Many hear. cannot people other that things Auditory: • may hear, see, feel, smell, or things that are not actually there. 1) of aperson’slife. much throughout stable often are symptoms These people. other in present ordinarily are that behaviors or , thoughts, of absence the are symptoms Conversely,negative noticeable. ly hardare- they sometimes and severe,are they Sometimes go. and come can symptoms These delusions. and hallucinations as such symptoms include They people. other in areordinarilyabsent but disorders psychotic with people in presentare that behaviors and perceptions,thoughts, referto symptoms Positive symptoms. tive disorders are generally categorized as positive symptoms or nega- psychotic of symptoms The here. described are disorders chotic to impairsocial,work,orotherareas offunctioning. severeenough be must order,experiences person a symptoms the disorder.schizoaffective dis- schizoaffective with diagnosed be To in seen are that symptoms cognitive and mood, psychotic, scribes de- handout This subtype. this for required not is it but occurred, have may also episode depressive Amajor illness. their of course the during episode manic a experienced have who those in nosed diag- is type bipolar The mania. of history no with only episode depressive major a experienced have who type those in The depressive diagnosed is type). ( schizoaffective or type) (depressive disorder schizoaffective either with diagnosed be will person The normal. relatively is mood their which in ods peri- during even symptoms psychotic experience also they but symptoms, psychotic experience they time same the at symptoms . Hallucinations are false perceptions. A person Aperceptions. false are Hallucinations Hallucinations. . Delusions are false beliefs that are held in spite of spite in held are that beliefs false are Delusions Delusions. PSYCHOTIC SYMPTOMS: PSYCHOTIC mood experiences disorder schizoaffective with person A symptoms ofschizoaffectivedisorder h fv ky etrs ofpsy- features key five The - - by excessiveoragitatedbodymovement.Catatoniaisrare today. postures, or not move. On the other hand, it could be characterized body rigid maintain people, other unresponsiveto be may person regularly.severity.ing a in form, range severe can its In their basic needs, such as bathing, dressing properly, and even eat- of care taking time hard a have may they or inappropriate, cially so- are that things bizarre do overall may person in The functioning. decline daily a as appear also may behavior Disorganized control. impulse or inhibition of lack and responses, appropriate in- or unpredictable behaviors, bizarre include behaviors ganized 4) is sometimesreferred toasathoughtdisorder. symptoms of category This ideas. or words repeat persistently to meaningless words, or “neologisms,” or perseverate which means thought had been taken out of their head. A person might make up the if as felt it that say may person the talking, stopped they why asked When thought. a of middle the in abruptly speaking stop and blocking” “thought experience may person A conversation. their follow to difficult very it making topic, unrelated an to topic wherefromassociations,” shift “loose rapidly make they one may hard to understand, often is referred that to as way a “wordincoherent salad.” an The person in together words string may ly.They trouble organizing his or her thoughts or connecting them logical- 3) Disorganizedthinking and actions are beingcontrolled byotherpeople. • Delusions of control: The belief that one’s feelings, thoughts, and a famousrock star. cial powers or abilities. For example, a person might think they are spe- has or special very is one Believing grandeur: of Delusions • inside orpassingthrough one’sbody. is foreign something that or exists illness physical terrible a that body.example, one’s For about beliefs False delusions: Somatic • Disor Grossly disorganizedbehaviororcatatonicbehavior. . This is when a person has person a when is This . - 3 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 4 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 be misdiagnosed with having another psychotic disorder,as psychotic such another having with misdiagnosed be disorder may schizoaffective with Individuals challenging. be can diagnosis accurate an making that means disorders mood and ic time. in overlapped have symptoms which and lasted, have they long how symptoms, the of severity the experienced, symptoms the to attention careful pays and interview comprehensive a conducts professional symp- mental trained Toa toms. diagnosis, the make similar have sometimes that conditions health mental or medical other out rule help can they disorder, but schizoaffective nosis. There are currently no physical or lab tests that can diagnose diag- the determine to used are evaluations medical and terviews in- Diagnostic professional. health mental trained a by diagnosed Feig o wrheses r xesv o inappropriate or guilt excessive or worthlessness of Feelings • • Fatigueorlossofenergy and bodymovements) thinking, speech, slowed (e.g., retardation psychomotor or pacing) or still sit to inability (e.g., agitation Psychomotor • get backtosleep,orsleepingexcessively) ing asleep, waking early in the morning and not being able to stay or asleep falling (difficulty or • decrease orincrease inappetite a or gain, weight dieting, not when loss weight Significant • joyable en be to found once things in pleasure or interest of Loss • symptoms: these of four least at experience also must person The weeks. two least day,at day,every for the nearly of most depressed feels person a which during period a is episode depressive a disorder, schizoaffective In DEPRESSIVE SYMPTOMS: close relationships withother people. having or movies, the to going sunset, a watching enjoy not may pleasurefrom activities one used to find experience enjoyable. For example, the person to inability the is Anhedonia: • trouble followingthrough onevensimpleplans. and have few interests. They may feel lethargic or sleepy, and have lives their in purpose of little have may They activities. and ent disinterest. appar The person may not feel motivated to pursue goals for mistaken often is It behavior.begin and goal-directed to in persist or inability difficulty the is Avolition: • able tospeakandmaygiveshort,emptyreplies toquestions. fluency and productivity. The person may have difficulty or be un- speech of lessening the is speech, of poverty or , Alogia: • vironment orhavingfeelings. en- her or his reactingto not is person the that mean not does this However,restricted. or reduced be may gestures and tone, voice decreased body language. The expressiveness of the person’s face, and contact, including eye poor expression, expressiveness, facial unresponsive emotional or limited of range the bya in reduction ischaracterized flattening Affective flattening: Affective • gory: cate- this into fall symptoms different of number Apeople. other in present ordinarily are that behaviors or perceptions, thoughts, of absence the are symptoms Negative 5) NegativeSymptoms. symptoms ofschizoaffectivedisorder diagnosis The fact that this diagnosis includes features of both psychot- featuresboth includes of diagnosis this that fact The Schizoaffective disorder is a psychiatric disorder that must be - - - n fins h hv osre te niiuls eair and behaviors moods. individual’s the observed have who friends relatives and from information collect to useful is It occurring. from a Therefore, exposure. toxin careful and thorough interview is needed to prevent misdiagnosis or , use, drug of result direct the not are and condition medical general a to due not are disorder. The diagnosing clinician must also make sure symptoms bipolar or depression major as disorder,such mood a with nosed misdiag- be may they Alternatively, disorder. delusional or der, disor psychotic brief disorder, schizophreniform schizophrenia, painful consequences (e.g., shopping sprees, driving reckless • Excessive involvement in activities with a high potential for (purposeless agitation non-goal-directed activity) psychomotor or school) or or work sexual, at social, (e.g., activities goal-directed Increased • irrelevant things) or unimportant to drawn easily is (attention Distractibility • the same time or rapid speech that jumps from topic to topic) • Flight of ideas or (has too many thoughts at • More talkativethanusualorpressure tokeeptalking of ) • Decreased need for sleep (e.g., feels rested after only 3 hours self andmaybeunrealistic abouttheirabilities) of opinion high a (has grandiosity or self-esteem Inflated • irritable): ence at least three of these symptoms (four if the mood is only experi also must person The hospitalized). if (less week one least day,day,at every the for nearly of most energy creased in has and irritable or extremelyhappy feels person a which during period a is episode manic A MANIC SYMPTOMS: for committingsuicide,orasuicideattempt plan specific a plan, specific a without ideation suicidal rent ing problems, andgraspingabstractconcepts. solv planning, difficulties and memory,thinking, poor slow attention, paying or troubleconcentrating include symptoms cognitive of examples Some living. independent and ships, disorder and contribute to difficulties in work, social relation schizoaffective Cognitive of feature core a problems. considered are impairments solve to and remember, to attention, us to perform day-to-day functions, such as the ability to pay allow that processes mental to refers impairment. ly all individuals with the disorder experience some cognitive are not part of the diagnosis for schizoaffective disorder, near symptoms cognitive Although COGNITIVE SYMPTOMS: ly, andunsafesex) • Recurrent thoughts of death (not just of dying), recur dying), of fear just (not death of thoughts Recurrent • • Decreased abilitytothinkorconcentrate,indecisiveness by a trained professional. The symptoms of schizoaffective Schizoaffective disorder is a psychiatric disorder that must be diagnosed Individuals with schizoaffective disorder experience psychotic symptoms as wellmoodsymptoms.Cognitivesymptomsare alsovery common. disorder mayoverlap withsymptomsofotherpsychiatric disorders. (cont’d) ------biological. The course of the disorder is impacted by environmenby - impacted disorderis the of course The biological. been devel- oped that reduce many symptoms. Also, the disorder is not have purely that effective medical are other there like problems, However, done. be can that nothing is there like feel people because hopelessness of feelings increase may it dictive ofrelapse. pre- be to shown been have attitudes hostile and critical because disorder areschizoaffective important causes what on views bers’ mem- disorder.Family the of view moral a hold who those than hold a medical view of the disorder are less critical of their relative willingness to help. Research greaterhas shown that a family members who and sympathy and warmth of feelings greater to leads This thereforesymptoms. their responsiblearefor not individuals and controllable, not are symptoms the that believe to members family lead may illness medical a is disorder schizoaffective belief that the contrast, In relative. ill their of members supportive family being prevent from may and of feelings to lead can symptoms, their for responsible are result a have as people and over, control that belief The symptoms. their control to able are disorder schizoaffective with individuals that believe to members by moral weakness, , or lack of self-discipline leads family caused is disorder the that belief The illness). medical a is it (i.e., biological purely are causes the believe others whereas cipline), moral failings (e.g., the or individual is weak, lazy, weaknesses personal or lacking self-dis- individual’s an by caused are disorders psychotic that think families Some causes. its understanding by ive, it may be because of what they believe is causing the disorder. support- being difficulty have members family If be. may it slow however made, being is that progress any appreciate and patient are they when best do often families but times, at difficult be may It blaming. or negative, critical, than rather understanding be to beneficial in the process of recovery. It is best if family members try very be can them areto that important activities and goals pursue risk of relapse. Helping an individual with schizoaffective disorder the decrease and with cope people help can support family Provide Support clinic. the to transportation providing and support, offering reminders, giving are attendance therapy encourage to ways Some tendance. at- treatment supporting in helpful very be can members Family rehabilitation. and treatment disorder psychosocial referredto be also may schizoaffective with individual An routine. daily their ful. Family members can help the person fit taking medication into remindersforgetand just Encouragement may it. take areto help- individual with schizoaffective disorder may not want to take it or an when times be will – there difficult be can Takingmedication medications. those taking regularly in support provide can bers mem- family prescribed, is medication If illness. the about learn and questions, doctor’s the answer help support, offer to uation ble, it is often helpful for family members to be present at the eval- The first step is to visit a doctor for a thorough evaluation. If possi- life. of quality their improve and activities, meaningful in engage Encourage Treatment andRehabilitation cess ofrecovery inmanyways. pro- the help can members family illness, frustrating a be can der disor the though disorder. Even schizoaffective with individuals Although the medical view of the disorder is more accurate, more is disorder the of view medical the Although disorders psychotic of sense make to try members Family Family stress can contribute to symptom relapses. Conversely, better,feel person a help can and Medications of recovery the in important very is environment family The how familymemberscanhelp - help ofamentalhealthprofessional ifneeded. the get should They can’t. They themselves. problems relative’s nally, family members should not feel responsible for solving their Fi- illness. one’s loved a with cope better friends and family help consider joining a support or therapy group. Counseling can often also may members Family well-being. own their for important friends is and members family other with or alone time Spending time. their monopolize to relative ill their allow not should bers mem- Family this. do to ways many areThere themselves. of care relative;fromill however,their good take they that important is it Take Care ofThemselves ble. possi- is recovery that hopeful remaining while supportive more the complexity of the causes involved can help family members be Understanding efforts. these with help can therapies Psychosocial skills. their increasing and stress their reducing by prove protectiveTherefore,and well. tal as factors im- can lives people’s disorder in many ways. Some ways include encouraging and helping and encouraging include ways Some ways. many in disorder schizoaffective from recovery of process the help can members Family with treatment, providing support,understanding thecauseof Family members often feel guilty about spending time away time spending about guilty feel often members Family disorder, andtakingcare ofthemselves. 5 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 6 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 is experiencing. Families then attend educational sessions where sessions educational attend then Families experiencing. is vices, the family and clinician meet ser to discuss problems the family family-based In recovery. toward together work to families Family-Based Services , positive and shaping. playing, role modeling, as such niques, tech- behavioral using way systematic very a in taught are skills independently.Social live and relationships, develop goals, their achieve to likely more are individuals effectively, so andcommu more nicate help express to skills teaching by deficits these correct to aims (SST) training skills Social skills. social with Social SkillsTraining of relapse. likelihood the reduce that changes behavior and relapse, of signs adverse effects of various treatment options, identification of early impor tance of the active involvement disorder, in treatment, the schizoaffective potential benefits and of course and the as such topics covers Psychoeducation relapse.preventing and toms symp- treating of ways effective most the and illness their about Psychoeducation illness. They are considered mental tobeevidence-based practices. severe with people for effective be to shown has research which ones are here listed treatments The rehabilitation. and treatment psychosocial with functioning their improve and with schizoaffective disorder can learn to manage their symptoms in managing symptoms (see pages 8-11). Additionally, individuals helpful be can medications and stabilizers, mood first-line the as recommended disorder. schizoaffective for treatment medications, are and symptoms reduce help can disorder. Medications schizoaffective from suffering those to treatment Mental illness affects the whole family. Family services teach family. services whole Family the affects illness Mental difficulties have disorder schizoaffective with people Many information with individuals provides Psychoeducation available therapies and medications of variety a are There - - - ann sgs o rvn rlpe Ti tetet prah also teaches individuals approach treatment This relapse. prevent to signs warning and triggers with cope to plan a developing and relapse, of toms symp- and signs warning tracking symptoms, situations trigger might that recognizing involves prevention Relapse symptoms. medica choices, tion adherence strategies, and coping skills to deal with stress and treatment their illness, psychiatric learn their Individuals about training. skills social and prevention, relapse symptoms, and stress manage to skills coping teaching ucation, Illness Self-Management Assertive CommunityTreatment (ACT) surable activitiesandbecomingmore activeifdepressed. plea- scheduling on work will they or hallucinations, other or es” “voic- with dealing for techniques coping various learn will they example, For symptoms. problematic with cope to learn also will Individuals hospitalization. a to lead can that stress of types the minimize disorder schizoaffective relapse. with individuals of help can This chance the reduce can which illness, the of episodes ed to daily functioning. Individuals learn to identify what triggers pist teaches problem solving and social skills, as well as skills relat- thera- The challenges. life’s with cope to techniques learn people and skill-oriented, is CBT patterns. behavior unhealthy change to adaptive thoughts. more with them replace and thoughts, them, maladaptive challenge logically identify to how learn individuals helps healthy.and adaptive CBT more be to thinking person’s a change and how they influence a person’s mood and actions. CBT aims to setting. better person groupa in or one-on-one a done be can CBT illness. their with cope help can medication, to add-on an as CBT, that shown has research but challenging, is CBT with disorder fective therapy.behavioral and Treatingtherapy cognitive schizoaf- pies: Cognitive BehavioralTherapy(CBT) and canbeconductedinsinglefamilyormulti-familyformats. months nine to six last Generally,interventions longer-term these relapse. to prone or symptomatic chronicallyare who individuals ilies that are experiencing high levels of stress and tension, and for fewses- sions, while a more intensive services are especially helpful for fam- just from benefit families specific Some family. the each of fit needs to available programs family of range a is There improved treatment adherence, and improved family functioning. relapses, and symptoms psychiatric fewer experience in- terventions family in participate who Patients recovery. toward another one with work to ways and problem-solvingskills, skills, nication commu skills, coping illness, mental about facts basic learn they clude case management, comprehensive treatment planning, cri- planning, treatment comprehensive management, case clude in- ACT in provided Services clients. 10 every for staff 1 usually ratio, client to staff high a ensure to caseloads limits and week, a peer specialists. The team provides coverage 24 hours a day, and 7 days specialists, treatment abuse substance specialists, vocational workers, social and nurses several , a managers, case including professionals, 12 to 10 usually of team interdisciplinary an fromtreatment receives In ACT,person homeless. the are who those or hospitalizations multiple of history a with those as such needs, service greatest the with individuals for effective most is opnns f lns sl-aaeet nld psychoed- include self-management illness of Components eairl hrp fcss n pro’ atos n aims and actions person’s a on focuses therapy Behavioral beliefs and thoughts person’s a on focuses therapy Cognitive thera- two of blend a is (CBT) therapy behavioral Cognitive Assertive Community Treatment (ACT) is an approach that approach an is (ACT) Treatment Community Assertive - - rgas lo mrv wr fntoig rltosi quality, relationship functioning, work improve also programs remediation cognitive that suggest to data some are There own. its approach on either than moreeffective is combination this that found has research approaches; in-person and computerized the use and cognitive-training exercises. Other programs use a combination of functioning cognitive improve to ways discuss groups These programs. remediation cognitive group-based in-person, also are there programs, computerized to for addition available In are purchase. programs these of Some sessions. practice the during included rewards and games have often programs these motivated, and engaged people keep help To cognition. of these areas improve to targeted exercises learning of repetition volve in- and computerized are programs remediation cognitive Most solving. problem and planning, memory, attention, as such cits, Cognitive Remediation is calledMOVE!Itoffered inasupportivegroup setting. VA’sThe loss. program weight this modest of to version lead and gain weight additional prevent help can program a such in tion Participa- goals. wellness personal attainable and realistic set and regularhave weigh-ins, levels, activity and intake food daily their monitor to about skills learn education Participants control. portion include and nutrition and longer or months 3 last generally Weightprograms available. are loss weight support to Resources individuals. many for issue health serious a it making hy- pertension, and as such problems to lead can gain Weightder. disor schizoaffective of symptoms the treat to used medications Management Psychosocial InterventionsforWeight job seekingandkeepingprocess. the during providesupport to specialist employment with closely goals and skills. Case managers and mental health providers work ployment specialists work with individuals to identify their career Em- obtained. is job a once support continued and training, tional prevoca- without search job rapid a work, competitive on focus by characterized is approach The employment. competitive keep and find illness mental severe with people help to designed gram through supported employment. Supported employment is a pro- employed successfully be can 60% about and work to want illness Supported Employment interventions canbedelivered one-on-oneorinagroup format. These longer. treatment in individuals keeping and relapse, ing grated treatments are effective at reducing substance use, prevent- Inte- interventions. cognitive-behavioral and enhancement tional motiva- includes treatments Integrated problem. drug or the for treatment the with integrated be should disorder fective aretreatedbest concurrently, treatmentthat meaning schizoaf- for disorder.use substance or alcohol disordersan Co-occurring with Substance UseDisorders Psychosocial Interventions for Alcohol and Intensive CaseManagement(MHICM). Health Mental employ- called is program supported this of VA’sversion The (e.g., ment). services rehabilitation other broad of a range and support, peer treatment, abuse substance therapy, supportive individual management, medication intervention, sis The goal of cognitive remediation is to reduce cognitive defi- cognitive reduce to is remediation cognitive of goal The is a significant and frustrating side effect of many mental severe with adults of 70% about that shows Research struggle also disorder schizoaffective with individuals Many - apy, familytherapy, andbehavioraltherapy. relapse. of ECT is usually given in combination risk with medication, psychother the reduce to year, a to months several for tinue each week, tapering down to one time each month. They may con- for week a two to three times weeks. Maintenance treatments three may be done to one time two done usually are treatments ECT endorphins. called relievers natural and serotonin like ters neurotransmit- including chemicals, brain altering by depression onds, producing ashortseizure. sec- eight to up last can current electrical The head. the on placed electrodes through brain the to sent briefly are currents Electrical worked. not have medications and psychotherapy as such ments treat- other when used is It depression. life-threatening or severe Electroconvulsive Therapy(ECT) tion programs, suchassocialskillstraining. rehabilita- psychiatric of types other with combined is mediation re- cognitive when are areas these in There improvements greater typically problems. interpersonal solve to ability people’s and individuals with schizoaffective disorder manage their symptoms and symptoms their manage disorder schizoaffective with individuals help can that available therapies and medications of variety a areThere It is believed this brain stimulation helps relieve symptoms of treat to used procedure a is (ECT) therapy Electroconvulsive improve theirfunctioning. - 7 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 medication: what you should know

• Because schizoaffective disorder involves many kinds of symp- toms, the treatment can be complex. You and your doctor have a lot of choices of medications, and it is hard to know which one may work best for you. It is also often the case that more than one medication is required to treat mood symptoms and symp- toms affecting your thinking processes. Sometimes the medication you first try may not lead to improvements in symptoms. This is because each person’s brain chemistry is unique; what works well for one person may not do as well for another. Be open to trying a different medication or combination of medications in order to find a good fit. Let your doctor know if your symptoms have not improved or have worsened, and do not give up searching for the This handout provides only general right medication! information about medication for schi- • There are different types of medications that are effective for schizoaffective disorder. These include antipsychotic medications, zoaffective disorder. It does not cover all mood stabilizers, and antidepressant medications. possible uses, actions, precautions, side • Once you have responded to treatment, it is important to contin- ue treatment. To prevent symptoms from coming back or worsen- effects, or interactions of the medicines ing, do not abruptly stop taking your medications, even if you are mentioned. This information does not feeling better. Stopping your medication can cause a relapse. Med- ication should only be stopped under your doctor’s supervision. If constitute medical advice or treatment you want to stop taking your medication, talk to your doctor about and is not intended as medical advice for how to correctly stop them. • Like all medications, medications prescribed for schizoaffective individual problems or for making an disorder can have side effects. Your doctor will discuss some com- evaluation as to the risks and benefits of mon side effects with you. In many cases, they are mild and tend taking a particular medication. The treat- to diminish with time. Some people have few or no side effects, and the side effects people typically experience are tolerable and ing physician, relying on experience and subside in a few days. Sometimes, common side effects can persist knowledge of the patient, must deter- or become bothersome. If you experience such side effects, discuss them with your doctor and be sure to talk to them before making mine dosages and the best treatment for any decisions about discontinuing treatment. the patient. • In rare cases, these medications can cause severe side effects. Contact your doctor immediately if you experience one or more severe symptoms.

antipsychotic medications: what you should know

• Research has found that antipsychotic medications are ef- medication to “catch up” on those you have forgotten. fective for treating the positive symptoms in schizoaffective • Some antipsychotic medications are available as long-act- disorder and other psychotic disorders. It is not known ex- ing injectables. Use of injectable medications is one strategy actly how they work, but one common feature is the ability to that can be used for individuals who regularly forget to take block the action of a chemical messenger in the brain called their medication. dopamine. Research suggests that malfunction of this chem- ical messenger system, as well as others, cause symptoms such as hallucinations and delusions. • All antipsychotic medications must be taken as prescribed. Their effects can sometimes be noticed within the same day of the first dose. However, the full benefit of the medication may not be realized until after a few weeks of treatment. It is im- portant that you don’t stop taking your medication because you think it’s not working. Give it time! • Most are prescribed once daily. If you forget to take your medication, do not double up the next day to “catch up” on the dose you missed. If your medication is pre- scribed to be taken twice a day, and you forget to take a dose, a rule of thumb is: if it has been 6 hours or less from the time you were supposed to take your medication, go ahead and take your medication. If it has been more than 6 hours after the missed dose should have been taken, just skip the forgotten dose and resume taking your medication at the next regularly scheduled time. Never double up on doses of your antipsychotic FALL 2016 IS SCHIZOAFFECTIVE DISORDER - MIRECC FALL WHAT 8 ness, sensitivitytothesun,and unusualdreams. menstrual periods,moodchanges,nausea, nervousness,restless- up orstandup,drowsiness, drymouth, excessivesaliva,missed diarrhea, difficultyurinating, orfaintingwhenyousit duction, constipation,decreased sexualperformanceinmen, , breast enlargement orpain,breast milk pro- variety ofothersideeffectsincludingblankfacialexpression, People takingantipsychoticmedicationscanalsoexperience a any ofthesesymptomsappear. if immediately doctor your Contact pressure. blood or rate heart These symptomsincludehighfever, musclerigidity, andirregular (NMS). Malignant Neuroleptic called is effect side ous body.and face the in seri- movements but muscle uncommon, An involuntary by marked condition a tardivedyskinesia, cause may internal restlessness. Additionally, prolonged use of antipsychotics of a feeling is which , is effect stiffness. side cle related A mus- and , walk, include shuffling These symptoms. midal extrapyra or parkinsonian called are which , Parkinson’s of symptoms mimic that effects side experience individuals Some MEDICATIONS SIDE EFFECTSOFANTIPSYCHOTIC (RisperdalConsta) (Sustena) (ZyprexaRelprevv) (HaldolDecanoate) (ProlixinDecanoate) cations are similar totheiroralcounterparts. have totakethemedicationsdaily. Thesideeffectsofthesemedi Some patientsfindthesemore convenientbecausetheydon’t injectables. Thesemedicationsare giveneverytwo tofourweeks. Certain antipsychoticmedicationsare availableaslong-acting MEDICATIONS LONG-ACTING INJECTABLE ANTIPSYCHOTIC (Geodon) Risperidone (Risperdal) (Seroquel) Paliperidone (Invega) Olanzapine (Zyprexa) (Latuda) (Fanapt) (Clozaril) (Saphris) Aripriprazole (Abilify) antipsychotic medications: These are sometimesreferred toasatypicalorsecond-generation (Stelazine) Thiothixene (Navane) (Trilafon) (LoxitaneorLoxapac) Haloperidol (Haldol) Fluphenazine (Prolixin) (Thorazine) first-generation antipsychoticmedications: These are sometimesreferred toasconventional,typical,or antipsychotic medications - - used safelyifmonitoring occursattheappropriate timeintervals. ine remains themosteffectiveantipsychotic availableandcanbe clozapine isdiscontinued.Despite thisserioussideeffect,clozap checked frequently. Thisveryseriouscondition isreversible if people whotakeclozapinemust gettheirwhitebloodcellcounts white bloodcellsthathelpaperson fightoffinfection.Therefore, Clozapine cancauseagranulocytosis, whichisalossofthe exercise program. be recommended thatyouswitchmedications orbeginadietand side effects.Ifyoustarttogainweight,talkyourdoctor. Itmay Each ofthesemedicationsdiffersintheirriskcausing at home,itwouldbehelpfultoregularly checkyourownweight. weight andbloodchemistryonaregular basis.Ifyouhavea scale with someantipsychotics.Therefore, yourdoctorwillcheck blood levelsoflipids( andtriglycerides)are common Weight gain,changesinbloodsugarregulation, andchangesin (cont’d) - 9 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 10 WHAT IS SCHIZOAFFECTIVE DISORDER - MIRECC - FALL 2016 (Topamax orTopiragen) (Fanatrex, Gabarone,Horizant, orNeurontin) (Trileptal) (Lamictal) (EquetroorTegretol) Depakene) /Valproic Acid/DivalproexSodium (Depakoteor (EskalithorLithobid) MOOD STABILIZING MEDICATIONS herbal supplements, vitamins,andminerals. medications, over-the-counter medications, prescription tell your doctor about all the medications you are taking, including to sure Be consequences. health serious potentially create to tions medica other with interact can medications stabilizing Mood • mood stabilizerto“catchup”onthoseyouhaveforgotten. time. scheduled regularly next the forgottenthe skip just resumeand dose at medication your taking been has were supposed to take your medication, take your medication. If it been has it if medication: bilizing • Here is a safe rule of thumb if you miss a dose of your mood sta- tor abouthowtocorrectly stop. supervi- sion. If you want to stop taking your medication, talk to your doc- doctor’s your under medication your taking stop only Youshould relapse. a in result may this better,as feeling are you if even medications, your taking stop abruptly not do worsening, or returning from symptoms preventTo time. of periods shorter stabilizers, your doctor may add other medications to be taken for treatment. If episodes of mania or depression occur while on mood recommenddepression,may or doctor longer-termmania your of episodes of number a had have you If symptoms. of relapse a to lead may earlier treatment Discontinuing years). 2 least (at time tinue taking mood stabilizing medications for extended periods of it is necessary for individuals with schizoaffective disorder to con- general, In prescribed. as medication your taking continue to ant import- is treatment,it medication respondedto have you Once • it time! Give working. not it’s think you because medication your taking depressive symptoms to lessen. It is important that you don’t stop for weeks 4 to up take may It symptoms. manic in improvement see to expect can you before weeks 1-2 additional an take ,may it a of dose effective desired, the achieving After prescribed. as taken be must medications stabilizing mood All • mitter. neurotrans- excitatory an is which glutamate, decrease they that believed also is It brain. the on effect calming a has which GABA, ,the increasing by work to believed are vulsants two of these neurotransmitters, serotonin and dopamine. Anticon- of to activity the affect may lithium that thought is It regulatemood. believed are messengers) (chemical neurotransmitters called chemicals Brain disorder. schizoaffective in symptoms mood ing treat- for effective are stabilizers mood that found has Research • effective fortreating mooddisorders. very be to found been have they but , treat to developed originally were medications . are zoaffective disorder. Except for lithium, many of these medications schi- of symptoms mood the treat to bipolar prescribed disorder,also are for prescribed frequently are which stabilizers, Mood • mood stabilizers:whatyoushouldknow after the dose should have been taken, been have should dose the after hours 3 than more from the time you time fromthe less or hours 3 Never double up on doses of your of doses on up double Never - in moodorbehaviorisadvised. depression, suicidal thoughts or behavior, or any unusual changes of symptoms worsening or new for monitoring Close behaviors. and thinking suicidal increase may medications Anticonvulsant Asian ancestry, includingSouth Asian Indians. of individuals for higher is risk the although carbamazepine extent with lesser a to occurs rash This lamotrigine. of dose your ing risk for getting this rash can be minimized by very slowly increas- this rash can cause permanent disability or be life threatening. The that should be reported to your doctor immediately. In some cases, Lamotrigine and carbamazepine can also cause a serious skin rash the medicationsare notimpactingtheirorgans inanegativeway. sure make to periodically checked blood their have to need will medications these prescribed Individuals organs. other ,and the cells, blood white affect may carbamazepine and Lamotrigine nation, nausea,sedation,vomiting,weightgainorloss. balance/coordi - of ,loss headache, vision, double ness, dizzi- change, appetite anticonvulsants: of effects side Common SIDE EFFECTSOFANTICONVULSANTS doctor rightawayifyouexperienceanyofthesesymptoms. , .Youyour worsening contact and should thirst, increased , dizziness, movements), eye (abnormal mus nystag- speech, slurred coordination, of loss headache, diarrhea, vomiting, nausea, of onset new include toxicity lithium of signs Youexerciseto safely.how about doctor your to talk should Some increase. to level lithium your cause can sweating significant with activity physical or ibuprofen) as (such medications of pain use certain addition, In functioning. thyroid or im- kidney not your is lithium pacting that ensure to tests blood periodic do to you require will doctor your reason, this For system. your in lithium is a serious condition caused by having too much weight gain. rash, temperatures), cold to sensitivity and energy, low hair, brittle with (associated hormone thyroid low nausea, thirst, hand tremor, fine acne, lithium: increased of effects side Common SIDE EFFECTSOFLITHIUM antidepressant medications: what you should know

• Antidepressant medications are sometimes used to treat symp- toms of depression in schizoaffective disorder. Individuals who are prescribed are usually required to take an anti- psychotic at the same time for psychotic symptoms. • Research has found that antidepressants are effective for treating depression, but it is not clear exactly how they work. Brain chem- icals called neurotransmitters (chemical messengers) are believed to regulate mood. Antidepressant medications work to increase the following neuro-transmitters: serotonin, norepinephrine, and/ or dopamine. • All antidepressants must be taken as prescribed for 3 to 4 weeks before you can expect to see positive changes in your symptoms. It is important that you don’t stop taking your medication because you think it’s not working. Give it time! • Here is a safe rule of thumb if you miss a dose of your antide- pressant medication: if it has been 3 hours or less from the time you were supposed to take your medication, take your medication. if it has been more than 3 hours after the dose should have been taken, (antidepressant Classes 4 and 5). The common side effects differ just skip the forgotten dose and resume taking your medication at for each of the medications in this class of antidepressants. the next regularly scheduled time. Never double up on doses of your antidepressant to “catch up” on those you have forgotten. (Wellbutrin) • There are five different classes of antidepressant medications. (Remeron) Like all medications, the antidepressants can have side effects. (Desyrel) (Serzone) The common side effects differ for each class of antidepressants, so they are not covered here. However, if you have any questions, ANTIDEPRESSANT CLASS #4: AND please talk to your doctor or refer to the patient information leaflet (TCA AND TECA) that comes with your medication. This is an older class of antidepressants that also work by increas- ing levels of serotonin and norepinephrine in the brain. These ANTIDEPRESSANT CLASS #1: SEROTONIN REUPTAKE medications are good alternatives if the newer medications are INHIBITORS ineffective. This group includes the selective serotonin reuptake inhibitors (SSRIs) which are the most commonly prescribed antidepressants (Elavil or Endep) because they have relatively few side effects. SSRIs increase the (Asendin) level of serotonin by inhibiting reuptake of the neurotransmitter. (Anafranil) Serotonin modulators are new drugs that act like SSRIs but also af- (Norpramin or Pertofrane) fect other serotonin receptors. Their side effects overlap with those (Sinequan or Adapin) of SSRIs. (Tofranil) Nortiptyline (Pamelor) SSRIs Serotonin Modulators (Vivactil) (Celexa) (Viibryd) (Surmontil) (Lexapro) (Brintellix) (Ludiomil) (Prozac) (Paxil) ANTIDEPRESSANT CLASS #5: MONOAMINE OXIDASE (Zoloft) INHIBITORS (MAOI) MAOIs are an older class of antidepressants that are not frequently used because of the need to follow a special diet to avoid poten- ANTIDEPRESSANT CLASS #2: SEROTONIN AND tial side effects. However, these medications can be very effective. NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI) These drugs work by blocking an enzyme called monoamine ox- SNRIs are similar to SSRIs in that they increase levels of serotonin idase, which breaks down the brain chemicals serotonin, norepi- in the brain. They also increase norepinephrine in the brain to im- nephrine, and dopamine. prove mood. When taking MAOIs, it is important to follow a low “” (Effexor) diet, which avoids foods such as cheeses, pickles, and alcohol, and (Cymbalta) to avoid some over-the-counter cold medications. Most people can (Pristiq) adopt to a low tyramine diet without much difficulty. Your doctor will provide a complete list of all food, drinks, and medications to ANTIDEPRESSANT CLASS #3: ATYPICAL avoid. ANTIDEPRESSANTS In addition to targeting serotonin and/or norepinephrine, atypical (Nardil) antidepressants may also target dopamine. They also tend to have (Parnate) fewer side effects than the older classes of medication listed below (Emsam) patch FALL 2016 IS SCHIZOAFFECTIVE DISORDER - MIRECC FALL WHAT 11 RT P SE A E C I D F

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R E E N T T N A E L C IL L LN A E IC SS IN R CL ESE N & ARCH, EDUCATIO

MENTAL ILLNESS RESEARCH, EDUCATION AND CLINICAL CENTER VA Desert Pacific Healthcare Network Long Beach VA Healthcare System Education and Dissemination Unit 06/116A 5901 E. 7th Street Long Beach, CA 90822

VISIT US ON THE INTERNET AT: http://www.mirecc.va.gov/visn22

DOWNLOAD THIS HANDOUT AT: http://www.mirecc.va.gov/visn22/mirecc_schizoaffective_education.pdf

Noosha Niv, PhD 1, 2 Bonnie Zucker, PhD 1 Nikki Frousakis, PhD 1 Kim Mueser, PhD 3 Christopher Reist, MD, MBA 1, 4

1VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC) 2UCLA Department of and Biobehavioral Sciences 3Boston University Center for Psychiatric Rehabilitation 4UCI Department of Psychiatry and Human Behavior

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