Everything you need to know about Schizoaffective Disorder

Perhaps your doctor diagnosed you (or someone you care about) with schizoaffective disorder.  Your first thought is, “Does that mean I have Schizophrenia?”  The second is typically, “I’ve never heard of schizoaffective disorder.  Is the doctor making things up?”

The quick answers:

• No, you don’t have Schizophrenia.
• No, your doctor isn’t inventing the diagnosis.  Although most people haven’t heard of this disorder, it’s a real mental health condition, occurring in about 5 out of every 1000 people.

So what is schizoaffective disorder?

Schizoaffective disorder can be hard to understand.  In short, the illness is diagnosed when someone has symptoms of both mood problems and psychosis.

Mood problems: too much feeling

Individuals with schizoaffective disorder experience depression or manic-like episodes.  If they only experience depression, they’re diagnosed with “Schizoaffective disorder, depressive type.”  If they have both depression and mania, or just mania, it’s called “Schizoaffective disorder, bipolar type.”

(1) Depression is an overwhelmingly sad mood that messes up a person’s life: relationships, work, school, etc.  The depressed person loses the ability to feel joy.  They can also experience hopelessness, indecision, fatigue, problems with sleep and appetite, low self esteem, problems thinking, and sometimes suicidal thoughts.  Depression lasts weeks to months to years.

(2) Mania involves feeling so happy or agitated that it disrupts the person’s life.  The high feeling always lasts longer than a week.  Symptoms of mania include super-high self-esteem, talking nonstop, having more energy than usual and wearing others out, not needing to sleep, doing impulsive or dangerous things, racing thoughts,  and starting all sorts of projects without finishing them.  “Hypomania” is a milder form of mania.

Psychosis: unreal thoughts and experiences

Like people with Schizophrenia, those with schizoaffective disorder experience psychosis.  But what’s “psychosis?”

A quick answer: it’s when the brain loses touch with reality.  The longer answer: people with psychosis struggle with delusions, hallucinations, confusion, or bizarre behaviors.

(1) Delusions are mistaken belief-systems that won’t go away no matter how much evidence there is to the contrary. Examples include paranoia (believing the FBI is out to get you) or bizarre delusions (believing aliens are trying to place electrodes in the brain.)  If you’ve been told you’re delusional, it’s possible you disagree with your provider’s opinion.  On one hand, you might be right (keep in mind that would mean everyone else is wrong).  Alternatively, there’s a chance you aren’t seeing reality clearly.  Talk to people you trust to tease that out.

(2) Hallucinations include hearing voices or sounds no one else hears.  Hallucinations are heard with the ears, not inside the mind.  They can be loud, derogatory, and commanding, even downright terrifying.  Other people have angelic voices, like God whispering at the ear telling them to save others from their demons.

(3) Confusion and bizarre behaviors are more symptoms of psychosis.  The individual might not talk about delusions or hallucinations, but they don’t make sense or do strange, nonsensical things, like staring up at the ceiling for three hours for no reason. A person with disorganized psychosis can be hard to follow in conversation and tends to jump from subject to subject without transition.

But how does it all fit together?

So a person with this illness experiences psychosis and mood problems, right?  There’s a slight complication.  Okay, a major complication, and you can skip this section if you don’t want to bother with it.

Schizoaffective disorder occurs when you have a psychotic disorder and mood disorder in the same person, but it isn’t always that easy to tell what’s what.  So psychiatrists added two extra rules, or criteria, to help tell the difference between schizoaffective disorder, Schizophrenia, and bipolar.  Here are those criteria in a nutshell, and both must be met:

Criteria #1. On the occasion the person with schizoaffective disorder has psychosis without mood problems. An example would be the person with a long history of depression and mania who complains about having hallucinations — and isn’t depressed or manic right now.   What would be this person’s diagnosis?  You got it: schizoaffective disorder, bipolar type.  (For anyone who’s curious, Criteria #1 rules out bipolar disorder.)

Criteria #2. Although there are times when psychosis is present alone (criteria #1), mood problems are a major part of the illness and are present much of the time.  An example might be someone who is manic and delusional — but who in the past has had psychosis without mood disturbance.  He would be diagnosed with schizoaffective disorder, bipolar type.  (For anyone who’s curious, criteria #2 rules out Schizophrenia.)

How do I know if I’ve got it?

If you’re struggling with mood problems or psychosis, please touch bases with a psychiatrist, and do so now!  They can evaluate your situation, do necessary testing, and help you understand what’s going on.

It can take time for providers to reach the right diagnosis.  Many people are incorrectly identified as suffering from Schizophrenia (people who experience only psychosis) or bipolar disorder (those who struggle with mood swings more than psychosis) before their condition is clarified.  Again, if you’re concerned about having this disorder, let your psychiatrist know.

What’s the treatment?

The best approach is a combination of medications, individual therapy, and life-skills training.  Self-help techniques and awareness of community resources can also be helpful.

Medications. Schizoaffective disorder may run a different course for each affected person, but most people absolutely need medications.  Prescription drugs help stabilize mood and thinking, improve functioning and realization of life passions, and increase the feasibility of reaching one’s goals.  They also diminish the risk of future meltdowns, making hospitalization and time in prison less likely.  The prognosis for those who don’t take meds is considerably darker than for those who do.  Treatment varies according to the type of schizoaffective disorder.

• Depressive type.  If it’s predominantly “depressive type,” then the psychiatrist focuses on treating the depression and psychosis.  That’ll probably include an antidepressant for mood (like Prozac or Effexor), and an antipsychotic medication for delusions, hallucinations or other psychotic symptoms (like Invega, Haldol, Risperidone, or Zyprexa).
• Bipolar type.  If the diagnosis is “bipolar type,” the focus of treatment shifts to antipsychotics with mood stabilizers.  Mood stabilizers include Lithium or Depakote, and are effective at helping with mania and mood swings.  Antipsychotic medication are used for psychosis and mood swings.  For depression, doctors often try depression-lowering antipsychotics or a medication called Lamictal.

Psychotherapy.  We all need extra support sometimes, especially when dealing with a mental health problem.  In addition to support, a talk-therapist can help you take on real-life stressors, past trauma, difficult thought patterns, and problem symptoms.  They’ll encourage you to focus on your strengths and teach you how to use them to your advantage.  Also, consider joining a support group or participating in group therapy, where you meet others with similar struggles; it’s important to know you aren’t alone.

Life-skills training.  In psychiatry, life-skill training are ways to function in day-to-day life.  These classes strengthen your ability to do things, like living in a group home with others, attending school or work, or communicating in a job interview.  Specific skills range from learning how to socialize, use public transportation, and go shopping to making friends and dealing with conflict.  Skills training can also include vocational rehabilitation (VR).  VR helps people step through the process of job-hunting and provides extra support maintaining employment.

Other resources. Don’t forget the stuff you can do without professional assistance!  Here are some ideas:

• Self-soothing techniques, like tai chi, yoga, abdominal breathing, mindfulness, muscle relaxation, imagery
• Passion stuff, like playing with a pet, dreaming about the future, writing music, drawing, making a house out of toothpicks, imagining where you want to be in ten years, planning a trip, writing a blog
• Coping skills, like journaling about issues, problem-solving, talking to a friend about stressors, looking for alternative perspectives to your situation, being assertive
• Distractions, like coloring, listening to music, watching TV, seeing a movie, going to a zoo, eating dessert, cleaning the house. For more ideas, read 150+ fun things to do.
• Exercise, like stretching, pacing, jumping jacks, walking

Extra help.  If your provider feels you’re still struggling despite current level of treatment, they may call on extra community resources, like a home-visiting social worker or treatment team (case management, ACT, or mobile crisis, depending on your clinical situation), day hospital or intensive outpatient (if you need more structure and daytime support), or crisis centers (short-term safe houses to help during difficult moments).  **Keep in mind that not all communities have these resources.**  Your treatment will also focus on your other mental health problems.  For example, if you’re having problems with drugs or alcohol, you’ll be encouraged to go to detox and/or drug rehab.  Talk to your provider to learn more about these options.

Emergencies.  An important final note: should there be safety concerns, your doctor will likely discuss hospitalization with you.  One way or another, if you’re feeling suicidal or afraid you’re going to hurt somebody right now, please make sure to reach out for help immediately.  Call 911 or go to the nearest emergency room.

So what should I expect down the road?  I mean, how do I survive Schizoaffective disorder?

Living with a mental illness can be painful, but there are good points here, and ways to improve the future.  They’re worth bringing up.

First, prognosis.  Prognosis is a word that means “likely future outcome.”  It’s different for each individual, very hard to generalize and predict, but studies suggest that schizoaffective disorder has a much better prognosis than Schizophrenia when it comes to future break-downs, education, employment, relationships, and independence in general.  People with schizoaffective disorder are more likely to take their medications and be aware of their illness, thus more motivated to stay in therapy.  Medications and non-med treatment improve the course of the illness.  So want to improve your future?  Stay in treatment and, as annoying as it might be, stay on those meds!

What else can you do to improve the outcome?  A few key points:

• If there’s one thing you’ve got to do, please please please stay away from drugs and alcohol!
• If they’re supportive, involve your family in your treatment.  They should talk to your psychiatrist about low expressive emotions and ways to best support you depending on how you’re doing.
• Ask your providers to help you lower stress in your life and up your stress tolerance.
• Have hope. People with Schizoaffective disorder can reach their dreams and thrive.  For example, college professor John Nash had the illness (depicted in the movie Beautiful Mind), as well as many other famous people.

Okay, that’s an overview of schizoaffective disorder.  For more information, check out these articles on healthyplace.com.