Schizophrenia (SZD) is a cyclically progressive endogenous psychosis. The disease is characterized by emotive and schizophrenic symptoms that are prominent in the same stage of the disease. This condition cannot be completely cured but can be controlled through a number of methods.
What is schizoaffective disorder?
Schizoaffective Disorder (SZD) is a mental disorder in which emotional symptoms (manic, depressive, mixed) are mixed with symptoms of schizophrenia. The characteristic feature of this pathology is that schizophrenia and affective symptoms are prominent in the same stage of the disease. At the same time, hallucinations and paranoia have content inconsistent with mood in emotional disorders.
Schizoaffective disorder is easily confused with affective disorders and schizophrenia and requires a thorough evaluation. According to experts, SZD has a better prognosis than schizophrenia but worse than emotional disorders.
According to the ICD-10, schizoaffective disorder is divided into the following 3 categories:
- Manic-type schizoaffective disorder (F25.0)
- Schizoaffective disorder depressive type (F25.1)
- Mixed schizoaffective disorder (F25.2)
However, the DSM-5 divides schizoaffective disorder into two categories:
Schizoaffective disorder depressive (if only includes major depressive episode and schizoaffective symptoms)
Bipolar schizoaffective disorder (including a manic or mixed episode and schizoaffective symptoms)
Recognizing schizoaffective disorder (SZD)
Schizoaffective disorder is characterized by pronounced schizoaffective and emotional symptoms. Mood disorders can be manic, depressive, or mixed. Schizoaffective and affective symptoms may develop concurrently or several days apart, but are prominent during a disease episode.
SZD is divided into 3 types based on clinical presentation and each type will have different symptoms:
1. Manic-type schizoaffective disorder
Manic-type schizoaffective disorder is characterized by prominent manic and schizophrenic symptoms during the same episode. Statistically, this form is more common than the depressive and mixed types, and also has a better prognosis.
Symptoms of manic-type schizoaffective disorder:
- Mood is high, always happy, lively, active, sometimes agitated and irritable
- Irregular and unstable mood
- Increased overactivity, can run and jump, exercise continuously without feeling tired
- Loss of inhibition and concentration disorder
- Exciting thinking, amplifying ideas, and overestimating yourself compared to reality. Some patients have persecutory delusions that lead to agitation and violent behavior.
- Sometimes delusions of self-righteousness, persecution, association, delusions of domination and control occur. These delusions dominate the patient’s emotions and behavior. The difference between SZD and mania in affective disorders is the presence of delusions that do not match mood. Because mania is often associated with delusions of self-esteem, delusions of being loved instead of delusions of persecution.
- Patients may also experience other delusions and sometimes hallucinations (mainly auditory hallucinations).
- Severe conduct disorder.
The symptoms of manic-type schizoaffective disorder appear suddenly and intensely. However, the manic type can go into remission quickly after just a few weeks. In between relapses, the patient is completely healthy and can study and work as usual.
2. Schizoaffective disorder depressive type
Depressive-type schizoaffective disorder is characterized by prominent depressive and schizophrenic symptoms during the same episode. This form has a lower incidence than the manic type, but the prognosis is often worse.
Schizoaffective disorder of the depressive type tends to have a chronic, long-lasting progression, some of which may go into complete remission, but some patients face sequelae of schizophrenia. Similar to the manic form, between relapses the patient is almost completely stable.
Signs of depressive schizoaffective disorder:
- There are typical depressive symptoms such as depressed mood, melancholy, face clearly showing sadness and suffering.
- Decreased ability to concentrate, inhibited activity leads to slow, sedentary behavior, lethargy and lack of vitality.
- Loss of interest and interest in surroundings, including previous activities and hobbies.
- Having paranoia of being checked, paranoia of pride, paranoia
- Ideas, thoughts echo out loud
- Appears a virtual sound with the content of ordering, commenting and evaluating
- Thinking that you have committed a serious sin that leads to suicidal thoughts and behavior
Schizoaffective disorder is a type of depression that is different from psychotic depression. In psychotic depression, more prominent depressive symptoms are accompanied by hallucinations and delusions of mood-matching content (i.e. accused delusions). Meanwhile, SZD induces egotistical, bizarre paranoia against a background of low mood.
3. Mixed schizoaffective disorder
Mixed schizoaffective disorder is a disorder in which the symptoms of schizophrenia and mixed bipolar disorder are prominent at the same time.
Signs of mixed schizoaffective disorder:
- Patients with mixed bipolar disorder symptoms with episodes of mania or hypomania accompanied by at least 3 depressive symptoms.
- Constantly changing cyclical states causes the patient to form thoughts and urges for suicidal behavior
- Having psychotic manifestations are hallucinations, paranoia
- Have at least one symptom of schizophrenia
Compared with the above two stages, mixed schizoaffective disorder has a worse prognosis. Between relapses, the disease often goes into remission, but not as completely as the manic and depressive types. Furthermore, because of the unstable mood, the suicide rate is higher than with other forms of schizoaffective disorder.
Causes of schizoaffective disorder
Schizophrenia is considered an endogenous psychotic disorder with a clear genetic predisposition. However, this factor is not the direct cause but also the impact of psychosocial factors and many other issues.
Similar to other mental disorders, experts still do not know what causes schizoaffective disorder. However, SZD was determined to be associated with the following:
- Family history of schizoaffective disorder, bipolar disorder, psychosis, etc.
- Facing traumatic events such as bereavement, accident, divorce, bankruptcy, etc.
- Pre-existing psychiatric or psychiatric disorders also increase the risk of schizoaffective disorder
Is schizoaffective disorder dangerous?
Schizophrenia is an endogenous psychotic disorder with a clear genetic predisposition. The disease progresses cyclically and between relapses the patient is almost in complete remission.
Prognosis varies according to the clinical type. Of these, manic-type schizoaffective disorder has the best prognosis. The remaining forms such as depression and mixed have an unfavorable prognosis, the disease tends to be prolonged and chronic. However, if actively treated, patients can still study and work as usual.
Schizoaffective disorder causes many complications – especially those left untreated or delayed. The effects of the disease stem from mood disturbances, delusions, and hallucinations. Patients with SZD may face the following complications:
- Increased conflict, conflict in relationships. The patient even has aggressive and violent behavior due to delusions.
- Living in isolation, social isolation.
- Faced with the risk of unemployment, unstable income due to schizoaffective disorder, patients have reduced ability to concentrate, pay attention and inhibit thinking. In addition, delusions, hallucinations and emotional disturbances also make patients more likely to develop conflicts with colleagues. Limited capacity and inappropriate attitudes make it difficult for patients to find work and more likely to be dependent on their families.
- Increased risk of anxiety disorders, alcoholism, stimulants, etc.
- Formation of suicidal thoughts and attempts to commit suicide.
- Schizoaffective disorder also increases the risk of health problems such as insomnia, body weakness, vestibular disorders, cardiovascular and endocrine diseases, etc.
Diagnosis of schizoaffective disorder (SZD)
Schizoaffective disorder (SZD) was diagnosed based on the DSM-5 or ICD-10 criteria. In addition, the patient will also have to have some tests to rule out other possibilities.
Steps to diagnose schizoaffective disorder (SZD):
- General health check
- Blood and urine tests to detect drugs, alcoholism
- The diagnostic imaging MRI, CT,…
- Psychiatric assessment by observing appearance, demeanor, reaction when talking, facial expressions, etc.
- Take family and personal history
After having enough data, the doctor will use the diagnostic criteria DSM-5 or ICD-10 to diagnose this pathology. Diagnosis can identify the disease form of SZD so that the doctor can make a prognosis and plan an appropriate treatment.
Treatments for schizoaffective disorder
Similar to schizophrenia, patients with schizoaffective disorder will be treated with medication and psychotherapy. In addition, patients will also be trained and equipped with life skills so that they can easily adapt and integrate.
The specific treatment regimen will depend on the clinical form and severity of symptoms. In the advanced stage, the patient must be hospitalized to avoid suicide and aggressive behaviors. The definitive treatment of schizoaffective disorder is still difficult, so the main goal is to control symptoms and improve the quality of life for patients.
Treatments for schizoaffective disorder include:
Pharmacotherapy is indicated in both advanced and stable phases. The type of medication used depends entirely on the symptoms and response of the individual patient.
Medications are highly effective in controlling the symptoms of mood disorders and schizophrenia. However, medication is not really effective in preventing the disease from coming back. Therefore, after the advanced stage, the patient needs to be consolidated by some other method.
Medications used in the treatment of schizoaffective disorder:
- Antipsychotics: Antipsychotics are used to relieve symptoms of delusions and hallucinations. The drug is used in low doses and gradually increased until a therapeutic effect is achieved. Currently, the most commonly used antipsychotic drug is paliperidone. However, in some cases, other drugs such as Sulpiride, Haloperidol, Aminazine, etc.
- Antidepressants: Antidepressants are used in patients with depressive schizoaffective disorder. There are many types of this class of drugs, but the most commonly used are selective serotonin reuptake inhibitors and tricyclic antidepressants. The drug has the effect of raising mood, reducing feelings of boredom, pessimism and preventing suicidal thoughts and behaviors.
- Mood stabilizers: Mood stabilizers are used in cases of mixed schizoaffective disorder. The drug has a mood-stabilizing effect in the mixed phase of bipolar disorder. Commonly used drugs include Lamotrigine, Divalproex, Lithium, etc.
- Sedatives: Sedatives are commonly used in all cases of schizoaffective disorders – especially the manic type. The drug has the effect of reducing agitation, anti-anxiety and improving symptoms caused by autonomic disorders.
Medications help control symptoms of schizoaffective disorder (SZD). However, there are also many cases where there is no response and requires intervention with brain impact methods.
2. Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is indicated in cases of depressive schizoaffective disorder that is poorly responsive to medication and has suicidal thoughts. This method uses a controlled electrical current that is directly applied to the brain. The action of the electric current creates small vibrations that help to regulate the concentration of neurotransmitters.
Electroconvulsive therapy is quite effective for depressive schizoaffective disorder. ECT has been shown to be effective in preventing suicidal thoughts and reducing symptoms caused by depression. With process improvements, electroconvulsive therapy is becoming increasingly safe and one of the best options when it comes to treating mental disorders.
In addition to pharmacotherapy, patients with schizoaffective disorder will also be prescribed psychotherapy. This method is effective in regulating emotions, improving behavioral disorders, increasing social interaction and helping patients effectively handle problems in life.
Depending on the specific situation of each patient, the specialist will choose the following forms of psychotherapy:
- Personal therapy
- Group therapy, family
Psychotherapy is highly effective in prolonging the stabilization period and preventing relapse. Experts say that this method helps patients know how to stabilize emotions and control stressors in life. As a result, the frequency and severity of disease progression can be reduced.
4. Life skills training
Patients with schizoaffective disorder often face isolation, social isolation, and difficulty finding work. Therefore, in addition to the above treatment methods, patients will be equipped with necessary life skills to increase their ability to integrate and increase employment opportunities.
Life skills training for patients with schizoaffective disorder (SZD):
- Social skills: Social skills include communication skills, teamwork skills, social interaction, etc. These skills will help patients increase their ability to adapt and integrate into the environment. From there, it is possible to improve isolation and isolation from society and contribute to creating a healthy living environment for patients.
- Occupational skills: Occupational skills focus on helping patients with schizoaffective disorder increase their career opportunities, stabilize labor productivity so that they can keep their jobs and have a stable income. This skill will help patients have a better life and minimize the risk of unemployment and homelessness.
In addition, patients will also be equipped with a number of other skills that can improve their long-term quality of life.
Advice for patients with schizoaffective disorder
Patients with schizoaffective disorder may be aware of their own health – especially during the stable phase. Currently, treatment of the disease has many limitations and challenges. Therefore, patients should take care measures to manage the disease successfully.
Here are some tips for patients with schizoaffective disorder:
- Actively learn about schizoaffective disorder to understand the causative factors and the factors that cause the disease to recur. Understanding this disease will help patients know how to care and manage in the most effective way.
- You should keep a record of the symptoms you experience to promptly detect the advanced stages. From there, timely intervene medical methods to control the disease and prevent dangerous complications.
- It is advisable to join groups of people with schizoaffective disorder or similar conditions. Practical experiences from other patients will help patients easily face challenges and annoyances in life.
- Keep yourself healthy lifestyle, do not look to alcohol, tobacco and stimulants.
Schizophrenia is an endogenous psychotic disorder of unknown etiology. Overall, this pathology has a better prognosis than schizophrenia. With the right treatment and care, the patient can settle into a long life without facing the sequelae of schizophrenia.