Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes.Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

A patient is currently exhibiting symptoms of mania (eg, elevated mood, decreased need for sleep, hypersexuality, grandiose delusions), he also has a history of delusions and hallucinations occurring in the absence of a major mood episode (ie, psychotic symptoms without mood symptoms in between hospitalizations). A lifetime history of at least 2 weeks of psychotic symptoms in the absence of a mood episode is a key requirement for the schizoaffective disorder diagnosis.

Differentiating schizoaffective disorder from bipolar disorder with psychotic features or major depression with psychotic features requires determining the temporal relationship between psychotic symptoms and mood symptoms. In bipolar disorder and major depression with psychotic features, psychotic symptoms occur exclusively during manic or depressive episodes; there are no psychotic symptoms outside of mood episodes.

Unlike schizoaffective disorder, a diagnosis of schizophrenia does not include prominent mood symptoms that meet the criteria for manic and/or depressive episodes.

Delusional disorder involves 1 delusions for at least 1 month in the absence of other psychotic
symptoms (eg, hallucinations, disorganized speech and behavior).

Schizophreniform disorder has the same symptoms as schizophrenia (eg, delusions, hallucinations, disorganized speech and/or behavior, negative symptoms), but the duration is 1 month and 6 months.

Antipsychotic medication is usually required both for acute treatment and the prevention of relapse. Atypical antipsychotics may be considered due to their mood-stabilizing abilities.

Paliperidone is the only antipsychotic approval for the treatment of schizoaffective disorder.

Clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.

The management of the bipolar type of schizoaffective disorder is similar to the treatment of bipolar disorder, with the goal of preventing mood episodes and cycling. Lithium or anticonvulsant mood stabilizers such as valproic acid, carbamazepine, and lamotrigine are prescribed in combination with an antipsychotic.

Summary of Schizoaffective disorder

DSM-5 criteria
• Major depressive or manic episode concurrent with symptoms of schizophrenia
• Lifetime history of delusions or hallucinations for 22 weeks in the absence of major depressive or manic episode
• Mood episodes are prominent & recur throughout illness
• Not due to substances or another medical condition

Differential diagnosis
• Major depressive or bipolar disorder with psychotic features: Psychotic symptoms occur exclusively during mood episodes
• Schizophrenia: Mood symptoms may be present for relatively brief periods

For diagnosis of schizoaffective disorder, psychosis must occur in the absence of major mood episodes, but mood
episodes must be present for a majority of this lifelong illness. In bipolar disorder and major depression with
psychotic features, psychotic symptoms occur exclusively during mood episodes.

By Unknown author - https://www.flickr.com/photos/x-ray_d..., Public Domain, https://commons.wikimedia.org/w/index...