Schizoaffective Disorder - Management

Management

Treatment for schizoaffective disorder consists of a combination of medicine, psychotherapy and psychosocial rehabilitation focused on symptom management and recovery.

A licensed psychiatrist will prescribe (usually combinations of) medicine aimed at reducing the patient's symptoms. Each person responds differently to medication, so there is usually a period of trial and error of medications, guided by both the psychiatrist's clinical experience and the patient's feedback to the psychiatrist about side effects and symptom reduction.

The only FDA-approved medication for schizoaffective disorder is paliperidone (Invega), which is an antipsychotic. In actual clinical practice, however, all types of antipsychotics are used with patient choice of medication usually based on how effective they are at both reducing symptoms and causing the least side effects.

For manic symptoms, an antipsychotic may be prescribed along with a mood stabilizer. Examples of mood stabilizers are:

• Lithium
• Valproate semisodium (Depakote ER)
• Carbamazepine (Tegretol)

In schizoaffective individuals with manic symptoms, combining lithium, carbamazepine, or valproate with an antipsychotic has been shown to be superior to antipsychotics alone. Lithium-antipsychotic combinations, however, may produce severe extrapyramidal reactions or confusion in some patients. When lithium is not effective or well tolerated in manic individuals with schizoaffective disorder, Tegretol or Depakote are frequently used. Granulocytopenia may occur during the first few weeks of carbamazepine treatment causing a substantial decrease in antipsychotic blood levels due to hepatic enzyme induction. Valproate can, in rare cases, cause liver toxicity and platelet dysfunction. Calcium channel blockers such as verapamil may also be an effective treatment for manic symptoms but are seldom prescribed for this purpose. The degree of benefit for an individual should be considered carefully, as each of these medications carries its own risks.

For depression, an antipsychotic may be prescribed with an antidepressant. Examples of antidepressants are:

• SSRI antidepressants (Prozac and Zoloft among others). An important precautionary note when using antidepressants: Some individuals with schizoaffective disorder may become psychotic and/or manic when taking only an antidepressant (antidepressant medication without antipsychotic medication) or when using high doses of antidepressant medication relative to their antipsychotic medication. In addition, the SNRI antidepressants and Wellbutrin tend not to be prescribed in schizoaffective disorder because they may cause mixed episode symptoms and induce psychosis, respectively.
• Lamotrigine is a mood stabilizer (from the anticonvulsant class of medications) which has antidepressant properties. Lamotrigine has gained prominence in treating depressed schizoaffective individuals, because antidepressants can increase the risk of mood cycling, mania and/or psychosis in some individuals.
• When antidepressants and/or lamotrigine do not relieve depression or cause undesirable side effects, electroconvulsive therapy (ECT) or repeated transcranial magnetic stimulation (rTMS) are additional options.

Benzodiazepines such as Ativan and Klonopin are effective adjunctive treatment agents for reducing irritability and anxiety during acute mania, and sometimes during maintenance medication therapy, but long-term use can result in dependency.

Often a sleeping pill will be prescribed initially to allow the individual rest from his or her anxiety, delusions or hallucinations. However, long-term use of sleeping medications can cause dependence and can also cause delusions and hallucinations, thereby exacerbating psychosis (needs citation).

Self-management techniques, including participating in internet forums, are sometimes used by individuals with schizoaffective disorder. These self-management techniques are part of the self-help movement which hasn't yet been extensively researched by mental health professionals.