Schizoaffective Disorder - Signs and Symptoms

Signs and Symptoms

Late adolescence and early adulthood are the peak years for the onset of schizoaffective disorder, although it has been very rarely diagnosed in childhood.

Schizoaffective disorder is a mental illness characterized by recurring episodes of mood disorder and psychosis. Psychosis is defined by paranoia, delusions and hallucinations. Mood disorders are defined by discrete periods of clinical depression, mixed episodes and manic episodes. Individuals with the disorder may experience psychotic symptoms before, during or (commonly) after their depressive, mixed or manic episodes.

As schizoaffective disorder is presently defined in the DSM-IV criteria, at some point during the lifetime course of the illness, psychosis must occur continuously for at least two-weeks without any mood disorder symptoms, and the symptoms must not be caused by medication(s), substance use or another medical condition.

Since the illness symptoms are similar to other disorders with prominent mood and psychotic symptoms like bipolar disorder with psychotic features and recurrent depression with psychotic features, the illness tends to be difficult to diagnose. It can be misdiagnosed as schizophrenia also, even though mood episodes have been thought to be absent or much less prominent in schizophrenia than in schizoaffective disorder. Given the difficulty of distinguishing these differences, an accurate and reliable schizoaffective disorder diagnosis usually requires an extended period of observation and treatment.

Untreated, the individual with schizoaffective disorder may experience delusions. It should be noted that delusions in schizoaffective disorder are acute manifestations of an active psychosis and are not personality traits; that is, they go away when the psychosis subsides. Manifestations of delusions include the individual being convinced that he or she is Jesus or the Antichrist, has some special purpose or destiny (such as to save the world), or is being monitored, watched or persecuted by something (commonly government agencies), when in reality they often are not. Individuals may also feel extremely paranoid. Other delusions may include the belief that an external force is controlling the individual's thought processes. (See thought insertion.)

Hallucinations involving all five senses can also occur in untreated or undertreated schizoaffective disorder. That is, the individual may see, hear, smell, feel or taste things that aren't there. For example, the individual may see overt visual hallucinations such as monsters, the devil or more subtle ones such as shadowy apparitions. Individuals may hear voices or, in some cases, music. Things may look or sound differently. Individuals may also experience strange sensations. These hallucinations may worsen when the individual is intoxicated.

The untreated individual may quickly change their mind about their romantic partner, friends or family if they hear something negative being said about them; as a result they may attack or, conversely, isolate themselves from the person or group until they regain normal thoughts.

These abnormal thoughts may result in behaviors that are unusual for the individual during asymptomatic periods. An example of unusual behaviors occurring as a result of an active illness period could be, for example, the individual lying compulsively or stealing impulsively and hiding the theft from family or friends. The individual may not rationally realize their actions, until after beginning treatment, and may then be shocked to realize what they did.

Comorbid or co-occurring anxiety disorders may also play a role in the subjective experience of schizoaffective disorder and thus may shape the individual's delusional thought content. For example, the individual may feel anxious, have trouble swallowing, and then believe that outside forces are controlling their throat functions. They may also suffer from various phobias which may also manifest as delusions.

There may be a decline in work or school functioning during episodes of illness. As stated above, individuals with schizoaffective disorder may withdraw socially and become isolated.

The untreated individual may sleep too much or, conversely, be unable to sleep.

Difficulties with executive function may also be a problem for individuals with schizoaffective disorder. This may include difficulties with concentration, attention, logical reasoning and impulse control.

Without treatment, the individual with schizoaffective disorder may further worsen in their abnormal emotions and delusional thought processes.

With comprehensive treatment, many individuals with schizoaffective disorder may recover much, most or even all of their functionality.