Schizoaffective disorder

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Schizoaffective disorder (SZA, SZD) is a mental disorder characterized by abnormal thought processes and an unstable mood.^[4][5] This diagnosis requires symptoms of both schizophrenia (usually psychosis) and a mood disorder: either bipolar disorder or depression.^[4][5] The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms.^[5] Schizoaffective disorder can often be misdiagnosed^[5] when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.^[5][6]

There are three forms of schizoaffective disorder: bipolar (or manic) type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).^[4][5][7] Common symptoms include hallucinations, delusions, and disorganized speech and thinking.^[8] Auditory hallucinations, or "hearing voices", are most common.^[9][10] The onset of symptoms usually begins in adolescence or young adulthood.^[11] On a ranking scale of symptom progression relating to the schizophrenic spectrum, schizoaffective disorder falls between mood disorders and schizophrenia in regards to severity.^[12]

Genetics (researched in the field of genomics); problems with neural circuits; chronic early, and chronic or short-term current environmental stress appear to be important causal factors.^[13][14][15] No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of tetrahydrobiopterin (BH4), dopamine, and glutamic acid in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.^[16]

While a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,^[17] it is considered a common diagnosis among psychiatric disorders.^[18] Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them.

The main current treatment is antipsychotic medication combined with either or both of mood stabilizers and antidepressants. There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.^{[citation needed]} When there is risk to self or others, usually early in treatment, hospitalization may be necessary.^[19] Psychiatric rehabilitation, psychotherapy, and vocational rehabilitation are very important for recovery of higher psychosocial function^{[citation needed]}. As a group, people diagnosed with schizoaffective disorder using DSM-IV and ICD-10 criteria (which have since been updated^{[clarification needed]}) have a better outcome,^[4][5] but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.^{[5][20][non-primary source needed]} Outcomes for people with DSM-5 diagnosed schizoaffective disorder depend on data from prospective cohort studies, which have not been completed yet.^[5] The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;^[19] that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV prevalence estimates were less than one percent of the population, in the range of 0.5–0.8 percent;^[21] newer DSM-5 prevalence estimates are not yet available.