Schizoaffective disorders are mental illnesses that manifest either monophasic or alternating phases of manic, depressive, and schizophrenic symptoms. Melancholic depressive symptoms are as much a part of the clinical picture as manic elation and schizophrenic catatonic, paranoid, or hallucinatory phenomena
What is schizoaffective disorder?
The term schizoaffective disorder is a collective term for mental illnesses that simultaneously or alternately include the symptoms of depression, schizophrenia, and mania. Thus, schizoaffective disorders stand between schizophrenias and affective psychoses, with their symptoms arising primarily from the overlap of these two areas. According to ICD-10, to be diagnosed with a schizoaffective disorder, the patient must have affective and schizophrenic symptoms in the same phase. Thus, mental disorders of this direction are actually not single disorders, but variably concentrated combinations of three different mental disorders. The weighting of the symptoms can vary. Schizoaffective disorders were first described in the mid-19th century, although at that time there was talk of mixed psychoses or intermediate cases. It was not until the first third of the 20th century that the term schizoaffective disorder was consolidated.
Causes
To date, medical science has assumed a causative genetic factor for schizoaffective disorder, but this has not been determined in detail. Neurochemically and neuroendocrinologically, the clinical picture has not yet been researched further. Mental and psychosocial factors such as stress, privately or professionally stressful situations, environmental reactions as well as partnership, family and friendship difficulties probably develop into an additional influencing factor on the onset and course of the disease. A specific personality structure with increased susceptibility to this form of mental illness has not yet been determined.
Symptoms, complaints, and signs
A main symptomatic area of schizoaffective disorder is melancholic-depressive symptoms such as sleep disturbances, feelings of guilt, or suicidal ideation. On the other hand, manic symptoms such as considerable agitation, excessive irritability, or a tremendous increase in self-propulsion may also constitute the main symptomatic area. To these symptoms are added those of the schizophrenic disorder, which are expressed in catatonic, paranoid or hallucinatory features. Thus, in addition to an affective disorder according to ICD-10, the patient additionally suffers from either an ego disorder such as thought-arousal, delusions of control such as delusions of influence, commenting or dialoguing voices, persistent and completely unrealistic delusions, disjointed speech, or catatonic symptoms such as negativism. The most common manifestations in the early phase include a tired, dull and rapidly exhaustible or distempered and slightly aggressive basic mood. Mood swings between cheerful, resigned, and depressed are equally common. In addition, anxious-phobic signs of illness may occur. In addition, there are often disturbances of memory and concentration or increasing forgetfulness, loss of performance and restless and nervous tension. Often there is also pain with no apparent cause. Behavioral changes are conceivable and usually manifest themselves in mistrust and social withdrawal. In addition to increased sensitivity to noise and light, abnormal and barely comprehensible sensations may also occur.
Diagnosis and course of the disease
The diagnosis of schizoaffective disorder is made according to ICD-10. Either schizoaffective psychoses run a phasic-recurrent course or a single-phase course. In the single-phase course, a differentiation is made between schizodepressive, schizomanic, and bipolar disorders. However, the phasic-revolutionary course is more common than the monophasic course. In this case, the individual phases can each correspond to a schizophrenic illness episode, a purely depressive illness episode, a purely manic illness episode, but also a mixed manic-depressive illness episode. On the other hand, the individual episodes may also be consistently manic depressive, schizodepressive, schizomanic, or mixed bipolar.In individual cases, the symptoms of schizophrenic and mixed manic-depressive illness are consistently present, that is, the illness manifests itself in schizomanic-depressive episodes.
Complications
Although episodes build up in succession, this may occur without intervening intervals of complete health. Almost all schizoaffective disorders show several types of progression at the latest in the late course, which means that the pattern of symptoms changes frequently. Stable remains overall only one third of the patients. A more favorable prognosis is associated with increased schizomanic episodes than with increased schizodepressive courses. Especially the schizodepressive form tends to become chronic in the later course. As a result of these disorders, those affected suffer from a significantly reduced quality of life and severe restrictions in their everyday lives. As a rule, the disease leads to a number of different psychological complaints. Those affected suffer from severe sleep disturbances and thus also from depression or psychological upsets. The feeling of permanent agitation can also occur and make everyday life more difficult. Most patients appear irritable or even slightly aggressive. Furthermore, paranoid feelings or hallucinations may occur, which can have a very negative effect on social contacts. Those affected often suffer from delusions of control and severe mood swings. Especially in children, the disorder can significantly limit and delay the child’s development. Likewise, children suffer from concentration disorders and often appear restless or nervous. A strong sensitivity to sounds or light can also occur due to the disease and further complicate the patient’s daily life. Treatment of this disorder usually involves the use of medications. However, antidepressants can be responsible for various side effects. It is also impossible to predict whether the treatment will lead to a positive course of the disease. Life expectancy itself is usually not reduced or limited by the disease.
When should one go to the doctor?
A doctor is needed if there is any abnormal behavior or emotional distress. Sleep disturbances, hallucinations, or delusions should be investigated and treated. If mood swings, memory problems, or a severely nervous demeanor occur, a physician should be consulted. If there is a marked change in drive, as well as behavior that is self-dangerous or puts others in a dangerous situation, consultation with a physician should be sought. Characteristic of schizoaffective disorder is a lack of feeling ill. Therefore, relatives or people from the social environment bear a special responsibility. If there is a stable and healthy relationship of trust, they should work together with the person affected to seek a doctor’s appointment so that a diagnosis can be made and medical care provided. In particularly serious cases, a public health officer must be called. If social rules are disregarded, if the person becomes restless or falls into a state of apathy, he or she needs help. Hypersensitivity of sensory perception, hearing voices or communication with imaginary entities are symptoms of the disorder. A visit to the doctor is necessary, because often actions are performed due to the delusions, which are hurtful. If everyday life can no longer be managed without help or if severe anxiety is evident, a doctor is also needed.
Treatment and therapy
In the acute stage, the therapy and treatment of schizoaffectively disturbed patients is oriented toward the symptomatology that is currently predominant. For predominantly schizophrenic symptoms, treatment with neuroleptics is indicated, whereas lithium may also be used against predominantly manic symptoms. For predominantly depressive syndromes, antidepressants can be given medicinally, and psychotherapeutic awake therapy is often indicated. In addition to acute treatment, patients with a schizoaffective form of the disease also receive phase prophylaxis, which can focus on carbamazepine or lithium, for example. Depending on the individual case, however, dual-track phase prophylaxis may also be necessary, combining the aforementioned medications with neuroleptics. In the accompanying psychotherapy, the focus is on current conflicts and stressful situations.The focus here is on coping with the disease and dealing with the consequences of the disease.
Prevention
Given the presumably mainly genetic risk factors of schizoaffective disorder, the disease can hardly be prevented. However, those who recognize the symptoms of the early course mentioned further above in themselves can at least benefit from an early diagnosis by contacting a specialist. In schizoaffective disorder, the affected person suffers from schizophrenia and additionally from manic or depressive moods. In severe cases, he or she is affected by all three disorders alternately.
Follow-up
Aftercare, as with all mental illnesses, is a necessary component of therapy. Avoiding relapse is the primary goal. If the person is taking psychotropic drugs for symptoms, the psychotherapist monitors the healing process. If the disorder can be treated satisfactorily in this way, close follow-up is no longer necessary. Occasional follow-up appointments should nevertheless be scheduled. The form of follow-up depends on the severity of the symptoms and on the question of which mood swings are bothering the patient in addition to the schizophrenia. Parallel depressive traits require different aftercare than manic disorders. Schizoaffective disorder can lead to disability if severe. This brings the risk of additional depression. During aftercare, the sufferer is built up, and a possible feeling of worthlessness should be taken away. A schizophrenic with shopping addiction as an expression of mania runs the risk of getting into debt. Here, too, intervention can take place at follow-up appointments. For this, a debt counselor must sometimes be consulted. Close relatives often also experience the illness as a burden. In such situations, follow-up care also extends to the patient’s parents or relatives to help them cope better with the disease and its effects.
Here’s what you can do yourself
In schizoaffective disorder, the options for action in the area of self-help are extremely limited. Due to the disorder and the associated impairments, the affected person can do little himself to improve his own situation. In the long term, he is dependent on the help and support of other people. Only relatives and members of the social environment can have a positive influence on further developments through their behavior, understanding and decisions. Cooperation with a physician is absolutely necessary in the case of this disease. In addition, it is extremely beneficial for the well-being of the person affected if a stable social environment is present and maintained in the long term. Although this disease usually requires an inpatient stay, regular contact with relatives is supportive and helpful in coping with the disease. According to studies, the feeling of security and a regular daily routine have a positive influence on the patient. The intensity of symptoms has been shown to be lower when there is continuous contact with familiar and family members. Joint activities that are tailored to the needs of the sufferer help to improve the overall situation. In addition, influencing factors such as a healthy diet and avoidance of harmful substances, such as alcohol or nicotine, are advised.
