Schizoaffective disorder

- [Voiceover] So schizoaffective disorders are those where someone meets the criteria for both schizophrenia and a major mood disorder, and both sets of symptoms are enough so that they cause some kind of distress or are interfering with normal daily life. So what exactly is a major mood disorder though? Well, it's a bit of a broad umbrella, or category, for illnesses that involve a serious change in mood. And I don't just mean like feeling sad or irritable from time to time, not just like having a bad day or something. Mood disorders affect your everyday emotional state, and they're more intense, and more difficult to manage compared to just a bad mood, or just feelings of sadness. This might be persistent sadness that doesn't go away. And so there's sort of a spectrum of mood disorders, where we put a normal mood right in the middle. And then all the way over on this side there's this severe depression, which seriously interferes with your ability to enjoy life, and then there's varying degrees of depression in between. And then all the way on the other side there's mania, which is like this abnormally elevated mood. So maybe things like feeling very irritable, or having insomnia, and having very fast and energetic speech, or racing thoughts. And just like major depression, this would be enough such that it interferes with your daily life. And then you've also got these varying degrees in between normal and mania. So a major mood disorder might be out here at severe depression, or out here at severe mania, or you might have these, like, huge swings in mood between depression and mania, which is sometimes called bi-polar disorder. Okay, so let's say you've got this circle for major mood disorders like depression, mania, or bi-polar disorder, and then this circle represents schizophrenia, and symptoms of psychosis like hallucinations and delusions. If we combine these two sets, this middle chunk is what we call schizoaffective disorder, which as we can see, has both a major mood disorder and also symptoms of schizophrenia. Now just like schizophrenia and mood disorders though, there have yet to be any imaging or lab tests that we've developed to definitely tell us that, hey, this person has schizophrenia, or hey, this person has severe depression, or this person has both, meaning that they would have schizoaffective disorder. That being the case, we have to look for symptoms of both schizophrenia and a mood disorder to come up with a diagnosis of schizoaffective disorder. So what's pretty much used to help psychiatrists diagnose mental disorders is a book called the Diagnostic and Statistical Manual of Mental Disorders, the 5th Edition, which is also frequently just called the DSM 5. Now this guide helps psychiatrists look for certain specific criteria for patients to meet to be diagnosed with a particular disorder. So if we page to the section on schizoaffective disorder we'll find several pieces of criteria to meet in order to be diagnosed. First, the patient has to have symptoms of psychosis, so things like delusions and hallucinations, without a major mood disorder for a period of two weeks in order to meet he criteria for the schizophrenic portion. If this doesn't ever happen, if we don't meet this criteria, then the symptoms are probably more likely to be in line with psychotic depression, as opposed to schizoaffective disorder. And secondly, a major mood episode, which is a mood disorder like depression, mania, or both, that lasts greater than two weeks has to be present along side schizophrenia for an uninterrupted period of time to be classified as schizoaffective disorder. But doesn't schizophrenia sometimes include depressive symptoms? Whats the difference between schizophrenia and depressive symptoms and schizoaffective disorder? Well, in order to be diagnosed with schizoaffective disorder you have to meet the criteria for major mood disorders as well, so if they were diagnosed with schizophrenia with depressive symptoms, the depressive symptoms must not be meeting the criteria to constitute a major mood disorder. Additionally, the patient has to be experiencing impairments in functioning due to both the schizophrenia and the major mood disorder. Alright, so let's pose the million dollar question, what causes schizoaffective disorder? Well, by now you might be able to guess that we don't exactly know, but it's thought to involve an imbalance in several neurotransmitters in your brain, like dopamine, or norepinephrine. Although genetics likely plays a role, there have yet to be any genes identified. But with that said, we know that having family members with schizophrenia, bi-polar disorder, or schizoaffective disorder itself, all increases your risk of developing schizoaffective disorder. And when we're treating schizoaffective disorder, we're usually gonna use medications, but we need to be careful because now there's both symptoms of schizophrenia and mood disorders. Currently there's only one antipsychotic drug that's been approved by the FDA for treatment of schizoaffective disorder, specifically, and it's called paliperidone, or invega. But there are other antipsychotics that may be used as well to target symptoms of schizophrenia and help manage psychotic symptoms. For the mood disorder symptoms, it depends on the mood disorder present. If they have depression, then antidepressants will probably be prescribed. If they have mania, then it's likely they'll receive antipsychotics and mood stabilizers, like lithium. Apart from drugs and medications though, the patient may undergo some sort of psychotherapy. And the outlook, or prognosis, of someone diagnosed with schizoaffective disorder varies, and it's thought to be somewhere between that of mood disorders and schizophrenia. With that said, there tends to be a better outlook than for those with schizophrenia alone, and a worse outlook for those with mood disorders alone. So the best prognosis would be over here with mood disorders and then the worst prognosis is over here with just schizophrenia. And schizoaffective disorder is somewhere in between. So things are risk factors that have been shown to be associated with a worse prognosis are things that relate to the psychosis side of it, so being closer to schizophrenia. Other things are things like earlier onset, and when there's no periods of remission, or temporary recovery, and finally, like we mentioned before, having a family member with schizophrenia.