Schizoaffective disorder: how to live better with it

Dysthymic schizophrenia (sometimes called a schizoaffective disorder or acute schizoaffective psychosis) is a form of schizophrenia that particularly affects the emotions and cognitive powers. Seizures are usually accompanied by manias and/or depression with a tendency to suicide. The subject may be the victim of mania, delusions, and paranoia. These disorders resemble bipolar disorders but are distinguished by delusions or hallucinations for at least two weeks. Treatment is based on psychotherapy and taking neuroleptics (tranquilizers), sometimes combined with antidepressants. Let’s get into it!

General

This condition is remarkable from several points of view. If it is clearly schizophrenia, the fact of its periodicity in time, involving fluctuations in mood, also brings it closer to bipolar disorder. This disease is usually considered as the element of transition between these two groups of pathologies, allowing arguing the hypothesis of a morbid continuum between schizophrenia and bipolar disorders.

In a simplified way, the schizoaffective disorder can be defined by alternating "schizomaniac" periods and "schizodepressive" periods, but without free, the asymptomatic interval between these periods to the persistence of interictal schizophrenic symptoms.

Epidemiology

It is an uncommon disorder with regard to the prevalence of schizophrenia and bipolar disorder, around 1%, respectively, since the prevalence of the schizoaffective disorder is estimated at 0.30%. There is a female predominance mainly in the depressive subgroup, with an average age of onset slightly lower than schizophrenia, which is to say, in young adults around 25 years old. It is conventional to consider that schizoaffective disorder preferentially affects women of good socioeconomic level, generally better integrated socially than a schizophrenic patient of the same age.

A positive diagnosis of schizoaffective disorder

As often, the diagnosis is difficult during the first episode.

The symptomatology borrows both from the clinic of schizophrenia and that of bipolar disorders. According to the predominance of the positive (manic) or negative (depressive) polarity, two subtypes of schizoaffective disorder are described, knowing that all the intermediate states can be found. All the symptoms of schizophrenia and bipolar disorder can be associated, positive, negative, and disorganized intermixed with mood symptoms.

Beyond the photograph of a rich and polymorphic clinic at a given moment, the diachronic evolution of this disorder contributes to the diagnosis, since it is necessary to evaluate the periodicity of thymic attacks interspersed with the more or less obvious persistence of 'schizophrenic symptomatology. This lack of "cleansing" is an essential argument in distinguishing schizoaffective disorder from genuine bipolar disorder.

Prognosis

The differentiation between schizophrenia, bipolar disorder, and schizoaffective disorder is prognostically important. Indeed, the prognosis of schizoaffective disorder is intermediate between a rather unfavorable prognosis of schizophrenia and that more favorable of bipolar disorders, essentially if we consider the frequency of hospitalizations and socio-professional integration.

Also, the evolutionary and prognostic modalities differ according to the "manic" or "depressive" subtype, with grossly a poor prognosis for manic forms, especially of late-onset.

Evolution

Over time, there is a very strong diagnostic instability, the symptomatology not being generally fixed throughout the course of the disease in the same person over time. Thus, some patients will evolve more on a "schizophrenic" register, while conversely, others will look more like bipolar disorders, in particular, due to the treatments offered. Perhaps those presenting an inaugural depressive episode would progress in a more stable way towards a schizodepressive disorder.

But we must keep in mind the more pejorative character of this schizoaffective disorder, in particular in relation to a stronger intensity, a longer duration, and a clear resistance to depressive episodes during the schizoaffective disorder. It is responsible for 'an increase in treatments, including a greater frequency of hospitalizations, but unfortunately also a high risk of suicide.

Symptoms of schizoaffective disorder

As we said earlier in this article, the symptoms of this disorder are those of depression, mania, and schizophrenia:

Symptoms of depression

·  Weight loss or gain

·  Small appetite

·  Lack of energy

·  Loss of interest in enjoyable activities

·  Feeling of guilt

·  The tendency to sleep too little or too much

· Inability to think or concentrate

·  Dark thoughts

·  Symptoms of mania

·  Low need for sleep

·  Agitation

·  Affected self-esteem

·  Tend to be easily distracted

·  Increase in social, professional or sexual activity

·  Dangerous or self-destructive behaviors

·  Quick thoughts

·  The tendency to speak quickly

·  Symptoms of schizophrenia

·  Hallucinations

·  Delusions

·  Disorganized thinking

·  Strange or unusual behavior

·  Slow movements or immobility

·  Low motivation

·  Language problems

Treatment

Not surprisingly, the more specific treatment for schizoaffective disorder combines treatments focused on psychotic symptoms associated with the establishment of a mood stabilizer. Obviously, the other classic measures proposed in the treatment of chronic psychoses are completely essential, in addition to drug treatment.

The treatment of the acute episode can be schematized as follows:

- In the case of schizogenic access, the association of a mood stabilizer with an atypical antipsychotic drug will be preferred. 

- In the case of a schizodepressive attack, an antidepressant will be combined with the atypical antipsychotic.

- The other therapeutic means will, of course, be adapted according to the evolution and, in particular, according to the degree of sensitivity or on the contrary of resistance to the initial treatments.

How does schizoaffective disorder manifest itself?

This disorder's signs and symptoms are all those of schizophrenia, manic episodes, and depressive disorders. Symptoms of schizophrenia and mood disorder can present at the same time or in different phases. The evolution is variable: cycles can be established during which the person's condition improves and worsens in terms of the manifestation of his symptoms until giving rise to progressive deterioration. Many researchers and clinicians have speculated on the psychotic symptoms incongruent with mood. The psychotic content (hallucinations or delusions) does not match the subject's mood.

Usually, the presence of these types of symptoms in a mood disorder is probably an indicator of a poor prognosis. It is also possible that this association is true for schizoaffective disorders, although the information available to date is very limited.

How to live with the schizoaffective disorder?

To treat the schizoaffective disorder, doctors recommend multidisciplinary treatment with support from a psychiatrist, psychologist, social worker, and nurse. The family often plays a preponderant role in this care. 

It's hard to imagine someone with this disorder leading a life like everyone else. The symptoms of the disease, whatever they may be (delirium, verbal hallucinations, weakening of the will, lack of energy, disorderly activity, personal language, offbeat behavior) are a real brake on a classic daily life. For example, finding accommodation is very difficult for the sick, and most of them return to their families after the first hospitalization. The burden that falls on relatives is very heavy, and this is why it can be very useful for them to turn to associations. "After treatment and depending on the disease's stage, it is possible for some patients to lead a normal life: to get married, have children, a job, a home, reassures Professor Nicolas Franck, psychiatrist, however. For others, acquiring a certain autonomy (taking your treatment, having a job, looking after yourself) is a reasonable goal. Finally, others will always need assistance. There are many things to consider, but management always helps patients in one way or another. "

Neuroleptics are at the heart of drug treatment for schizoaffective disorder

They act in particular on positive symptoms and, more particularly, on delirium, which they allow to control well. "They are less effective on verbal hallucinations, for example, notes Professor Franck. The principle is to restore a balance. Another aspect of the treatment, in addition to drugs and cognitive remediation, makes it possible to work on the disease's negative symptoms. It is a method of training certain cerebral processes: attention, memory, concentration, etc. Due to the treatment, patients can hope to return to work, to live independently. “The principle is to stabilize the disease and achieve remission because it is certain that it is not possible to cure the disease, in the literal sense of the word. We always manage to help them, and in the best cases, they even manage to become autonomous. “Patients also undergo psychotherapy which allows them to take stock of the evolution of symptoms, the effects of treatments, and the events that may have destabilized them. The goal of psychotherapy is to reduce positive, negative, cognitive, behavioral, and affective symptoms, taking into account the disease's phase and the particular needs of the patient. It is an essential approach in the treatment of the disease to evacuate the suffering due to the psychosis of the patient.

Schizoaffective disorder: are they dangerous?

Since people with schizoaffective disorder can be prone to verbal hallucinations, their behavior can certainly be confusing on the one hand, but above all, potentially dangerous, both for them and for those around them. As Dr. Franck confirms, "It is often very difficult for the family to cope with one of their own behavioral problems. Furthermore, schizoaffective disorder suffers from a bad image, and the patient's illness is, therefore, taboo. As a result, access to care for patients is very often late. This is also why cases of suicide are very frequent in people suffering from this disorder ".

When there is a passage to the act on another, which remains quite rare, the patient has a very precise motivation and most often does so by mistake. For example, it is possible for him to think that one of his relatives has been replaced by a double or that he has evil ideas about him. This is not a generality, these cases are quite rare, and there is no need to worry more than reason. "It is very important that relatives are not in denial and maintain a dialogue with the patient, leading him to consult. Even if it is difficult for them to admit that one of theirs has schizoaffective disorder.”

To improve the patient's life and help him overcome his troubles, it is necessary to consult as soon as possible. "As in many cases, the earlier the treatment you have, the more effective the treatment. In the case of imminent danger for him or a third party, it is absolutely necessary to call the emergency services (the fire brigade at 18). If there is an emergency, the law of June 27, 1990, allows, in case of danger, to hospitalize a patient without his consent at the request of a third party.

Doctor's advice

Discontinuation of antipsychotic medication is the main cause of relapse, even under supervision by a psychiatrist. Workaround stress and treatment adherence should be a priority for people with schizoaffective disorder.

How can you treat schizoaffective disorder?

You can treat this disorder with the help of medication, psychosocial interventions and even hospitalization. The basic principles underlying the pharmacological treatment of these disorders recommend the application of anti-depressive and anti-manic protocols. Anti-psychotics should be taken alone if short-term compensation is needed for the patient.

If treatments to improve mood are not effective in controlling symptoms, then antipsychotics, such as haloperidol or risperidone, would also be indicated.

Patients with schizoaffective bipolar disorder would be treated with lithium, carbamazepine, valproate, or a combination of all three. Patients with schizoaffective depressive-type disorder should be treated with anti-depressants' consumption and electro-convulsive therapy before determining their lack of response to anti-depressive therapy.

As we have seen, this disorder is complex, both in its definition and in its treatment. All you need to understand that this is a type of schizophrenia and it is all about depressive disorders and manic episodes that make it complex. 

Author: Vicki Lezama