Treatment for Schizoaffective Disorder
Treatment for schizoaffective disorder, a serious and chronic mental health condition, typically includes a combination of medication and psychotherapy. Medications used for treatment include antipsychotics for symptoms of psychosis and mood stabilizers or antidepressants to treat the symptoms of bipolar disorder or depression.
What is Schizoaffective Disorder?
Schizoaffective disorder is a very serious mental illness that can have a devastating impact on a patient’s life. Treatment is essential to help manage the symptoms of this chronic condition. Although it cannot be cured, a combination of therapy and medications can help most patients live a normal life, resume ordinary activities, and live independently.
Any schizoaffective disorder definition must include a description of schizophrenia, because this condition is characterized by a combination of schizophrenia and a mood disorder. Schizophrenia is a serious mental illness that causes periods of psychosis during which a person loses touch with reality. Most characteristic of the condition are the hallucinations and delusions that a person feels are actually real.
The second part of schizoaffective disorder is a mood disorder. A person with this condition experiences both the symptoms of schizophrenia and the symptoms of depression, or a combination of depression and mania known as bipolar disorder.
Signs and Symptoms of Schizoaffective Disorder
Schizoaffective Disorder symptoms can include any of the symptoms of schizophrenia as well as any of the symptoms of bipolar disorder and depression. There are several different symptoms of schizophrenia that may manifest as part of this disorder:
- Positive symptoms. These are symptoms that are not typically present in the patient and may include hallucinations, delusions, and disorganized thinking that leads to disorganized communication and speech that is difficult to follow.
- Behavioral and movement symptoms. These may also be considered positive symptoms, but can be categorized separately. A person with schizoaffective disorder or schizophrenia may act in ways that are not typical, such as acting agitated, moving in unusual ways, engaging in repetitive movements or speech, or even acting catatonic or unresponsive.
- Negative symptoms. These symptoms are deficits, such as a flat affect, a lack of emotion, or a lack of appropriate emotion or response to situations and other people. Other negative symptoms may include lethargy and inactivity, lack of engagement, personal hygiene deficits, or being unable to manage relationships, work or school.
The mood disorders that accompany schizoaffective disorder include symptoms of depression and, in some people, the symptoms of mania, or manic episodes. Major depression is characterized by intense feelings of sadness, lack of energy, physical pain, shame and guilt, and sometimes even suicidal thoughts. Manic episodes are the opposite in many ways, including:
- Extreme energy
- Inflated self-esteem
- Racing thoughts and speech
- Risky behaviors
Getting a Diagnosis Determines Treatment
Treatment for schizoaffective disorder is not always straightforward. Different people experience different symptoms and respond in differing ways to treatments. It is also important to understand that this condition will not improve without treatment from professionals. For these reasons it is crucial to get a diagnosis from a mental health professional and to either be diagnosed by, or have a diagnosis confirmed by, a psychiatrist.
Diagnosis may begin with a person’s primary doctor, which means having a physical examination and even blood tests or imaging scans, to rule out any physical health condition that could be causing symptoms. The next step is to undergo a psychiatric evaluation. This involves going through a checklist of diagnostic criteria, observing the demeanor and appearance of a patient, and asking about a patient’s thoughts, moods, any hallucinations or delusions, and drug use. Because some drugs can cause symptoms of psychosis, it is important for a patient who uses drugs to detox before being evaluated for a mental health condition.
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Developing a Treatment Plan
Once a diagnosis of schizoaffective disorder has been made, mental health professionals, possibly along with the patient’s primary doctor, work with the patient to develop a treatment plan. This condition is chronic and incurable, but a good treatment plan can help a patient manage symptoms and live as normal a life as possible. Because there is no single correct treatment for everyone, the treatment plan may change and evolve over time to provide the best care for the patient. The goal is to reduce symptoms with as few side effects as possible.
Schizoaffective Disorder Medications – Antipsychotics
The vast majority of patients diagnosed with schizoaffective disorder use medication as part of the treatment plan, and most use more than one type. Antipsychotic medications treat the symptoms of psychosis, like hallucinations. Medications for mood disorders, especially antidepressants, treat bipolar depression and major depression symptoms. Both types of medication can cause symptoms and may work to varying degrees, depending on each individual patient. A patient may have to try more than one, and use it for several weeks, to determine what will work best to minimize symptoms and side effects.
Antipsychotics prescribed are typically second generation, a newer class of drugs that cause fewer side effects than first generation antipsychotics. These second generation antipsychotics include:
These second generation, or atypical, antipsychotics, can be prescribed for schizophrenia, schizoaffective disorder, bipolar disorder, and severe depression. They cover a broader spectrum than the first generation drugs, also called typical antipsychotics. When the atypical drugs don’t work well or cause side effects, a doctor may prescribe one of the older medications: chlorpromazine, haloperidol, perphenazine, or fluphenazine.
Antipsychotics generally have the effect of relieving agitation and hallucinations quickly, while it may take a few weeks to reduce delusional thoughts. It can take up to six weeks for a patient to experience the full effects and benefits of an antipsychotic. Possible side effects of antipsychotics include:
- Dry mouth
- Weight gain
- Low blood pressure
- Blurred vision
- Tics and tremors
In addition to these side effects, typical antipsychotics can potentially cause a serious condition called tardive dyskinesia. It causes uncontrollable muscle movements, often around the mouth, and can be severe or even permanent. The risk is greater with long-term use of first generation
Schizoaffective Disorder Medications – Mood Stabilizers and Antidepressants
In addition to an antipsychotic, a patient with schizoaffective disorder may need a medication to control symptoms of a mood disorder. These may include one or two types: mood stabilizers and antidepressants. Mood stabilizers are most often prescribed for someone who experiences mania and depression. They help to minimize the extremes in mood change between a depressive and a manic phase. Lithium is the most common of the mood stabilizers, but anticonvulsants can also be used to even out mood:
- Valproic acid
Anticonvulsants were developed to treat seizure disorders but have since been found to help stabilize mood. These, along with Lithium, may cause some side effects, such as:
- Rashes and itchiness
- Weight changes
- Back pain
- Ringing in the ears
- Excessive thirst
- Frequent urination
- Slurred speech
- Vision changes
- Fast or slow heartbeat
- Loss of coordination
For someone who experiences schizoaffective disorder with depression, but no manic episodes, antidepressants may be prescribed. As with antipsychotics, it can take several weeks for the full effects to be felt. It is common to try more than one drug before settling on one that works, but it is important to never stop using an antidepressant without a doctor’s guidance. Doing so can cause a dangerous condition called antidepressant discontinuation syndrome. The most commonly used types of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs):
The most common side effects of antidepressants are not serious, but they can be uncomfortable and hard to live with: nausea, vomiting, diarrhea, sleepiness, weight gain, and sexual dysfunction. More critically, they may cause symptoms such as the following that should be treated seriously and should be reported to a doctor:
- Suicidal thoughts
- Agitation and restlessness
- Panic attacks
- Worsening depression or anxiety
- Aggression and anger
- Any other unusual changes in mood or behavior
Psychotherapy for Schizoaffective Disorder
Medications are essential for managing symptoms in patients with schizoaffective disorder, but psychotherapy is also an important part of treatment. One of the most common types of therapy used is called cognitive behavioral therapy, or CBT. CBT involves working with a patient to recognize and change negative thinking associated with depression and anxiety. The therapist helps the patient learn to be more mindful of this thinking, to reorganize it, and to use coping strategies. For psychotic symptoms, therapists use additional techniques to teach patients the coping strategies for these types of symptoms that are not well controlled with medication.
Additional types of therapy a patient may use for treating schizoaffective disorder include family or relationship therapy. These types of therapy can help a patient learn to manage relationships and teach family members and partners how to help their loved one. Group therapy and support groups can also be useful in sharing experiences and learning from others coping with the same illness.
Schizoaffective disorder will not get better without treatment, and any effective treatment plan begins with a good diagnosis. It is so important to seek professional and medical help when you experience troubling symptoms related to mood or psychosis and to get help for loved ones who struggle to see these symptoms in themselves.