Meloncauli is a former nurse and anxiety management therapist. She hopes everyone can take something away from her articles.
Schizoaffective Disorder is Hard to Diagnose
Schizoaffective disorder is one of the more rare forms of mental illness in which both the symptoms of bipolar disorder and schizophrenia are encountered. It can be quite difficult to diagnose and is more common in teenagers and young adults.
It is not unusual for a person to be primarily diagnosed with either bipolar or schizophrenia for quite a while, before a firm diagnosis of schizoaffective disorder is made. It can therefore be said that a psychiatric misdiagnosis is not unusual, causing uncertainty and confusion for the sufferer.
The table of symptoms below is not an exhaustive list by any means, but these are common symptoms of both schizophrenia and bipolar disorder. There is a crossover of some of the symptoms from both mental illnesses.
Diagnosing Schizoaffective Disorder: Symptoms
|Schizophrenia||Bipolar Disorder Mania||Bipolar Disorder Depression|
Inability to sleep
Forgetful, slow thinking
Low self esteem
If you have bipolar disorder, you can see that there are some similar symptoms in schizophrenia. Bipolar disorder is usually fairly straightforward to identify as there will be a marked shift in extreme moods on a consistent basis. Schizophrenia on its own is also easy to distinguish given the set of symptoms described. You do not have to have all the symptoms listed above to be diagnosed with either condition.
With schizoaffective disorder, you can probably see how difficult it is for a psychiatrist to be absolutely sure you have sufficient symptoms of both disorders to warrant a schizoaffective disorder diagnosis. So how do they know they have got it right? What are the criteria? Simply put, you will have symptoms of bipolar disorder with a psychotic element i.e. delusions and/or hallucinations.
To complicate matters further, cycles of mania and depression vary but must be experienced consistently to be more accurate in diagnosis. Some people have a rapid cycling bipolar in which they can experience mood changes daily, whilst others have very long breaks, even years between cycles. Your manic episodes may vary. Some people may have severe manic episodes and some may have what are known as hypomania episodes (mild mania).
Many bipolar sufferers can get delusional and paranoid with bipolar disorder alone, and not suffer with schizoaffective disorder.
It is the timing of the symptoms that is the most important aspect of diagnosing schizoaffective disorder. As a bipolar episode stabilizes, any psychotic symptoms should disappear within a couple of weeks. Schizoaffective disorder would be suspected if this was not the case and if there were other schizophrenic symptoms in this normal phase.
Schizoaffective disorder has a better prognosis than schizophrenia but a less favourable prognosis than bipolar disorder. Bipolar disorder is said to have a better prognosis than both schizoaffective disorder and schizophrenia.
Living with Schizoaffective Disorder
Medication: Standard First-Line Treatment
Medication is offered as the first line of treatment with a schizoaffective diagnosis. You will typically be offered medications that treat both mood disorder and schizophrenia such as:
- Mood stabilizers
Medications may have to be tried in combinations until the desired effect is achieved. It can be very difficult to get the balance of medications just right and even when this happens, it may be not too long before the dosages need adjusting. A sufferer often has to contend with living with the side-effects of these medications too.
Living With Scizoaffective Disorder
Schizoaffective disorder is usually a lifelong disorder with intermittent flare ups that obviously interfere with personal and social aspects of life. Finding a job is difficult and relationships can become affected. The isolating nature of this disorder can cause much self doubt and further depressive feelings.
Severe flare-ups or acute psychotic episodes will very possibly require hospital admissions, to establish a stabilization and to a re-evaluate medications. When a flare up happens, not only is the sufferer having a traumatic time but often the immediate family is affected too. Having a diagnosis of schizoaffective disorder can feel very difficult to live with and extremely frightening at times. Sufferers may turn to alcohol or illicit drugs in order to cope but this can make the disorder worse.
Psychotherapy for Schizoaffective Disorder
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Medication is the primary treatment, but talking therapies such as psychotherapy are good for learning to address the problems associated with the disorder. Learn how to manage such things as:
- Achieving goals
- Attitude towards the disorder
- Self-esteem and confidence issues
- Social inclusion
All of these elements are important in coping with schizoaffective disorder. How you manage your life and perceive yourself both have an effect on living with the diagnosis. People who have this disorder tend to feel defeated quite easily because of the implications on confidence, work and relationships. Only by looking at the negative way that you think and feel can the burden of the disorder be easier to carry.
In a Crisis with Schizoaffective Disorder
You should have a care plan drawn up when you are diagnosed with this disorder. This plan will let everyone know what your needs are and how those needs are being addressed. You will be assessed and have a care co-coordinator who will be your “middleman” within the mental health service.
There may be times you feel in crisis and you need prompt help. Usually you will have community psychiatric workers with whom you can establish a trusting relationship. If you are unhappy with those workers, you should not be afraid to ask for alternative workers. It is vital that you feel you have a good rapport with community services because the majority of your support will come from this field. Speak out if you feel the support is failing; this is your disorder and you know what you need more than anyone else. You need to feel that in a crisis you have a good support network.
There is a possibility that you may be placed on a community treatment order (CTO). This can happen after you have been detained under The Mental Health Act and upon your discharge from hospital. You should ask what the conditions for your CTO are and ask for a review if you feel this is necessary. Make sure you have a written copy of these conditions to remind yourself, as failure to comply with the conditions can result in you being recalled back to hospital.
Advance Directive for a Crisis
You can arrange to have an advance directive or decision prepared, for when the need arises during a crisis. As long as you are stable at the time of making the advance directive, this will be recognized as decisions by you regarding the care and treatment you receive. This should be binding if you lose the capacity to make those decisions during a crisis. Those treating you are obliged to take into consideration the wishes on your advance directive, so if you have strong feelings about a certain medication or any other concern, you should express these feelings for your own good. Ask your community worker or psychiatrist for the necessary forms to make an advance directive.
Well Recovery Action Planning (WRAP)
The nature of the disorder can be unpredictable and it is wise to complete a plan of action to give you a feeling of at least some control over your problems. Wellness Recovery Action Planning, or WRAP, is a perfect way for you to recognize and document what makes you feel better and what makes you feel worse, especially leading up to a crisis. Recognizing early warning signs is important to prompt intervention. It is wise to make sure your care co-coordinator or community worker and your relatives or partner has a copy of your WRAP, so others can support you in using it. You should offer one to your psychiatrist also.
Support Groups for Schizoaffective Disorder
National mental health charity MIND in the UK is a good place to start with regards support for any metal health disorders. MIND offers substantial support to sufferers and advice to family members also. This charity runs support groups and is a service where you will not be judged, not face any stigma and always welcome.
Help for Families of Schizoaffective Disorder Patients
It may be the situation that family is the main support for those suffering from schizoaffective disorder. This can bring considerable strain to the family or partner of a sufferer. Firstly, it is a good idea to understand the illness as much as possible, so that you know what to expect. Much patience may be required of you at times, and you too need to learn coping skills in order to be the best support possible.
The family or partner learns to recognize the signs of crisis quite quickly due to the sudden onset and nature of the symptoms. It may be that they are the ones who alert mental health services to the impending crisis, but the days leading up to this can cause worry and indecision about what best to do in the situation. It is helpful to join a local carer support group if possible and attend regularly. Much can be gained from just feeling you are not alone.
With the permission of the patient, you should also attend as many appointments with the sufferer as possible to acquaint yourself with anything important with regards treatment. You can of course also use these times to ask any questions.
Support Website for Schizoaffective Disorder
- Schizoaffective Disorder Patient Support, Chat,Messageboard, Family, Anti Psychiatry, Zyprexa, Rispe
Information About Care Plans
- Accessing mental health services
Find out what mental health services are available to you (including care plans) and how to access them.
Carer and Family Support Mental Health
- Carer support | Rethink Mental Illness, The Leading Mental Health Membership Charity
Rethink's carer support services, including training, respite and groups
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Lisa on June 28, 2018:
I was diagnosed with schizoaffective disorder more than 25 years ago. I appreciate this article very much...especially the parts about advance directives and pre-planned care-in-crisis plans. I am very fortunate: I was only out of work for one year. With my husband’s and family’s support, I have held high level executive positions for many years and a.m. currently in a well-paid administrative position. My mother wasn’t as lucky. She was fiagnosed paranoid schizophrenic and lived a very sad life. I am writing a memoir about my mom’s and my experiences with mental illness and the writing has been very healing. Thank you again for writing this article.
WendyR on November 27, 2016:
Great information I need to abreast myself with this illness because right now my cousin is suffering from it and she's on denial and I don't know what to do. I pray someone can help me to help her. Please help.....
meloncauli (author) from UK on November 13, 2012:
Thanks for your comment carozy! I am glad you found it helpful :)
carozy from San Francisco on November 12, 2012:
This is a very helpful hub and helped me understand schizoaffective disorder more. Thanks for writing it.
meloncauli (author) from UK on September 20, 2012:
Thanks for your comment Kristy. It is surprising how many people have never heard of schizoaffective disorder!
Kristy LeAnn from Princeton, WV on September 19, 2012:
Thanks for writing this. My mom has schizoaffective disorder (and I have bipolar 2 disorder myself) and schizoaffective disorder is such a misunderstood illness so I'm all for articles like this that can shed some light on the issue.
meloncauli (author) from UK on September 19, 2012:
Thanks for your comment...it made me smile! Another example of how little is truly understood about mental "illness".
Dr. Gary L. Sidley from Lancashire, England on September 19, 2012:
Another quality hub to add to your growing library of mental health topics.
I must admit to an inner smile when I hear the diagnosis "schizo-affective disorder" - not because people don't suffer hugely with the symptoms you describe, but rather the emergence of the term in the history of psychiatry i.e after trying to convince everyone that schizophrenia and bipolar disorder were "illnesses" that could never occur together, psychiatry finally gave up on this lost cause and instead invented another discrete "illness" that shared the symptoms of both!
meloncauli (author) from UK on September 19, 2012:
Thanks for your comment billybuc. Yes, it's one of the lesser known mental health disorders. I have seen first hand the effects this disorder can have on peoples' lives.
Bill Holland from Olympia, WA on September 19, 2012:
Hubs like this one are very important for raising awareness. I had no idea about this disorder; thank you for the enlightenment.