What Is Schizoaffective Disorder?

You may be familiar with common mental health conditions like major depression, schizophrenia, and bipolar disorder. But did you know that there’s a relatively rare mental illness that has elements of all three?

Schizoaffective disorder (SZA) is a mental health condition where you have symptoms of schizophrenia, and you also have symptoms of major depression and/or mania. 

There is some debate about whether SZA is a distinct condition or if it’s part of schizophrenia. SZA also has a lot in common with both bipolar disorder and depression, which can make diagnosis tricky. Read on for more information about SZA, how it’s diagnosed and treated, and how it differs from other mental health conditions.

What are the symptoms of schizoaffective disorder? 

People with SZA have a combination of schizophrenia symptoms and mood disorder symptoms. 

Everyone with SZA has at least two schizophrenia symptoms. These symptoms are present almost all of the time:

• Delusions (fixed, false beliefs)

• Hallucinations (hearing or seeing things that aren’t there)

• Disorganized speech

• Erratic behavior

• Flat emotions or a noticeable lack of motivation

People with SZA also have mood symptoms that come and go — though they are present most of the time. People with “depressive type” SZA have symptoms of major depression: 

• Irritability

• Hopelessness

• Decreased energy

• Trouble concentrating

• Difficulty sleeping

• Increased or decreased appetite

• Thoughts of suicide or death

People with “bipolar type” SZA also have symptoms of mania: 

• Feeling energetic or irritable

• Having lots of energy

• Needing less sleep

• Having racing thoughts

• Being very talkative

• Starting lots of projects

• Engaging in risky activities

• Feeling very important or powerful

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How is schizoaffective disorder diagnosed?

Like most mental health conditions, SZA is what’s called a “clinical” diagnosis. This means it can be diagnosed just by talking to a trained healthcare professional — like a primary care doctor, a therapist, or a psychiatrist. 

There are no tests or medical procedures that can diagnose you with SZA. Some providers use a clinical guidebook (called the DSM-5) to diagnose schizoaffective disorder. This guidebook lists all of the symptoms for SZA.  

To be diagnosed with SZA, you need to have both of the following:

1) Symptoms of schizophrenia: These include hallucinations, delusions, and disorganized thinking and behavior.

2) Symptoms of major depression or mania: These are also called “mood disorder” symptoms. They happen at the same time as your schizophrenia symptoms. 

Most of the time, people with SZA have schizophrenia symptoms and mood disorder symptoms. But you also need to have had at least 2 weeks in the past where you had hallucinations or delusions without depression or mania. 

Also keep in mind: You can only be diagnosed with SZA if your symptoms aren’t caused by a medical condition or substance use. 

Schizoaffective disorder vs. schizophrenia 

It can be difficult to tell the difference between SZA and schizophrenia. Both disorders cause psychotic symptoms, erratic behavior, and disorganized thoughts. Both schizophrenia and SZA also usually start around the same time in life — in the late teens to early 30s. And just to make it more complicated: Up to 80% of people with schizophrenia will have at least 1 episode of major depression during their life. 

The difference is that people with SZA have mood symptoms most of the time — compared to just a couple of episodes during their lifetime.   

Schizoaffective disorder vs. bipolar disorder 

Bipolar disorder is a mental health condition that causes episodes of depression and mania. During these episodes, people with bipolar disorder can sometimes have psychotic symptoms, like delusions or hallucinations. 

But in bipolar disorder, these psychotic symptoms only happen during an episode of depression or mania. This is different from schizoaffective disorder, where psychotic symptoms can happen on their own.

Treatments for schizoaffective disorder 

Treatment for schizoaffective disorder is usually a combination of therapy and medication. The best way to know which treatment is best for you or a loved one is to make sure symptoms are improving. Careful follow-up with a mental health professional is key. If one medication or therapy type is not working, then it might be time to try a different approach.

Therapy 

Schizoaffective disorder can be treated with psychotherapy, also known as talk therapy. The goal of psychotherapy is recognizing and changing troubling emotions, thoughts, and behaviors. It also helps to understand how certain thoughts and emotions can affect mood and behavior. Other goals of psychotherapy include help with:

• Coping strategies 

• Stress management

• Emotional awareness

• Social skills

• Relaxation techniques

Family therapy aims to improve support systems. There are several different types of family therapy: 

• Supportive family therapy: This helps create a safe environment to promote sharing feelings. Patients are more likely to seek support if they feel safe. 

• Psychoeducation: This teaches family members about the illness, medications, and other treatments. Such education allows them to help patients take medications and make it to therapy appointments. 

• Narrative family therapy: This involves family members telling stories from their own perspectives. They can then help their loved one to see things more objectively. 

Medications 

There are many different medications used to treat schizoaffective disorder:

• Antipsychotics: These medications can improve thinking, mood, and behavior in people with SZA. Invega is the only antipsychotic medication that is FDA approved for SZA. 

• Mood stabilizers: These are sometimes prescribed for people with bipolar type SZA.   They can treat and prevent mood changes. Examples include lithium, valproic acid, and carbamazepine. 

• Antidepressants: These are sometimes used to treat depressive type SZA. They can help treat sadness and other symptoms of depression. 

Mood stabilizers and antidepressants are not specifically approved for the treatment of SZA, but they are still often used. This is called “off-label” use. 

Schizoaffective disorder controversy explained

Schizoaffective disorder is a controversial diagnosis. The DSM-V calls schizoaffective disorder a distinct condition. Many experts agree with the current criteria for diagnosis. But some clinicians believe it is a type of schizophrenia. Furthering the controversy, some mental health professionals want to change diagnostic criteria. Others want to eliminate the diagnosis altogether. Despite the controversy, the goal of treatment is to relieve symptoms.

How to respond when someone exhibits schizoaffective behavior

It can be disturbing when a loved one shows schizoaffective behavior. It is important to remain calm and be compassionate. Listening and making your loved one feel heard and understood is important. If your loved one has this disorder, it’s a good idea to have an emergency plan ready. That way, in the event of a crisis, you have easy access to phone numbers for doctors, therapists, and a hospital.

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Written by:

Tee Todd, MD

Tee Todd, MD, is a board-certified anesthesiologist. He completed his undergraduate degree in neuroscience and behavioral biology at Emory University.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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