Schizoaffective Disorder

What is schizoaffective disorder?

Schizoaffective disorder (SAD) is a mental illness that may change how you think, feel, and act around others. You may have symptoms of psychosis (loss of reality), along with symptoms of a mood problem. A mood problem includes being depressed (very sad), manic (very happy), or both. With SAD, you may not know what is real and what is not real. Your mood symptoms will be present for a large portion of the illness. SAD is a long-term disease. Symptoms may go away on their own, only to appear again later. Treatment may help decrease your symptoms and help you return to your daily activities.

What causes schizoaffective disorder?

No one knows exactly what causes SAD. Caregivers feel it may be caused by problems with your brain, and how it works. Certain parts of the brain help you control your movement, thoughts, and how you feel. These are controlled by special chemicals called neurotransmitters. Caregivers feel the symptoms of SAD appear when there is an imbalance in these chemicals.

What increases my risk of having schizoaffective disorder?

Women are at higher risk of developing SAD than men. SAD is also more common in people born during winter months. Your risk of having SAD is also increased with any of the following:

• Environmental stress: This may come from a major life change or from your daily activities. Some major life changes include loss of a loved one, or moving to a new area. Stress may also be from facing a disaster, or being a victim of physical or sexual abuse. Stress may increase your risk of having SAD, or may make your condition worse.
  
  
• Fetal brain development: This may occur if your mother had trouble with her pregnancy at the time of your brain growth.
  
  
• Genetics and heredity: Having abnormal genes may increase your risk for this condition. A gene is a little piece of information that tells your body what to do or what to make. Having a close family member with a mental health problem may also increase your risk for SAD. Mental health problem may include schizophrenia, a mood disorder, or SAD.

What are the signs and symptoms of schizoaffective disorder?

• Psychosis:
  
  
  • Delusions: You may believe that something is true or right when it is not. These false beliefs do not go away even if there is proof that they are not true. You may believe someone is spying on you, after you, or that people are controlling your mind. You may believe that certain gestures, articles from books, or songs are about you. You may also believe there is something wrong with how your body works.
    
    
  • Hallucinations: You may see, hear, smell, feel, or taste things that are not really there. The most common hallucination is hearing voices. You may believe someone is telling you to do things or threatening you.
    
    
  • Disordered speech: You may be talking about things that do not make sense. You may make up your own words or sounds, and move from one subject to another.
    
    
  • Disorganized behavior: You may behave differently than you normally do. Your movements may become very slow and stiff. You may dress in strange clothing. You may have mood swings (being very happy one moment then very angry the next). You may find yourself suddenly screaming, or being very quiet and not talking at all. You may also have trouble remembering things.
    
    
  • Negative symptoms: These include lack of expression and words. When talking to others, your face may not show any emotion. You may avoid eye contact, and have limited body movements or gestures. When asked, your answers may be very brief and short. You may have decreased or loss of ability to start and continue a planned activity. You may sit for long periods of time and show little interest in work or social activities.
  
  
• Mood symptoms:
  
  
  • Depression: You feel very sad, or be tearful, most of the day or nearly everyday. Other people may see these changes before you see or feel them. You may have lost interest in taking care of yourself and the activities you enjoy. You may also have lost weight without dieting or gained weight. Your appetite for food may also be increased or decreased. You may have trouble sleeping or feel sleepy most of the time. You cannot think or concentrate well or make decisions. You may feel hopeless and helpless and have thoughts about death, including fear of dying or killing yourself.
    
    
  • Manic: You have increased self-esteem and feel very energetic even with little or no sleep. You are more talkative and have thoughts racing in your mind. You are easily distracted and have an increased interest in social activities.
    
    
  • Mixed: You have symptoms of being both depressed and manic.

How is schizoaffective disorder diagnosed?

• Psychiatric assessment: Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. How you answer these questions can help caregivers decide on treatment. To help during treatment, caregivers will ask you about such things as how you feel about it and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.
  
  
• Tests: There is no lab or imaging test that can diagnose SAD. Tests may need to be done to check for medical conditions that may be causing your symptoms.
  
  
• Signs and symptoms: Your caregiver will talk with you about your behavior and feelings. He will look for signs and symptoms of SAD. The following must be true for SAD to be diagnosed:
  
  
  • You have symptoms of a mood problem, along with at least two symptoms of psychosis.
    
    
  • You have delusions or hallucinations, but without mood symptoms, for at least two weeks.
    
    
  • Your mood symptoms should be present for a long time during the course of the illness.
    
    
  • Your signs and symptoms cause problems with your social skills, relationships, and other areas of life. Your relationships with family and the community are poor. Your ability to work and take care of yourself has also decreased.
    
    
  • Your symptoms are not caused by other mental health or medical problems.
    
    
  • Your symptoms are not caused by side effects of a medicine or from substance abuse. Substance abuse means you use alcohol, drugs, or both too much, too often.

How is schizoaffective disorder treated?

You may need one or more of the following:

• Medicines: Medicines used to treat your condition may depend on your symptoms. Medicines may be given to help stop your symptoms and to keep them from coming back.
  
  
  • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
    
    
  • Anti-depressants: These medicines are given to decrease or stop the symptoms of depression. Other behavior problems may also be treated with anti-depressants.
    
    
  • Anti-psychotics: These medicines help decrease psychotic symptoms or severe agitation (very tense and unable to relax). Anti-psychotics may cause problems with how your body moves. This medicine can be taken as a pill or given as a shot.
    
    
  • Atypical anti-psychotics: These are also called second generation anti-psychotics. These medicines also help to decrease psychotic symptoms but have a decreased risk of movement problems.
    
    
  • Mood stabilizers: These medicines help control quick changes in your mood that happen for no reason.
  
  
• Other medicines: These medicines may be added by your caregiver to help with other problems. Some of these medicines may help decrease the side effects of anti-psychotic medicines. Your caregiver may give you any of the following:
  
  
  • Anticholinergic medicine: This medicine may be given to decrease the side effects of other needed medicines.
    
    
  • Anticonvulsants: This medicine is given to control seizures. It may also be used to decrease violent behavior. This medicine may help control your mood swings.
    
    
  • Anti-Parkinson: These medicines are also sometimes called side-effect pills. These may be given to control muscle stiffness, twitching, and shaking caused by anti-psychotic medicines.
    
    
  • Blood pressure medicines: These medicines are usually used to control high blood pressure. They may also be used to help decrease motor tics (uncontrolled movements). Blood pressure medicines may help you feel calmer, more focused, and less irritable.
    
    
  • Sedative: This medicine is given to help you stay calm and relaxed.
  
  
• Psychotherapy:
  
  
  • Assertive community treatment: This treatment is also called ACT. A team of caregivers and support groups in your own community help you with your therapy.
    
    
  • Cognitive behavior therapy: This therapy helps you to change your behavior. It will help you handle symptoms like hallucinations and delusions. It also trains you how to get along with others, and helps you cope and handle your disease.
    
    
  • Compliance therapy: This therapy looks at why you would not want to take your medicine or see your caregiver. Your caregiver will help you find ways to make it easier to do your treatments. You may also get telephone calls and letters to help you remember your scheduled visits with your caregiver.
    
    
  • Counseling: You and your caregiver will work together to decrease your symptoms, and prevent them from coming back. Your caregiver will tell you about the importance of taking your medicines everyday, and help you make an action plan. This plan is a set of instructions for what to do when you have symptoms of SAD. It shows a list of your medicines, their dosage, and side effects. It tells you when to seek help if your symptoms get worse. He will also teach you how to cope with daily activities like working or dealing with other people.
    
    
  • Family intervention: These visits let your family be part of your therapy. Meetings are set by your caregiver with your family. These may be done with all of your family together or with one person at a time. In these meetings your family learns about your condition, and they can talk about their concerns. Your family may learn ways they can help you manage your disease. They may be given special training to help them cope and handle your condition. Special services may also be given to your support people when they need a break from caregiving. This form of therapy may last for at least nine months.
    
    
  • Skills training: This trains you how to get along with other people. Your caregiver will teach you how to behave with others and talk to others properly. You will also learn how to do everyday activities. These may include knowing how to budget your money, and finding a good home and means of transport. Learning these skills may help you be able to live on your own.
    
    
  • Supported employment: This program helps you find a job that is good for you, when you are ready to work. You may be given job skill training and emotional and mental health support while you are working. This may help give you independence and self-confidence.
  
  
• Electroconvulsive therapy: Electroconvulsive therapy (ECT) is a type of shock therapy. This treatment sends small electric shock to your brain. ECT may be used if your condition does not get better after medicines or other therapies.

How can I help treat my schizoaffective disorder?

The following may help you feel better or prevent symptoms of SAD from coming back:

• Find support for yourself and your family. There are many others who have SAD or a similar condition. Talking to them may help you cope with your illness better. Talk to others about how you are doing, and how your family has adjusted. This may also help to improve how you relate to others. Being in a self-help group will encourage you and your peers to have better lives.
  
  
• Keep all medical appointments. Do not miss your regular appointments with your caregiver. There are many medical problems that may be caused by your medicines. Doing regular exams and tests will help caregivers know if you have any treatment problems.
  
  
• Learn more about SAD. Read about SAD so you can learn how to help your illness. The more you know about your condition, the better you can cope with it.
  
  
• Learn ways to manage stress. Deep breathing, meditation, relaxing your muscles, listening to music, or biofeedback may help you relax. Talk to someone about the things that upset you. Talk to your caregiver about these or other ways to manage stress.
  
  
• Use your medicines exactly as ordered by your caregiver. Taking your medicines regularly may help prevent you from getting sick. Put your medicines in a pillbox placed in an area you can easily see. Use a watch with an alarm to help you remember when it is time to take your medicine. Tell your caregiver if you know or think you might be pregnant. Your medicines will help you but may also have side effects. Do not stop taking your medicines without your caregivers OK as this may cause a bad response.
  
  
• Watch for early signs of a relapse. Knowing the early signs of psychosis will help you know when to get help right away. Warning signs may include one or more of the following:
  
  
  • How you think, feel, and see things has changed.
    
    
  • You are behaving differently than usual.
    
    
  • You are becoming more nervous and upset, but do not know why.
    
    
  • You are eating less and have trouble sleeping.
    
    
  • You have little or no interest in your friends.

What problems may come with schizoaffective disorder?

• Aggressive behavior: You may physically hurt others when you have SAD. You may yell, curse at them, or threaten to kill them without any reason. You may become harmful to yourself and the people around you. This may be triggered by stressful events.
  
  
• Medicine side effects: Medicines used to treat SAD may cause an allergic response. Some medicines may take a few weeks to work. Others may change the way you eat and sleep, cause weight gain, and make you anxious. Changes in your sleep and eating may cause other problems and medical conditions. You may have heart, eye, stomach, and movement problems from certain medicines. You may also feel shaky, dizzy, have sexual problems, or urinary problems because of the medicines. Medicines may also cause dry mouth, drooling, and slurred speech.
  
  
• Relapse: This is when your symptoms return after a period of having no signs or symptoms of SAD. A relapse may happen if you stop taking your medicines or choose not to do ordered treatments. Relapses may occur as a normal course of the illness. Substance use and stressful life events may also cause relapse.
  
  
• Risk of suicide: You may think about killing yourself or try to kill yourself. These thoughts may worsen after staying in a hospital or once you have started taking your medicines. Talk to your family if you are having these thoughts. Your family should also call your caregiver immediately if they think you might kill yourself. Ask your caregiver about warning signs of suicide that you and your family should be aware of.
  
  
• Substance use: Having SAD may cause you to use substances regularly. These substances may be cigarettes, alcohol, or illegal drugs such as marijuana. These substances can worsen your psychotic symptoms, or cause a relapse. Ask for help from your caregiver to help you stop taking these substances.
  
  
• Treatment failure: Your symptoms may not go away even with medicines. You may choose to stop taking your medicines because of their side effects. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you talk to your caregiver. Your caregiver may change your medicines to help you get better.
  
  
• Working: You may have a hard time getting a job if you have SAD. You may need to depend on your family. The feeling of helplessness may worsen your condition. Once you feel like you are ready, you may ask for support to help you get a job.

When should I call my caregiver?

Call your caregiver if:

• You are having side effects from your medicine, or they are not helping.
  
  
• You are not sleeping well or sleep more than usual.
  
  
• You cannot eat or are eating more than usual.
  
  
• You cannot make it to your meeting with your caregiver.
  
  
• You have muscle spasms, stiffness, or trouble walking.
  
  
• Your sad feelings or thoughts change the way you function during the day.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You feel like hurting or killing yourself or others.
  
  
• You feel that your condition is getting worse.
  
  
• You feel very upset, threaten someone, or you feel violent. This may include talking loudly or shouting, or becoming very demanding (telling others what to do).
  
  
• You suddenly have changes in your vision.
  
  
• You suddenly have chest pain, trouble breathing, or a fever.

Where can I find support and more information?

Accepting that you have schizoaffective disorder is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, and friends about your feelings. Contact the following:

• American Psychiatric Association
  1000 Wilson Boulevard, Suite 1825
  Arlington , VA 22209
  Phone: 1- 703 - 907
  Web Address: http://www.psych.org
  

• National Alliance for Research on Schizophrenia and Depression
  60 Cutter Mill Road, Suite 404
  Great Neck , NY 11021
  Phone: 1- 800 - 829-8289
  Web Address: www.narsad.org
  

• National Institute of Mental Health (NIMH), Public Information & Communication Branch
  6001 Executive Boulevard, Room 8184, MSC 9663
  Bethesda , MD 20892-9663
  Phone: 1- 301 - 443-4513
  Phone: 1- 866 - 615-6464
  Web Address: http://www.nimh.nih.gov/
  

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You have the right to refuse treatment. This right holds strong unless your life or the lives of others may be in danger. You may also make advance care plans. These plans are made ahead of time in case you lose your ability to make decisions for yourself.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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