One of the more enduring, common, and incapacitating mental illnesses, schizoaffective disorder is a time-based disease noticeable by psychotic signs that happen separately and concurrently over time with major mood episodes. Up to 1 in 3 patients showing with symptoms indicative of severe or chronic psychosis might essentially have schizoaffective disorder.
Schizoaffective disorder victims might be categorized as bipolar or depressive subtypes based on their mood constituents.
DSM-5 Diagnostic Criteria for Schizoaffective Disorder
An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The variances among schizoaffective disorder and the classical group of psychotic disorders like schizophrenia and affective psychoses back the hypothesis that schizoaffective disorder is of cases-in-between schizophrenia and affective psychoses. The limits, though, amongst schizoaffective disorder and schizophrenia on the one hand and affective disorder on the other hand are uncertain rather than straightforward. The notion of schizoaffective disorder as the cases-in-between and, more significantly, its mobile and unsolidified boundaries with schizophrenia and the affective disorders shows specific difficulties. Not only are there problems about the classification and the description of homogeneous schizoaffective subtypes for fundamental research but there are likewise problems for clinical practice regarding treatment and prophylaxis.
Should schizoaffective disorder be measured a variant of the affective disorders? The modest answer is to re-categorize schizoaffective disorder under affective disorders. But is the simplest solution also the best one? Is it actually always probable to place the pathological alterations of mental life into unmistakably distinct patterns? Or is it better to admit the proposal that schizoaffective disorder could best be thought about and investigated if we adopt a model of a psychotic scale.
The present conceptualization of schizoaffective disorders is properly well combined by the definition suggested in the ICD-lO (World Health Organization): “These are episodic disorders in which affective and schizophrenic symptoms are both prominent and present simultaneously.” Diagnostic criteria vary with respect to the number and nature of the affective and “schizophrenic” symptoms whose occurrence is essential, or to the time-based relationship which is required among the happening of the affective and the “schizophrenic” symptoms. It must be acknowledged, though, that all of them reliably reflect a method to the description of schizoaffective disorders which is fundamentally cross-sectional.
Described as above, schizoaffective disorders have been the focus of a substantial disagreement throughout the past few decades. At least five diverse suppositions about their nature have been put forward: (a) that they are variants of schizophrenia; (b) that they are variants of major affective disorders; ( c) that they symbolize a third psychosis, diverse from both schizophrenia and major affective disorders; (d) that they are in the in-between position of a spectrum whose ends are characterized by the typical forms of schizophrenia and manic-depressive illness; (e) that they result from the concurrent existence of a schizophrenia and a major affective disorder in the same victim, as a unexpected event.
The hypothesis that schizoaffective disorders are variants of schizophrenia is invalidated by presently obtainable family studies, most of which display that the pervasiveness of schizophrenia in first-degree relatives of schizoaffective victims is obviously lower than in the relatives of schizophrenics. Instead, result studies document that at slightest schizodepressive disorders cannot be understood in every case as alternatives of major affective disorders.
Additionally, even the impression that schizoaffective disorders are variants occasionally of schizophrenia and occasionally of major affective disorders is not reinforced by empirical studies. The spectrum hypothesis is not unswervingly refuted by empirical studies, but it appears unreliable with the finding of a low morbid risk for each of the major psychoses in the first-degree relatives of patients distressed from the other. Furthermore if the spectrum model were effective, the occurrence of schizoaffective disorders (that lie middle in the continuum) should be higher than that of both schizophrenia and major affective disorders.
The view that schizoaffective disorders symbolize a third psychosis is unreliable with the results of family studies, which show that a homo typical heredity defect is very rare in schizoaffective victims. It is important to argue that several empirical data have reinforced the independence from schizoaffective disorders of the illness known as cycloid psychosis. This last disorder has been observed as an at least temporarily separate diagnostic entity, on the basis of the described familial reliability of its pattern and of the relative consistency between patients regarding course and outcome.
Research findings concerning cycloid psychotic disorder, though, should be considered not applicable to the issue of the nosological nature of schizoaffective disorders. Therefore, none of the above-mentioned hypotheses on the nature of schizoaffective disorders is sustained by the available empirical proof. Thus, empirical studies seem to show that such disorders signify a heterogeneous group of syndromes.