Schizoaffective Disorder

dr. Rohmania Setiarini

schizoaffective disorder has features of both schizophrenia and affective disorders (now called mood disorders).

 ICD-10, schizoaffective disorder is a distinct entity and can be applied to patients who have co-occurring mood symptoms and schizophreniclike mood-incongruent psychosis

the onset of symptoms was sudden and often occurred in adolescence. Patients tended to have a good premorbid level of functioning, and often a specific stressor preceded the onset of symptoms

epidemiology
prevalence is less than 1 percent, possibly 0.5 to 0.8 percent The depressive type of schizoaffective disorder may be more common in older persons than in younger persons, and the bipolar type may be more common in young adults than in older adults onset for women is later than that for men

cause
unknown

prognosis
schizoaffective disorder have a better prognosis than patients with schizophrenia and a worse prognosis than patients with mood disorders.

 patients with schizoaffective disorder are a heterogeneous group: some have schizophrenia with prominent affective symptoms, others have a mood disorder with prominent schizophrenic symptoms,

DSM-IV-TR Diagnostic Criteria for Schizoaffective Disorder

A. An uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia.
Note: The major depressive episode must include Criterion A1: depressed mood.

DSM-IV-TR Diagnostic Criteria for Schizoaffective Disorder

B.During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

DSM-IV-TR Diagnostic Criteria for Schizoaffective Disorder

D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type: Bipolar type: if the disturbance includes a manic or a mixed episode (or a manic or a mixed episode and major depressive episodes) Depressive type: if the disturbance only includes major depressive episodes

Criterion A for schizophrenia.

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1month period (or less if successfully treated): delusions hallucinations disorganized speech (e.g., frequent derailment or incoherence) grossly disorganized or catatonic behavior negative symptoms, i.e., affective flattening, alogia, or avolition

Pedoman diagnosis (PPDGJ-III)

Apabila gejala adanya skizofrenia dan gangguan afektif sama-sama menonjol pada saat bersamaan atau dalam beberapa hari yang satu sesudah yg lain dlm satu episode penyakit yg sama

Differential Diagnosis
mood disorders Schizophrenia In any differential diagnosis of psychotic disorders, a complete medical workup should be performed to rule out organic causes for the symptoms.

Course and Prognosis

an increasing presence of schizophrenic symptoms predicted worse prognosis. After 1 year, patients with schizoaffective disorder had different outcomes, depending on whether their predominant symptoms were affective (better prognosis) or schizophrenic (worse prognosis

treatment
Mood stabilizers antipsychotic agents

Psychosocial Treatment
family therapy, social skills training, and cognitive rehabilitation