The video below is the section for Schizoaffective Disorder from Part 7 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 7, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Schizoaffective Disorder
Schizoaffective Disorder is a diagnosis from the chapter on Schizophrenia Spectrum and Other Psychotic Disorder that is characterized by symptoms of both schizophrenia and a mood episode. More specifically, a diagnosis of Schizoaffective Disorder requires an uninterrupted period of illness, at least one month in duration, in which a Major Depressive or Manic Episode is concurrent with symptoms that meet Criterion A for schizophrenia — which requires two or more of the following symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative/deficit symptoms (e.g., poverty of speech, a volition, affective flattening).
A diagnosis of Schizoaffective Disorder requires that during the period of illness, there be at least two weeks in which psychotic symptoms are present in the absence of prominent mood symptoms, in order to ascertain that the schizophrenic symptoms are not a direct result of the Mood Disorder. In addition, symptoms that meet diagnostic criteria for a Mood Episode must be present for a substantial portion of the illness.
Schizoaffective Disorder is categorized into two subtypes. (1) Bipolar Type is used to denote cases in which a Manic Episode has occurred; Depressive Episodes may also have been present but are not required for this specifier. (2) Depressive Type is used to denote cases in which only Major Depressive Episodes have occurred.
Individuals with Schizoaffective Disorder may demonstrate poor occupational functioning as well as impaired self-care abilities. They may be lonely and have restricted social lives, relying heavily on support from their families. Schizoaffective Disorder is seen more often in women than in men, accounted for by women’s increased rates of Schizoaffective Disorder, Depressive Type.
Schizoaffective disorder appears to be about one-third as common as schizophrenia and the life-time prevalence is estimated at 0.3%. The typical age of onset is during early adulthood. Evidence suggests that Bipolar Type is more likely to occur in younger adults, while Depressive Type is more likely to occur in older adults. On average, the prognosis for Schizoaffective Disorder is better than that for schizophrenia but worse than the prognosis for Mood Disorders. Residual symptoms, negative/deficit symptoms, and deficits in insight tend to be less severe in Schizoaffective Disorder than in schizophrenia. Factors associated with poor prognosis include lack of precipitating factors, insidious onset, poor premorbid history, presence of Depressive Type rather than Bipolar Type, presence of negative/deficit symptoms, earlier onset, unremitting course, and having a relative with schizophrenia.
Individuals with Schizoaffective Disorder may also experience difficulties with alcohol- or substance-related disorders. There is some clinical evidence to suggest that Schizoid, Schizotypal, Borderline, or Paranoid Personality Disorders may be present before the onset of Schizoaffective Disorder. Little is known about the exact etiology of Schizoaffective Disorder, although researchers believe that,the risk for schizoaffective disorder may be increased among individuals who have a first-degree relative with schizophrenia, biploar disorder, or schizoaffective disorder.
Treatment for this disorder is commonly centered around medications, and varies according to the type of illness. Neuroleptics are commonly used to treat the psychotic disorder, and either antidepressants or mood stabilizers (lithium) are used to treat the mood disturbance, depending from what needs to be targeted (depression or mania).
Individual supportive therapy is also implemented. Although these individuals are often socially uncomfortable, support groups with family members as well as other people suffering of the same illness can be very helpful (http://www.psychnet-uk.com).
Schizophrenia Spectrum and Other Psychotic Disorder involving symptoms of both schizophrenia and a mood episode
1. Diagnosis of Schizoaffective Disorder requires an uninterrupted period of illness of at least one month in duration, in which a Major Depressive or Manic Episode is concurrent with symptoms that meet Criterion A for schizophrenia
2. There must be at least two weeks in which psychotic symptoms are present in the absence of prominent mood symptoms
3. Substantial social, self-care, and occupational impairment typically present
4. Higher risk in family members of those with schizophrenia, bipolar, or schizoaffective
5. Comorbidities: substance abuse, possibility of pre-existent Schizoid, Schizotipal, Borderline or Paranoid PD
6. Treatment involves medications and supportive psychotherapy
7. Medications targeting both the psychosis and the mood disturbance
8. Neuroleptics used to treat psychotic symptoms
9. Manic mood disturbance: combine with lithium
10. Depressed mood disturbance: combine with antidepressants
11. Although these patients are often socially uncomfortable, it appears that support groups in which patients can participate, sometimes with family members, other times with others with same diagnosis, can be very helpful
12. Prognosis better for bipolar than depressed type
Which of the following disorders is least likely to be associated with the development of Schizoaffective Disorder?
A. Histrionic Personality Disorder
B. Schizotypal Personality Disorder
C. Borderline Personality Disorder
D. Paranoid Personality Disorder
A is correct, as Histrionic Personality Disorder is less likely to be associated with Schizoaffective Disorder than Schizotypical, Borderline, and Paranoid Personality Disorders. This makes answers B, C, and D incorrect.