Schizophrenia Versus Schizoaffective Disorder

Similar Or Different?


Some experts think that there is a spectrum of mental disorders with bipolar disorder at one end, schizophrenia at the other end, and schizoaffective disorder (SAD) sitting somewhere in the middle.  It is somewhat confusing, as on the surface there are many similarities between schizophrenia and schizoaffective disorder.  Due to these similarities both schizophrenia and schizoaffective disorder belong under the bigger category of primary psychotic disorders.

  Which means that there is a core of psychotic symptoms, such as hallucinations, fixed delusional ideation, or disorganized thinking, frequently seen in patients diagnosed with either schizophrenia as well as schizoaffective disorder.  However, from both a clinical and research perspective, schizoaffective disorder is seen as a diagnosis different from schizophrenia.

What are the important differences between schizophrenia and schizoaffective disorder?

1. The presence of mood episodes. In addition to psychotic symptoms patients with schizoaffective disorder frequently experience mood episodes.  These episodes can be episodes of either depression or mania.  Also in schizoaffective disorder the times when the patient has serious mood problems need to add up to a significant period of time.  To make a diagnosis of schizoaffective disorder the time that the patient has severe mood symptoms should account for more than a half of the total duration of illness.

 In contrast, while a patient with schizophrenia may also experience mood episodes, the total duration of the mood symptoms in schizophrenia is brief relative to the duration of the psychotic symptoms.

2. The course of the psychotic symptoms.  The psychotic symptoms in schizophrenia tend to be persistent.

 The psychotic symptoms in schizoaffective disorder tend to come and go, in other words, they have a more episodic course.

With is the relationship between the affective symptoms and the psychotic symptoms?

In schizophrenia the mood symptoms overlap on the psychotic symptoms.  In other words the psychotic symptoms are present most of the time, including during the times when the patient might also experience severe mood symptoms.  The mood symptoms might come and go, while the psychotic symptoms are almost always present.

In schizoaffective disorder the psychotic symptoms may be present during the times when the patient also experiences depression or mania.  However, the diagnosis of schizoaffective disorder requires that the psychotic symptoms should be present for a long enough time (at least a couple of weeks) at times when the patient does not experience any serious mood symptoms.

Are there differences in treatment between schizophrenia and schizoaffective disorder?

The treatment in schizophrenia relies mostly on a special group of medications called antipsychotics.

 These include older medications such as haloperidol, chlorpromazine, as well as newer medications such as well as risperidone, olanzapine, ziprazidone, quetiapine, asenapine or lurasidone.  Maintenance treatment for schizophrenia is almost always an antipsychotic medication.

The treatment for the "affective disorder" part of schizoaffective also includes antipsychotics, mostly during the times when the patient experiences severe psychotic symptoms, in addition to specific treatments for the mood symptoms.  Patients with schizoaffective disorder are prescribed antidepressants during a depressive episode and mood stabilizers, such as valproate or lithium, during a manic or mixed episode.  Maintenance treatment for his schizoaffective disorder and is almost always with an antipsychotic, usually at lower doses than in schizophrenia, as well as an antidepressant or mood stabilizer.

Are there differences in the course of schizophrenia and schizoaffective disorder?

Most of the patients diagnosed with schizophrenia have a more chronic and persistent course, while most patients diagnosed with schizoaffective disorder have a more episodic course.  However there different course trajectories for both schizophrenia and schizoaffective disorder.  Some patients diagnosed with schizophrenia have a more episodic course; similarly some patients diagnosis with schizoaffective disorder might have a more chronic and persistent course of symptoms.

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