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Schizoaffective Disorder
WHAT IS SCHIZOAFFECTIVE DISORDER?

Some psychiatric disorders are very difficult to diagnose accurately. One of the most
confusing conditions is schizoaffective disorder.
This relatively rare disorder is defined as "the presence of psychotic symptoms in the absence
of mood changes for at least two weeks in a patient who has a mood disorder." The diagnosis
is used when an individual does not fit diagnostic standards for either schizophrenia or
"affective" (mood) disorders such as depression and bipolar disorder (manic depression).
Some people may have symptoms of both a depressive disorder and schizophrenia at the
same time, or they may have symptoms of schizophrenia without mood symptoms.
Many individuals with schizoaffective disorder are originally diagnosed with manic
depression. If the person experiences delusions or hallucinations that go away in less than
two weeks when the mood is "normal," bipolar disorder may be the proper diagnosis.
Someone who experiences psychosis for three or four weeks while in a manic phase does not
have schizoaffective disorder.
However, if delusions or hallucinations continue after the mood has stabilized and are
accompanied by other symptoms of schizophrenia such as catatonia, paranoia, bizarre
behavior, or thought disorders, a diagnosis of schizoaffective disorder may be appropriate.
Accurate diagnosis is easier once the acute psychotic episode is under control.
Distinguishing between bipolar disorder and schizophrenia can be particularly difficult in an
adolescent, since at that age psychotic features are especially common during manic periods.
Because schizoaffective disorder is so complicated, misdiagnosis is common. Some people
may be misdiagnosed as having schizophrenia. Others may be misdiagnosed as having
bipolar disorder. And those diagnosed as having schizoaffective disorder may actually have

schizophrenia with prominent mood symptoms. Or they may have a mood disorder with
symptoms similar to those of schizophrenia.

WHAT IS THE TREATMENT FOR THIS DISORDER?

Psychiatrists often treat this disorder with an anti-psychotic medication and
lithium, or with carbamazepine (an anticonvulsant medication) and lithium.
As a practical matter, differentiating between schizophrenia, bipolar disorder,
and schizoaffective disorder is not absolutely critical, since anti psychotic
medication is recommended for all three. If a mood problem is suspected, lithium
or an antidepressant should be added

WHAT IS THE PROGNOSIS FOR THOSE WITH THIS DISORDER?

The prognosis for individuals diagnosed with schizoaffective disorder is generally better than
for those diagnosed with schizophrenia, but not quite as good for those diagnosed with a
mood disorder. (Schizophrenia is a chronic brain disorder interfering with a persons' ability to
think clearly, manage emotions, make decisions, and relate to others. Persons with
schizophrenia may experience hallucinations and delusions. Mood disorders, including
depression and bipolar disorder, are chronic illnesses in which the person's mood may return
to "normal" between depressive or manic episodes.) Those with schizoaffective disorder
generally respond to lithium better than those with schizophrenia, but not as well as those
with mood disorders.
More research is needed to fully understand this illness and why it resists conventional
treatment. New medications may be developed to treat this disorder more effectively.

DEFINITIONS
I - DSM-IV Diagnostic Criteria*
DIAGNOSTIC CRITERIA

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.

Criteria For Major Depressive Episode

Five (or more) of the following symptoms have been present during the same 2-week period
and represent a change from previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or moodincongruent delusions or hallucinations.

depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others
(e.g., appears tearful). Note: In children and adolescents, can be irritable
mood.

markedly diminished interest or pleasure in all, or almost all, activities

most of the day, nearly every day (as indicated by either subjective
account or observation made by others)

significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in a month), or decrease or increase in
appetite nearly every day. Note: In children, consider failure to make
expected weight gains.

insomnia or hypersomnia nearly every day.

psychomotor agitation or retardation nearly every day (observable by

others, not merely subjective feelings of restlessness or being slowed
down).

fatigue or loss of energy nearly every day.

feelings of worthlessness or excessive or inappropriate guilt (which may

be delusional) nearly every day (not merely self-reproach or guilt about
being sick).

diminished ability to think or concentrate, or indecisiveness, nearly every

day (either by subjective account or as observed by others).

recurrent thoughts of death (not just fear of dying), recurrent suicidal

ideation without a specific plan, or a suicide attempt or a specific plan for
committing suicide

The symptoms do not meet criteria for a Mixed Episode

The symptoms cause clinically significant distress or impairment in social, occupational, or

other important areas of functioning.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one,
the symptoms persist for longer than 2 months or are characterized by marked functional
impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic
symptoms, or psychomotor retardation.

Criteria For Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood,

lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have
persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity.

decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

more talkative than usual or pressure to keep talking.

insomnia or hypersomnia nearly every day.

psychomotor agitation or retardation nearly every day (observable by

others, not merely subjective feelings of restlessness or being slowed
down).

flight of ideas or subjective experience that thoughts are racing.

distractibility (i.e., attention too easily drawn to unimportant or irrelevant

external stimuli).

increase in goal-directed activity (either socially, at work or school, or

sexually) or psychomotor agitation.

excessive involvement in pleasurable activities that have a high potential

for painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)

The symptoms do not meet criteria for a Mixed Episode

The mood disturbance is sufficiently severe to cause marked impairment in occupational

functioning or in usual social activities or relationships with others, or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).

Criteria For Mixed Episodes

The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for
duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational
functioning or in usual social activities or relationships with others, or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).

Criterion A For Schizophrenia

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

Only one symptom is required if delusions are bizarre or hallucinations consist of a voice
keeping up a running commentary on the person's behavior or thoughts, or two or more
voices conversing with each other.
During the same period of illness, there have been delusions or hallucinations for at least 2
weeks in the absence of prominent mood symptoms.

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.
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 if:
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
ASSOCIATED FEATURES

Learning Problem

Hypoactivity

Psychotic

Euphoric Mood

Depressed Mood

Somatic/Sexual Dysfunction

Hyperactivity

Guilt/Obsession

Odd/Eccentric/Suspicious Personality

Anxious/Fearful/Dependent Personality

Dramatic/Erratic/Antisocial Personality

DIFFERENTIAL DIAGNOSIS

Psychotic Disorder Due to a General Medical Condition, a delirium, or a dementia;

Substance-Induced Psychotic Disorder; Substance-Induced Delirium; Delusional Disorder;
Psychotic Disorder Not Otherwise Specified.

II. The ICD-10 Classification of Mental and Behavioral Disorders**

Schizoaffective Disorders

These are episodic disorders in which both affective and schizophrenic symptoms are
prominent within the same episode of illness, preferably simultaneously, but at least within a
few days of each other. Their relationship to typical mood (affective) disorders and to
schizophrenic disorders is uncertain. They are given a separate category because they are too
common to be ignored.
Other conditions in which affective symptoms are superimposed upon or form part of a
preexisting schizophrenic illness, or in which they coexist or alternate with other types of
persistent delusional disorders, are classified under the appropriate category. Moodincongruent delusions or hallucinations in affective disorders do not by themselves justify a
diagnosis of schizoaffective disorder.
Patients who suffer from recurrent schizoaffective episodes, particularly those whose
symptoms are of the manic rather than the depressive type, usually make a full recovery and
only rarely develop a defect state.

Diagnostic Guidelines

A diagnosis of schizoaffective disorder should be made only when both definite

schizophrenic and definite affective symptoms are prominent simultaneously, or within a few
days of each other, within the same episode of illness, and when, as a consequence of this, the
episode of illness does not meet criteria for either schizophrenia or a depressive or manic
episode.
The term should not be applied to patients who exhibit schizophrenic symptoms and affective
symptoms only in different episodes of illness. It is common, for example, for a
schizophrenic patient to present with depressive symptoms in the aftermath of a psychotic
episode (see post-schizophrenic depression).
Some patients have recurrent schizoaffective episodes, which may be of the manic or
depressive type or a mixture of the two. Others have one or two schizoaffective episodes
interspersed between typical episodes of mania or depression. In the former case,
schizoaffective disorder is the appropriate diagnosis. In the latter, the occurrence of an
occasional schizoaffective episode does not invalidate a diagnosis of bipolar affective
disorder or recurrent depressive disorder if the clinical picture is typical in other respects.

F25.0 Schizoaffective Disorder, Manic Type

A disorder in which schizophrenic and manic symptoms are both prominent in the same
episode of illness. The abnormality of mood usually takes the form of elation, accompanied
by increased self-esteem and grandiose ideas, but sometimes excitement or irritability are
more obvious and accompanied by aggressive behavior and persecutory ideas. In both cases
there is increased energy, overactivity, impaired concentration, and a loss of normal social
inhibition.
Delusions of reference, grandeur, or persecution may be present, but other more typically
schizophrenic symptoms are required to establish the diagnosis. People may insist, for
example, that their thoughts are being broadcast or interfered with, or that alien forces are
trying to control them, or they may report hearing voices of varied kinds or express bizarre
delusional ideas that are not merely grandiose or persecutory.
Careful questioning is often required to establish that an individual really is experiencing
these morbid phenomena, and not merely joking or talking in metaphors. Schizoaffective
disorders, manic type, are usually florid psychoses with an acute onset; although behavior is
often grossly disturbed, full recovery generally occurs within a few weeks.

Diagnostic Guidelines

There must be a prominent elevation of mood, or a less obvious elevation of mood combined
with increased irritability or excitement. Within the same episode, at least one and preferably
two typically schizophrenic symptoms (as specified for schizophrenia [F20], diagnostic
guidelines (a) - (d)) should be clearly present.
This category should be used both for a single schizoaffective episode of the manic type and
for a recurrent disorder in which the majority of episodes are schizoaffective, manic type.
Includes:

schizoaffective psychosis, manic type

schizophreniform psychosis, manic type

F25.1 Schizoaffective Disorder, Depressive Type

A disorder in which schizophrenic and depressive symptoms are both prominent in the same
episode of illness. Depression of mood is usually accompanied by several characteristic
depressive symptoms or behavioral abnormalities such as retardation, insomnia, loss of

energy, appetite or weight, reduction of normal interests, impairment of concentration, guilt,

feelings of hopelessness, and suicidal thoughts.
At the same time, or within the same episode, other more typically schizophrenic symptoms
are present; patients may insist, for example, that their thoughts are being broadcast or
interfered with, or that alien forces are trying to control them. They may be convinced that
they are being spied upon or plotted against and this is not justified by their own behavior.
Voices may be heard that are not merely disparaging or condemnatory but that talk of killing
the patient or discuss this behavior between themselves.
Schizoaffective episodes of the depressive type are usually less florid and alarming than
schizoaffective episodes of the manic type, but they tend to last longer and the prognosis is
less favorable. Although the majority of patients recover completely, some eventually
develop a schizophrenic defect.

Diagnostic Guidelines

There must be prominent depression, accompanied by at least two characteristic depressive

symptoms or associated behavioral abnormalities as listed for depressive episode; within the
same episode, at least one and preferably two typically schizophrenic symptoms (as specified
for schizophrenia), diagnostic guidelines (a)-(d) should be clearly present.
This category should be used both for a single schizoaffective episode, depressive type, and
for a recurrent disorder in which the majority of episodes are schizoaffective, depressive type.
Includes:

schizoaffective psychosis, depressive type

schizophreniform psychosis, depressive type

http://remotelib.ui.ac.id:2073/docview/1492831369/B8A4E0A2106D42
2APQ/4?accountid=17242
The schizoaffective disorder diagnosis: a conundrum in
the clinical setting
Wilson, Jo EllenAuthor Information
Heckers, StephanAuthor Information
Psychiatry and Clinical Neuroscience

; Nian, HuiAuthor Information

. European Archives of
264.1

(Feb 2014): 29-34.

http://remotelib.ui.ac.id:2073/docview/858140135/fulltextPDF/B8A4E0A2106D422APQ/7?
accountid=17242

Schizoaffective Disorder

Kantrowitz, Joshua TAuthor Information

. CNS Drugs

25.4

; Citrome, LeslieAuthor Information

(Apr 2011): 317-331.

https://www.klikdokter.com/tanyadokter/psikiatri/gangguan-skizoafektif-bipolar

Terimakasih telah menggunakan layanan e-konsultasi Klikdokter.

1. Skizoafektif
Gangguan skizoafektif adalah kelainan mental yang rancu yang ditandai dengan adanya
gejala kombinasi antara gejala skizofrenia dan gejala gangguan afektif. Gangguan
skizoafektif terbagi dua yaitu, tipe manik dan tipe depresif.
Pada gangguan Skizoafektif gejala klinis berupa gangguan episodik gejala gangguan mood
maupun gejala skizofreniknya menonjol dalam episode penyakit yang sama, baik secara
simultan atau secara bergantian dalam beberapa hari. Bila gejala skizofrenik dan manik
menonjol pada episode penyakit yang sama, gangguan disebut gangguan skizoafektif tipe
manik. Dan pada gangguan skizoafektif tipe depresif, gejala depresif yang menonjol.
Gejala yang khas pada pasien skizofrenik berupa waham, halusinasi, perubahan dalam
berpikir, perubahan dalam persepsi disertai dengan gejala gangguan suasana perasaan baik itu
manik maupun depresif.

Skizoafektif Tipe Depresif

Pada episode yang sama terdapat gejala-gejala skizofrenia maupun depresif yang sama-sama
menonjol. Gejala depresi disini ditandai dengan adanya perilaku yang retardasi, insomnia,
hilangnya enersi, perubahan nafsu makan, kurang minat, gangguan konsentrasi, perasaan
bersalah,keputusasaan, dan ide-ide bunuh diri. Secara bersamaan dalam satu epsode terdapat
gejala-gejala skizofrenia yg khas antara lain :

Merasa pikirannya sedang disiarkan, atau diganggu, ada kekuatan2

yang mengendalikan pikirannya. Pasien yakin sedang di matamatai, sedang diincar .

Mendengar suara2 yang menghina, mengutuk dirinya, atau akan

membunuhnya. Bahkan seperti ada yang mendiskusikan dirinya.

Untuk mendiagnosisnya dibutuhkan wawancara psikiatri yang terarah.

2. Bipolar
Gangguan Bipolar yaitu perubahan mood yang berganti ganti dari perasaan sangat bahagia
berubah menjadi depresi. Untuk memastikannya diperlukan wawancara lebih lanjut untuk
memastikan diagnosis bipolar. Kelainan ini biasanya memang ditemukan pada akhir masa
remaja atau awal masa dewasa. Hingga saat ini belum ditemukan obat yang mampu
menyembuhkan kelainan bipolar, namun kelainan ini dapat dikontrol dengan pemberian
terapi non-farmakologi (tanpa obat) dikombinasi dengan pemberian terapi farmakologi
(dengan obat-obatan) secara terus menerus. Terapi non-farmakologi yang dapat dilakukan
antara lain dengan Psikoterapi dan dengan melakukan berbagai usaha-usaha untuk
mengurangi stres, seperti dengan relaksasi, yoga, berolah raga, dll. Sementara obat-obatan
yang dapat digunakan untuk mengontrol kelainan ini adalah obat-obatan mood stabilizer.
Gejala Gangguan Bipolar:
1. Mengalami depresi, terlihat kehilangan minat, murung, cepat lelah dan menarik diri
dari lingkungannya selama beberapa minggu sampai bulan. Fungsi sosialnya
terganggu secara jelas
2. Mengalami manik, yaitu peningkatan mood, berbicara cepat dan kadang-kadang
loncat dari satu id eke ide lain dengan cepat, secara sadar senang menghamburkan
uang walaupun tidak memiliki banyak uang, perilaku ingin menyenangkan semua
orang terlihat.

3. Dua hal di atas harus terjadi secara bergantian, dalam kurun waktu minggu atau bulan.
Dan mengganggu fungsi sosial penderita dengan jelas, misalnya pekerjaannya
terbengkalai.
Faktor penyebabnya adalah:

Genetik

Terganggunya keseimbangan cairan kimia utama di dalam otak

yaitu Norepinephrin, dopamine, dan serotonin

Faktor eksternal lingkungan seperti stress, obat anti depresan,

penyalahgunaan zat narkotika, kurang tidur.

Faktor psikologis

Demikian informasi yang dapat Kami berikan. Semoga bermanfaat. (AAS)

Salam,

Tim Redaksi Klikdokter