Schizoaffective disorder

- [Voiceover] So schizoaffective
disorders are those

where someone meets the
criteria for both schizophrenia

and a major mood disorder,
and both sets of symptoms

are enough so that they
cause some kind of distress

or are interfering with normal daily life.

So what exactly is a major
mood disorder though?

Well, it's a bit of a broad
umbrella, or category,

for illnesses that involve
a serious change in mood.

And I don't just mean like feeling sad

or irritable from time to time,

not just like having a
bad day or something.

Mood disorders affect your
everyday emotional state,

and they're more intense,
and more difficult to manage

compared to just a bad mood,
or just feelings of sadness.

This might be persistent
sadness that doesn't go away.

And so there's sort of a
spectrum of mood disorders,

where we put a normal
mood right in the middle.

And then all the way over on this side

there's this severe depression,

which seriously interferes with
your ability to enjoy life,

and then there's varying degrees
of depression in between.

And then all the way on the
other side there's mania,

which is like this
abnormally elevated mood.

So maybe things like
feeling very irritable,

or having insomnia, and having very fast

and energetic speech, or racing thoughts.

And just like major depression,
this would be enough

such that it interferes
with your daily life.

And then you've also got
these varying degrees

in between normal and mania.

So a major mood disorder might be out here

at severe depression, or
out here at severe mania,

or you might have these,
like, huge swings in mood

between depression and mania,

which is sometimes
called bi-polar disorder.

Okay, so let's say you've got this circle

for major mood disorders like depression,

mania, or bi-polar disorder,

and then this circle
represents schizophrenia,

and symptoms of psychosis like
hallucinations and delusions.

If we combine these two
sets, this middle chunk

is what we call schizoaffective disorder,

which as we can see, has
both a major mood disorder

and also symptoms of schizophrenia.

Now just like schizophrenia
and mood disorders though,

there have yet to be
any imaging or lab tests

that we've developed to
definitely tell us that,

hey, this person has schizophrenia,

or hey, this person has severe depression,

or this person has both,
meaning that they would

have schizoaffective disorder.

That being the case, we
have to look for symptoms

of both schizophrenia and a mood disorder

to come up with a diagnosis
of schizoaffective disorder.

So what's pretty much
used to help psychiatrists

diagnose mental disorders
is a book called the

Diagnostic and Statistical
Manual of Mental Disorders,

the 5th Edition, which is also frequently

just called the DSM 5.

Now this guide helps
psychiatrists look for

certain specific criteria
for patients to meet

to be diagnosed with
a particular disorder.

So if we page to the section
on schizoaffective disorder

we'll find several pieces
of criteria to meet

in order to be diagnosed.

First, the patient has to
have symptoms of psychosis,

so things like delusions
and hallucinations,

without a major mood disorder
for a period of two weeks

in order to meet he criteria
for the schizophrenic portion.

If this doesn't ever happen,
if we don't meet this criteria,

then the symptoms are probably more likely

to be in line with psychotic depression,

as opposed to schizoaffective disorder.

And secondly, a major mood episode,

which is a mood disorder like depression,

mania, or both, that lasts
greater than two weeks

has to be present along side schizophrenia

for an uninterrupted period of time

to be classified as
schizoaffective disorder.

But doesn't schizophrenia sometimes

include depressive symptoms?

Whats the difference between schizophrenia

and depressive symptoms and
schizoaffective disorder?

Well, in order to be diagnosed
with schizoaffective disorder

you have to meet the criteria for

major mood disorders as well,

so if they were diagnosed
with schizophrenia

with depressive symptoms,
the depressive symptoms

must not be meeting the criteria

to constitute a major mood disorder.

Additionally, the patient has to be

experiencing impairments in functioning

due to both the schizophrenia

and the major mood disorder.

Alright, so let's pose the
million dollar question,

what causes schizoaffective disorder?

Well, by now you might be able to guess

that we don't exactly know,
but it's thought to involve

an imbalance in several
neurotransmitters in your brain,

like dopamine, or norepinephrine.

Although genetics likely plays a role,

there have yet to be any genes identified.

But with that said, we know that having

family members with schizophrenia,

bi-polar disorder, or
schizoaffective disorder itself,

all increases your risk of developing

schizoaffective disorder.

And when we're treating
schizoaffective disorder,

we're usually gonna use medications,

but we need to be careful because now

there's both symptoms of
schizophrenia and mood disorders.

Currently there's only
one antipsychotic drug

that's been approved by the FDA

for treatment of schizoaffective
disorder, specifically,

and it's called paliperidone, or invega.

But there are other antipsychotics
that may be used as well

to target symptoms of schizophrenia

and help manage psychotic symptoms.

For the mood disorder symptoms,

it depends on the mood disorder present.

If they have depression,
then antidepressants

will probably be prescribed.

If they have mania, then
it's likely they'll receive

antipsychotics and mood
stabilizers, like lithium.

Apart from drugs and medications though,

the patient may undergo
some sort of psychotherapy.

And the outlook, or prognosis,

of someone diagnosed with
schizoaffective disorder varies,

and it's thought to be somewhere between

that of mood disorders and schizophrenia.

With that said, there tends
to be a better outlook

than for those with schizophrenia alone,

and a worse outlook for those
with mood disorders alone.

So the best prognosis would be

over here with mood disorders

and then the worst prognosis

is over here with just schizophrenia.

And schizoaffective disorder
is somewhere in between.

So things are risk factors that have been

shown to be associated
with a worse prognosis

are things that relate to
the psychosis side of it,

so being closer to schizophrenia.

Other things are things
like earlier onset,

and when there's no periods of remission,

or temporary recovery, and finally,

like we mentioned before,

having a family member with schizophrenia.