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Ever hear of this? http://www.emedicine.com/med/topic3514.htm The term schizoaffective disorder was coined by Dr. Jacob Kasanin in 1933. Schizoaffective disorder is a perplexing mental illness distinguished by a combination of symptoms of a thought disorder or other psychotic symptoms such as hallucinations or delusions (schizophrenia component) and those of a mood disorder (depressive or manic component). The coupling of symptoms from these divergent spectrums makes treating patients who are schizoaffective difficult. Schizoaffective disorder is defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria or by International Classification of Diseases, Tenth Revision (ICD-10) coding. Schizoaffective disorder has features of both schizophrenia, including hallucinations, delusions, and distorted thinking, and a mood component, such as depression or mania. The diagnosis is made when the patient has features of both illnesses but does not strictly meet diagnostic criteria for either schizophrenia or a mood disorder alone. Unfortunately, determining if a patient has 2 separate illnesses (schizophrenia or a mood disorder), a combination of illnesses (schizophrenia and a mood disorder), or perhaps even a distinct and separate illness apart from schizophrenia or a mood disorder is difficult. Making the diagnosis of schizoaffective disorder can be difficult because it encompasses 2 other diagnostic entities, namely schizophrenia and mood disorders. An accurate diagnosis is made when the patient meets criteria for major depressive disorder or mania while also meeting the criteria for schizophrenia. Moreover, the patient must have psychosis for at least 2 weeks without a mood disorder. Men with schizoaffective disorder tend to exhibit antisocial personality traits. The age of onset is later for women than for men, and the exact etiology and epidemiology is unclear because of limited research in this area. Patients with schizoaffective disorder are thought to have a better prognosis than that of patients with schizophrenia. Treatment consists of both pharmacotherapy and psychotherapy. Pathophysiology Although the exact etiology of schizoaffective disorder is unknown, it may involve the balance of dopamine and serotonin in the brain.1 Others believe that it may be due to in utero exposure to viruses, malnutrition, or even birth complications. Frequency United States The lifetime prevalence of schizoaffective disorder is thought to be approximately 0.32%2, with a range of 0.5-0.8%3. This rate is only an estimate because no studies have been performed. International The international prevalence rates are difficult to determine because the diagnostic criteria have changed over the last few years. Mortality/Morbidity The prognosis for patients with schizoaffective disorder is thought to lie between that of patients with schizophrenia and that of patients with a mood disorder. That is, the prognosis is better with schizoaffective disorder than with schizophrenic disorder but worse than with a mood disorder alone. Individuals with the bipolar subtype are thought to have a prognosis similar to those with bipolar type I, whereas the prognosis of people with the depressive subtype is thought to be similar to that of people with schizophrenia. Overall, determination of the prognosis is difficult. The incidence of suicide is estimated at 10% (Williams, 1998). Also consider difference in suicide attempts among different ethnic groups. Caucasian individuals have a higher rate of suicide than African Americans. Persons who immigrated to a country have higher suicide rates then people born in that country. In regards to gender, women attempt suicide more than men, but men complete suicide more often.1 Schizoaffective disorder affects more women than men, but this appears to be influenced the fact that more women are in the depressive subtype as compared with the bipolar subtype. A poor prognosis in patients with schizoaffective disorder is generally associated with a poor premorbid history, an insidious onset, no precipitating factors, a predominant psychosis, negative symptoms, an early onset, an unremitting course, or their having a family member with schizophrenia. |
