Jason is a 19-year-old college student. His friends notice that he begins staying up all night, not just studying for exams but also writing furiously in his journals. At first they admire his spurt of creativity, but then he begins looking disheveled and has a hard time remembering to shower, brush his teeth or comb his hair. He seems a flurry of activity, telling them he is launching an Internet business. At the same time, they notice him putting black coverings over his windows and pulling up some of his floor tiles. When they ask what he is doing, he appears anxious and finally reveals he is looking for hidden cameras.
Then just as suddenly, one day Jason appears to lose his energy. He stays in his room, skips meals and neglects his classes. Eventually he stops opening his mail or answering his phone. When his friends visit he appears distracted and has difficulty answering their questions, and he sometimes turns to the other side of the room as if hearing something that’s not there.
Jason’s parents help him get a medical excuse for the rest of the semester, and he spends the subsequent term at home. When he returns to his old campus the next year, he no longer appears either frenzied or withdrawn. He tells his friends he is being treated for schizoaffective disorder.
So what is schizoaffective disorder? Present in about one in every 200 people, schizoaffective disorder produces ongoing struggles not only with mood symptoms (as in depression or bipolar disorder), but also with psychotic symptoms—disturbances of reality testing. Psychotic symptoms can include hallucinations (voices, apparitions or other false sensory symptoms), delusions (fixed false beliefs) or disruptions of logical thought, as well as social withdrawal and difficulties with planning. In schizoaffective disorder, these psychotic symptoms continue to occur even during periods when mood has returned to normal.
Psychotic symptoms are also present in schizophrenia, and schizoaffective disorder is believed to lie on a continuum between mood disorders and schizophrenia, with symptoms of both. Because disturbances of reality testing can have serious consequences, schizophrenia and schizoaffective disorder together are responsible for more psychiatric hospitalizations than any other psychiatric illness.
Since accurate diagnosis of schizoaffective disorder requires closely observing the pattern of symptoms over time, the condition may initially be misdiagnosed as bipolar disorder or depression (if the diagnosis is made during a mood episode), or as schizophrenia (if the diagnosis is made when mood is normal). Consequently, continued re-evaluation is important for all of these illnesses to make sure the initial diagnosis is correct. With schizoaffective disorder, two different categories of symptoms must be addressed—often with a combination of medications—for treatment to be successful.
Good treatment involves both medical therapy to relieve mood and psychotic symptoms as well as psychological and social therapies to address many of the accompanying difficulties people with schizoaffective disorder frequently face—such as higher rates of unemployment, poverty and homelessness.
Fortunately, today there is a wide range of antidepressant, mood stabilizing and antipsychotic medications, with dozens more under development. Consequently, patients have a good chance of finding a successful combination with a minimum of side effects. Unfortunately, however, only a minority of people with schizoaffective disorder continue medications after their first year of treatment, so relapse and repeated hospitalization are common.
But beyond medications, social interventions like group therapy, case management and family support are vital for rehabilitation. Traditional insight-oriented psychotherapy is not generally thought to be helpful, with better results from supportive and practical interventions that focus on real-life problems and planning, interpersonal interactions, social and work roles, recreation and cooperation with drug treatment.
by Gillian Friedman, MD
For more information about diagnosing, treating and living with schizoaffective disorder and other mental health conditions, visit
National Alliance on Mental Illness
National Mental Health Association