• Schizoaffective Disorder

    by  • 25/12/2013 • Psychiatry

    Definition: A condition which has features of both schizophrenia and mood disorders.

    Epidemiology

    Less common than schizophrenia. No data figures for the UK.

    Commonly presents in early adulthood.

    Woman are more affected.

     

    Diagnosis

    Diagnosed when the patient meets the full criteria for both a mood disorder and schizophrenia. Delusions or hallucinations need to be present for min 2weeks when the mood symptoms are not present.

    It can be divided into:

    1. manic/bipolar-type (when a manic or mixed episode occurs)
    2. depressed type (when illness has mainly depressive episodes)

     

    Presentation

    Divided into major depressive episode, manic episode, mixed episode, and schizophrenia:

     

    Major depressive episode

    Five of the following present for min 2 weeks. One symptom must be either depressed mood or loss of interest/pleasure

     

    • Depressed mood* *compulsory trait
    • Loss of interest*
    • Weight loss or weight gain
    • Insomnia or hypersomnia
    • Psychomotor agitation
    • Fatigue
    • Feelings of guilt or worthlessness
    • Decreased concentration
    • Suicidal notions or thoughts of death

     

    Manic episode

    Persistent elevated or irritable mood for min one week. 3 of the following must be present:

     

    • Inflated self-esteem or grandiosity
    • Reduced need for sleep
    • Pressure of speech
    • Flight of ideas
    • Easily distractible
    • Excessive involvement in high risk activities e.g. huge shopping sprees

     

    Mixed episode

    Features of both episodes- but only for one week

     

    Schizophrenia

    2 or more of the following during 1 month:

     

    • Delusions if bizarre then diagnosis can be made
    • Hallucinations if a ‘running commentary’ or 2 voices, then diagnosis made.
    • Speech abnormalities
    • Behavioural abnormalities catatonia or disorganized
    • Negative symptoms e.g lack of emotions

     

    Management

    1. Treatment of an acute exacerbation Antipsychotics
    2. Long-term treatment Antipsychotics + Psychological treatments (cognitive behavioural therapy, family intervention, counseling).
    3. Ongoing depressive symptoms Antidepressants and ECT occasionally
    4. Mood stabilizer Carbamezapine

    Prognosis

    The bipolar type has a better prognosis than the depressive type as the latter usually results in long term mood disturbance. 

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