Dr.Varunee Mekareeya ,M.D.,FRCPsychT
Schizoaffective disorder
Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered thought process and abnormal emotional respons. Common symptoms include delusions ,hallucinations ,disorganized speech ,and bizarre behaviors ,as well as mood problems.
Schizoaffective disorder is divided into two mood disorder types : bipolar or depressive. Symptoms of schizoaffective disorder usually begin in young adulthood.
In DSM-5 and ICD-10 ,schizoaffective disorder is in the same diagnostic class as schizophrenia ,but not in the same class as mood disorders.
Epidemiology
Schizoaffective disorder appears to be about one-third as common as schizophrenia. Lifetime prevalence of schizoaffective disorder is uncertain ,but probably less than 1 percent ,in the range of 0.5 to 0.8 percent. The incidence of the disorder is higher in females than in males ,mainly due to an increa
d incidence of the depressive type among females. The typical age at ont of schizoaffective disorder is early adulthood ,although ont can occur anywhere from adolescence to late in life.
Etiology
Genetic ,neurobiology ,early and current environment ,behavioral ,social ,and experiential components appear to be important contributory factors. Biological and environmental factors interact with an individual´s genes in ways which may increa or decrea the risk for developing schizoaffective disorder. Schizophrenia spectrum disorders ,of which schizoaffective disorder is a part ,have been increasingly linked to advanced paternal age at the time of conception ,a known cau of genetic mutations.
我心中的好声音Among people with schizophrenia ,there may be an incread risk for schizoaffective disorder in first–degree relatives. The risk for schizoaffective disorder may be incread among patients who have a first–degree relative with schizophrenia ,bipolar disorder ,or schizoaffective disorder.
The physiology of persons with schizoaffective disorder appears to be not identical to that of tho with schizophrenia and bipolar disorder.
Clinical features
Schizoaffective disorder is distinguished by mood disorder–free psychosis in the context of a long–term psychotic and mood disorder. Psychosis may include delusions ,hallucinations ,disorganized speech ,thinking or behavior and negative symptoms. Negative symptoms include a lack of spontaneous speech ,reduced intensity of outward emotional expression ,loss of motivation ,and inability of experience pleasure. Negative symptoms can be more lasting and more debilitating than positive symptoms.
Mood symptoms are of mania ,hypomania ,mixed state or depression ,and tend to be episodic rather than continuous. Symptoms of mania include elevated or irritable mood ,inflated lf–esteem ,agitation ,risk–taking behavior ,decread need for sleep ,poor concentration ,rapid speech ,and racing thoughts.
Symptoms of depression include
▪ low mood or apathy
▪ loss of pleasure in activities which the individual once enjoyed
▪ changes in appetite or weight
▪ disturbances in sleep
▪ changes in motor activity or decread energy
▪ fatigue
▪ guilt or worthlessness and suicidal thinking
▪ difficulty making decisions and concentrating
Diagnosis
Diagnosis is bad on mental health clinician’s obrvation of patient’s behavior while the patient is experiencing active symptoms. Diagnosis is also bad on t he patient’s lf–reported experiences ,behavioral abnormalities reported by family members ,friends or co–workers. The criteria for diagnosis depend on both the prence and duration of certain signs and symptoms.
The most widely–ud criteria for diagnosing schizoaffective disorder are from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–5 (DSM-5). Diagnostic Criteria
A.An uninterrupted period of illness during which there is a major mood episode (major depressive or
manic) concurrent with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1:Depresd mood.
B.Delusions or hallucinations for 2 or more weeks in the abnce of a major mood episode (depressive
or manic) during the lifetime duration of the illness.
C.Symptoms that meet criteria for a major mood episode are prent for the majority of the total
duration of the active and residual portions of the illness.
D.The disturbance is not attributable to the effects of a substance (e.g.,a drug of abu , a
medication) or another medical condition.
Specify whether:
Bipolar type : This subtype applies if a manic episode is part of the prentation. Major
Depressive episodes may also occur.
Depressive type : This subtype applies if only major depressive episodes are part of the怎么折小盒子
prentation.
当归和党参的区别Associated Features Supporting Diagnosis
Occupational functioning is frequently impaired. People with schizoaffective disorder have restricted social contact and difficulties with lf-care. They also have less vere and less negative symptoms than schizophrenic patients. Individuals with schizoaffective disorder may be at incread risk for later developing episodes of major depressive disorder or bipolar disorder. There may be associated alcohol and other substance-related disorder.
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Differential Diagnosis
A wide variety of psychiatric and medical conditions can manifest with psychotic and mood symptoms that must be considered in the differential diagnosis of schizoaffective disorder. The include ▪ psychotic disorder due to another medical condition
▪ delirium
▪ major neurocognitive disorder
▪ substance / medication-induced psychotic disorder
▪ bipolar disorders with psychotic features
▪ major depressive disorder with psychotic features
▪ depressive or bipolar disorders with catatonic features
▪ schizotypal ,schizoid ,or paranoid personality disorder
▪ brief psychotic disorder
▪ schizophreniform disorder
虚心涵泳▪ schizophrenia
▪ delusional disorder
▪ other specified and unspecified schizophrenia spectrum and other psychotic
disorder
▪ psychotic disorder due to another medical condition
Distinguishing schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features is often difficult. Criteria C is designed to parate schizoaffective disorder from schizophrenia ,and Criteria B is designed to distinguish schizoaffective disorder from a depressive or bipolar disorder with psychotic features.
Comorbidity
Many patients with schizoaffective disorder are also diagnod with other mental disorders ,especially substance u disorders and anxiety disorders. The incidence of medical conditions is incread in schizoaffective disorder.
People with schizoaffective disorder generally respond best to a combination of medical treatment and long-term psychosocial and social supports.
Medical treatment
Medication
Medications are chon to reduce psychotic symptoms and stabilize mood symptoms.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) may be considered for patients with schizoaffective disorder experiencing vere depression or vere psychotic symptoms that have not responded to medications. Psychosocial Treatment华维外国语学校
Cognitive behavioral therapy is helpful. Building a trusting relationship in therapy can help patients with schizoaffective disorder better understand their condition and feel helpful about their future. Effective ssions focus on real-life plans ,problems and relationships. Intensive ca management (ICM) has been shown to reduce hospitalizations , improve adherence to treatment ,and improve social functioning.
High quality psychiatric rehabilitation is very important for recovery from schizoaffective disorder. Psychiatric rehabilitation consists of eight main areas:
▪ Psychiatric (symptom management)
▪ Health and Medical (maintaining consistency of care)
▪ Housing (safe environments)
▪ Basic Living skills (hygiene ,meals ,safety ,planning ,chores)
▪ Social (relationships ,family ,boundaries ,communications & community integration)
▪ Vocational and/or Educational (coping skills , motivation)
▪ Financial (personal budget)
▪ Community and Legal (resources)
Complication
The following complications are more prevalent in outpatient treatment.
夸赞▪ Difficulty following medical treatment.
▪ Substance u ,misu ,abu and addiction.
▪ Serious side effects and adver effects from long-term u of prescribed
medication ,including obesity ,types diabetes and metabolic syndrome.
▪ Problems resulting from untreated or undertreated manic behavior.
▪ Suicide due to mixed episode ,vere depression ,or psychosis.
1.Schizoaffective disorder. [Internet]. Available from:
公共意识
2.American Psychiatric Association. Diagnostic and statistical Manual of Mental Disorders ,fifth
edition. Arlington ,VA: American Psychiatric Association ; 2013.p.105-110.
3.Schizoaffective disorder. [Internet]. Available from:
/health/schizoaffective-disorder/DS00866
4.Schizoaffective disorder.[Internet]. Available from:
