Mental disorders require careful differential diagnosis, as they have many similar symptoms. However, in the mass consciousness, they are often identified. A person with mental problems is called a schizophrenic, schizoid, or just a psychopath. In this article, we describe the features of schizoaffective disorder and schizophrenia. Let’s find out what the difference is between them.
This disorder has several names. Three include the word schizophrenia – recurrent, periodic, and circular. It is also sometimes referred to as schizoaffective psychosis. The first word has two roots. One of them is associated with schizophrenia, and the other with effect, which is an affective disorder.
This means that SAD (schizoaffective disorder) includes both schizophrenic symptoms and signs of an affective disorder. The patient’s condition is characterized by abnormal thought processes and unregulated effects – external manifestations of emotions and feelings.
The International Classification of Diseases, Tenth Revision (ICD-10) is in the same class as schizophrenia. The disorder was first described in 1913 by George Hughes Kirby and August Hoch, who introduced him to the manic-depressive group of the scientist Kraepelin.
In 1933, Jacob Kazanin coined the term “schizoaffective state.” The diagnosis of schizoaffective disorder has only been used since 1993. Today it is considered borderline between schizophrenia and affective disorders. Therefore, in the presence of psychotic symptoms, a differential diagnosis is always required.
Schizoaffective disorder is found in about 0.5-0.8% of people.
There are a lot of schizophrenic diseases, just as there are many affective disorders – major depressive, which includes a dozen varieties of depression, bipolar and manic. Therefore, the signs of directly schizoaffective psychosis can be very diverse. We will talk about this later.
The causes of schizoaffective disorder and schizophrenia can be considered together, not because they are the same, but because they are unknown in both cases. In almost any mental illness, we are always talking about disposing of factors and not about specific causes that cause pathology.
As a rule, such diseases occur in people with a genetic predisposition. However, the presence of a particular gene does not always lead to the development of a psychiatric disorder. He can live his whole life in a “sleeping” state. He wakes up in certain circumstances, which are not always possible to find out and very rarely – to predict. Triggers should include:
- Difficult social living conditions;
- Upbringing in an unfavourable environment;
- Early alcoholism or drug addiction;
- Head injuries and infectious lesions of the brain;
- Violence, including sexual;
- Psychological problems, etc.
It is essential to identify the factor that triggered the development of the disorder, but scientists still do not know precisely the mechanism for the development of mental illness.
Symptoms of Schizoaffective Psychosis
The symptoms of schizophrenia and schizoaffective disorder can also be considered within the same paragraph since the second includes the symptoms of the first. But we will describe them to make comparison easier. Affective signs of IAD are:
- Mania. In this state, a person is very active, he feels a surge of strength and energy, and he has a lot of things to do, all of which he strives to redo. There would be nothing wrong with this if the brain, working in such an accelerated mode, did not lose the ability to concentrate. A person jumps from one topic to another, not having time to do anything. It becomes difficult to communicate with him, as the patient’s speech is inconsistent and empty.
- Anger. Suddenly there are signs of aggression. A person is rude to everyone, gets into fights, and starts conflicts. This symptom is especially noticeable against the background of crazy ideas, for example, cleaning the world of garbage. A passerby who throws a piece of paper may become the object of rudeness on the part of the patient. In this state, it can be dangerous.
- Depression. Instead of acting, the passivity of the psyche is observed. A person eats little, does not want anything, sleeps a lot, does not want to get out of bed, strives for loneliness, and does not communicate with anyone. He also tends to self-flagellation. Everything positive around is hidden from him; he sees only the bad. Often in a state of depression, a person thinks about death and suicide.
- Agitation. It is a type of depression in which motor excitation is observed. But usually, in such cases, a person tries to hide a depressed mood behind the imitation of activity.
These are just some of the signs. The only major depressive disorder has dozens of them, as there are different types of depression – postpartum, alcoholic, seasonal, psychotic, and so on. Bipolar disorder and manic syndrome also manifest themselves in different ways. They are known to be included in the list of schizoaffective psychoses.
The schizoaffective disorder would be effective if, along with the above symptoms, signs characteristic of schizophrenia were not observed. Doctors usually deal with the following symptoms:
- Rave. The state of the person primarily determines crazy ideas. If he develops a manic syndrome, there are manias – persecution or grandeur. The patient will have a very high opinion of himself. He may consider himself a great inventor, genius, or possessor of superpowers. Those around him, of course, will not understand. As a result, they may face aggression. With depression, the patient, on the contrary, considers himself a nonentity. At the same time, he will begin to turn his hatred on himself and those nearby.
- Delirium of influence and control. It can be considered separately. When it is present, it seems to a person that his thoughts, feelings, or actions are controlled not by him but by someone else. The patient feels that ideas are being put into his head without his desire.
- Hallucinations. They are auditory, visual, gustatory, tactile, or olfactory. A person can hear, see or touch something that is not real. If delusions accompany this, for example, persecution, it is complicated to convince the patient. Everyone will appear to him as a conspirator.
- Catatonia. It is a movement disorder. There are usually two types of catatonic syndrome, each of which can become a separate stage in the development of the disease. At first, the patient is overly excited, incoherent, talks, performs unnecessary actions, etc. After that, he falls into a stupor, freezing for a long time in an unnatural position.
All of the above symptoms can be with schizophrenia, but with some differences. Let’s consider this aspect in more detail.
Symptoms of schizophrenia
Schizophrenia is a polymorphic disease. This means that it has many manifestations, which depend on the form of flow. Conventionally, the symptoms of all psychopathologies of the schizophrenic spectrum are divided into two groups – negative and positive.
The former partially overlaps with the depressive symptoms of schizoaffective and affective disorders. We are talking about apathy, lack of will, initiative, the inability to receive pleasure, etc. Also, in this state, a person is very close and tends to be lonely and idly. All these symptoms testify to the passivity of the mental apparatus.
The symptoms change with an exacerbation of schizophrenia, that is, the onset of an attack. It becomes productive as the psyche shows activity. At the physiological level, there is a significant release of the hormone dopamine. The patient may be very active and mobile. Thinking speeds up and starts to falter. In the operational phase, hallucinations, delusions, and catatonic disorders develop.
Hallucinations do not occur with every form of schizophrenia. They are not always present in schizoaffective psychosis.
Based on the dominant symptom, schizophrenia is divided into several types:
- Paranoid. With this form, there is always delusion – persecution, jealousy, megalomania, invention, reformism, etc. Delusional ideas become more complicated in the presence of hallucinations.
- Hebephrenic. It occurs very early in adolescence, characterized by ridiculous, childish, and inappropriate behaviour, when, for example, the patient walks naked down the street, etc.
- Catatonic. The main symptom is movement disorders, manifested in periods of excitement and stupor. The patient may suddenly freeze in an unnatural position for several hours or even years.
- Residual. The absence of symptoms characterizes it. Partially similar to a depressive disorder, but it occurs after an attack and therefore can again go into an exacerbation phase.
There are other types of schizophrenia. So, a fur coat is characterized by the presence of seizures and remissions. This is observed in all forms of schizophrenic diseases, but in this case, each exacerbation is more complicated than the previous one.
There is also sluggish schizophrenia, which can progress for years, accompanied by negative symptoms. It is tricky to identify and even more challenging to differentiate it from other mental disorders. In other words, this disease is highly unpredictable, and competent diagnostics can reduce unpredictability.
According to ICD-10, a diagnosis of schizoaffective disorder can be made if a person has affective symptoms, as well as two signs from the following list:
- Auditory hallucinations in the form of voices;
- Delusions of influence and control;
- Broken speech, meaningless words, and neologisms;
- Persistent delirium that is not related to the patient’s activities;
- Catatonic disorders.
At the same time, two of the listed signs must persist for at least two weeks. Then the question of schizoaffective psychosis is raised. Organic brain damage and the use of psychoactive substances, which can also cause the development of such symptoms, are excluded using instrumental and laboratory research methods.
In schizoaffective disorder, signs of schizophrenia and affective disorders develop simultaneously during the same attack.
It is impossible to make a diagnosis in one day. Most likely, the patient will be admitted to a hospital and observed for several weeks. Further, stay in the hospital depends on the patient’s condition and the nature of the disorder, which the doctors identify.
Similar techniques are used in the treatment of schizophrenia and schizoaffective psychosis. With a depressed state, the development of a negative phase, or a depressive disorder, antidepressants help. Increased agitation, mania, and the active period of the disease are stopped with the help of antipsychotics that act on neurotransmitters.
Psychotherapy sessions are of great importance. They are held individually and in a group. The patient’s relatives are also consulted, who should familiarize themselves with the basic rules for communicating with people suffering from mental illness.
This does not mean that one wrong word can throw a person off-balance, and he will become violent. Relatives should determine by the condition of the patient, by his behaviour and words, that something is wrong with him. Usually, before an exacerbation, specific symptoms intensify. If ignored, even a minor event can lead to an attack. But, if you take action on time, it becomes possible to stop the symptoms at an early stage.
The prognosis is the main difference between schizoaffective disorder and schizophrenia. It is connected with the consequences of the patient’s exit from the attack. In schizoaffective psychosis, if treatment is started on time, there is no residual schizophrenic defect. This means that the person retains the essential personality traits.
With schizophrenia, things are much more complicated. After each exacerbation, an indelible mark remains on the psyche. It may not be noticeable at first, but, as a rule, after an attack, the patient no longer becomes the same as he was before the psychosis. He will show signs of passivity, abulia, and apathy. There is a risk of a complete loss of connection with reality and the collapse of the individual.
However, this does not mean that in schizoaffective disorder, the prognosis is always favourable, and in schizophrenia – wrong. This largely depends on the timeliness of the therapy started, the individual characteristics of the organism, and the preventive measures people take during remission.
In general, schizoaffective psychosis is somewhat more dangerous than affective disorders but not as destructive as schizophrenia. If IAD develops according to a type that is closer to bipolar disorder, then the outcome is more productive. In cases where schizoaffective psychosis proceeds in a depressive form, the likelihood of residual negative phenomena is higher, as in schizophrenia.
Regardless of the type and form of these disorders, treatment is carried out almost continuously, even in remission. You don’t always need to drink pills, but you will have to visit a psychiatrist, lead a healthy lifestyle, and control your emotional state until the end of your days. This will help prolong the healthy phase and improve the quality of life.