Schizoaffective disorder

The exact cause of schizoaffective disorder is unknown. Experts believe genetics, developmental delays and stressful life events can all play a part.

Different causes may operate in different people. This may be why there is wide variation in the symptoms of schizoaffective disorder and the way it develops.

It’s important to remember that it is not your fault you experience a mental health condition.

People with schizoaffective disorder experience both symptoms of schizophrenia (psychosis) and symptoms of depression or bipolar affective disorder (depression and/or mania).

The symptoms of schizoaffective disorder can vary between individuals and, over time, within an individual.

Symptoms of psychosis

The experience of psychosis is different for everyone, and you may find it varies for you at different times. Types of psychosis include hallucinations, delusions and disorganised thinking and speech. 

• Hallucinations – this is when you hear, see, feel, taste or smell something that is not there. Hearing voices is the most common hallucination. These voices might talk about or to you and might command you to do things. 
• Delusions – unusual beliefs that are real to you but not to those around you. You may experience ‘paranoid delusions’, believing that other people want to harm you (e.g. that the government is trying to hunt you down). Or you may believe you have extraordinary abilities (e.g. being able to read people’s minds).
• Disorganised thinking and speech – you may feel your thoughts are racing, and friends may notice that you constantly change the topic of conversation, are easily distracted, or laugh at irrational times. You may speak in an unusual way, perhaps using words that only you understand.

Symptoms of depression

Depression can cause you to lose interest in usual activities, become irritable, or find it hard to concentrate or make everyday decisions. This can also make thinking clearly quite difficult; you may lose confidence, feel excessively guilty and have thoughts of hopelessness, death and suicide.

Signs of depression may vary. Not everyone with depression will complain of sadness or a persistent low mood. You may have other signs of depression such as sleep problems − difficulty getting to sleep or waking and being unable to get back to sleep, as well as feeling constantly tired. You might find you eat much less, or much more, than usual. Or you might feel restless or that you are moving more slowly than usual.

Symptoms can include:

• low or depressed mood
• a sense of hopelessness
• lack of energy
• feelings of guilt or worthlessness
• inability to concentrate
• loss of interest in/enjoyment of usual activities
• sleep disturbances
• changes in how much you eat
• changes in the way you move
• feeling suicidal or trying to hurt yourself – these feelings must always be taken seriously; get help urgently.

Symptoms of mania

If you experience mania, you might not be distressed by it – you may feel fantastic, especially at the start of an episode. Mania symptoms vary between people, and your own symptoms may also vary over time. Some people experience hypomania, which is a milder version of mania with similar but less intense symptoms.  

During a manic episode, your elevated mood can be appealing to others, and you might be the life of the party. You might tell friends you’re feeling great or never been better. However, your behaviour might be recognised as excessive by friends or family. You may also be irritable and experience rapidly changing emotions, from laughter to tears to anger and back.

You may find you need less sleep or won’t sleep for days, yet are full of energy, and have an increased appetite for food, sex or other pleasurable things. Or you might feel like you can do a lot of things at once without getting tired.   

Experiencing mania can change how you process thoughts or your ability to concentrate. For example, you may feel like your thoughts are racing, and friends may notice that you are constantly changing the topic of conversation or are easily distracted.  

You may have an increased sense of self-importance. This may start out as increased self-confidence that is not realistically in line with your skills, experience or abilities. For example, you might borrow money and start a business in a field where you have no experience.

When you are experiencing mania, you may not be aware that it is connected to a mental health condition. The experience can feel very positive or spiritual, and this might make you less likely to seek support.   

Manic episodes may include:

• elevated or ‘high’ mood
• restlessness
• extreme irritability
• talking very fast
• poor judgement
• racing thoughts and ideas
• inability to sleep
• feeling very important
• risky behaviour (e.g. excessive use of drugs/alcohol, spending money, aggressive or overly sexualised behaviour)
• doing things very fast and often (e.g. excessive cleaning)
• symptoms of psychosis (losing touch with reality).

Treatment of schizoaffective disorder can involve a number of aspects, each of which will be tailored to meet your individual needs. Many of the strategies used to treat both schizophrenia and depression/bipolar conditions can be used.

These include medications, family involvement, and therapy (i.e. problem solving training or psychotherapy). Treatment can also include help for other problems which make your symptoms worse, such as drug or alcohol abuse.

These therapies involve a trained professional who uses clinically researched talking therapies to assess and help people to make positive changes in their lives. They may involve the use of specific therapies such as cognitive-behavioural therapy.

Cognitive-behavioural therapy (CBT) 

This largely focuses on overcoming unhelpful beliefs. During CBT, your therapist will help you identify patterns of thought and behaviour that are unhelpful to you. They will work with you to change these patterns and learn new ways of coping with challenges such as psychosis, stress, depression, social anxiety, side effects from medication and anything else you are experiencing.

Counselling 

This may include some techniques referred to above, but is mainly based on supportive listening, practical problem solving and information giving.

All types of therapy/counselling should be provided to you and your family/whānau in a manner that is respectful of you, and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medication can vary depending on your needs. Mood stabilisers such as anti-psychotics may be used to help with symptoms of mania or psychosis. Additionally, you may be prescribed anti-depressants for help with depression.

If you’re prescribed medication, you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for
• whether your current dose could change over time
• possible side effects (both short and long term)
• possible interactions with other medications, drugs or alcohol
• what the process of stopping them could look like.

The side effects of medication can be uncomfortable, and some people will want to stop taking them as a result. If this is how you feel, it’s important that you talk to your doctor before you make changes to your medication yourself. They can help you come up with a plan, which might involve finding a way to better manage side effects, safely changing how much medication you take, changing to a new medication, or stopping altogether.

If you are pregnant or breastfeeding, medication may still be an option. Talk to your doctor about what is right for your situation.

Thanks to Dasha Fedchuk, registered clinical psychologist, for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.