Having a mental health concern can make life difficult. Living with a condition like schizoaffective disorder can be even more challenging, as it involves symptoms of two separate mental health issues.
People who have schizoaffective disorder not only have to cope with psychotic symptoms like delusions and hallucinations. They also face manic episodes or periods of depression. In the case of schizoaffective disorder bipolar type, they might experience both.
People with schizoaffective disorder are at a high risk for complications like unemployment, homelessness, health concerns, substance abuse issues, isolation, suicide, and relationship difficulties. People who don’t get treatment or who stop treatment have a higher risk for suicide. They may behave in risky or impulsive ways, and they may have a higher likelihood of arrest and incarceration.
Treatment for schizoaffective disorder typically includes a combination of therapy and medication. It’s not always easy to treat schizoaffective disorder, especially when the condition isn’t diagnosed right away. But medication and therapy can reduce symptoms and improve daily life. Many people with this condition also find life skills training helpful.
Therapy for Schizoaffective Disorder
Because schizoaffective disorder is lifelong, long-term treatment is necessary. People who feel better for a while may stop taking their medication, but this can cause symptoms to come back. It’s important to work with a treatment team and stick to a treatment plan. Continuing the treatment recommended by a care provider can make it more likely symptoms will go into remission. Going to therapy and joining a support group can help prevent isolation and lead to a better quality of life.
For therapy to be effective, it’s important to get the correct diagnosis. A misdiagnosis of schizophrenia often means psychotic symptoms become the primary focus of treatment. Mood symptoms that go untreated then continue to negatively affect well-being. It’s important to talk over all symptoms with a therapist, even the symptoms that seem less important or unrelated.
Mood symptoms are generally addressed first in therapy. This is partially because depression and mania tend to respond better to treatment than psychotic symptoms. It’s also often difficult to tell whether symptoms best fit a diagnosis of schizophrenia, bipolar, depression, or schizoaffective disorder. When mood symptoms respond to treatment but psychotic symptoms persist, it can be easier for a mental health professional to tell what the person seeking help is dealing with.
Therapy for schizoaffective disorder often includes individual counseling, group therapy, and family or relationship counseling.
- Individual counseling helps people learn more about their condition. Therapists can offer guidance and support for concerns related to the condition, such as difficulties with relationships, work, or school life. They can also help people develop specific goals and learn to recognize triggers. Cognitive behavioral therapy (CBT) may also help people with schizoaffective disorder, depressive type. CBT is considered an effective treatment for depression. A specific kind of CBT, CBTp, helps people learn to deal with psychotic symptoms that may not respond readily to medication.
- Group therapy or support groups can help people connect to others who have related conditions. This can help reduce feelings of isolation and provide a space where people can share specific challenges and talk about coping methods.
- Family therapy or relationship counseling can help loved ones learn more about schizoaffective disorder and how they can best offer support. People with social support, such as friends and family, tend to have a better outlook than people who are isolated.
People with schizoaffective disorder might also benefit from other types of therapy, like art therapy or animal therapy.
Schizophrenia spectrum conditions can make it difficult for people to perform activities of daily life, such as paying bills, tending to personal hygiene, or interacting with people socially. Life skills training can help people improve social skills, learn effective ways to communicate at home or work, and become better able to tend to their basic needs.
Medications for Schizoaffective Disorder
In most cases, a psychiatrist or other mental health professional will prescribe medication to treat symptoms of schizoaffective disorder. Because people living with this condition have mood symptoms as well as psychotic symptoms, separate medications may be needed to treat each set of symptoms. Along with an antipsychotic medication that treats symptoms like delusions and hallucinations, people who have the bipolar type may be prescribed lithium or another mood stabilizer. People who have the depressive type are often prescribed an antidepressant.
Doctors could also prescribe what’s known as an atypical antipsychotic. These medications are antipsychotics that also act as mood stabilizers or antidepressants. They don’t work for everyone, but people who respond well to them may be able to take only one medication. Atypical antipsychotics are still being studied, and it hasn’t yet been determined whether they are an ideal long-term medication.
Paliperidone, or Invega, is the only medication the Food and Drug Administration (FDA) has approved specifically to treat schizoaffective disorder. This medication can be taken orally or through injection. A study from 2016 suggested offering this drug as a long-acting injection could help reduce relapse in people who have a hard time taking a daily dose of medication. A second study from 2016 supported this finding.
Clozapine is often used to treat psychosis as well. This medication can be helpful even when symptoms resist other treatment, so it’s considered a good choice for people with schizophrenia and related conditions.
Living with Schizoaffective Disorder
Schizoaffective disorder is a serious condition that requires compassionate treatment. It primarily affects mental well-being, but it can have a severe impact on all areas of life. The condition can make it difficult to communicate effectively and take care of basic needs.
It’s important to practice self-care and have a crisis plan. A counselor and a support system of friends and loved ones can offer assistance. They can encourage you to stick to the crisis plan and the treatment plan you’ve worked out with your care provider.
It can help to:
- Know what triggers symptoms. Busy times, stressful people, and negative events might all make symptoms worse. Sometimes these things can’t be helped, but learning to recognize them can help you prepare for their effects. For example, recognizing an oncoming manic episode can help you take steps to prevent impulsive choices.
- Follow a routine. Having a regular routine won’t necessarily improve symptoms or keep them from coming back if they’re in remission. But having a regular bedtime, mealtime, and exercise routine can improve your ability to deal with symptoms when they arise. Following a routine can also help you cope with the effects of symptoms. For example, spending 8-9 hours in bed each night can help you combat either the low energy of depression or the high energy of mania.
- Reach out to loved ones. Both isolation and suicidal thoughts are common with schizoaffective disorder. Remaining connected to other people whenever possible can help your mood remain stable and help you feel less alone. Friends and family members may offer different kinds of support. A parent might offer to drive you to appointments. A friend might sit with you if you’re feeling low. A romantic partner might remind you to take your medication every day.
Remember that you do not have to face schizoaffective disorder alone. If you need someone to talk you through a difficult time, you can find a compassionate therapist here.
Case Example of Schizoaffective Disorder, Bipolar Type
- Schizoaffective disorder misdiagnosed as schizophrenia. Adelaide, 27, was diagnosed with schizophrenia at 23 after dropping out of college and living on the streets until being taken home by her mother. Antipsychotic medication helps prevent hallucinations and improve her disorganized thoughts and speech. Yet she continues to experience other symptoms that don’t go away. After not going to therapy for a few years, she finds a new therapist. In therapy, she reports feelings of restlessness and hopelessness. She has a pattern of sleeping most of several days and then being unable to sleep at all. When she isn’t able to sleep, she tells the counselor, she often goes out to meet strangers in bars for casual sex. More questions from the counselor reveals a clear pattern of low moods following high moods. During these low periods, Adelaide often feels guilty for her condition and inability to finish school or find a job, and she has recurring thoughts of suicide. The therapist suggests a diagnosis of schizoaffective disorder, bipolar type, as a better fit for Adelaide’s pattern of symptoms than schizophrenia. He works with the psychiatrist currently prescribing Adelaide’s medication to get her started on paliperidone and lithium. She continues to go to therapy and also joins a support group recommended by her counselor. After about six months, Adelaide has made a few friends in the group, and her high and low periods have become more stable. Her psychotic symptoms continue to occur very rarely. With her mother’s encouragement, she decides to go back to school and finish her degree.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
- Chue, P., & Chue, J. (2016, January 27). A critical appraisal of paliperidone long-acting injection in the treatment of schizoaffective disorder. Therapeutics and Clinical Risk Management, 12(1), 109-116. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737499
- Joshi, K., Lin, J., Lingohr-Smith, M, Fu, D., & Muser, E. (2016, August 31). Treatment patterns and antipsychotic medication adherence among commercially insured patients with schizoaffective disorder in the United States. Journal of Clinical Psychopharmacology, 36(5). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017269
- Kvarnstrom, E. (2018, January 25). Schizoaffective disorder vs. schizophrenia: Correct diagnosis ensures effective treatment. Retrieved from https://www.bridgestorecovery.com/blog/schizoaffective-disorder-vs-schizophrenia-correct-diagnosis-ensures-effective-treatment
- Peterson, T. J. (2018, October 26). Schizoaffective disorder prognosis: Will I ever get better? Retrieved from https://www.healthyplace.com/thought-disorders/schizoaffective-disorder-information/schizoaffective-disorder-prognosis-will-i-ever-get-better
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- Schizoaffective disorder. (n.d.). National Alliance on Mental Illness. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizoaffective-Disorder/Overview
- Schizoaffective disorder. (2017, October 27). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504
- Strakowski, S. M. (2003). Schizoaffective disorder: Which symptoms should be treated first? Current Psychiatry, 2(1). Retrieved from https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0201_Schizoaffective.pdf
