Schizoaffective disorder Flashcards
What is the ICD-10 definition of schizoaffective disorder?
Is an episodic disorder in which both affective and schizophrenic symptoms are prominent but do not justify a diagnosis of either schizophrenia or depressive or manic episodes.
What are the different types of schizoaffective disorder?
- Schizoaffective disorder, manic type
- Schizoaffective disorder, depressive type
- Schizoaffective disorder, mixed (bipolar) type
What is the typical presentation during a major depressive episode?
- Depressed mood
- Anhedonia
- Weight change and appetite change
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feelings of guilt or worthlessness
- Poor or lack of concentration
- Recurrent thoughts of death or suicidal notions
- Thoughts of self-harm
What is the typical presentation during a manic episode?
- Inflated self-esteem or grandiosity
- Reduced need for sleep
- Pressure of speech
- Flight of ideas and racing thoughts
- Easily distracted
- Increase in goal-directed activity with psychomotor agitation
- Excessive involvement in high risk activities e.g. shopping sprees
What is the presentation of a mixed episode?
features both manic and depressive symptoms but only present for a week
Which schizophrenia symptoms are seen ?
- Delusions (if bizarre, no other symptoms are required to make diagnosis)
- Hallucinations (if in form of running commentary or two voices then no other symptoms are required to make diagnosis)
- Speech abnormalities e.g. incoherent speech, speech derailment, clanging association
- Behavioural abnormalities e.g. disorganised, catatonia
- Negative symptoms e.g. lack of emotions or apathy
What are the DDx?
- Substance misuse e.g. cannabis
- Organic illness e.g. hypothyroidism, delirium
- Side effects of medication
- Depressive episode may be due to a recent life event e.g. recent bereavement, loss of employment
- Other psychiatric illness e.g. dementia and delusional disorder, schizophrenia, bipolar
What investigations would be done?
- Baseline bloods
- Urine and plasma toxicity
- CXR to exclude pneumonia in the elderly
- CT/MRI if suspected organic neurological cause
What are the complications experienced with schizoaffective disorder?
- Poor social integration
- Poor function
- Self-neglect
- Difficulties with relationships
- Substance misuse e.g. alcohol, illicit drugs
- Suicidal behaviour
- Homicidal thoughts
What is the management of an acute exacerbation of schizoaffective disorder?
antipsychotics - often second gen (atypical) are superior to typical e.g. risperidone or olanzapine
what is the long-term management of schizoaffective disorder?
antipsychtics (also more efficacious in the bipolar type)( use clozapine in resistant cases)
psychological treatments - CBT, family interventions, counselling, art therapy, supportive psychotherapy
What is the treatment for ongoing depressive symptoms in schizoaffective disorder?
Trial antidepressants - often SSRIs (sertraline, fluoxetine)
ECT occasionally required
What is the treatment of bipolar type
Mood stabilisers can be useful - lithium, valproate
