Schizoaffective disorders

Question 1

Define

Answer 1

A group of disorders in which BOTH affective and schizophrenic (psychotic) symptoms are prominent equally (50/50) but do not justify a full diagnosis of either schizophrenia or depressive/manic episodes

Two types:
1.Manic type

• Both schizophrenic and manic symptoms prominent - develop at the same time
• Single episode, or recurrent disorder (majority manic episodes)

2.Depressive type

• Both schizophrenic and depressive symptoms prominent - develop at the same time
• Single episode, or recurrent disorder (majority depressive episodes)

These individuals experience both symptoms of mood disorder (mania or depression) and schizophrenia at the same time (within days) and of the same intensity without another medical disorder or substance misuse cause.

Symptoms satisfy criteria for schizophrenia and mood disorder during the same episode and psychosis is NOT secondary to mood disturbance.

Question 2

Epidemiology

Answer 2

0.5% lifetime prevalence

Commonly presents in early adulthood

Women more affected

Question 3

Aetiology

Answer 3

Unknown cause

Various factors- genetic, nutritional, viral, prenatal, metabolic

 

Question 4

Symptoms and signs

Answer 4

Symptoms of schizophrenia and mood disorder (depressive or manic) are equally prominent

In order to diagnose:
- Psychotic states to persist for ≥2 weeks without concurrent affective symptoms
- Requires 2 episodes of psychosis:

1 episode lasting >2w without mood disorder symptoms

1 episode requires obvious overlap of mood and psychotic symptoms

• With schizoaffective, the psychosis may not be mood congruent, but in depression with psychosis it is usually mood congruent and the depression symp are usually much more than the psychosis

Question 5

Investigations

Answer 5

Collateral history

Brief Psychiatric Rating Scale (BPRS) - https://www.smchealth.org/sites/main/files/file-attachments/bprsform.pdf?1497977629
- Severity of various psych symp

Positive and Negative Syndrome Scale (PANSS)- used for assessing severity of schizophrenia

MMSE

Physical examination

Basic observations

Urine drug screen

Bloods- abnormal LFTs and macrocytosis on FBC suggests alcohol abuse

Serological tests for syphilis, HIV- ruling out organic causes

Imaging if indicated
- MRI - hypofunction in the prefrontal cortex
- EEG - if epilepsy or another organic cause suspected

Question 6

Management

Answer 6

Treated the same as schizophrenia

Antidepressants and mood stabilisers can be added to augment antipsychotics if affective component is not being controlled

1st line -> fluoxetine (SSRI) + olanzapine (antipsychotic)

2nd line -> lamotrigine

Question 7

PACES schizophrenia

Answer 7

After reviewing the information you’ve given us about what you’ve been experiencing lately, we believe that you have a condition called schizophrenia. This is a mental condition in which your thinking about reality becomes distorted, and explains why you’ve been hearing the voice that’s been bothering you and your belief that the government is after you.

This condition is by no means simply ‘the way you are’ and may be caused by some stressful experiences you’ve had. We can work together to reduce the annoying voice and unsettling belief you have and help you find a bit more peace in your life.

We manage schizophrenia by taking a biopsychosocial approach, addressing the body, mind and social life.

Starting with the body, we’d suggest physically coping with stress through exercise, good sleep hygiene and a healthy diet to start with. We will also give you some medication called an antipsychotic, such as aripiprazole. We will start with a low dose for 6 weeks and work our way up to see the level you need. I must warn you that there can be quite bad side effects depending on the exact drug (aripiprazole can make you fidgety and agitated), but overall we think the medication will be of benefit. We will need to take measurements of your full body functioning before and during the time you are on medication.

To help you address the thoughts and voice in your mind, we will begin a course of CBT with at least 16 sessions. In these sessions, we will try to figure out what is really going on and try to line up your thoughts

and feeling with what’s happening in the world around us.

To help socially, we can put you in touch with support groups to meet people with similar issues and how they overcame them. It would also be wise to inform your loved ones about your diagnosis so they can support you.

The early intervention in psychosis services will be accessible to you and we will also give you some informational booklets with the numbers of some crisis teams in case you ever feel under threat or worried at all.