🕷️ Crawler Inspector

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Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 152 (from laksa097)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa152.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Schizoaffective_disorder\')), getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Schizoaffective_disorder\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder","crawl_time":1774017510,"first_indexed_time":1379278899,"http_code":200,"src_unparsed":"org,wikipedia!en,\/wiki\/Schizoaffective_disorder s443","src_root_hash":"17790707453426894952","history_drop_reason":null,"meta_title":"Schizoaffective disorder - Wikipedia","meta_descriptions":[],"attrs_boilerpipe_text":"Schizoaffective disorder\nSpecialty\nPsychiatry\nSymptoms\nHallucinations\ndelusions\ndisorganized thought and behavior\ninappropriate affect\ndepression\nmania\nComplications\nlack of motivation\ncognitive issues\nrisk of harm to self or others\nanxiety disorders\nUsual onset\n16–30 years of age\nTypes\nbipolar type\n[\n1\n]\ndepressive type\n[\n2\n]\nMixed type (Includes both depressive and bipolar symptoms)\nCauses\nUnknown\n[\n3\n]\nRisk factors\nGenetics\nbrain chemistry and structure\nstress\ndrug use\n[\n3\n]\nDiagnostic method\nPsychiatric assessment\nDifferential diagnosis\nPsychotic depression\nbipolar disorder with psychotic features\nschizophreniform disorder\nschizophrenia\nMedication\nAntipsychotics\nmood stabilizers\nantidepressants\nPrognosis\nDepends on the individual, medication response, and therapeutic support available\nFrequency\n0.3%\nSchizoaffective disorder\nis a\nmental disorder\ncharacterized by symptoms of both\nschizophrenia\n(\npsychosis\n) and a\nmood disorder\n, either\nbipolar disorder\nor\ndepression\n.\n[\n4\n]\n[\n5\n]\nThe main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms.\n[\n5\n]\nCommon symptoms include\nhallucinations\n,\ndelusions\n,\ndisorganized speech and thinking\n, as well as mood episodes.\n[\n6\n]\nSchizoaffective disorder can often be\nmisdiagnosed\n[\n5\n]\nwhen the correct diagnosis may be\npsychotic depression\n,\nbipolar I disorder\n,\nschizophreniform disorder\n, or schizophrenia. This is a problem as treatment and\nprognosis\ndiffer greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including\nanxiety disorders\n.\n[\n5\n]\n[\n7\n]\nThere are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).\n[\n4\n]\n[\n5\n]\n[\n8\n]\nAuditory hallucinations\nare most common.\n[\n9\n]\n[\n10\n]\nThe onset of symptoms usually begins in adolescence or young adulthood.\n[\n11\n]\nGenetics\n(researched in the field of\ngenomics\n); problems with\nneural circuits\n; chronic early, and chronic or short-term current\nenvironmental stress\nappear to be important causal factors.\n[\n12\n]\n[\n13\n]\n[\n14\n]\nNo single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of\ntetrahydrobiopterin\n(BH4),\ndopamine\n, and\nglutamic acid\nin people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.\n[\n15\n]\nWhile a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,\n[\n16\n]\nit is considered a common diagnosis among psychiatric disorders.\n[\n17\n]\nDiagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them.\nThe main current treatment is\nantipsychotic\nmedication combined with either\nmood stabilizers\nor\nantidepressants\n(or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.\n[\ncitation needed\n]\nWhen there is risk to self or others, usually early in treatment, hospitalization may be necessary.\n[\n18\n]\nPsychiatric rehabilitation\n,\npsychotherapy\n, and\nvocational rehabilitation\nare very important for\nrecovery\nof higher psychosocial function\n[\ncitation needed\n]\n. As a group, people diagnosed with schizoaffective disorder using\nDSM-IV\nand\nICD-10\ncriteria (which have since been updated\n[\nclarification needed\n]\n) have a better\noutcome\n,\n[\n4\n]\n[\n5\n]\nbut have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.\n[\n5\n]\n[\n19\n]\n[\nnon-primary source needed\n]\nOutcomes for people with\nDSM-5\ndiagnosed schizoaffective disorder depend on data from\nprospective cohort studies\n, which have not been completed yet.\n[\n5\n]\nThe DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;\n[\n18\n]\nthat is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV\nprevalence\nestimates were less than one percent of the population, in the range of 0.5–0.8 percent;\n[\n20\n]\nnewer DSM-5 prevalence estimates are not yet available.\nSigns and symptoms\nSchizoaffective disorder is defined by\nmood disorder-free psychosis\nin the context of a long-term psychotic and mood disorder.\n[\n5\n]\nPsychosis\nmust meet criterion A for\nschizophrenia\nwhich may include\ndelusions\n,\nhallucinations\n,\ndisorganized speech and behavior\nand\nnegative symptoms\n.\n[\n5\n]\nBoth delusions and hallucinations are classic symptoms of psychosis.\n[\n21\n]\nDelusions are false beliefs which are strongly held despite evidence to the contrary.\n[\n21\n]\nBeliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although\nauditory hallucinations\n(or \"hearing voices\") are the most common. Negative symptoms include\nalogia\n(lack of speech),\nblunted affect\n(reduced intensity of outward emotional expression),\navolition\n(lack of motivation), and\nanhedonia\n(inability to experience pleasure).\n[\n21\n]\nNegative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.\nMood symptoms include\nmania\n,\nhypomania\n,\nmixed episode\n, or\ndepression\n, and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.\n[\n21\n]\nSymptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and\nsuicidal thinking\n.\nDSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.\n[\n4\n]\nCauses\nA combination of genetic and\nenvironmental factors\nare believed to play a role in the development of schizoaffective disorder.\n[\n22\n]\n[\n23\n]\nGenetic studies do not support the view that schizophrenia, psychotic\nmood disorders\nand schizoaffective disorder are distinct\netiological\nentities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for\nbipolar disorder\n, and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective [or mood disorder] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and\npathogenesis\n. Laboratory studies of putative\nendophenotypes\n,\nbrain imaging\nstudies, and\npost mortem\nstudies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects.\nViewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced\npaternal age\nat the time of conception, a known cause of genetic mutations.\n[\n24\n]\nThe physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human\nneurophysiological\nfunction in normal brain and mental disorder\nsyndromes\nis not fully understood.\n[\n9\n]\nWhile there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan.\n[\n25\n]\nIn some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age.\n[\n25\n]\nSubstance use disorder\nA clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of\ncannabis (marijuana)\n, however, evidence supports a link between earlier onset of psychotic illness and cannabis use.\n[\n26\n]\nThe more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness,\n[\n27\n]\n[\n28\n]\n[\n29\n]\nwith frequent use being correlated with double the risk of psychosis and schizoaffective disorder.\n[\n30\n]\nA 2009 Yale review stated that in individuals with an established psychotic disorder,\ncannabinoids\ncan exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness.\n[\n31\n]\nWhile cannabis use is accepted as a contributory cause of schizoaffective disorder by many,\n[\n32\n]\nit remains controversial,\n[\n33\n]\n[\n34\n]\nsince not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased\nodds ratio\nof about 3.\n[\n35\n]\nCertain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed.\n[\n5\n]\nMechanisms\nThough the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.\n[\n36\n]\nWhite matter\nand\ngrey matter\nreductions in the right\nlentiform nucleus\n, left\nsuperior temporal gyrus\n, and right\nprecuneus\n, and other areas in the brain are also characteristic of schizoaffective disorder.\n[\n36\n]\n[\n37\n]\nDeformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.\n[\n37\n]\nDue to its role in emotional regulation, researchers believe that the\nhippocampus\nis also involved in the progression of schizoaffective disorder.\n[\n38\n]\nSpecifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.\n[\n38\n]\nMoreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.\n[\n36\n]\nDiagnosis\nPsychosis as a\nsymptom\nof a psychiatric disorder is first and foremost a\ndiagnosis of exclusion\n.\n[\n39\n]\nSo a new-onset episode of psychosis\ncannot\nbe considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out.\n[\n39\n]\nMany clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis.\n[\n39\n]\nAn initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to\nexclude\npsychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital.\nDelirium\nshould be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses.\n[\n39\n]\nExcluding medical illnesses associated with psychosis is performed by using\nblood tests\nto measure:\nThyroid-stimulating hormone\nto exclude\nhypo-\nor\nhyperthyroidism\n,\nBasic electrolytes and\nserum calcium\nto rule out a metabolic disturbance,\nFull blood count\nincluding\nESR\nto rule out a systemic infection or chronic disease, and\nSerology\nto exclude\nsyphilis\nor\nHIV\ninfection.\nOther investigations which may be performed include:\nEEG\nto exclude\nepilepsy\n, and an\nMRI\nor\nCT scan\nof the head to exclude brain lesions.\nBlood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific\nmedical\nindication. These may include serum\nBSL\nif\nolanzapine\nhas previously been prescribed, thyroid function if\nlithium\nhas previously been taken to rule out\nhypothyroidism\n, liver function tests if\nchlorpromazine\nhas been prescribed,\nCPK\nlevels to exclude\nneuroleptic malignant syndrome\n, and a\nurinalysis\nand serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.\nBecause psychosis may be precipitated or exacerbated by common classes of\npsychiatric medications\n, such as\nantidepressants\n,\n[\n40\n]\n[\n41\n]\n[\n42\n]\n[\n43\n]\n[\n44\n]\nADHD stimulant medications\n,\n[\n45\n]\n[\n46\n]\n[\n47\n]\nand\nsleep medications\n,\n[\n48\n]\n[\n49\n]\nprescribed medication-induced psychosis\nshould be\nruled out\n, particularly for first-episode psychosis.\n[\n39\n]\nThis is an essential step to reduce diagnostic error and to evaluate potential medication sources of further\npatient harm\n.\n[\n39\n]\nRegarding prescribed medication sources of patient harm,\nYale School of Medicine\nProfessor of Psychiatry Malcolm B. Bowers Jr, MD wrote:\n[\n50\n]\n[\nself-published source\n]\nIllicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field [of psychiatry] and disastrous for some of our patients.\nIt is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications,\nI am urging caution in their use\n. I believe [clinicians] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by [the clinician] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for [the clinician] to take.\nI believe that psychiatry as a field has not emphasized this point sufficiently\n. As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed.\n[\n40\n]\n[\n41\n]\n[\n42\n]\n[\n43\n]\n[\n46\n]\n[\n47\n]\n[\n48\n]\n[\n49\n]\nSubstance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be\nexcluded\nto a high level of certainty while the person is psychotic, typically in an emergency department, using both a:\nBroad spectrum urine toxicology screening, and a\nFull serum toxicology screening (of the blood).\nSome\ndietary supplements\nmay also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements.\n[\n51\n]\nCommon mistakes made when diagnosing psychotic patients include:\n[\n39\n]\nNot properly excluding delirium,\nMissing a\ntoxic psychosis\nby not screening for substances\nand\nmedications,\nNot appreciating medical abnormalities (e.g.,\nvital signs\n),\nNot obtaining a medical history and family history,\nIndiscriminate screening without an organizing framework,\nNot asking family or others about dietary supplements,\nPremature diagnostic closure, and\nNot revisiting or questioning the initial diagnostic impression of primary psychiatric disorder.\nSchizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms\n[\n52\n]\nsuch as\nhallucinations\nor\ndelusions\n, and\ndepressive episodes\n. There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder.\n[\n52\n]\nResearch has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse.\n[\n53\n]\nThere are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress.\n[\n25\n]\nOnly after these relevant and known causes of psychosis have been ruled out can a psychiatric\ndifferential diagnosis\nbe made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include:\nNot screening for\ndissociative disorders\n.\nDissociative identity disorder\nand psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach.\n[\n54\n]\nDSM-5 criteria\nThe most widely used criteria for diagnosing schizoaffective disorder are from the\nAmerican Psychiatric Association\n's\nDiagnostic and Statistical Manual of Mental Disorders-5\n.\n[\n5\n]\nThe DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or\nunreliably\n) used on patients;\n[\n5\n]\nwhen the diagnosis is made, it does not stay with most patients over time,\n[\n5\n]\nand it has questionable\ndiagnostic validity\n(that is, it does not describe a distinct disorder, nor predict any particular outcome).\n[\n5\n]\nThese problems have been slightly reduced (or \"modestly improved\") in the\nDSM-5\naccording to Carpenter.\n[\n5\n]\nWhen\npsychotic\nsymptoms are confined to an episode of\nmania\nor\ndepression\n(with or without\nmixed features\n), the diagnosis is that of a \"psychotic\"\nmood disorder\n, namely either psychotic\nbipolar disorder\nor\npsychotic major depression\n. Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder,\nschizophreniform disorder\nor\nschizophrenia\n.\n[\n5\n]\nThe second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe.\nDSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis.\n[\n5\n]\nAs such, it is no longer an \"episode diagnosis.\"\n[\n5\n]\nThe new schizoaffective framework looks at the time from \"the [first episode of] psychosis up to the current episode [of psychosis], rather than only defining a single episode with [co-occurring] psychotic and mood\nsyndromes\n.\"\n[\n5\n]\nSpecifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic.\n[\n5\n]\nThe other period of psychosis \"requires the overlap of mood [disorder] symptoms with psychotic symptoms to be conspicuous\" and last for a greater portion of the disorder.\n[\n55\n]\nThese two changes are intended by the DSM-5 workgroup to accomplish two goals:\n[\n5\n]\nIncrease the diagnosis' consistency (or reliability) when it is used;\nSignificantly decrease the overall use of the schizoaffective disorder diagnosis.\nIf the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of\npsychiatric genetics\n,\nneuroimaging\n, and\ncognitive science\nthat includes the overlapping fields of\ncognitive\n,\naffective\n, and\nsocial neuroscience\n, which may change the way schizoaffective disorder is\nconceptualized\nand defined in future versions of the\nDSM\nand\nICD\n.\n[\n5\n]\n[\n56\n]\nComorbidities\nSchizoaffective disorder shares a high level of\ncomorbidity\nwith anxiety disorders, depression, and bipolar disorder.\n[\n57\n]\n[\n58\n]\nIndividuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to\ntobacco\n,\nmarijuana\n, or\nalcohol\n.\n[\n59\n]\nHealth care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder.\nTypes\nOne of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder:\n[\n4\n]\n[\n5\n]\n[\n8\n]\nBipolar type, when the disturbance includes\nmanic episodes\n,\nhypomania\n, or\nmixed episodes\n—major depressive episodes also typically occur;\nDepressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes.\nMixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder.\n[\n8\n]\nProblems with DSM-IV schizoaffective disorder\nThe\nAmerican Psychiatric Association's\nDSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often,\n[\n5\n]\nlargely because the criteria were poorly defined,\nambiguous\n, and hard to use (or poorly\noperationalized\n).\n[\n5\n]\n[\n60\n]\nPoorly trained clinicians used the diagnosis without making necessary\nexclusions\nof common causes of psychosis, including some prescribed psychiatric medications.\n[\n5\n]\nSpecialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis.\n[\n61\n]\n[\n62\n]\n[\n63\n]\n[\n64\n]\nCarpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that:\n[\n5\n]\na recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused.\nAs stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable.\n[\n5\n]\nA diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively.\n[\n5\n]\nEven when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records,\nreliability\nwas still poor for the DSM-IV schizoaffective diagnosis.\n[\n5\n]\nThe DSM-IV schizoaffective diagnosis is not stable over time either.\n[\n5\n]\nAn initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients.\n[\n5\n]\nBy comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression.\n[\n5\n]\nMost patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis.\n[\n5\n]\nIn April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were \"developing new criteria for schizoaffective disorder to improve reliability and\nface validity\n,\" and were \"determining whether the dimensional assessment of mood [would] justify a recommendation to drop schizoaffective disorder as a diagnostic category.\"\n[\n20\n]\nSpeaking to an audience at the May 2009 annual conference of the\nAmerican Psychiatric Association\n, Carpenter said:\n[\n20\n]\nWe had hoped to get rid of schizoaffective [disorder] as a diagnostic category [in the DSM-5] because we don't think it's [a] valid [scientific entity] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice.\nA major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV \"schizophrenia\" or \"mood disorder with psychotic features\".\nBut DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a \"mood disorder with psychotic features\" diagnosis,\n[\n5\n]\nbecause\nlong-term data\nrevealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features,\n[\n5\n]\n[\n19\n]\neven though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders.\n[\n5\n]\n[\n19\n]\nThese problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed;\n[\n5\n]\nfurthermore,\noutcome studies\ndone 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor\nprognosis\n.\n[\n5\n]\nThe DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also.\nDSM-5 research directions\nThe new schizoaffective disorder criteria continue to have questionable diagnostic validity.\n[\n5\n]\nQuestionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5\ncategorizes\nand defines schizoaffective disorder.\nEmil Kraepelin's\ndichotomy\n(\nc.\n 1898\n) continues to influence\nclassification and diagnosis\nin psychiatry.\nA core concept in modern psychiatry since\nDSM-III\nwas released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the\nKraepelinian dichotomy\n.\nEmil Kraepelin\nintroduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before\ngenetics\nwere known and before any treatments existed for\nmental illness\n.\n[\n65\n]\nThe Kraepelinian dichotomy was not used for\nDSM-I\nand\nDSM-II\nbecause both manuals were influenced by the dominant\npsychodynamic\npsychiatry of the time,\n[\n66\n]\nbut the designers of DSM-III wanted to use more scientific and biological definitions.\n[\n66\n]\nConsequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system.\nThe Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by\ndata\nfrom modern psychiatric genetics for over eight years,\n[\n67\n]\nand there is now\nevidence\nof a significant overlap in the genetics of schizophrenia and bipolar disorder.\n[\n65\n]\nAccording to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken\nfalse dichotomy\n.\n[\n65\n]\n[\n68\n]\nThe dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis.\n[\n5\n]\nReal life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder.\n[\n69\n]\nPeople with\npsychotic depression\n, bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders.\n[\n65\n]\n[\n68\n]\nThe categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients.\n[\n65\n]\n[\n68\n]\nThus, they are likely to continue to introduce\neither-or\nconceptual\nand diagnostic error, by way of\nconfirmation bias\ninto clinicians'\nmindsets\n, hindering accurate assessment and treatment.\n[\n65\n]\n[\n68\n]\nThe new definition continues the lack of\nparsimony\nof the old definition.\n[\n5\n]\n[\n69\n]\nSimpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more \"research [is] needed to establish a new\nclassification system\nof equal or greater validity\"\n[\n69\n]\nto the existing system.\n[\n5\n]\n[\n69\n]\nBecause of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful.\n[\n65\n]\n[\n68\n]\nAfter enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a\nspectrum or dimensional approach\nto diagnosis.\n[\n5\n]\n[\n68\n]\nMore\nparsimonious\ndefinitions than the current one were considered by Carpenter and the DSM-5 workgroup:\n[\n5\n]\nOne option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective [or mood] symptoms [that is,\nmania\n,\nhypomania\n,\nmixed episode\n, or\ndepression\n] as a dimension to\nschizophrenia\nand\nschizophreniform disorder\nor\nto define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect [or mood] dimensions covering the entire course of illness, that would capture the current\nconcept\nof periods of psychosis related and unrelated to mood episodes.\n[N]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis [or psychotic\nmood disorders\n] and schizophrenia. To the contrary,\nthe idea of a dichotomy between these types of conditions has proven naïve\n. [T]he admixture of \"schizophrenic\" and affective [or mood] symptoms is a feature of many, or even most, cases with severe mental illness. Most\npresenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response\nin psychosis. [U]ltimately a more ...\ndimensional approach\n[to assessment and treatment] will be required.\nThe field of\npsychiatry\nhas begun to question its assumptions and analyze its data in order to merge closer with\nevidence-based medicine\n.\n[\n68\n]\nThe removal of the \"episode diagnosis\", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed\nexactingly\n.\n[\n55\n]\nBut the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness.\n[\n5\n]\n[\n55\n]\nCommunity clinicians used the previous definition \"for about a third of cases with non-affective psychotic disorders.\"\n[\n5\n]\nNon-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems.\n[\n55\n]\nFrom a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's\nneural circuits\n, for example, are just beginning to be mapped by modern neuroscience in the\nHuman Connectome Project\nand\nCLARITY\n. Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and\npatient harm\n; this is crucial both for responsible patient care and to retain public trust. Looking forward, a\nparadigm shift\nis needed in psychiatric research to address unanswered questions about schizoaffective disorder. The\ndimensional\nResearch Domain Criteria project currently being developed by the\nU.S. National Institute of Mental Health\n, may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders.\n[\n70\n]\nTreatment\nThe primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports.\n[\n22\n]\nHospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it)\ninvoluntarily\n. Long-term hospitalization is uncommon since\ndeinstitutionalization\nstarted in the 1950s, although it still occurs.\n[\n18\n]\nCommunity support services including drop-in centers, visits by members of a\ncommunity mental health team\n, supported employment and support groups are common.\n[\n71\n]\nEvidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder.\n[\n72\n]\nBecause of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be\nmisdiagnosed\n. Many people are either diagnosed with\ndepression\n, schizophrenia, or\nbipolar disorder\ninstead of schizoaffective disorder.\n[\n52\n]\nBecause of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders.\n[\n52\n]\nWhile various medications and treatment options\nexist\nfor those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.\n[\n25\n]\nSchizoaffective\ndisorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age.\n[\n25\n]\nTherapy\nPsychosocial treatments have been found to improve outcomes related to schizoaffective disorder.\n[\n73\n]\nSupportive\npsychotherapy\nand\ncognitive behavioral therapy\nare both helpful.\n[\n74\n]\nIntensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning.\n[\n75\n]\nWith ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing.\nPsychiatric\/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing\nactivities of daily living\n; increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on\nvocational rehabilitation\n.\n[\n76\n]\nEvidence suggests that cognition-based approaches may be able to improve work and social functioning.\n[\n77\n]\nPsychiatric rehabilitation consists of eight main areas:\nPsychiatric (symptom reduction and management)\nHealth and Medical (maintaining consistency of care)\nHousing (safe environments)\nBasic living skills (\nhygiene\n, meals [including increasing healthy food intake and reducing processed food intake], safety, planning and chores)\nSocial (\nrelationships\n, family boundaries, communication and integration of client into the community)\nEducation and vocation (coping skills,\nmotivation\nand suitable goals chosen by client)\nFinance (\npersonal budget\n)\nCommunity and legal (resources)\nMedication\nAntipsychotic\nmedication is usually required both for acute treatment and the prevention of relapse.\n[\n21\n]\n[\n78\n]\nThere is no single antipsychotic of choice in treating schizoaffective disorder, but\natypical antipsychotics\nmay be considered due to their mood-stabilizing abilities.\n[\n21\n]\n[\n73\n]\nTo date,\npaliperidone\n(Invega) is the only antipsychotic with\nFood and Drug Administration\n(FDA) approval for the treatment of schizoaffective disorder.\n[\n79\n]\nOther antipsychotics may be prescribed to further alleviate psychotic symptoms.\n[\n80\n]\nThe management of the bipolar type of schizoaffective disorder is similar to the\ntreatment of bipolar disorder\n, with the goal of preventing mood episodes and cycling.\n[\n81\n]\nLithium\nor anticonvulsant mood stabilizers such as\nvalproic acid\n,\ncarbamazepine\n, and\nlamotrigine\nare prescribed in combination with an antipsychotic.\n[\n73\n]\nAntidepressants have also been used to treat schizoaffective disorder.\n[\n82\n]\nThough they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers.\n[\n83\n]\nSome research has supported the efficacy of\nanxiolytics\nin treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive.\n[\n84\n]\nDue to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment.\n[\n84\n]\nClozapine\nClozapine\nis FDA-approved for treatment resistant schizophrenia.\n[\n85\n]\nThough not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.\n[\n86\n]\nClozapine is an\natypical antipsychotic\nthat is recognized as being particularly effective when other antipsychotic agents have failed.\n[\n81\n]\nWhen combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals.\n[\n86\n]\nClozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality.\n[\n78\n]\n[\n87\n]\nDespite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant.\n[\n88\n]\nClozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include\nagranulocytosis\nand\nneutropenia\n.\n[\n89\n]\nTo mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests.\n[\n90\n]\nElectroconvulsive therapy\nElectroconvulsive therapy\n(ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics.\n[\n78\n]\nEpidemiology\nCompared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.\n[\n91\n]\nSchizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.\n[\n92\n]\n30% of cases occur between the ages of 25 and 35.\n[\n36\n]\nIt is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.\n[\n93\n]\nChildren are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.\n[\n11\n]\n[\n94\n]\nHistory\nThe term\nschizoaffective psychosis\nwas introduced by the American psychiatrist\nJacob Kasanin\nin 1933\n[\n95\n]\nto describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia.\n[\n62\n]\nKasanin's concept of the illness was influenced by the\npsychoanalytic\nteachings of\nAdolf Meyer\nand Kasanin postulated that\nschizoaffective psychosis\nwas caused by \"emotional conflicts\" of a \"mainly sexual nature\" and that psychoanalysis \"would help prevent the recurrence of such attacks.\"\n[\n63\n]\nHe based his description on a case study of nine individuals.\n[\n63\n]\nKarl Kahlbaum\n(1828–1899)\nOther psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist\nKarl Kahlbaum\n(1828–1899) described schizoaffective disorders as a separate group in his\nvesania typica circularis\n.\n[\n63\n]\nKahlbaum distinguished between\ncross-sectional\nand\nlongitudinal\nobservations. In 1920, psychiatrist\nEmil Kraepelin\n(1856–1926) observed a \"great number\" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses,\ndementia praecox\n(now called schizophrenia) and\nmanic depressive insanity\n(now called bipolar disorders and recurrent depression).\n[\n63\n]\nKraepelin acknowledged that \"there are many overlaps in this area,\" that is, the area between schizophrenia and mood disorders.\n[\n96\n]\nIn 1959, psychiatrist\nKurt Schneider\n(1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed \"concurrent and sequential types\".\n[\n63\n]\n(The\nconcurrent type\nof illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time [now called psychotic mood disorders or affective psychosis]; while his\nsequential type\nrefers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.)\n[\n63\n]\nSchneider described schizoaffective disorders as \"cases in-between\" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders.\n[\n63\n]\nThe historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes\nand\npolygenic variations.\n[\n97\n]\n[\n98\n]\n[\n99\n]\n[\n100\n]\nEmil Kraepelin\n(1856–1926). Embracing the\nKraepelinian dichotomy\nin\nDSM-III\nin 1980, while a step forward from\npsychodynamic\nexplanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the\nDSM-5\nworkgroup.\nSchizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in \"Psychotic Disorders Not Otherwise Specified\" before being formally recognized in DSM-III-R.\n[\n62\n]\nDSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive.\n[\n62\n]\nIn DSM-IV, published in 1994, schizoaffective disorders belonged to the category \"Other Psychotic Disorders\" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology.\n[\n63\n]\nDSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly\noperationalized\n.\n[\n5\n]\nThese\nambiguous\nand unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis.\n[\n5\n]\nPatients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were\nlongitudinally determined\nto have outcomes indistinguishable from those with mood disorders with or without psychotic features.\n[\n5\n]\nA poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was\nharmful\nto many patients.\n[\n5\n]\n[\n101\n]\nThe poor prognosis for DSM-IV schizoaffective disorder was not based on\npatient outcomes\nresearch\n, but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician\nenculturation\nwith\nunscientific\nassumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy;\n[\n65\n]\n[\n68\n]\nand by clinicians being unfamiliar with the\nscientific\nlimitations of the diagnostic and classification system.\n[\n5\n]\nThe DSM-5 schizoaffective disorder workgroup analyzed all of the available research\nevidence\non schizoaffective disorder, and concluded that \"presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response.\"\n[\n5\n]\nGiven our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness\nsyndromes\n, the limits of our knowledge are clearer:\nPresenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more\n.\n[\n5\n]\nSchizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason.\n[\n5\n]\nStigma of schizoaffective disorder include moralist arguments, religious causes, and others during history.\n[\n102\n]\n[\n103\n]\nResearch\nLittle is known of the causes and mechanisms that lead to the development of schizoaffective disorder.\n[\n55\n]\n[\n68\n]\nWhether schizoaffective disorder is a variant of schizophrenia (as in DSM-5 and ICD-10 classification systems), a variant of bipolar disorder, or part of a dimensional continuum between\npsychotic depression\n, bipolar disorders and schizophrenia is currently being investigated.\n[\n68\n]\nMore recently, some research suggests the need for a more specialized classification for schizoaffective disorder. In a 2017 examining diagnostic heterogeneity study, researchers found that when compared to a schizophrenia sample, individuals with schizoaffective disorder rate higher in suicidality and anxiety disorder comorbidity.\n[\n104\n]\nSee also\nSchizophrenia\nBipolar disorder\nReferences\n^\n\"Schizoaffective disorder, bipolar type\"\n.\nwww.icd10data.com\n.\n^\n\"Schizoaffective disorder, depressive type\"\n.\nwww.icd10data.com\n.\n^\na\nb\n\"Schizoaffective Disorder Overview – Causes\"\n.\nwww.nami.org\n.\n^\na\nb\nc\nd\ne\n\"F25 Schizoaffective disorders\"\n.\nICD-10 Version:2010\n. 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(1 April 2023).\n\"Prevention of suicide by clozapine in mental disorders: systematic review\"\n.\nEuropean Neuropsychopharmacology\n.\n69\n:\n4–\n23.\ndoi\n:\n10.1016\/j.euroneuro.2022.12.011\n.\nISSN\n \n0924-977X\n.\n^\n\"New Center Aims to Bolster Treatment of Schizoaffective Disorders\"\n.\nwww.hopkinsmedicine.org\n. Retrieved\n19 November\n2022\n.\n^\nMiller, D. D. (2000).\n\"Review and management of clozapine side effects\"\n.\nThe Journal of Clinical Psychiatry\n. 61 Suppl 8:\n14–\n17, discussion 18–19.\nISSN\n \n0160-6689\n.\nPMID\n \n10811238\n.\n^\nFarooq, Saeed; Choudry, Abid; Cohen, Dan; Naeem, Farooq; Ayub, Muhammad (February 2019).\n\"Barriers to using clozapine in treatment-resistant schizophrenia: systematic review\"\n.\nBJPsych Bulletin\n.\n43\n(1):\n8–\n16.\ndoi\n:\n10.1192\/bjb.2018.67\n.\nISSN\n \n2056-4694\n.\nPMC\n \n6327301\n.\nPMID\n \n30261942\n.\n^\n\"Schizoaffective disorder: MedlinePlus Genetics\"\n.\nmedlineplus.gov\n. Retrieved\n30 September\n2022\n.\n^\nKaplan, HI; Saddock, VA (2007).\nSynopsis of Psychiatry\n. New York: Lippincott, Williams & Wilkins. pp. \n501–\n502.\nISBN\n \n978-0-7817-7327-0\n.\n^\nSommer, Iris E.; Tiihonen, Jari; van Mourik, Anouk; Tanskanen, Antti; Taipale, Heidi (1 May 2020).\n\"The clinical course of schizophrenia in women and men-a nation-wide cohort study\"\n.\nnpj Schizophrenia\n.\n6\n(1): 12.\ndoi\n:\n10.1038\/s41537-020-0102-z\n.\nISSN\n \n2334-265X\n.\nPMC\n \n7195359\n.\nPMID\n \n32358572\n.\n^\nFreudenreich, Oliver (3 December 2012).\n\"Differential Diagnosis of Psychotic Symptoms: Medical \"Mimics\"\n\"\n.\nPsychiatric Times\n. UBM Medica. Archived from\nthe original\non 4 June 2013\n. Retrieved\n19 October\n2013\n.\n^\nLake, C.R.; Hurwitz, N. (August 2006). \"Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders\".\nPsychiatry Research\n.\n143\n(\n2–\n3):\n255–\n87.\ndoi\n:\n10.1016\/j.psychres.2005.08.012\n.\nPMID\n \n16857267\n.\nS2CID\n \n35916818\n.\n^\nMarneros & Akiskal 2007\n, pp. 3–4.\n^\nVan Snellenberg, J.X.; de Candia, T. (July 2009). \"Meta-analytic evidence for familial coaggregation of schizophrenia and bipolar disorder\".\nArch. Gen. Psychiatry\n.\n66\n(7):\n748–\n55.\ndoi\n:\n10.1001\/archgenpsychiatry.2009.64\n.\nPMID\n \n19581566\n.\nS2CID\n \n20216200\n.\n^\n\"Schizophrenia and bipolar disorder may share genetic origins\".\nHarv Ment Health Lett\n.\n25\n(12): 7. June 2009.\nPMID\n \n19582944\n.\n^\nPurcell, S.M.; Wray, N.R.; Stone, J.L.; Visscher, P.M.; O'Donovan, M.C.; Sullivan, P.F.; Sklar, P. (July 2009).\n\"Common polygenic variation contributes to risk of schizophrenia and bipolar disorder\"\n.\nNature\n.\n460\n(7256):\n748–\n52.\nBibcode\n:\n2009Natur.460..748P\n.\ndoi\n:\n10.1038\/nature08185\n.\nPMC\n \n3912837\n.\nPMID\n \n19571811\n.\n^\nPotash, J.B.; Bienvenu, OJ (June 2009). \"Neuropsychiatric disorders: Shared genetics of bipolar disorder and schizophrenia\".\nNature Reviews Neurology\n.\n5\n(6):\n299–\n300.\ndoi\n:\n10.1038\/nrneurol.2009.71\n.\nPMID\n \n19498428\n.\nS2CID\n \n21986987\n.\n^\nLake, C.R.; Hurwitz, N. (2007). \"Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease\".\nCurrent Opinion in Psychiatry\n.\n20\n(4):\n365–\n79.\ndoi\n:\n10.1097\/YCO.0b013e3281a305ab\n.\nPMID\n \n17551352\n.\nS2CID\n \n37664803\n.\n^\nAssis, Jorge Cândido de; Villares, Cecília Cruz; Bressan, Rodrigo Affonseca (2023).\nBetween Reason and Illusion: Demystifying Schizophrenia\n. Copernicus Books. Cham: Springer Nature Switzerland.\ndoi\n:\n10.1007\/978-3-031-24556-5\n.\nISBN\n \n978-3-031-24555-8\n.\n^\nFarrell, Michael (2024).\nControversies in schizophrenia: issues, causes, and treatment\n. New York, NY: Routledge, Taylor & Francis Group.\nISBN\n \n978-1-003-41355-4\n.\n^\nSeldin, Katherine; Armstrong, Kristan; Schiff, Max L.; Heckers, Stephan (2017).\n\"Reducing the Diagnostic Heterogeneity of Schizoaffective Disorder\"\n.\nFrontiers in Psychiatry\n.\n8\n: 18.\ndoi\n:\n10.3389\/fpsyt.2017.00018\n.\nISSN\n \n1664-0640\n.\nPMC\n \n5300988\n.\nPMID\n \n28239362\n.\nFurther reading\nMoore, D.P.; Jefferson, J.W. (2004).\nHandbook of medical psychiatry\n(2nd ed.). Philadelphia: Elsevier\/Mosby. pp. \n126–\n127.\nISBN\n \n978-0-323-02911-7\n.\nGoetzt, C.G. (2003).\nTextbook of clinical neurology\n(2nd ed.). Philadelphia: W.B. Saunders. p. 48.\nISBN\n \n978-0-7216-3800-3\n.\nExternal links","attrs_markdown":"[Jump to content](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#bodyContent)\n\nMain menu\n\nMain menu\n\nmove to sidebar\n\nhide\n\nNavigation\n\n- [Main page](https:\/\/en.wikipedia.org\/wiki\/Main_Page \"Visit the main page [z]\")\n- [Contents](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents \"Guides to browsing Wikipedia\")\n- [Current events](https:\/\/en.wikipedia.org\/wiki\/Portal:Current_events \"Articles related to current events\")\n- [Random article](https:\/\/en.wikipedia.org\/wiki\/Special:Random \"Visit a randomly selected article [x]\")\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About \"Learn about Wikipedia and how it works\")\n- [Contact us](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us \"How to contact Wikipedia\")\n\nContribute\n\n- [Help](https:\/\/en.wikipedia.org\/wiki\/Help:Contents \"Guidance on how to use and edit Wikipedia\")\n- [Learn to edit](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction \"Learn how to edit Wikipedia\")\n- [Community portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Community_portal \"The hub for editors\")\n- [Recent changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChanges \"A list of recent changes to Wikipedia [r]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_upload_wizard \"Add images or other media for use on Wikipedia\")\n- [Special pages](https:\/\/en.wikipedia.org\/wiki\/Special:SpecialPages \"A list of all special pages [q]\")\n\n[![](https:\/\/en.wikipedia.org\/static\/images\/icons\/enwiki-25.svg) ![Wikipedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-tagline-en-25.svg)](https:\/\/en.wikipedia.org\/wiki\/Main_Page)\n\n[Search](https:\/\/en.wikipedia.org\/wiki\/Special:Search \"Search Wikipedia [f]\")\n\nAppearance\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Schizoaffective+disorder \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Schizoaffective+disorder \"You're encouraged to log in; however, it's not mandatory. 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[o]\")\n\n## Contents\nmove to sidebar\n\nhide\n\n- [(Top)](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder)\n- [1 Signs and symptoms](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Signs_and_symptoms)\n- [2 Causes](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Causes)\n  Toggle Causes subsection\n  - [2\\.1 Substance use disorder](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Substance_use_disorder)\n- [3 Mechanisms](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Mechanisms)\n- [4 Diagnosis](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Diagnosis)\n  Toggle Diagnosis subsection\n  - [4\\.1 DSM-5 criteria](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#DSM-5_criteria)\n    - [4\\.1.1 Comorbidities](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Comorbidities)\n    - [4\\.1.2 Types](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Types)\n    - [4\\.1.3 Problems with DSM-IV schizoaffective disorder](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Problems_with_DSM-IV_schizoaffective_disorder)\n    - [4\\.1.4 DSM-5 research directions](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#DSM-5_research_directions)\n- [5 Treatment](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Treatment)\n  Toggle Treatment subsection\n  - [5\\.1 Therapy](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Therapy)\n  - [5\\.2 Medication](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Medication)\n    - [5\\.2.1 Clozapine](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Clozapine)\n  - [5\\.3 Electroconvulsive therapy](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Electroconvulsive_therapy)\n- [6 Epidemiology](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Epidemiology)\n- [7 History](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#History)\n- [8 Research](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Research)\n- [9 See also](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#See_also)\n- [10 References](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#References)\n- [11 Further reading](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#Further_reading)\n- [12 External links](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#External_links)\n\nToggle the table of contents\n\n# Schizoaffective disorder\n31 languages\n\n- [العربية](https:\/\/ar.wikipedia.org\/wiki\/%D8%A7%D8%B6%D8%B7%D8%B1%D8%A7%D8%A8_%D9%81%D8%B5%D8%A7%D9%85%D9%8A_%D8%B9%D8%A7%D8%B7%D9%81%D9%8A \"اضطراب فصامي عاطفي – Arabic\")\n- [Basa Bali](https:\/\/ban.wikipedia.org\/wiki\/Panglalah_skizoafektif \"Panglalah skizoafektif – Balinese\")\n- [Català](https:\/\/ca.wikipedia.org\/wiki\/Trastorn_esquizoafectiu \"Trastorn esquizoafectiu – Catalan\")\n- [Čeština](https:\/\/cs.wikipedia.org\/wiki\/Schizoafektivn%C3%AD_porucha \"Schizoafektivní porucha – Czech\")\n- [Deutsch](https:\/\/de.wikipedia.org\/wiki\/Schizoaffektive_St%C3%B6rung \"Schizoaffektive Störung – German\")\n- [Ελληνικά](https:\/\/el.wikipedia.org\/wiki\/%CE%A3%CF%87%CE%B9%CE%B6%CE%BF%CF%83%CF%85%CE%BD%CE%B1%CE%B9%CF%83%CE%B8%CE%B7%CE%BC%CE%B1%CF%84%CE%B9%CE%BA%CE%AE_%CE%B4%CE%B9%CE%B1%CF%84%CE%B1%CF%81%CE%B1%CF%87%CE%AE \"Σχιζοσυναισθηματική διαταραχή – Greek\")\n- [Esperanto](https:\/\/eo.wikipedia.org\/wiki\/Skizoafektiva_perturbo \"Skizoafektiva perturbo – Esperanto\")\n- [Español](https:\/\/es.wikipedia.org\/wiki\/Trastorno_esquizoafectivo \"Trastorno esquizoafectivo – Spanish\")\n- [Euskara](https:\/\/eu.wikipedia.org\/wiki\/Nahasmendu_eskizoafektibo \"Nahasmendu eskizoafektibo – Basque\")\n- [فارسی](https:\/\/fa.wikipedia.org\/wiki\/%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D8%A7%D8%B3%DA%A9%DB%8C%D8%B2%D9%88%D8%A7%D9%81%DA%A9%D8%AA%DB%8C%D9%88 \"اختلال اسکیزوافکتیو – Persian\")\n- [Suomi](https:\/\/fi.wikipedia.org\/wiki\/Skitsoaffektiivinen_h%C3%A4iri%C3%B6 \"Skitsoaffektiivinen häiriö – Finnish\")\n- [Français](https:\/\/fr.wikipedia.org\/wiki\/Trouble_schizo-affectif \"Trouble schizo-affectif – French\")\n- [עברית](https:\/\/he.wikipedia.org\/wiki\/%D7%94%D7%A4%D7%A8%D7%A2%D7%94_%D7%A1%D7%9B%D7%99%D7%96%D7%95%D7%90%D7%A4%D7%A7%D7%98%D7%99%D7%91%D7%99%D7%AA \"הפרעה סכיזואפקטיבית – Hebrew\")\n- [Magyar](https:\/\/hu.wikipedia.org\/wiki\/Szkizoaffekt%C3%ADv_zavar \"Szkizoaffektív zavar – Hungarian\")\n- [Bahasa Indonesia](https:\/\/id.wikipedia.org\/wiki\/Gangguan_skizoafektif \"Gangguan skizoafektif – Indonesian\")\n- [Italiano](https:\/\/it.wikipedia.org\/wiki\/Disturbo_schizoaffettivo \"Disturbo schizoaffettivo – Italian\")\n- [日本語](https:\/\/ja.wikipedia.org\/wiki\/%E7%B5%B1%E5%90%88%E5%A4%B1%E8%AA%BF%E6%84%9F%E6%83%85%E9%9A%9C%E5%AE%B3 \"統合失調感情障害 – Japanese\")\n- [Nederlands](https:\/\/nl.wikipedia.org\/wiki\/Schizoaffectieve_stoornis \"Schizoaffectieve stoornis – Dutch\")\n- [Norsk bokmål](https:\/\/no.wikipedia.org\/wiki\/Schizoaffektiv_lidelse \"Schizoaffektiv lidelse – Norwegian Bokmål\")\n- [ଓଡ଼ିଆ](https:\/\/or.wikipedia.org\/wiki\/%E0%AC%B8%E0%AC%BF%E0%AC%9C%E0%AD%8B%E0%AC%86%E0%AC%AB%E0%AD%87%E0%AC%95%E0%AD%8D%E0%AC%9F%E0%AC%BF%E0%AC%AD_%E0%AC%AC%E0%AD%87%E0%AC%AE%E0%AC%BE%E0%AC%B0%E0%AD%80 \"ସିଜୋଆଫେକ୍ଟିଭ ବେମାରୀ – Odia\")\n- [Polski](https:\/\/pl.wikipedia.org\/wiki\/Zaburzenia_schizoafektywne \"Zaburzenia schizoafektywne – Polish\")\n- [Português](https:\/\/pt.wikipedia.org\/wiki\/Transtorno_esquizoafetivo \"Transtorno esquizoafetivo – Portuguese\")\n- [Русский](https:\/\/ru.wikipedia.org\/wiki\/%D0%A8%D0%B8%D0%B7%D0%BE%D0%B0%D1%84%D1%84%D0%B5%D0%BA%D1%82%D0%B8%D0%B2%D0%BD%D0%BE%D0%B5_%D1%80%D0%B0%D1%81%D1%81%D1%82%D1%80%D0%BE%D0%B9%D1%81%D1%82%D0%B2%D0%BE \"Шизоаффективное расстройство – Russian\")\n- [Simple English](https:\/\/simple.wikipedia.org\/wiki\/Schizoaffective_disorder \"Schizoaffective disorder – Simple English\")\n- [Slovenčina](https:\/\/sk.wikipedia.org\/wiki\/Schizoafekt%C3%ADvna_porucha \"Schizoafektívna porucha – Slovak\")\n- [Српски \/ srpski](https:\/\/sr.wikipedia.org\/wiki\/%C5%A0izoafektivni_poreme%C4%87aj \"Šizoafektivni poremećaj – Serbian\")\n- [Svenska](https:\/\/sv.wikipedia.org\/wiki\/Schizoaffektivt_syndrom \"Schizoaffektivt syndrom – Swedish\")\n- [Türkçe](https:\/\/tr.wikipedia.org\/wiki\/%C5%9Eizoaffektif_bozukluk \"Şizoaffektif bozukluk – Turkish\")\n- [Українська](https:\/\/uk.wikipedia.org\/wiki\/%D0%A8%D0%B8%D0%B7%D0%BE%D0%B0%D1%84%D0%B5%D0%BA%D1%82%D0%B8%D0%B2%D0%BD%D0%B8%D0%B9_%D1%80%D0%BE%D0%B7%D0%BB%D0%B0%D0%B4 \"Шизоафективний розлад – Ukrainian\")\n- [اردو](https:\/\/ur.wikipedia.org\/wiki\/%D8%B4%DB%8C%D8%B2%D9%88_%D8%A7%D9%81%DB%8C%DA%A9%D9%B9%DB%8C%D9%88_%D8%B9%D8%A7%D8%B1%D8%B6%DB%81 \"شیزو افیکٹیو عارضہ – Urdu\")\n- [中文](https:\/\/zh.wikipedia.org\/wiki\/%E5%88%86%E8%A3%82%E6%83%85%E6%84%9F%E9%9A%9C%E7%A2%8D \"分裂情感障碍 – Chinese\")\n\n[Edit links](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q834047#sitelinks-wikipedia \"Edit interlanguage links\")\n\n- [Article](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder \"View the content page [c]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Talk:Schizoaffective_disorder \"Discuss improvements to the content page [t]\")\n\nEnglish\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder)\n- [View source](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&action=edit \"This page is protected.\n  You can view its source [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&action=history \"Past revisions of this page [h]\")\n\nTools\n\nTools\n\nmove to sidebar\n\nhide\n\nActions\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder)\n- [View source](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&action=edit)\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&action=history)\n\nGeneral\n\n- [What links here](https:\/\/en.wikipedia.org\/wiki\/Special:WhatLinksHere\/Schizoaffective_disorder \"List of all English Wikipedia pages containing links to this page [j]\")\n- [Related changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChangesLinked\/Schizoaffective_disorder \"Recent changes in pages linked from this page [k]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_Upload_Wizard \"Upload files [u]\")\n- [Permanent link](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&oldid=1336230406 \"Permanent link to this revision of this page\")\n- [Page information](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&action=info \"More information about this page\")\n- [Cite this page](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CiteThisPage&page=Schizoaffective_disorder&id=1336230406&wpFormIdentifier=titleform \"Information on how to cite this page\")\n- [Get shortened URL](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UrlShortener&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FSchizoaffective_disorder)\n\nPrint\/export\n\n- [Download as PDF](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:DownloadAsPdf&page=Schizoaffective_disorder&action=show-download-screen \"Download this page as a PDF file\")\n- [Printable version](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&printable=yes \"Printable version of this page [p]\")\n\nIn other projects\n\n- [Wikidata item](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q834047 \"Structured data on this page hosted by Wikidata [g]\")\n\nAppearance\n\nmove to sidebar\n\nhide\n\n[![Page semi-protected](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/1b\/Semi-protection-shackle.svg\/20px-Semi-protection-shackle.svg.png)](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Protection_policy#semi \"This article is semi-protected until September 29, 2026 at 16:47 UTC, to prevent sock puppets of blocked or banned users from editing it\")\n\nFrom Wikipedia, the free encyclopedia\n\nMental disorder\n\n|   |   |\n|---|---|\n| ![](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/f2\/Edit-clear.svg\/40px-Edit-clear.svg.png) | This article may **require [cleanup](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Cleanup \"Wikipedia:Cleanup\")** to meet Wikipedia's [quality standards](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style \"Wikipedia:Manual of Style\"). The specific problem is: **This article is mostly about ideas about treatment, and does not read like a reference.** Please help [improve this article](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Schizoaffective_disorder \"Special:EditPage\/Schizoaffective disorder\") if you can. *(April 2025)* *([Learn how and when to remove this message](https:\/\/en.wikipedia.org\/wiki\/Help:Maintenance_template_removal \"Help:Maintenance template removal\"))* |\n\nMedical condition\n\n| Schizoaffective disorder |   |\n|---|---|\n| [Specialty](https:\/\/en.wikipedia.org\/wiki\/Medical_specialty \"Medical specialty\") | [Psychiatry](https:\/\/en.wikipedia.org\/wiki\/Psychiatry \"Psychiatry\") |\n| [Symptoms](https:\/\/en.wikipedia.org\/wiki\/Signs_and_symptoms \"Signs and symptoms\") | [Hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucinations \"Hallucinations\") [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusions \"Delusions\") [disorganized thought and behavior](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\") [inappropriate affect](https:\/\/en.wikipedia.org\/wiki\/Inappropriate_affect \"Inappropriate affect\") [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") |\n| [Complications](https:\/\/en.wikipedia.org\/wiki\/Complication_\\(medicine\\) \"Complication (medicine)\") | lack of motivation cognitive issues risk of harm to self or others anxiety disorders |\n| Usual onset | 16–30 years of age |\n| Types | bipolar type[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-1) depressive type[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-2) Mixed type (Includes both depressive and bipolar symptoms) |\n| [Causes](https:\/\/en.wikipedia.org\/wiki\/Cause_\\(medicine\\) \"Cause (medicine)\") | Unknown[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-NAMI2017-3) |\n| [Risk factors](https:\/\/en.wikipedia.org\/wiki\/Risk_factor \"Risk factor\") | Genetics brain chemistry and structure stress drug use[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-NAMI2017-3) |\n| [Diagnostic method](https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis \"Medical diagnosis\") | [Psychiatric assessment](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_assessment \"Psychiatric assessment\") |\n| [Differential diagnosis](https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis \"Differential diagnosis\") | Psychotic depression bipolar disorder with psychotic features schizophreniform disorder schizophrenia |\n| [Medication](https:\/\/en.wikipedia.org\/wiki\/Medication \"Medication\") | [Antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Antipsychotics \"Antipsychotics\") [mood stabilizers](https:\/\/en.wikipedia.org\/wiki\/Mood_stabilizers \"Mood stabilizers\") [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressants \"Antidepressants\") |\n| [Prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\") | Depends on the individual, medication response, and therapeutic support available |\n| Frequency | 0\\.3% |\n\n**Schizoaffective disorder** is a [mental disorder](https:\/\/en.wikipedia.org\/wiki\/Mental_disorder \"Mental disorder\") characterized by symptoms of both [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") ([psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\")) and a [mood disorder](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\"), either [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") or [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\").[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Common symptoms include [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucination \"Hallucination\"), [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusion \"Delusion\"), [disorganized speech and thinking](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\"), as well as mood episodes.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-6) Schizoaffective disorder can often be [misdiagnosed](https:\/\/en.wikipedia.org\/wiki\/Misdiagnosed \"Misdiagnosed\")[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the correct diagnosis may be [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), [bipolar I disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_I_disorder \"Bipolar I disorder\"), [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\"), or schizophrenia. This is a problem as treatment and [prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\") differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including [anxiety disorders](https:\/\/en.wikipedia.org\/wiki\/Anxiety_disorders \"Anxiety disorders\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock.-7)\n\nThere are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8) [Auditory hallucinations](https:\/\/en.wikipedia.org\/wiki\/Auditory_hallucination \"Auditory hallucination\") are most common.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18056246-9)[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-10) The onset of symptoms usually begins in adolescence or young adulthood.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:22-11)\n\n[Genetics](https:\/\/en.wikipedia.org\/wiki\/Genetics \"Genetics\") (researched in the field of [genomics](https:\/\/en.wikipedia.org\/wiki\/Genomics \"Genomics\")); problems with [neural circuits](https:\/\/en.wikipedia.org\/wiki\/Neural_circuits \"Neural circuits\"); chronic early, and chronic or short-term current [environmental stress](https:\/\/en.wikipedia.org\/wiki\/Stress_\\(biology\\) \"Stress (biology)\") appear to be important causal factors.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-12)[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-13)[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-14) No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of [tetrahydrobiopterin](https:\/\/en.wikipedia.org\/wiki\/Tetrahydrobiopterin \"Tetrahydrobiopterin\") (BH4), [dopamine](https:\/\/en.wikipedia.org\/wiki\/Dopamine \"Dopamine\"), and [glutamic acid](https:\/\/en.wikipedia.org\/wiki\/Glutamic_acid \"Glutamic acid\") in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-15)\n\nWhile a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-16) it is considered a common diagnosis among psychiatric disorders.[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-17) Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them.\n\nThe main current treatment is [antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Antipsychotic \"Antipsychotic\") medication combined with either [mood stabilizers](https:\/\/en.wikipedia.org\/wiki\/Mood_stabilizer \"Mood stabilizer\") or [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressant \"Antidepressant\") (or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\] When there is risk to self or others, usually early in treatment, hospitalization may be necessary.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) [Psychiatric rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_rehabilitation \"Psychiatric rehabilitation\"), [psychotherapy](https:\/\/en.wikipedia.org\/wiki\/Psychotherapy \"Psychotherapy\"), and [vocational rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Vocational_rehabilitation \"Vocational rehabilitation\") are very important for [recovery](https:\/\/en.wikipedia.org\/wiki\/Recovery_approach \"Recovery approach\") of higher psychosocial function\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]. As a group, people diagnosed with schizoaffective disorder using [DSM-IV](https:\/\/en.wikipedia.org\/wiki\/DSM-IV \"DSM-IV\") and [ICD-10](https:\/\/en.wikipedia.org\/wiki\/ICD-10 \"ICD-10\") criteria (which have since been updated\\[*[clarification needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify \"Wikipedia:Please clarify\")*\\]) have a better [outcome](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\"),[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\\[*[non-primary source needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:No_original_research#Primary,_secondary_and_tertiary_sources \"Wikipedia:No original research\")*\\] Outcomes for people with [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") diagnosed schizoaffective disorder depend on data from [prospective cohort studies](https:\/\/en.wikipedia.org\/wiki\/Prospective_cohort_studies \"Prospective cohort studies\"), which have not been completed yet.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV [prevalence](https:\/\/en.wikipedia.org\/wiki\/Prevalence \"Prevalence\") estimates were less than one percent of the population, in the range of 0.5–0.8 percent;[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20) newer DSM-5 prevalence estimates are not yet available.\n\n## Signs and symptoms\nSchizoaffective disorder is defined by *mood disorder-free psychosis* in the context of a long-term psychotic and mood disorder.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) [Psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") must meet criterion A for [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") which may include [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusions \"Delusions\"), [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucinations \"Hallucinations\"), [disorganized speech and behavior](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\") and [negative symptoms](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia#Negative_symptoms \"Schizophrenia\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Both delusions and hallucinations are classic symptoms of psychosis.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Delusions are false beliefs which are strongly held despite evidence to the contrary.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although [auditory hallucinations](https:\/\/en.wikipedia.org\/wiki\/Auditory_hallucination \"Auditory hallucination\") (or \"hearing voices\") are the most common. Negative symptoms include [alogia](https:\/\/en.wikipedia.org\/wiki\/Alogia \"Alogia\") (lack of speech), [blunted affect](https:\/\/en.wikipedia.org\/wiki\/Blunted_affect \"Blunted affect\") (reduced intensity of outward emotional expression), [avolition](https:\/\/en.wikipedia.org\/wiki\/Avolition \"Avolition\") (lack of motivation), and [anhedonia](https:\/\/en.wikipedia.org\/wiki\/Anhedonia \"Anhedonia\") (inability to experience pleasure).[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.\n\nMood symptoms include [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), [mixed episode](https:\/\/en.wikipedia.org\/wiki\/Mixed_episode \"Mixed episode\"), or [depression](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\"), and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and [suicidal thinking](https:\/\/en.wikipedia.org\/wiki\/Suicidal_thinking \"Suicidal thinking\").\n\nDSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)\n\n## Causes\nA combination of genetic and [environmental factors](https:\/\/en.wikipedia.org\/wiki\/Environmental_factor \"Environmental factor\") are believed to play a role in the development of schizoaffective disorder.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Lancet09-22)[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ07-23)\n\n> Genetic studies do not support the view that schizophrenia, psychotic [mood disorders](https:\/\/en.wikipedia.org\/wiki\/Mood_disorders \"Mood disorders\") and schizoaffective disorder are distinct [etiological](https:\/\/en.wikipedia.org\/wiki\/Etiology \"Etiology\") entities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\"), and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective \\[or mood disorder\\] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and [pathogenesis](https:\/\/en.wikipedia.org\/wiki\/Pathogenesis \"Pathogenesis\"). Laboratory studies of putative [endophenotypes](https:\/\/en.wikipedia.org\/wiki\/Endophenotype \"Endophenotype\"), [brain imaging](https:\/\/en.wikipedia.org\/wiki\/Brain_imaging \"Brain imaging\") studies, and [post mortem](https:\/\/en.wikipedia.org\/wiki\/Post_mortem \"Post mortem\") studies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects.\n\n— According to [William T. Carpenter](https:\/\/en.wikipedia.org\/wiki\/William_T._Carpenter \"William T. Carpenter\") the head of the [University of Maryland, Baltimore](https:\/\/en.wikipedia.org\/wiki\/University_of_Maryland,_Baltimore \"University of Maryland, Baltimore\") School of Medicine DSM-5 psychotic disorders workgroup, and others.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nViewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced [paternal age](https:\/\/en.wikipedia.org\/wiki\/Paternal_age \"Paternal age\") at the time of conception, a known cause of genetic mutations.[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-24) The physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human [neurophysiological](https:\/\/en.wikipedia.org\/wiki\/Neurophysiology \"Neurophysiology\") function in normal brain and mental disorder [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndromes \"Syndromes\") is not fully understood.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18056246-9)\n\nWhile there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) In some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\n### Substance use disorder\nA clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of [cannabis (marijuana)](https:\/\/en.wikipedia.org\/wiki\/Cannabis_\\(drug\\) \"Cannabis (drug)\"), however, evidence supports a link between earlier onset of psychotic illness and cannabis use.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-26) The more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness,[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-27)[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-28)[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Moore_TH,_Zammit_S,_[[Anne_Lingford-Hughes|Lingford-Hughes_A]],_et_al._2005_187-94-29) with frequent use being correlated with double the risk of psychosis and schizoaffective disorder.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-30) A 2009 Yale review stated that in individuals with an established psychotic disorder, [cannabinoids](https:\/\/en.wikipedia.org\/wiki\/Cannabinoids \"Cannabinoids\") can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-31) While cannabis use is accepted as a contributory cause of schizoaffective disorder by many,[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Henquet2008-32) it remains controversial,[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Genes10-33)[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Amar2007-34) since not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased [odds ratio](https:\/\/en.wikipedia.org\/wiki\/Odds_ratio \"Odds ratio\") of about 3.[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Cannabis&Psychosis-35) Certain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n## Mechanisms\nThough the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36) [White matter](https:\/\/en.wikipedia.org\/wiki\/White_matter \"White matter\") and [grey matter](https:\/\/en.wikipedia.org\/wiki\/Grey_matter \"Grey matter\") reductions in the right [lentiform nucleus](https:\/\/en.wikipedia.org\/wiki\/Lentiform_nucleus \"Lentiform nucleus\"), left [superior temporal gyrus](https:\/\/en.wikipedia.org\/wiki\/Superior_temporal_gyrus \"Superior temporal gyrus\"), and right [precuneus](https:\/\/en.wikipedia.org\/wiki\/Precuneus \"Precuneus\"), and other areas in the brain are also characteristic of schizoaffective disorder.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36)[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:42-37) Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:42-37) Due to its role in emotional regulation, researchers believe that the [hippocampus](https:\/\/en.wikipedia.org\/wiki\/Hippocampus \"Hippocampus\") is also involved in the progression of schizoaffective disorder.[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:52-38) Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:52-38) Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36)\n\n## Diagnosis\nPsychosis as a [symptom](https:\/\/en.wikipedia.org\/wiki\/Symptom \"Symptom\") of a psychiatric disorder is first and foremost a [diagnosis of exclusion](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\").[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) So a new-onset episode of psychosis *cannot* be considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39)\n\nAn initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to [exclude](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") psychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital.\n\n[Delirium](https:\/\/en.wikipedia.org\/wiki\/Delirium \"Delirium\") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Excluding medical illnesses associated with psychosis is performed by using [blood tests](https:\/\/en.wikipedia.org\/wiki\/Blood_tests \"Blood tests\") to measure:\n\n- [Thyroid-stimulating hormone](https:\/\/en.wikipedia.org\/wiki\/Thyroid-stimulating_hormone \"Thyroid-stimulating hormone\") to exclude [hypo-](https:\/\/en.wikipedia.org\/wiki\/Hypothyroidism \"Hypothyroidism\") or [hyperthyroidism](https:\/\/en.wikipedia.org\/wiki\/Hyperthyroidism \"Hyperthyroidism\"),\n- Basic electrolytes and [serum calcium](https:\/\/en.wikipedia.org\/wiki\/Serum_calcium \"Serum calcium\") to rule out a metabolic disturbance,\n- [Full blood count](https:\/\/en.wikipedia.org\/wiki\/Complete_blood_count \"Complete blood count\") including [ESR](https:\/\/en.wikipedia.org\/wiki\/Erythrocyte_sedimentation_rate \"Erythrocyte sedimentation rate\") to rule out a systemic infection or chronic disease, and\n- [Serology](https:\/\/en.wikipedia.org\/wiki\/Serology \"Serology\") to exclude [syphilis](https:\/\/en.wikipedia.org\/wiki\/Syphilis \"Syphilis\") or [HIV](https:\/\/en.wikipedia.org\/wiki\/HIV \"HIV\") infection.\n\nOther investigations which may be performed include:\n\n- [EEG](https:\/\/en.wikipedia.org\/wiki\/EEG \"EEG\") to exclude [epilepsy](https:\/\/en.wikipedia.org\/wiki\/Epilepsy \"Epilepsy\"), and an\n- [MRI](https:\/\/en.wikipedia.org\/wiki\/MRI \"MRI\") or [CT scan](https:\/\/en.wikipedia.org\/wiki\/CT_scan \"CT scan\") of the head to exclude brain lesions.\n\nBlood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific *medical* indication. These may include serum [BSL](https:\/\/en.wikipedia.org\/wiki\/Blood_sugar \"Blood sugar\") if [olanzapine](https:\/\/en.wikipedia.org\/wiki\/Olanzapine \"Olanzapine\") has previously been prescribed, thyroid function if [lithium](https:\/\/en.wikipedia.org\/wiki\/Lithium_\\(medication\\) \"Lithium (medication)\") has previously been taken to rule out [hypothyroidism](https:\/\/en.wikipedia.org\/wiki\/Hypothyroidism \"Hypothyroidism\"), liver function tests if [chlorpromazine](https:\/\/en.wikipedia.org\/wiki\/Chlorpromazine \"Chlorpromazine\") has been prescribed, [CPK](https:\/\/en.wikipedia.org\/wiki\/Creatine_kinase \"Creatine kinase\") levels to exclude [neuroleptic malignant syndrome](https:\/\/en.wikipedia.org\/wiki\/Neuroleptic_malignant_syndrome \"Neuroleptic malignant syndrome\"), and a [urinalysis](https:\/\/en.wikipedia.org\/wiki\/Urinalysis \"Urinalysis\") and serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.\n\nBecause psychosis may be precipitated or exacerbated by common classes of [psychiatric medications](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_medications \"Psychiatric medications\"), such as [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressant \"Antidepressant\"),[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis2-44) [ADHD stimulant medications](https:\/\/en.wikipedia.org\/wiki\/ADHD#Medication \"ADHD\"),[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-45)[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-ReferenceB-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47) and [sleep medications](https:\/\/en.wikipedia.org\/wiki\/Hypnotics \"Hypnotics\"),[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) [prescribed medication-induced psychosis](https:\/\/en.wikipedia.org\/wiki\/Substance-induced_psychosis \"Substance-induced psychosis\") should be [ruled out](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\"), particularly for first-episode psychosis.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) This is an essential step to reduce diagnostic error and to evaluate potential medication sources of further [patient harm](https:\/\/en.wikipedia.org\/wiki\/Iatrogenesis \"Iatrogenesis\").[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Regarding prescribed medication sources of patient harm, [Yale School of Medicine](https:\/\/en.wikipedia.org\/wiki\/Yale_School_of_Medicine \"Yale School of Medicine\") Professor of Psychiatry Malcolm B. Bowers Jr, MD wrote:[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Malcolm2004-50)\\[*[self-published source](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Verifiability#Self-published_sources \"Wikipedia:Verifiability\")*\\]\n\n> Illicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field \\[of psychiatry\\] and disastrous for some of our patients.\n> \n> > It is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications, *I am urging caution in their use*. I believe \\[clinicians\\] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by \\[the clinician\\] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for \\[the clinician\\] to take. *I believe that psychiatry as a field has not emphasized this point sufficiently*. As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed.[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-ReferenceB-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47)[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49)\n\nSubstance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be [excluded](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") to a high level of certainty while the person is psychotic, typically in an emergency department, using both a:\n\n- Broad spectrum urine toxicology screening, and a\n- Full serum toxicology screening (of the blood).\n\nSome [dietary supplements](https:\/\/en.wikipedia.org\/wiki\/Dietary_supplements \"Dietary supplements\") may also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-51)\n\nCommon mistakes made when diagnosing psychotic patients include:[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39)\n\n- Not properly excluding delirium,\n- Missing a [toxic psychosis](https:\/\/en.wikipedia.org\/wiki\/Substance-induced_psychosis \"Substance-induced psychosis\") by not screening for substances *and* medications,\n- Not appreciating medical abnormalities (e.g., [vital signs](https:\/\/en.wikipedia.org\/wiki\/Vital_signs \"Vital signs\")),\n- Not obtaining a medical history and family history,\n- Indiscriminate screening without an organizing framework,\n- Not asking family or others about dietary supplements,\n- Premature diagnostic closure, and\n- Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder.\n\nSchizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) such as [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucination \"Hallucination\") or [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusion \"Delusion\"), and [depressive episodes](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\"). There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) Research has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse.[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-53) There are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\nOnly after these relevant and known causes of psychosis have been ruled out can a psychiatric [differential diagnosis](https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis \"Differential diagnosis\") be made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include:\n\n- Not screening for [dissociative disorders](https:\/\/en.wikipedia.org\/wiki\/Dissociative_disorders \"Dissociative disorders\"). [Dissociative identity disorder](https:\/\/en.wikipedia.org\/wiki\/Dissociative_identity_disorder \"Dissociative identity disorder\") and psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach.[\\[54\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-54)\n### DSM-5 criteria\nThe most widely used criteria for diagnosing schizoaffective disorder are from the [American Psychiatric Association](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\")'s *[Diagnostic and Statistical Manual of Mental Disorders-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\")*.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or [unreliably](https:\/\/en.wikipedia.org\/wiki\/Reliability_\\(statistics\\) \"Reliability (statistics)\")) used on patients;[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the diagnosis is made, it does not stay with most patients over time,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) and it has questionable [diagnostic validity](https:\/\/en.wikipedia.org\/wiki\/Validity_\\(statistics\\) \"Validity (statistics)\") (that is, it does not describe a distinct disorder, nor predict any particular outcome).[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These problems have been slightly reduced (or \"modestly improved\") in the [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") according to Carpenter.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nWhen [psychotic](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") symptoms are confined to an episode of [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") or [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") (with or without [mixed features](https:\/\/en.wikipedia.org\/wiki\/Mixed_affective_state \"Mixed affective state\")), the diagnosis is that of a \"psychotic\" [mood disorder](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\"), namely either psychotic [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") or [psychotic major depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"). Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder, [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\") or [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe.\n\nDSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) As such, it is no longer an \"episode diagnosis.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The new schizoaffective framework looks at the time from \"the \\[first episode of\\] psychosis up to the current episode \\[of psychosis\\], rather than only defining a single episode with \\[co-occurring\\] psychotic and mood [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndrome \"Syndrome\").\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The other period of psychosis \"requires the overlap of mood \\[disorder\\] symptoms with psychotic symptoms to be conspicuous\" and last for a greater portion of the disorder.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)\n\nThese two changes are intended by the DSM-5 workgroup to accomplish two goals:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n- Increase the diagnosis' consistency (or reliability) when it is used;\n- Significantly decrease the overall use of the schizoaffective disorder diagnosis.\n\nIf the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of [psychiatric genetics](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_genetics \"Psychiatric genetics\"), [neuroimaging](https:\/\/en.wikipedia.org\/wiki\/Neuroimaging \"Neuroimaging\"), and [cognitive science](https:\/\/en.wikipedia.org\/wiki\/Cognitive_science \"Cognitive science\") that includes the overlapping fields of [cognitive](https:\/\/en.wikipedia.org\/wiki\/Cognitive_neuroscience \"Cognitive neuroscience\"), [affective](https:\/\/en.wikipedia.org\/wiki\/Affective_neuroscience \"Affective neuroscience\"), and [social neuroscience](https:\/\/en.wikipedia.org\/wiki\/Social_neuroscience \"Social neuroscience\"), which may change the way schizoaffective disorder is [conceptualized](https:\/\/en.wikipedia.org\/wiki\/Construct_\\(philosophy_of_science\\) \"Construct (philosophy of science)\") and defined in future versions of the [DSM](https:\/\/en.wikipedia.org\/wiki\/Diagnostic_and_Statistical_Manual_of_Mental_Disorders \"Diagnostic and Statistical Manual of Mental Disorders\") and [ICD](https:\/\/en.wikipedia.org\/wiki\/ICD \"ICD\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-TransformingDiagnosis-56)\n\n#### Comorbidities\nSchizoaffective disorder shares a high level of [comorbidity](https:\/\/en.wikipedia.org\/wiki\/Comorbidity \"Comorbidity\") with anxiety disorders, depression, and bipolar disorder.[\\[57\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-57)[\\[58\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-58) Individuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to [tobacco](https:\/\/en.wikipedia.org\/wiki\/Tobacco \"Tobacco\"), [marijuana](https:\/\/en.wikipedia.org\/wiki\/Cannabis_\\(drug\\) \"Cannabis (drug)\"), or [alcohol](https:\/\/en.wikipedia.org\/wiki\/Alcohol_\\(drug\\) \"Alcohol (drug)\").[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-59) Health care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder.\n\n#### Types\nOne of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder:[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8)\n\n- Bipolar type, when the disturbance includes [manic episodes](https:\/\/en.wikipedia.org\/wiki\/Manic_episodes \"Manic episodes\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), or [mixed episodes](https:\/\/en.wikipedia.org\/wiki\/Mixed_episodes \"Mixed episodes\")—major depressive episodes also typically occur;\n- Depressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes.\n- Mixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder.[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8)\n#### Problems with DSM-IV schizoaffective disorder\nThe [American Psychiatric Association's](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\") DSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) largely because the criteria were poorly defined, [ambiguous](https:\/\/en.wikipedia.org\/wiki\/Ambiguity \"Ambiguity\"), and hard to use (or poorly [operationalized](https:\/\/en.wikipedia.org\/wiki\/Operationalization \"Operationalization\")).[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18199238-60) Poorly trained clinicians used the diagnosis without making necessary [exclusions](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") of common causes of psychosis, including some prescribed psychiatric medications.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis.[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-The_Overlap_of_Schizophrenic_and_Affective_Spectra-61)[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_Disorders:_New_Research-64)\n\nCarpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n> a recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused.\n\nAs stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Even when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records, [reliability](https:\/\/en.wikipedia.org\/wiki\/Interrater_reliability \"Interrater reliability\") was still poor for the DSM-IV schizoaffective diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-IV schizoaffective diagnosis is not stable over time either.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) An initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) By comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Most patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nIn April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were \"developing new criteria for schizoaffective disorder to improve reliability and [face validity](https:\/\/en.wikipedia.org\/wiki\/Face_validity \"Face validity\"),\" and were \"determining whether the dimensional assessment of mood \\[would\\] justify a recommendation to drop schizoaffective disorder as a diagnostic category.\"[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20) Speaking to an audience at the May 2009 annual conference of the [American Psychiatric Association](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\"), Carpenter said:[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20)\n\n> We had hoped to get rid of schizoaffective \\[disorder\\] as a diagnostic category \\[in the DSM-5\\] because we don't think it's \\[a\\] valid \\[scientific entity\\] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice.\n\nA major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV \"schizophrenia\" or \"mood disorder with psychotic features\".\n\nBut DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a \"mood disorder with psychotic features\" diagnosis,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) because [long-term data](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_data \"Longitudinal data\") revealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) even though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\n\nThese problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed;[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) furthermore, [outcome studies](https:\/\/en.wikipedia.org\/wiki\/Cohort_study \"Cohort study\") done 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor [prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also.\n\n#### DSM-5 research directions\nThe new schizoaffective disorder criteria continue to have questionable diagnostic validity.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Questionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5 [categorizes](https:\/\/en.wikipedia.org\/wiki\/Categorization \"Categorization\") and defines schizoaffective disorder.\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/29\/Emil_Kraepelin2.gif)](https:\/\/en.wikipedia.org\/wiki\/File:Emil_Kraepelin2.gif)\n\n[Emil Kraepelin's](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") [dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\") (\n\nc.\n\n1898) continues to influence [classification and diagnosis](https:\/\/en.wikipedia.org\/wiki\/Nosology \"Nosology\") in psychiatry.\n\nA core concept in modern psychiatry since [DSM-III](https:\/\/en.wikipedia.org\/wiki\/DSM_III#DSM-III_\\(1980\\) \"DSM III\") was released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the [Kraepelinian dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\"). [Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") introduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before [genetics](https:\/\/en.wikipedia.org\/wiki\/Genetics \"Genetics\") were known and before any treatments existed for [mental illness](https:\/\/en.wikipedia.org\/wiki\/Mental_illness \"Mental illness\").[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) The Kraepelinian dichotomy was not used for [DSM-I](https:\/\/en.wikipedia.org\/wiki\/DSM-I \"DSM-I\") and [DSM-II](https:\/\/en.wikipedia.org\/wiki\/DSM-II \"DSM-II\") because both manuals were influenced by the dominant [psychodynamic](https:\/\/en.wikipedia.org\/wiki\/Psychodynamic \"Psychodynamic\") psychiatry of the time,[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Revolution-66) but the designers of DSM-III wanted to use more scientific and biological definitions.[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Revolution-66) Consequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system.\n\nThe Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by [data](https:\/\/en.wikipedia.org\/wiki\/Empirical_data \"Empirical data\") from modern psychiatric genetics for over eight years,[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-EndofKraepelinianDichotomy-67) and there is now [evidence](https:\/\/en.wikipedia.org\/wiki\/Empirical_evidence \"Empirical evidence\") of a significant overlap in the genetics of schizophrenia and bipolar disorder.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) According to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken [false dichotomy](https:\/\/en.wikipedia.org\/wiki\/False_dichotomy \"False dichotomy\").[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nThe dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Real life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder.[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) People with [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Thus, they are likely to continue to introduce [either-or](https:\/\/en.wikipedia.org\/wiki\/False_dichotomy \"False dichotomy\") [conceptual](https:\/\/en.wikipedia.org\/wiki\/Conceptualization \"Conceptualization\") and diagnostic error, by way of [confirmation bias](https:\/\/en.wikipedia.org\/wiki\/Confirmation_bias \"Confirmation bias\") into clinicians' [mindsets](https:\/\/en.wikipedia.org\/wiki\/Mindset \"Mindset\"), hindering accurate assessment and treatment.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nThe new definition continues the lack of [parsimony](https:\/\/en.wikipedia.org\/wiki\/Occam%27s_razor \"Occam's razor\") of the old definition.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Simpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more \"research \\[is\\] needed to establish a new [classification system](https:\/\/en.wikipedia.org\/wiki\/Nosology \"Nosology\") of equal or greater validity\"[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) to the existing system.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Because of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) After enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a [spectrum or dimensional approach](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") to diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nMore [parsimonious](https:\/\/en.wikipedia.org\/wiki\/Occam%27s_razor \"Occam's razor\") definitions than the current one were considered by Carpenter and the DSM-5 workgroup:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n> One option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective \\[or mood\\] symptoms \\[that is, [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), [mixed episode](https:\/\/en.wikipedia.org\/wiki\/Mixed_state_\\(psychiatry\\) \"Mixed state (psychiatry)\"), or [depression](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\")\\] as a dimension to [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") and [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\") *or* to define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect \\[or mood\\] dimensions covering the entire course of illness, that would capture the current [concept](https:\/\/en.wikipedia.org\/wiki\/Conceptualization \"Conceptualization\") of periods of psychosis related and unrelated to mood episodes.\n\n> \\[N\\]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis \\[or psychotic [mood disorders](https:\/\/en.wikipedia.org\/wiki\/Mood_disorders \"Mood disorders\")\\] and schizophrenia. To the contrary, *the idea of a dichotomy between these types of conditions has proven naïve*. \\[T\\]he admixture of \"schizophrenic\" and affective \\[or mood\\] symptoms is a feature of many, or even most, cases with severe mental illness. Most *presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response* in psychosis. \\[U\\]ltimately a more ... [dimensional approach](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") \\[to assessment and treatment\\] will be required.\n\nThe field of [psychiatry](https:\/\/en.wikipedia.org\/wiki\/Psychiatry \"Psychiatry\") has begun to question its assumptions and analyze its data in order to merge closer with [evidence-based medicine](https:\/\/en.wikipedia.org\/wiki\/Evidence-based_medicine \"Evidence-based medicine\").[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The removal of the \"episode diagnosis\", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed *exactingly*.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55) But the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55) Community clinicians used the previous definition \"for about a third of cases with non-affective psychotic disorders.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Non-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)\n\nFrom a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's [neural circuits](https:\/\/en.wikipedia.org\/wiki\/Neural_circuit \"Neural circuit\"), for example, are just beginning to be mapped by modern neuroscience in the [Human Connectome Project](https:\/\/en.wikipedia.org\/wiki\/Human_Connectome_Project \"Human Connectome Project\") and [CLARITY](https:\/\/en.wikipedia.org\/wiki\/CLARITY \"CLARITY\"). Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and [patient harm](https:\/\/en.wikipedia.org\/wiki\/Iatrogenesis \"Iatrogenesis\"); this is crucial both for responsible patient care and to retain public trust. Looking forward, a [paradigm shift](https:\/\/en.wikipedia.org\/wiki\/Paradigm_shift \"Paradigm shift\") is needed in psychiatric research to address unanswered questions about schizoaffective disorder. The [dimensional](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") Research Domain Criteria project currently being developed by the [U.S. National Institute of Mental Health](https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Mental_Health \"National Institute of Mental Health\"), may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders.[\\[70\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-RDoC-70)\n\n## Treatment\nThe primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Lancet09-22) Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) [involuntarily](https:\/\/en.wikipedia.org\/wiki\/Involuntary_commitment \"Involuntary commitment\"). Long-term hospitalization is uncommon since [deinstitutionalization](https:\/\/en.wikipedia.org\/wiki\/Deinstitutionalization \"Deinstitutionalization\") started in the 1950s, although it still occurs.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) Community support services including drop-in centers, visits by members of a [community mental health team](https:\/\/en.wikipedia.org\/wiki\/Community_mental_health_service \"Community mental health service\"), supported employment and support groups are common.[\\[71\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-71) Evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder.[\\[72\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-72)\n\nBecause of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be [misdiagnosed](https:\/\/en.wikipedia.org\/wiki\/Medical_error \"Medical error\"). Many people are either diagnosed with [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\"), schizophrenia, or [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") instead of schizoaffective disorder.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) Because of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52)\n\nWhile various medications and treatment options *exist* for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)*Schizoaffective* disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\n### Therapy\nPsychosocial treatments have been found to improve outcomes related to schizoaffective disorder.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Supportive [psychotherapy](https:\/\/en.wikipedia.org\/wiki\/Psychotherapy \"Psychotherapy\") and [cognitive behavioral therapy](https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy \"Cognitive behavioral therapy\") are both helpful.[\\[74\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-74) Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-75) With ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing.\n\nPsychiatric\/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing [activities of daily living](https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living \"Activities of daily living\"); increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on [vocational rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Vocational_rehabilitation \"Vocational rehabilitation\").[\\[76\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-76) Evidence suggests that cognition-based approaches may be able to improve work and social functioning.[\\[77\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-77)\n\nPsychiatric rehabilitation consists of eight main areas:\n\n- Psychiatric (symptom reduction and management)\n- Health and Medical (maintaining consistency of care)\n- Housing (safe environments)\n- Basic living skills ([hygiene](https:\/\/en.wikipedia.org\/wiki\/Hygiene \"Hygiene\"), meals \\[including increasing healthy food intake and reducing processed food intake\\], safety, planning and chores)\n- Social ([relationships](https:\/\/en.wikipedia.org\/wiki\/Intimate_relationship \"Intimate relationship\"), family boundaries, communication and integration of client into the community)\n- Education and vocation (coping skills, [motivation](https:\/\/en.wikipedia.org\/wiki\/Motivation \"Motivation\") and suitable goals chosen by client)\n- Finance ([personal budget](https:\/\/en.wikipedia.org\/wiki\/Personal_budget \"Personal budget\"))\n- Community and legal (resources)\n### Medication\n[Antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Antipsychotic \"Antipsychotic\") medication is usually required both for acute treatment and the prevention of relapse.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78) There is no single antipsychotic of choice in treating schizoaffective disorder, but [atypical antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Atypical_antipsychotic \"Atypical antipsychotic\") may be considered due to their mood-stabilizing abilities.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21)[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) To date, [paliperidone](https:\/\/en.wikipedia.org\/wiki\/Paliperidone \"Paliperidone\") (Invega) is the only antipsychotic with [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) approval for the treatment of schizoaffective disorder.[\\[79\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manufacturer's_Official_webpage-79) Other antipsychotics may be prescribed to further alleviate psychotic symptoms.[\\[80\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-80)\n\nThe management of the bipolar type of schizoaffective disorder is similar to the [treatment of bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Treatment_of_bipolar_disorder \"Treatment of bipolar disorder\"), with the goal of preventing mood episodes and cycling.[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Stahl-81) [Lithium](https:\/\/en.wikipedia.org\/wiki\/Lithium_\\(medication\\) \"Lithium (medication)\") or anticonvulsant mood stabilizers such as [valproic acid](https:\/\/en.wikipedia.org\/wiki\/Valproic_acid \"Valproic acid\"), [carbamazepine](https:\/\/en.wikipedia.org\/wiki\/Carbamazepine \"Carbamazepine\"), and [lamotrigine](https:\/\/en.wikipedia.org\/wiki\/Lamotrigine \"Lamotrigine\") are prescribed in combination with an antipsychotic.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73)\n\nAntidepressants have also been used to treat schizoaffective disorder.[\\[82\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-82) Though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers.[\\[83\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-83)\n\nSome research has supported the efficacy of [anxiolytics](https:\/\/en.wikipedia.org\/wiki\/Anxiolytic \"Anxiolytic\") in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive.[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:0-84) Due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment.[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:0-84)\n\n#### Clozapine\nMain article: [Clozapine](https:\/\/en.wikipedia.org\/wiki\/Clozapine \"Clozapine\")\n\n[Clozapine](https:\/\/en.wikipedia.org\/wiki\/Clozapine \"Clozapine\") is FDA-approved for treatment resistant schizophrenia.[\\[85\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-85) Though not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine is an [atypical antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Atypical_antipsychotic \"Atypical antipsychotic\") that is recognized as being particularly effective when other antipsychotic agents have failed.[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Stahl-81) When combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals.[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality.[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78)[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-87)\n\nDespite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant.[\\[88\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-88) Clozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include [agranulocytosis](https:\/\/en.wikipedia.org\/wiki\/Agranulocytosis \"Agranulocytosis\") and [neutropenia](https:\/\/en.wikipedia.org\/wiki\/Neutropenia \"Neutropenia\").[\\[89\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-89) To mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests.[\\[90\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-90)\n\n### Electroconvulsive therapy\n[Electroconvulsive therapy](https:\/\/en.wikipedia.org\/wiki\/Electroconvulsive_therapy \"Electroconvulsive therapy\") (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics.[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78)\n\n## Epidemiology\nCompared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.[\\[91\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:3-91) Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.[\\[92\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock._p.501-502-92) 30% of cases occur between the ages of 25 and 35.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36) It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-93) Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:22-11)[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx2-94)\n\n## History\nThe term *schizoaffective psychosis* was introduced by the American psychiatrist [Jacob Kasanin](https:\/\/en.wikipedia.org\/wiki\/Jacob_S._Kasanin \"Jacob S. Kasanin\") in 1933[\\[95\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid16857267-95) to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) Kasanin's concept of the illness was influenced by the [psychoanalytic](https:\/\/en.wikipedia.org\/wiki\/Psychoanalysis \"Psychoanalysis\") teachings of [Adolf Meyer](https:\/\/en.wikipedia.org\/wiki\/Adolf_Meyer_\\(psychiatrist\\) \"Adolf Meyer (psychiatrist)\") and Kasanin postulated that *schizoaffective psychosis* was caused by \"emotional conflicts\" of a \"mainly sexual nature\" and that psychoanalysis \"would help prevent the recurrence of such attacks.\"[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) He based his description on a case study of nine individuals.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Karl_Ludwig_Kahlbaum.JPG\/250px-Karl_Ludwig_Kahlbaum.JPG)](https:\/\/en.wikipedia.org\/wiki\/File:Karl_Ludwig_Kahlbaum.JPG)\n\n[Karl Kahlbaum](https:\/\/en.wikipedia.org\/wiki\/Karl_Kahlbaum \"Karl Kahlbaum\") (1828–1899)\n\nOther psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist [Karl Kahlbaum](https:\/\/en.wikipedia.org\/wiki\/Karl_Kahlbaum \"Karl Kahlbaum\") (1828–1899) described schizoaffective disorders as a separate group in his *vesania typica circularis*.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kahlbaum distinguished between [cross-sectional](https:\/\/en.wikipedia.org\/wiki\/Cross-sectional_study \"Cross-sectional study\") and [longitudinal](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_study \"Longitudinal study\") observations. In 1920, psychiatrist [Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") (1856–1926) observed a \"great number\" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, *dementia praecox* (now called schizophrenia) and *manic depressive insanity* (now called bipolar disorders and recurrent depression).[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nKraepelin acknowledged that \"there are many overlaps in this area,\" that is, the area between schizophrenia and mood disorders.[\\[96\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-96) In 1959, psychiatrist [Kurt Schneider](https:\/\/en.wikipedia.org\/wiki\/Kurt_Schneider \"Kurt Schneider\") (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed \"concurrent and sequential types\".[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) (The *concurrent type* of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time \\[now called psychotic mood disorders or affective psychosis\\]; while his *sequential type* refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Schneider described schizoaffective disorders as \"cases in-between\" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nThe historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes *and* polygenic variations.[\\[97\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-97)[\\[98\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-98)[\\[99\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-99)[\\[100\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-100)\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Emil_Kraepelin_1926.jpg\/250px-Emil_Kraepelin_1926.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:Emil_Kraepelin_1926.jpg)\n\n[Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") (1856–1926). Embracing the [Kraepelinian dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\") in [DSM-III](https:\/\/en.wikipedia.org\/wiki\/DSM-III \"DSM-III\") in 1980, while a step forward from [psychodynamic](https:\/\/en.wikipedia.org\/wiki\/Psychodynamic \"Psychodynamic\") explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") workgroup.\n\nSchizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in \"Psychotic Disorders Not Otherwise Specified\" before being formally recognized in DSM-III-R.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) DSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) In DSM-IV, published in 1994, schizoaffective disorders belonged to the category \"Other Psychotic Disorders\" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nDSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly [operationalized](https:\/\/en.wikipedia.org\/wiki\/Operationalization \"Operationalization\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These [ambiguous](https:\/\/en.wikipedia.org\/wiki\/Ambiguous \"Ambiguous\") and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Patients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were [longitudinally determined](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_study \"Longitudinal study\") to have outcomes indistinguishable from those with mood disorders with or without psychotic features.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was [harmful](https:\/\/en.wikipedia.org\/wiki\/Iatrogenic \"Iatrogenic\") to many patients.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[101\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment-101) The poor prognosis for DSM-IV schizoaffective disorder was not based on [patient outcomes](https:\/\/en.wikipedia.org\/wiki\/Cohort_study \"Cohort study\") [research](https:\/\/en.wikipedia.org\/wiki\/Empirical_research \"Empirical research\"), but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician [enculturation](https:\/\/en.wikipedia.org\/wiki\/Enculturation \"Enculturation\") with [unscientific](https:\/\/en.wikipedia.org\/wiki\/Unscientific \"Unscientific\") assumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy;[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) and by clinicians being unfamiliar with the [scientific](https:\/\/en.wikipedia.org\/wiki\/Empirical_science \"Empirical science\") limitations of the diagnostic and classification system.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-5 schizoaffective disorder workgroup analyzed all of the available research [evidence](https:\/\/en.wikipedia.org\/wiki\/Empirical_science#Philosophy_of_science \"Empirical science\") on schizoaffective disorder, and concluded that \"presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Given our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndrome \"Syndrome\"), the limits of our knowledge are clearer: *Presenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more*.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Schizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nStigma of schizoaffective disorder include moralist arguments, religious causes, and others during history.[\\[102\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-102)[\\[103\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-103)\n\n## Research\nLittle is known of the causes and mechanisms that lead to the development of schizoaffective disorder.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Whether schizoaffective disorder is a variant of schizophrenia (as in DSM-5 and ICD-10 classification systems), a variant of bipolar disorder, or part of a dimensional continuum between [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), bipolar disorders and schizophrenia is currently being investigated.[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nMore recently, some research suggests the need for a more specialized classification for schizoaffective disorder. In a 2017 examining diagnostic heterogeneity study, researchers found that when compared to a schizophrenia sample, individuals with schizoaffective disorder rate higher in suicidality and anxiety disorder comorbidity.[\\[104\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-104)\n\n## See also\n- [Schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\")\n- [Bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\")\n## References\n1. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-1)**\n   [\"Schizoaffective disorder, bipolar type\"](http:\/\/www.icd10data.com\/ICD10CM\/Codes\/F01-F99\/F20-F29\/F25-\/F25.0). *www.icd10data.com*.\n2. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-2)**\n   [\"Schizoaffective disorder, depressive type\"](http:\/\/www.icd10data.com\/ICD10CM\/Codes\/F01-F99\/F20-F29\/F25-\/F25.1). *www.icd10data.com*.\n3. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-NAMI2017_3-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-NAMI2017_3-1)\n   [\"Schizoaffective Disorder Overview – Causes\"](https:\/\/www.nami.org\/Learn-More\/Mental-Health-Conditions\/Schizoaffective-Disorder). *www.nami.org*.\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-4)\n   [\"F25 Schizoaffective disorders\"](http:\/\/apps.who.int\/classifications\/icd10\/browse\/2010\/en#\/F25). *ICD-10 Version:2010*. World Health Organization.\n5. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-8) [***j***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-9) [***k***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-10) [***l***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-11) [***m***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-12) [***n***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-13) [***o***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-14) [***p***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-15) [***q***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-16) [***r***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-17) [***s***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-18) [***t***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-19) [***u***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-20) [***v***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-21) [***w***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-22) [***x***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-23) [***y***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-24) [***z***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-25) [***aa***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-26) [***ab***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-27) [***ac***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-28) [***ad***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-29) [***ae***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-30) [***af***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-31) [***ag***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-32) [***ah***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-33) [***ai***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-34) [***aj***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-35) [***ak***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-36) [***al***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-37) [***am***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-38) [***an***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-39) [***ao***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-40) [***ap***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-41) [***aq***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-42) [***ar***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-43) [***as***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-44) [***at***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-45) [***au***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-46) [***av***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-47) [***aw***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-48) [***ax***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-49) [***ay***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-50) [***az***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-51) [***ba***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-52) [***bb***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-53) [***bc***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-54) [***bd***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-55) [***be***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-56)\n   Malaspina D, Owen MJ, Heckers S, Tandon R, Trump D, Schultz S, Barch DM, Gaebel W, Gur RE, Tsuang M, Van Os J, Carpenter W (May 2013). \"Schizoaffective disorder in the DSM-5\". *Schizophrenia Research*. **150** (1): 21–5\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.schres.2013.04.026](https:\/\/doi.org\/10.1016%2Fj.schres.2013.04.026). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [23707642](https:\/\/pubmed.ncbi.nlm.nih.gov\/23707642). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [14770729](https:\/\/api.semanticscholar.org\/CorpusID:14770729).\n6. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-6)**\n   Brannon, Guy E; Bienenfeld, David; Talavera, Francisco (9 September 2013). [\"Schizoaffective Disorder\"](http:\/\/emedicine.medscape.com\/article\/294763-overview). *Medscape Drugs & Diseases*. WebMD.\n7. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Kaplan_&_Saddock._7-0)**\n   Kaplan, HI; Saddock, VA (2007). *Synopsis of Psychiatry*. New York: Lippincott, Williams & Wilkins. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-7817-7327-0](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7817-7327-0 \"Special:BookSources\/978-0-7817-7327-0\")\n   \n   .\n8. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-2)\n   [\"Schizoaffective disorder\"](https:\/\/www.rcpsych.ac.uk\/mental-health\/problems-disorders\/schizoaffective-disorder). *Royal College of Psychiatrists*. Retrieved 30 September 2022.\n9. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18056246_9-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18056246_9-1)\n   Martin LF, Hall MH, Ross RG, Zerbe G, Freedman R, Olincy A (December 2007). \"Physiology of schizophrenia, bipolar disorder, and schizoaffective disorder\". *The American Journal of Psychiatry*. **164** (12): 1900–6\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1176\/appi.ajp.2007.06010017](https:\/\/doi.org\/10.1176%2Fappi.ajp.2007.06010017). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18056246](https:\/\/pubmed.ncbi.nlm.nih.gov\/18056246).\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-10)**\n    Startup H, Freeman D, Garety PA (19 June 2006). \"Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence\". *Behaviour Research and Therapy*. **45** (3): 523–537\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.brat.2006.04.006](https:\/\/doi.org\/10.1016%2Fj.brat.2006.04.006). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16782048](https:\/\/pubmed.ncbi.nlm.nih.gov\/16782048).\n11. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:22_11-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:22_11-1)\n    [\"Schizoaffective Disorder in Children and Adolescents\"](https:\/\/www.mindyra.com\/solutions\/child\/schizoaffective-disorder). *www.mindyra.com*. Retrieved 30 September 2022.\n12. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-12)**\n    Kempf, L. (11 July 2009). \"Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: Trouble at the borders\". *International Review of Psychiatry*. **17** (1): 9–19\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/09540260500064959](https:\/\/doi.org\/10.1080%2F09540260500064959). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16194767](https:\/\/pubmed.ncbi.nlm.nih.gov\/16194767). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [21422704](https:\/\/api.semanticscholar.org\/CorpusID:21422704) – via Taylor & Francis.\n13. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-13)**\n    American Psychiatric Association (2013). *Diagnostic and Statistical Manual of Mental Disorders* (Fifth ed.). Arlington, VA: American Psychiatric Publishing. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-89042-555-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-89042-555-8 \"Special:BookSources\/978-0-89042-555-8\")\n    \n    .\n14. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-14)**\n    Munk Laursen, Thomas (16 June 2009). [\"Bipolar Disorder, Schizoaffective Disorder, and Schizophrenia Overlap: A New Comorbidity Index\"](https:\/\/www.psychiatrist.com\/jcp\/medical\/comorbidity\/bipolar-disorder-schizoaffective-disorder-schizophrenia\/). *The Journal of Clinical Psychiatry*. **70** (10) – via Psychiatrist.com.\n15. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-15)**\n    Archibald, Luke (20 December 2019). [\"Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). *Alcohol Research: Current Reviews*. **40** (1) 6. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.35946\/arcr.v40.1.06](https:\/\/doi.org\/10.35946%2Farcr.v40.1.06). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6927747](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [31886105](https:\/\/pubmed.ncbi.nlm.nih.gov\/31886105) – via NIH.\n16. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-16)**\n    Marneros, Andreas (30 June 2012). [\"Schizoaffective Disorder\"](https:\/\/doi.org\/10.16946%2Fkjsr.2012.15.1.5). *Korean Journal of Schizophrenia Research*. **15** (1): 5–12\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.16946\/kjsr.2012.15.1.5](https:\/\/doi.org\/10.16946%2Fkjsr.2012.15.1.5) – via KoreaMed Synapse.\n17. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-17)**\n    Joshi, Kruti; Lin, Jay; Lingohr-Smith, Melissa; Fu, Dong-Jing; Muser, Erik (October 2016). [\"Treatment Patterns and Antipsychotic Medication Adherence Among Commercially Insured Patients With Schizoaffective Disorder in the United States\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5017269). *Journal of Clinical Psychopharmacology*. **36** (5): 429–435\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/JCP.0000000000000549](https:\/\/doi.org\/10.1097%2FJCP.0000000000000549). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [0271-0749](https:\/\/search.worldcat.org\/issn\/0271-0749). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5017269](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5017269). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27525965](https:\/\/pubmed.ncbi.nlm.nih.gov\/27525965).\n18. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-2)\n    Becker, T.; Kilian, R. (2006). \"Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?\". *[Acta Psychiatrica Scandinavica. Supplementum](https:\/\/en.wikipedia.org\/wiki\/Acta_Psychiatrica_Scandinavica._Supplementum \"Acta Psychiatrica Scandinavica. Supplementum\")*. **113** (429): 9–16\\. 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[PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [14674956](https:\/\/pubmed.ncbi.nlm.nih.gov\/14674956). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [43303750](https:\/\/api.semanticscholar.org\/CorpusID:43303750).\n20. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-2)\n    Jeffrey, Susan (26 May 2009). [\"APA 2009: DSM on Track for 2012, But Difficult Decisions Lie Ahead\"](http:\/\/www.medscape.com\/viewarticle\/703312). *Medscape Medical News*. WebMD. 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(December 2010). \"Acute psychotic disorders related to bupropion: review of the literature\". *Encephale*. **36** (6): 461–71\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.encep.2010.01.005](https:\/\/doi.org\/10.1016%2Fj.encep.2010.01.005). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [21130229](https:\/\/pubmed.ncbi.nlm.nih.gov\/21130229).\n44. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Wellbutrin-Zyban-Psychosis2_44-0)**\n    Kumar, S.; Kodela, S.; Detweiler, J.G.; Kim, K.Y.; Detweiler, M.B. (November–December 2011). \"Bupropion-induced psychosis: folklore or a fact? A systematic review of the literature\". *General Hospital Psychiatry*. **33** (6): 612–7\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.genhosppsych.2011.07.001](https:\/\/doi.org\/10.1016%2Fj.genhosppsych.2011.07.001). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [21872337](https:\/\/pubmed.ncbi.nlm.nih.gov\/21872337).\n45. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-45)**\n    Bramness, Jørgen G; Gundersen, Øystein Hoel; Guterstam, Joar; Rognli, Eline Borger; Konstenius, Maija; Løberg, Else-Marie; Medhus, Sigrid; Tanum, Lars; et al. (5 December 2012). [\"Amphetamine-induced psychosis – a separate diagnostic entity or primary psychosis triggered in the vulnerable?\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3554477). *BMC Medicine*. **12** (1): 221. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1186\/1471-244X-12-221](https:\/\/doi.org\/10.1186%2F1471-244X-12-221). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3554477](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3554477). 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[PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [2670101](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2670101). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18698321](https:\/\/pubmed.ncbi.nlm.nih.gov\/18698321).\n48. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391_48-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391_48-1)\n    Markowitz, J.S.; Brewerton, T.D. (June 1996). \"Zolpidem-induced psychosis\". *Annals of Clinical Psychiatry*. **8** (2): 89–91\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3109\/10401239609148806](https:\/\/doi.org\/10.3109%2F10401239609148806). 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[\"Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk\"](https:\/\/www.federalregister.gov\/a\/04-2912\/p-276). *Federal Register*. **69** (28). HHS Food And Drug Administration: 6787–854\\. 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[\"A Misdiagnosed Case of Schizoaffective Disorder With Bipolar Manifestations\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8394638). *Cureus*. **13** (7) e16686. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.7759\/cureus.16686](https:\/\/doi.org\/10.7759%2Fcureus.16686). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [2168-8184](https:\/\/search.worldcat.org\/issn\/2168-8184). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [8394638](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8394638). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [34466319](https:\/\/pubmed.ncbi.nlm.nih.gov\/34466319).\n53. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-53)**\n    McQueen, Janie. [\"Schizophrenia and Substance Use Disorder: What to Know\"](https:\/\/www.webmd.com\/schizophrenia\/schizophrenia-substance-use-disorder). *WebMD*. Retrieved 10 November 2023.\n54. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-54)**\n    Shibayama, M. (2011). \"Differential diagnosis between dissociative disorders and schizophrenia\". *Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica*. **113** (9): 906–911\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [22117396](https:\/\/pubmed.ncbi.nlm.nih.gov\/22117396).\n55. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-4)\n    Malhi, G.S. (October 2013). \"Making up schizoaffective disorder: Cosmetic changes to a sad creation?\". *Australian and New Zealand Journal of Psychiatry*. **47** (10): 891–4\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1177\/0004867413505522](https:\/\/doi.org\/10.1177%2F0004867413505522). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24072567](https:\/\/pubmed.ncbi.nlm.nih.gov\/24072567). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [206399250](https:\/\/api.semanticscholar.org\/CorpusID:206399250).\n56. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-TransformingDiagnosis_56-0)**\n    [\"NIMH Director's Blog: Transforming Diagnosis\"](https:\/\/web.archive.org\/web\/20130529152509\/http:\/\/www.nimh.nih.gov\/about\/director\/2013\/transforming-diagnosis.shtml). *NIMH Director's Blog*. Archived from [the original](http:\/\/www.nimh.nih.gov\/about\/director\/2013\/transforming-diagnosis.shtml) on 29 May 2013. Retrieved 20 October 2013.\n57. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-57)**\n    Laursen, Thomas Munk; Agerbo, Esben; Pedersen, Carsten Bøcker (October 2009). \"Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index\". *The Journal of Clinical Psychiatry*. **70** (10): 1432–1438\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.4088\/JCP.08m04807](https:\/\/doi.org\/10.4088%2FJCP.08m04807). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1555-2101](https:\/\/search.worldcat.org\/issn\/1555-2101). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19538905](https:\/\/pubmed.ncbi.nlm.nih.gov\/19538905). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [34270304](https:\/\/api.semanticscholar.org\/CorpusID:34270304).\n58. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-58)**\n    Young, Sarah; Pfaff, Danielle; Lewandowski, Kathryn Eve; Ravichandran, Caitlin; Cohen, Bruce M.; Öngür, Dost (2013). \"Anxiety disorder comorbidity in bipolar disorder, schizophrenia and schizoaffective disorder\". *Psychopathology*. **46** (3): 176–185\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1159\/000339556](https:\/\/doi.org\/10.1159%2F000339556). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1423-033X](https:\/\/search.worldcat.org\/issn\/1423-033X). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [22906962](https:\/\/pubmed.ncbi.nlm.nih.gov\/22906962). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [20297075](https:\/\/api.semanticscholar.org\/CorpusID:20297075).\n59. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-59)**\n    Archibald, Luke; Brunette, Mary F.; Wallin, Diana J.; Green, Alan I. (20 December 2019). [\"Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). *Alcohol Research: Current Reviews*. **40** (1) arcr.v40.1.06. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.35946\/arcr.v40.1.06](https:\/\/doi.org\/10.35946%2Farcr.v40.1.06). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [2168-3492](https:\/\/search.worldcat.org\/issn\/2168-3492). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6927747](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [31886105](https:\/\/pubmed.ncbi.nlm.nih.gov\/31886105).\n60. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18199238_60-0)**\n    Malhi, G.S.; Green, M.; Fagiolini, A.; Peselow, E.D.; Kumari, V. (February 2008). \"Schizoaffective disorder: diagnostic issues and future recommendations\". *Bipolar Disorders*. **10** (1 Pt 2): 215–30\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1111\/j.1399-5618.2007.00564.x](https:\/\/doi.org\/10.1111%2Fj.1399-5618.2007.00564.x). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18199238](https:\/\/pubmed.ncbi.nlm.nih.gov\/18199238).\n61. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-The_Overlap_of_Schizophrenic_and_Affective_Spectra_61-0)**\n    Marneros, A; Akiskal, HS (2007). *The Overlap of Schizophrenic and Affective Spectra*. New York: Cambridge University Press. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-521-85858-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-521-85858-8 \"Special:BookSources\/978-0-521-85858-8\")\n    \n    .\n62. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-3)\n    Goodwin, FK; Jamison, KR (2007). *Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition*. 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[ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-19-513579-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-19-513579-4 \"Special:BookSources\/978-0-19-513579-4\")\n    \n    .\n63. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-8)\n    Goodwin, FK; Marneros, A (2005). *Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms*. 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[PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6327301](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6327301). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [30261942](https:\/\/pubmed.ncbi.nlm.nih.gov\/30261942).\n91. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:3_91-0)**\n    [\"Schizoaffective disorder: MedlinePlus Genetics\"](https:\/\/medlineplus.gov\/genetics\/condition\/schizoaffective-disorder\/). *medlineplus.gov*. Retrieved 30 September 2022.\n92. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Kaplan_&_Saddock._p.501-502_92-0)**\n    Kaplan, HI; Saddock, VA (2007). *Synopsis of Psychiatry*. New York: Lippincott, Williams & Wilkins. pp. 501–502\\. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-7817-7327-0](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7817-7327-0 \"Special:BookSources\/978-0-7817-7327-0\")\n    \n    .\n93. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-93)**\n    Sommer, Iris E.; Tiihonen, Jari; van Mourik, Anouk; Tanskanen, Antti; Taipale, Heidi (1 May 2020). [\"The clinical course of schizophrenia in women and men-a nation-wide cohort study\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7195359). *npj Schizophrenia*. **6** (1): 12. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/s41537-020-0102-z](https:\/\/doi.org\/10.1038%2Fs41537-020-0102-z). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [2334-265X](https:\/\/search.worldcat.org\/issn\/2334-265X). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [7195359](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7195359). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [32358572](https:\/\/pubmed.ncbi.nlm.nih.gov\/32358572).\n94. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-PsychosisExclusionaryDx2_94-0)**\n    Freudenreich, Oliver (3 December 2012). [\"Differential Diagnosis of Psychotic Symptoms: Medical \"Mimics\"\"](https:\/\/web.archive.org\/web\/20130604094749\/http:\/\/www.psychiatrictimes.com\/forensic-psychiatry\/differential-diagnosis-psychotic-symptoms-medical-%E2%80%9Cmimics%E2%80%9D). *Psychiatric Times*. UBM Medica. Archived from [the original](http:\/\/www.psychiatrictimes.com\/forensic-psychiatry\/differential-diagnosis-psychotic-symptoms-medical-%E2%80%9Cmimics%E2%80%9D) on 4 June 2013. Retrieved 19 October 2013.\n95. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid16857267_95-0)**\n    Lake, C.R.; Hurwitz, N. (August 2006). \"Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders\". *Psychiatry Research*. **143** (2–3\\): 255–87\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.psychres.2005.08.012](https:\/\/doi.org\/10.1016%2Fj.psychres.2005.08.012). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16857267](https:\/\/pubmed.ncbi.nlm.nih.gov\/16857267). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [35916818](https:\/\/api.semanticscholar.org\/CorpusID:35916818).\n96. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-96)** [Marneros & Akiskal 2007](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#CITEREFMarnerosAkiskal2007), pp. 3–4.\n97. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-97)**\n    Van Snellenberg, J.X.; de Candia, T. (July 2009). \"Meta-analytic evidence for familial coaggregation of schizophrenia and bipolar disorder\". *Arch. Gen. Psychiatry*. **66** (7): 748–55\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1001\/archgenpsychiatry.2009.64](https:\/\/doi.org\/10.1001%2Farchgenpsychiatry.2009.64). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19581566](https:\/\/pubmed.ncbi.nlm.nih.gov\/19581566). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [20216200](https:\/\/api.semanticscholar.org\/CorpusID:20216200).\n98. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-98)**\n    \"Schizophrenia and bipolar disorder may share genetic origins\". *Harv Ment Health Lett*. **25** (12): 7. June 2009. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19582944](https:\/\/pubmed.ncbi.nlm.nih.gov\/19582944).\n99. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-99)**\n    Purcell, S.M.; Wray, N.R.; Stone, J.L.; Visscher, P.M.; O'Donovan, M.C.; Sullivan, P.F.; Sklar, P. (July 2009). [\"Common polygenic variation contributes to risk of schizophrenia and bipolar disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3912837). *Nature*. **460** (7256): 748–52\\. [Bibcode](https:\/\/en.wikipedia.org\/wiki\/Bibcode_\\(identifier\\) \"Bibcode (identifier)\"):[2009Natur.460..748P](https:\/\/ui.adsabs.harvard.edu\/abs\/2009Natur.460..748P). [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/nature08185](https:\/\/doi.org\/10.1038%2Fnature08185). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3912837](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3912837). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19571811](https:\/\/pubmed.ncbi.nlm.nih.gov\/19571811).\n100. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-100)**\n     Potash, J.B.; Bienvenu, OJ (June 2009). \"Neuropsychiatric disorders: Shared genetics of bipolar disorder and schizophrenia\". *Nature Reviews Neurology*. **5** (6): 299–300\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/nrneurol.2009.71](https:\/\/doi.org\/10.1038%2Fnrneurol.2009.71). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19498428](https:\/\/pubmed.ncbi.nlm.nih.gov\/19498428). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [21986987](https:\/\/api.semanticscholar.org\/CorpusID:21986987).\n101. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment_101-0)**\n     Lake, C.R.; Hurwitz, N. (2007). \"Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease\". *Current Opinion in Psychiatry*. **20** (4): 365–79\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/YCO.0b013e3281a305ab](https:\/\/doi.org\/10.1097%2FYCO.0b013e3281a305ab). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [17551352](https:\/\/pubmed.ncbi.nlm.nih.gov\/17551352). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [37664803](https:\/\/api.semanticscholar.org\/CorpusID:37664803).\n102. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-102)**\n     Assis, Jorge Cândido de; Villares, Cecília Cruz; Bressan, Rodrigo Affonseca (2023). [*Between Reason and Illusion: Demystifying Schizophrenia*](https:\/\/link.springer.com\/10.1007\/978-3-031-24556-5). Copernicus Books. Cham: Springer Nature Switzerland. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/978-3-031-24556-5](https:\/\/doi.org\/10.1007%2F978-3-031-24556-5). [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n     \n     [978-3-031-24555-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-3-031-24555-8 \"Special:BookSources\/978-3-031-24555-8\")\n     \n     .\n103. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-103)**\n     Farrell, Michael (2024). *Controversies in schizophrenia: issues, causes, and treatment*. New York, NY: Routledge, Taylor & Francis Group. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n     \n     [978-1-003-41355-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-003-41355-4 \"Special:BookSources\/978-1-003-41355-4\")\n     \n     .\n104. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-104)**\n     Seldin, Katherine; Armstrong, Kristan; Schiff, Max L.; Heckers, Stephan (2017). [\"Reducing the Diagnostic Heterogeneity of Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5300988). *Frontiers in Psychiatry*. **8**: 18. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3389\/fpsyt.2017.00018](https:\/\/doi.org\/10.3389%2Ffpsyt.2017.00018). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1664-0640](https:\/\/search.worldcat.org\/issn\/1664-0640). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5300988](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5300988). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [28239362](https:\/\/pubmed.ncbi.nlm.nih.gov\/28239362).\n## Further reading\n- Moore, D.P.; Jefferson, J.W. (2004). *Handbook of medical psychiatry* (2nd ed.). Philadelphia: Elsevier\/Mosby. pp. 126–127\\. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n  \n  [978-0-323-02911-7](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-323-02911-7 \"Special:BookSources\/978-0-323-02911-7\")\n  \n  .\n- Goetzt, C.G. (2003). *Textbook of clinical neurology* (2nd ed.). Philadelphia: W.B. Saunders. p. 48. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n  \n  [978-0-7216-3800-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7216-3800-3 \"Special:BookSources\/978-0-7216-3800-3\")\n  \n  .\n## External links\n|   |   |\n|---|---|\n| Classification | [D](https:\/\/www.wikidata.org\/wiki\/Q834047 \"d:Q834047\") **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[11](https:\/\/en.wikipedia.org\/wiki\/ICD-11 \"ICD-11\")**: [6A21](https:\/\/icd.who.int\/browse\/latest-release\/mms\/en#106339515) **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[10](https:\/\/en.wikipedia.org\/wiki\/ICD-10 \"ICD-10\")**: [F25](https:\/\/icd.who.int\/browse10\/2019\/en#\/F25) **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[9-CM](https:\/\/en.wikipedia.org\/wiki\/List_of_ICD-9_codes \"List of ICD-9 codes\")**: [295\\.70](http:\/\/www.icd9data.com\/getICD9Code.ashx?icd9=295.70) **[OMIM](https:\/\/en.wikipedia.org\/wiki\/Online_Mendelian_Inheritance_in_Man \"Online Mendelian Inheritance in Man\")**: [181500](https:\/\/omim.org\/entry\/181500) **[MeSH](https:\/\/en.wikipedia.org\/wiki\/Medical_Subject_Headings \"Medical Subject Headings\")**: [D011618](https:\/\/meshb.nlm.nih.gov\/record\/ui?ui=D011618) **[DiseasesDB](https:\/\/en.wikipedia.org\/wiki\/Diseases_Database \"Diseases Database\")**: [33444](http:\/\/www.diseasesdatabase.com\/ddb33444.htm) **[SNOMED CT](https:\/\/en.wikipedia.org\/wiki\/SNOMED_CT \"SNOMED CT\")**: [68890003](https:\/\/browser.ihtsdotools.org\/?perspective=full&conceptId1=68890003&languages=en) |\n| External resources | **[MedlinePlus](https:\/\/en.wikipedia.org\/wiki\/MedlinePlus \"MedlinePlus\")**: [000930](https:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/000930.htm) **[eMedicine](https:\/\/en.wikipedia.org\/wiki\/EMedicine \"EMedicine\")**: [article\/294763](https:\/\/emedicine.medscape.com\/article\/294763-overview) **[Patient UK](https:\/\/en.wikipedia.org\/wiki\/Patient_UK \"Patient UK\")**: [Schizoaffective disorder](https:\/\/patient.info\/doctor\/Schizoaffective-Disorder) |\n\n[Portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents\/Portals \"Wikipedia:Contents\/Portals\"):\n\n- ![icon](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/20px-WHO_Rod.svg.png) [Medicine](https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine \"Portal:Medicine\")\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:Mental_disorders \"Template:Mental disorders\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:Mental_disorders \"Template talk:Mental disorders\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:Mental_disorders \"Special:EditPage\/Template:Mental disorders\")[Mental disorders](https:\/\/en.wikipedia.org\/wiki\/Mental_disorder \"Mental disorder\") ([Classification](https:\/\/en.wikipedia.org\/wiki\/Classification_of_mental_disorders \"Classification of mental disorders\")) |   |\n|---|---|\n| Adult personality and behavior |   |\n|   |   |\n| Sexual | [Ego-dystonic sexual orientation](https:\/\/en.wikipedia.org\/wiki\/Ego-dystonic_sexual_orientation \"Ego-dystonic sexual orientation\") [Paraphilia](https:\/\/en.wikipedia.org\/wiki\/Paraphilia \"Paraphilia\") [Fetishism](https:\/\/en.wikipedia.org\/wiki\/Sexual_fetishism \"Sexual fetishism\") [Voyeurism](https:\/\/en.wikipedia.org\/wiki\/Voyeurism \"Voyeurism\") [Sexual anhedonia](https:\/\/en.wikipedia.org\/wiki\/Sexual_anhedonia \"Sexual anhedonia\") [Sexual anorexia](https:\/\/en.wikipedia.org\/wiki\/Sexual_anorexia \"Sexual anorexia\") [Sexual maturation disorder](https:\/\/en.wikipedia.org\/wiki\/Sexual_maturation_disorder \"Sexual maturation disorder\") [Sexual relationship disorder](https:\/\/en.wikipedia.org\/wiki\/Sexual_relationship_disorder \"Sexual relationship disorder\") [Compulsive sexual behaviour disorder](https:\/\/en.wikipedia.org\/wiki\/Compulsive_sexual_behaviour_disorder \"Compulsive sexual behaviour disorder\") |\n| Other | [Factitious disorder](https:\/\/en.wikipedia.org\/wiki\/Factitious_disorder \"Factitious disorder\") [Munchausen syndrome](https:\/\/en.wikipedia.org\/wiki\/Factitious_disorder_imposed_on_self \"Factitious disorder imposed on self\") [Fear of intimacy](https:\/\/en.wikipedia.org\/wiki\/Fear_of_intimacy \"Fear of intimacy\") [Gender dysphoria](https:\/\/en.wikipedia.org\/wiki\/Gender_dysphoria \"Gender dysphoria\") [Intermittent explosive disorder](https:\/\/en.wikipedia.org\/wiki\/Intermittent_explosive_disorder \"Intermittent explosive disorder\") [Dermatillomania](https:\/\/en.wikipedia.org\/wiki\/Excoriation_disorder \"Excoriation disorder\") [Kleptomania](https:\/\/en.wikipedia.org\/wiki\/Kleptomania \"Kleptomania\") [Pyromania](https:\/\/en.wikipedia.org\/wiki\/Pyromania \"Pyromania\") [Trichotillomania](https:\/\/en.wikipedia.org\/wiki\/Trichotillomania \"Trichotillomania\") [Personality disorder](https:\/\/en.wikipedia.org\/wiki\/Personality_disorder \"Personality disorder\") |\n| [Childhood and learning](https:\/\/en.wikipedia.org\/wiki\/Mental_disorders_diagnosed_in_childhood \"Mental disorders diagnosed in childhood\") |   |\n|   |   |\n| [Emotional and behavioral](https:\/\/en.wikipedia.org\/wiki\/Emotional_and_behavioral_disorders \"Emotional and behavioral disorders\") | [ADHD](https:\/\/en.wikipedia.org\/wiki\/Attention_deficit_hyperactivity_disorder \"Attention deficit hyperactivity disorder\") [Conduct disorder](https:\/\/en.wikipedia.org\/wiki\/Conduct_disorder \"Conduct disorder\") [ODD](https:\/\/en.wikipedia.org\/wiki\/Oppositional_defiant_disorder \"Oppositional defiant disorder\") [Emotional and behavioral disorders](https:\/\/en.wikipedia.org\/wiki\/Emotional_and_behavioral_disorders \"Emotional and behavioral disorders\") [Separation anxiety disorder](https:\/\/en.wikipedia.org\/wiki\/Separation_anxiety_disorder \"Separation anxiety disorder\") [Movement disorders](https:\/\/en.wikipedia.org\/wiki\/Movement_disorders \"Movement disorders\") [Stereotypic](https:\/\/en.wikipedia.org\/wiki\/Stereotypic_movement_disorder \"Stereotypic movement disorder\") Social functioning [DAD](https:\/\/en.wikipedia.org\/wiki\/Disinhibited_attachment_disorder \"Disinhibited attachment disorder\") [RAD](https:\/\/en.wikipedia.org\/wiki\/Reactive_attachment_disorder \"Reactive attachment disorder\") [Selective mutism](https:\/\/en.wikipedia.org\/wiki\/Selective_mutism \"Selective mutism\") [Speech](https:\/\/en.wikipedia.org\/wiki\/Speech_disorder \"Speech disorder\") [Cluttering](https:\/\/en.wikipedia.org\/wiki\/Cluttering \"Cluttering\") [Stuttering](https:\/\/en.wikipedia.org\/wiki\/Stuttering \"Stuttering\") [Tic disorder](https:\/\/en.wikipedia.org\/wiki\/Tic_disorder \"Tic disorder\") [Tourette syndrome](https:\/\/en.wikipedia.org\/wiki\/Tourette_syndrome \"Tourette syndrome\") |\n| [Intellectual disability](https:\/\/en.wikipedia.org\/wiki\/Intellectual_disability \"Intellectual disability\") | [X-linked intellectual disability](https:\/\/en.wikipedia.org\/wiki\/X-linked_intellectual_disability \"X-linked intellectual disability\") [Lujan–Fryns syndrome](https:\/\/en.wikipedia.org\/wiki\/Lujan%E2%80%93Fryns_syndrome \"Lujan–Fryns syndrome\") |\n| Psychological development ([developmental disabilities](https:\/\/en.wikipedia.org\/wiki\/Developmental_disability \"Developmental disability\")) | [Pervasive](https:\/\/en.wikipedia.org\/wiki\/Pervasive_developmental_disorder \"Pervasive developmental disorder\") [Specific](https:\/\/en.wikipedia.org\/wiki\/Specific_developmental_disorder \"Specific developmental disorder\") |\n| [Mood](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\") (affective) |   |\n| [Bipolar](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") [Bipolar I](https:\/\/en.wikipedia.org\/wiki\/Bipolar_I_disorder \"Bipolar I disorder\") [Bipolar II](https:\/\/en.wikipedia.org\/wiki\/Bipolar_II_disorder \"Bipolar II disorder\") [Bipolar NOS](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder_not_otherwise_specified \"Bipolar disorder not otherwise specified\") [Cyclothymia](https:\/\/en.wikipedia.org\/wiki\/Cyclothymia \"Cyclothymia\") [Depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") [Atypical depression](https:\/\/en.wikipedia.org\/wiki\/Atypical_depression \"Atypical depression\") [Dysthymia](https:\/\/en.wikipedia.org\/wiki\/Dysthymia \"Dysthymia\") [Major depressive disorder](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder \"Major depressive disorder\") [Melancholic depression](https:\/\/en.wikipedia.org\/wiki\/Melancholic_depression \"Melancholic depression\") [Seasonal affective disorder](https:\/\/en.wikipedia.org\/wiki\/Seasonal_affective_disorder \"Seasonal affective disorder\") [Mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") |   |\n| Neurological and symptomatic |   |\n|   |   |\n| [Autism spectrum](https:\/\/en.wikipedia.org\/wiki\/Autism_spectrum \"Autism spectrum\") | [Autism](https:\/\/en.wikipedia.org\/wiki\/Autism \"Autism\") [Asperger syndrome](https:\/\/en.wikipedia.org\/wiki\/Asperger_syndrome \"Asperger syndrome\") [High-functioning autism](https:\/\/en.wikipedia.org\/wiki\/High-functioning_autism \"High-functioning autism\") [PDD-NOS](https:\/\/en.wikipedia.org\/wiki\/Pervasive_developmental_disorder_not_otherwise_specified \"Pervasive developmental disorder not otherwise specified\") [Savant syndrome](https:\/\/en.wikipedia.org\/wiki\/Savant_syndrome \"Savant syndrome\") |\n| [Dementia](https:\/\/en.wikipedia.org\/wiki\/Dementia \"Dementia\") | [AIDS dementia complex](https:\/\/en.wikipedia.org\/wiki\/HIV-associated_neurocognitive_disorder \"HIV-associated neurocognitive disorder\") [Alzheimer's disease](https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease \"Alzheimer's disease\") [Creutzfeldt–Jakob disease](https:\/\/en.wikipedia.org\/wiki\/Creutzfeldt%E2%80%93Jakob_disease \"Creutzfeldt–Jakob disease\") [Frontotemporal dementia](https:\/\/en.wikipedia.org\/wiki\/Frontotemporal_dementia \"Frontotemporal dementia\") [Huntington's disease](https:\/\/en.wikipedia.org\/wiki\/Huntington%27s_disease \"Huntington's disease\") [Mild cognitive impairment](https:\/\/en.wikipedia.org\/wiki\/Mild_cognitive_impairment \"Mild cognitive impairment\") [Parkinson's disease](https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease \"Parkinson's disease\") [Pick's disease](https:\/\/en.wikipedia.org\/wiki\/Pick%27s_disease \"Pick's disease\") [Sundowning](https:\/\/en.wikipedia.org\/wiki\/Sundowning \"Sundowning\") [Vascular dementia](https:\/\/en.wikipedia.org\/wiki\/Vascular_dementia \"Vascular dementia\") [Wandering](https:\/\/en.wikipedia.org\/wiki\/Wandering_\\(dementia\\) \"Wandering (dementia)\") |\n| Other | [Delirium](https:\/\/en.wikipedia.org\/wiki\/Delirium \"Delirium\") [Organic brain syndrome](https:\/\/en.wikipedia.org\/wiki\/Organic_brain_syndrome \"Organic brain syndrome\") [Post-concussion syndrome](https:\/\/en.wikipedia.org\/wiki\/Post-concussion_syndrome \"Post-concussion syndrome\") |\n| [Neurotic](https:\/\/en.wikipedia.org\/wiki\/Neurosis \"Neurosis\"), [stress](https:\/\/en.wikipedia.org\/wiki\/Stress_\\(biology\\) \"Stress (biology)\")\\-related and [somatoform](https:\/\/en.wikipedia.org\/wiki\/Somatic_symptom_disorder \"Somatic symptom disorder\") |   |\n|   |   |\n| [Adjustment](https:\/\/en.wikipedia.org\/wiki\/Adjustment_disorder \"Adjustment disorder\") | [Adjustment disorder](https:\/\/en.wikipedia.org\/wiki\/Adjustment_disorder \"Adjustment disorder\") with depressed mood |\n| [Anxiety](https:\/\/en.wikipedia.org\/wiki\/Anxiety_disorder \"Anxiety disorder\") |   |\n|   |   |\n| [Phobia](https:\/\/en.wikipedia.org\/wiki\/Phobia \"Phobia\") | [Agoraphobia](https:\/\/en.wikipedia.org\/wiki\/Agoraphobia \"Agoraphobia\") [Childhood phobia](https:\/\/en.wikipedia.org\/wiki\/Childhood_phobia \"Childhood phobia\") [Social anxiety](https:\/\/en.wikipedia.org\/wiki\/Social_anxiety \"Social anxiety\") [Social phobia](https:\/\/en.wikipedia.org\/wiki\/Social_anxiety_disorder \"Social anxiety disorder\") [Anthropophobia](https:\/\/en.wikipedia.org\/wiki\/Anthropophobia \"Anthropophobia\") [Specific social phobia](https:\/\/en.wikipedia.org\/wiki\/Specific_social_phobia \"Specific social phobia\") [Specific phobia](https:\/\/en.wikipedia.org\/wiki\/Specific_phobia \"Specific phobia\") [Claustrophobia](https:\/\/en.wikipedia.org\/wiki\/Claustrophobia \"Claustrophobia\") |\n| Other | [Generalized anxiety disorder](https:\/\/en.wikipedia.org\/wiki\/Generalized_anxiety_disorder \"Generalized anxiety disorder\") [OCD](https:\/\/en.wikipedia.org\/wiki\/Obsessive%E2%80%93compulsive_disorder \"Obsessive–compulsive disorder\") [Panic attack](https:\/\/en.wikipedia.org\/wiki\/Panic_attack \"Panic attack\") [Panic disorder](https:\/\/en.wikipedia.org\/wiki\/Panic_disorder \"Panic disorder\") [Paranoia](https:\/\/en.wikipedia.org\/wiki\/Paranoia \"Paranoia\") [Stress](https:\/\/en.wikipedia.org\/wiki\/Psychological_stress \"Psychological stress\") [Acute stress reaction](https:\/\/en.wikipedia.org\/wiki\/Acute_stress_reaction \"Acute stress reaction\") [PTSD](https:\/\/en.wikipedia.org\/wiki\/Post-traumatic_stress_disorder \"Post-traumatic stress disorder\") |\n| [Dissociative](https:\/\/en.wikipedia.org\/wiki\/Dissociative_disorder \"Dissociative disorder\") | [Depersonalization-derealization disorder](https:\/\/en.wikipedia.org\/wiki\/Depersonalization-derealization_disorder \"Depersonalization-derealization disorder\") [Dissociative identity disorder](https:\/\/en.wikipedia.org\/wiki\/Dissociative_identity_disorder \"Dissociative identity disorder\") [Dissociative amnesia](https:\/\/en.wikipedia.org\/wiki\/Dissociative_amnesia \"Dissociative amnesia\") [Dissociative fugue](https:\/\/en.wikipedia.org\/wiki\/Dissociative_fugue \"Dissociative fugue\") [Dissociative disorder not otherwise specified](https:\/\/en.wikipedia.org\/wiki\/Dissociative_disorder_not_otherwise_specified \"Dissociative disorder not otherwise specified\") [Other specified dissociative disorder](https:\/\/en.wikipedia.org\/wiki\/Other_specified_dissociative_disorder \"Other specified dissociative disorder\") |\n| [Somatic symptom](https:\/\/en.wikipedia.org\/wiki\/Somatic_symptom_disorder \"Somatic symptom disorder\") | [Body dysmorphic disorder](https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphic_disorder \"Body dysmorphic disorder\") [Conversion disorder](https:\/\/en.wikipedia.org\/wiki\/Conversion_disorder \"Conversion disorder\") [Ganser syndrome](https:\/\/en.wikipedia.org\/wiki\/Ganser_syndrome \"Ganser syndrome\") [Globus pharyngeus](https:\/\/en.wikipedia.org\/wiki\/Globus_pharyngeus \"Globus pharyngeus\") [Psychogenic non-epileptic seizures](https:\/\/en.wikipedia.org\/wiki\/Psychogenic_non-epileptic_seizure \"Psychogenic non-epileptic seizure\") [False pregnancy](https:\/\/en.wikipedia.org\/wiki\/False_pregnancy \"False pregnancy\") [Hypochondriasis](https:\/\/en.wikipedia.org\/wiki\/Hypochondriasis \"Hypochondriasis\") [Mass psychogenic illness](https:\/\/en.wikipedia.org\/wiki\/Mass_psychogenic_illness \"Mass psychogenic illness\") [Nosophobia](https:\/\/en.wikipedia.org\/wiki\/Nosophobia \"Nosophobia\") [Psychogenic pain](https:\/\/en.wikipedia.org\/wiki\/Psychogenic_pain \"Psychogenic pain\") |\n| Physiological and physical behavior |   |\n|   |   |\n| [Eating](https:\/\/en.wikipedia.org\/wiki\/Eating_disorder \"Eating disorder\") | [Anorexia nervosa](https:\/\/en.wikipedia.org\/wiki\/Anorexia_nervosa \"Anorexia nervosa\") [Bulimia nervosa](https:\/\/en.wikipedia.org\/wiki\/Bulimia_nervosa \"Bulimia nervosa\") [Binge eating disorder](https:\/\/en.wikipedia.org\/wiki\/Binge_eating_disorder \"Binge eating disorder\") [Avoidant\/restrictive food intake disorder](https:\/\/en.wikipedia.org\/wiki\/Avoidant\/restrictive_food_intake_disorder \"Avoidant\/restrictive food intake disorder\") [Pica](https:\/\/en.wikipedia.org\/wiki\/Pica_\\(disorder\\) \"Pica (disorder)\") [Rumination syndrome](https:\/\/en.wikipedia.org\/wiki\/Rumination_syndrome \"Rumination syndrome\") [Other specified feeding or eating disorder](https:\/\/en.wikipedia.org\/wiki\/Other_specified_feeding_or_eating_disorder \"Other specified feeding or eating disorder\") |\n| Nonorganic [sleep](https:\/\/en.wikipedia.org\/wiki\/Sleep_disorder \"Sleep disorder\") | [Hypersomnia](https:\/\/en.wikipedia.org\/wiki\/Hypersomnia \"Hypersomnia\") [Insomnia](https:\/\/en.wikipedia.org\/wiki\/Insomnia \"Insomnia\") [Parasomnia](https:\/\/en.wikipedia.org\/wiki\/Parasomnia \"Parasomnia\") [Night terror](https:\/\/en.wikipedia.org\/wiki\/Night_terror \"Night terror\") [Nightmare](https:\/\/en.wikipedia.org\/wiki\/Nightmare \"Nightmare\") [REM sleep behavior disorder](https:\/\/en.wikipedia.org\/wiki\/Rapid_eye_movement_sleep_behavior_disorder \"Rapid eye movement sleep behavior disorder\") |\n| [Postnatal](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_disorders_of_childbirth \"Psychiatric disorders of childbirth\") | [Postpartum depression](https:\/\/en.wikipedia.org\/wiki\/Postpartum_depression \"Postpartum depression\") [Postpartum psychosis](https:\/\/en.wikipedia.org\/wiki\/Postpartum_psychosis \"Postpartum psychosis\") |\n| [Sexual desire](https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Sexual_desire_disorders \"Sexual dysfunction\") | [Hypersexuality](https:\/\/en.wikipedia.org\/wiki\/Hypersexuality \"Hypersexuality\") [Hypoactive sexual desire disorder](https:\/\/en.wikipedia.org\/wiki\/Hypoactive_sexual_desire_disorder \"Hypoactive sexual desire disorder\") |\n| [Psychoactive](https:\/\/en.wikipedia.org\/wiki\/Psychoactive_drug \"Psychoactive drug\") substances, [substance abuse](https:\/\/en.wikipedia.org\/wiki\/Substance_abuse \"Substance abuse\") and substance-related |   |\n| [Drug overdose](https:\/\/en.wikipedia.org\/wiki\/Drug_overdose \"Drug overdose\") [Hallucinogen persisting perception disorder](https:\/\/en.wikipedia.org\/wiki\/Hallucinogen_persisting_perception_disorder \"Hallucinogen persisting perception disorder\") [Intoxication](https:\/\/en.wikipedia.org\/wiki\/Substance_intoxication \"Substance intoxication\") [Physical dependence](https:\/\/en.wikipedia.org\/wiki\/Physical_dependence \"Physical dependence\") [Rebound effect](https:\/\/en.wikipedia.org\/wiki\/Rebound_effect \"Rebound effect\") [Stimulant psychosis](https:\/\/en.wikipedia.org\/wiki\/Stimulant_psychosis \"Stimulant psychosis\") [Substance dependence](https:\/\/en.wikipedia.org\/wiki\/Substance_dependence \"Substance dependence\") [Substance-induced psychosis](https:\/\/en.wikipedia.org\/wiki\/Substance-induced_psychosis \"Substance-induced psychosis\") [Withdrawal](https:\/\/en.wikipedia.org\/wiki\/Drug_withdrawal \"Drug withdrawal\") |   |\n| [Schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\"), [schizotypal](https:\/\/en.wikipedia.org\/wiki\/Schizotypal_personality_disorder \"Schizotypal personality disorder\") and [delusional](https:\/\/en.wikipedia.org\/wiki\/Delusional_disorder \"Delusional disorder\") |   |\n|   |   |\n| Delusional | [Delusional disorder](https:\/\/en.wikipedia.org\/wiki\/Delusional_disorder \"Delusional disorder\") [Folie à deux](https:\/\/en.wikipedia.org\/wiki\/Folie_%C3%A0_deux \"Folie à deux\") |\n| [Psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") and schizophrenia-like | [Brief reactive psychosis](https:\/\/en.wikipedia.org\/wiki\/Brief_reactive_psychosis \"Brief reactive psychosis\") [Schizoaffective disorder]() [Schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\") |\n| Schizophrenia | [Childhood schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Childhood_schizophrenia \"Childhood schizophrenia\") [Disorganized (hebephrenic) schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Disorganized_schizophrenia \"Disorganized schizophrenia\") [Pseudoneurotic schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Pseudoneurotic_schizophrenia \"Pseudoneurotic schizophrenia\") [Simple-type schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Simple-type_schizophrenia \"Simple-type schizophrenia\") |\n| Other | [Catatonia](https:\/\/en.wikipedia.org\/wiki\/Catatonia \"Catatonia\") |\n| Symptoms and uncategorized |   |\n| [Impulse-control disorder](https:\/\/en.wikipedia.org\/wiki\/Impulse-control_disorder \"Impulse-control disorder\") [Klüver–Bucy syndrome](https:\/\/en.wikipedia.org\/wiki\/Kl%C3%BCver%E2%80%93Bucy_syndrome \"Klüver–Bucy syndrome\") [Psychomotor agitation](https:\/\/en.wikipedia.org\/wiki\/Psychomotor_agitation \"Psychomotor agitation\") [Stereotypy](https:\/\/en.wikipedia.org\/wiki\/Stereotypy \"Stereotypy\") [Caregiver burden](https:\/\/en.wikipedia.org\/wiki\/Caregiver_burden \"Caregiver burden\") |   |\n| ![](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/96\/Symbol_category_class.svg\/20px-Symbol_category_class.svg.png) [Category](https:\/\/en.wikipedia.org\/wiki\/Category:Mental_disorders \"Category:Mental disorders\") |   |\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:Mood_disorders \"Template:Mood disorders\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:Mood_disorders \"Template talk:Mood disorders\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:Mood_disorders \"Special:EditPage\/Template:Mood disorders\")[Mood disorder](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\") |   |\n|---|---|\n| [Spectrum](https:\/\/en.wikipedia.org\/wiki\/Affective_spectrum \"Affective spectrum\") |   |\n|   |   |\n| [Bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") | [Bipolar I](https:\/\/en.wikipedia.org\/wiki\/Bipolar_I_disorder \"Bipolar I disorder\") [Bipolar II](https:\/\/en.wikipedia.org\/wiki\/Bipolar_II_disorder \"Bipolar II disorder\") [Cyclothymia](https:\/\/en.wikipedia.org\/wiki\/Cyclothymia \"Cyclothymia\") [Bipolar NOS](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder_not_otherwise_specified \"Bipolar disorder not otherwise specified\") [Childhood](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder_in_children \"Bipolar disorder in children\") [Hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\") [Mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") [Mixed affective state](https:\/\/en.wikipedia.org\/wiki\/Mixed_affective_state \"Mixed affective state\") [Rapid cycling](https:\/\/en.wikipedia.org\/wiki\/Rapid_cycling \"Rapid cycling\") |\n| [Depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") | [Major depressive disorder](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder \"Major depressive disorder\") [Dysthymia](https:\/\/en.wikipedia.org\/wiki\/Dysthymia \"Dysthymia\") [Seasonal affective disorder](https:\/\/en.wikipedia.org\/wiki\/Seasonal_affective_disorder \"Seasonal affective disorder\") [Atypical depression](https:\/\/en.wikipedia.org\/wiki\/Atypical_depression \"Atypical depression\") [Melancholic depression](https:\/\/en.wikipedia.org\/wiki\/Melancholic_depression \"Melancholic depression\") [Major depressive episode](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\") [Depression in childhood and adolescence](https:\/\/en.wikipedia.org\/wiki\/Depression_in_childhood_and_adolescence \"Depression in childhood and adolescence\") |\n| Comorbidities | [Schizoaffective disorder]() |\n| [Symptoms](https:\/\/en.wikipedia.org\/wiki\/Symptom \"Symptom\") | [Delusion](https:\/\/en.wikipedia.org\/wiki\/Delusion \"Delusion\") [Depression (differential diagnoses)](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(differential_diagnoses\\) \"Depression (differential diagnoses)\") [Emotional dysregulation](https:\/\/en.wikipedia.org\/wiki\/Emotional_dysregulation \"Emotional dysregulation\") [Anhedonia](https:\/\/en.wikipedia.org\/wiki\/Anhedonia \"Anhedonia\") [Dysphoria](https:\/\/en.wikipedia.org\/wiki\/Dysphoria \"Dysphoria\") [Suicidal ideation](https:\/\/en.wikipedia.org\/wiki\/Suicidal_ideation \"Suicidal ideation\") [Episodic memory](https:\/\/en.wikipedia.org\/wiki\/Episodic_memory \"Episodic memory\") [Hallucination](https:\/\/en.wikipedia.org\/wiki\/Hallucination \"Hallucination\") [Mood swing](https:\/\/en.wikipedia.org\/wiki\/Mood_swing \"Mood swing\") *[Sleep disorder](https:\/\/en.wikipedia.org\/wiki\/Sleep_disorder \"Sleep disorder\")* [Hypersomnia](https:\/\/en.wikipedia.org\/wiki\/Hypersomnia \"Hypersomnia\") [Insomnia](https:\/\/en.wikipedia.org\/wiki\/Insomnia \"Insomnia\") [Psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") [Psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\") [Racing thoughts](https:\/\/en.wikipedia.org\/wiki\/Racing_thoughts \"Racing thoughts\") [Reduced affect display](https:\/\/en.wikipedia.org\/wiki\/Reduced_affect_display \"Reduced affect display\") |\n| [Diagnosis](https:\/\/en.wikipedia.org\/wiki\/List_of_diagnostic_classification_and_rating_scales_used_in_psychiatry \"List of diagnostic classification and rating scales used in psychiatry\") | [Bipolar Spectrum Diagnostic Scale](https:\/\/en.wikipedia.org\/wiki\/Bipolar_Spectrum_Diagnostic_Scale \"Bipolar Spectrum Diagnostic Scale\") [Child Mania Rating Scale](https:\/\/en.wikipedia.org\/wiki\/Child_Mania_Rating_Scale \"Child Mania Rating Scale\") [General Behavior Inventory](https:\/\/en.wikipedia.org\/wiki\/General_Behavior_Inventory \"General Behavior Inventory\") [Hypomania Checklist](https:\/\/en.wikipedia.org\/wiki\/Hypomania_Checklist \"Hypomania Checklist\") [Mood Disorder Questionnaire](https:\/\/en.wikipedia.org\/wiki\/Mood_Disorder_Questionnaire \"Mood Disorder Questionnaire\") [Rating scales for depression](https:\/\/en.wikipedia.org\/wiki\/Rating_scales_for_depression \"Rating scales for depression\") [Young Mania Rating Scale](https:\/\/en.wikipedia.org\/wiki\/Young_Mania_Rating_Scale \"Young Mania Rating Scale\") |\n| [Treatment](https:\/\/en.wikipedia.org\/wiki\/Treatment_of_bipolar_disorder \"Treatment of bipolar disorder\") |   |\n|   |   |\n| [Anticonvulsants](https:\/\/en.wikipedia.org\/wiki\/Anticonvulsant \"Anticonvulsant\") | [Carbamazepine](https:\/\/en.wikipedia.org\/wiki\/Carbamazepine \"Carbamazepine\") [Lamotrigine](https:\/\/en.wikipedia.org\/wiki\/Lamotrigine \"Lamotrigine\") [Oxcarbazepine](https:\/\/en.wikipedia.org\/wiki\/Oxcarbazepine \"Oxcarbazepine\") [Valproate](https:\/\/en.wikipedia.org\/wiki\/Valproate \"Valproate\") [Sodium valproate](https:\/\/en.wikipedia.org\/wiki\/Sodium_valproate \"Sodium valproate\") [Valproate semisodium](https:\/\/en.wikipedia.org\/wiki\/Valproate_semisodium \"Valproate semisodium\") |\n| [Sympathomimetics](https:\/\/en.wikipedia.org\/wiki\/Sympathomimetic_drug \"Sympathomimetic drug\"), [SSRIs](https:\/\/en.wikipedia.org\/wiki\/Selective_serotonin_reuptake_inhibitor \"Selective serotonin reuptake inhibitor\") and similar | [Bupropion](https:\/\/en.wikipedia.org\/wiki\/Bupropion \"Bupropion\") [Dextroamphetamine](https:\/\/en.wikipedia.org\/wiki\/Dextroamphetamine \"Dextroamphetamine\") [Escitalopram](https:\/\/en.wikipedia.org\/wiki\/Escitalopram \"Escitalopram\") [Fluoxetine](https:\/\/en.wikipedia.org\/wiki\/Fluoxetine \"Fluoxetine\") [Methylphenidate](https:\/\/en.wikipedia.org\/wiki\/Methylphenidate \"Methylphenidate\") [Sertraline](https:\/\/en.wikipedia.org\/wiki\/Sertraline \"Sertraline\") |\n| Other [mood stabilizers](https:\/\/en.wikipedia.org\/wiki\/Mood_stabilizer \"Mood stabilizer\") | [Antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Antipsychotic \"Antipsychotic\") [Atypical antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Atypical_antipsychotic \"Atypical antipsychotic\") [Lithium](https:\/\/en.wikipedia.org\/wiki\/Lithium_\\(medication\\) \"Lithium (medication)\") [Lithium carbonate](https:\/\/en.wikipedia.org\/wiki\/Lithium_carbonate \"Lithium carbonate\") [Lithium citrate](https:\/\/en.wikipedia.org\/wiki\/Lithium_citrate \"Lithium citrate\") |\n| Non-pharmaceutical | [Clinical psychology](https:\/\/en.wikipedia.org\/wiki\/Clinical_psychology \"Clinical psychology\") [Psychotherapy](https:\/\/en.wikipedia.org\/wiki\/Psychotherapy \"Psychotherapy\") [Cognitive behavioral therapy](https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy \"Cognitive behavioral therapy\") [Dialectical behavior therapy](https:\/\/en.wikipedia.org\/wiki\/Dialectical_behavior_therapy \"Dialectical behavior therapy\") [Electroconvulsive therapy](https:\/\/en.wikipedia.org\/wiki\/Electroconvulsive_therapy \"Electroconvulsive therapy\") [Involuntary commitment](https:\/\/en.wikipedia.org\/wiki\/Involuntary_commitment \"Involuntary commitment\") [Light therapy](https:\/\/en.wikipedia.org\/wiki\/Light_therapy \"Light therapy\") [Transcranial magnetic stimulation](https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation \"Transcranial magnetic stimulation\") |\n| [History](https:\/\/en.wikipedia.org\/wiki\/History_of_bipolar_disorder \"History of bipolar disorder\") | [Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") [Karl Leonhard](https:\/\/en.wikipedia.org\/wiki\/Karl_Leonhard \"Karl Leonhard\") [John Cade](https:\/\/en.wikipedia.org\/wiki\/John_Cade \"John Cade\") [Mogens Schou](https:\/\/en.wikipedia.org\/wiki\/Mogens_Schou \"Mogens Schou\") [Frederick K. Goodwin](https:\/\/en.wikipedia.org\/wiki\/Frederick_K._Goodwin \"Frederick K. Goodwin\") [Kay Redfield Jamison](https:\/\/en.wikipedia.org\/wiki\/Kay_Redfield_Jamison \"Kay Redfield Jamison\") [S. Nassir Ghaemi](https:\/\/en.wikipedia.org\/wiki\/S._Nassir_Ghaemi \"S. Nassir Ghaemi\") |\n\n|   |   |\n|---|---|\n| [Authority control databases](https:\/\/en.wikipedia.org\/wiki\/Help:Authority_control \"Help:Authority control\"): National [![Edit this at Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q834047#identifiers \"Edit this at Wikidata\") | [Japan](https:\/\/id.ndl.go.jp\/auth\/ndlna\/01175908) [Czech Republic](https:\/\/aleph.nkp.cz\/F\/?func=find-c&local_base=aut&ccl_term=ica=ph732864&CON_LNG=ENG) |\n\n![](https:\/\/en.wikipedia.org\/wiki\/Special:CentralAutoLogin\/start?useformat=desktop&type=1x1&usesul3=1)\n\nRetrieved from \"<https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&oldid=1336230406>\"\n\n[Categories](https:\/\/en.wikipedia.org\/wiki\/Help:Category \"Help:Category\"):\n\n- [Bipolar spectrum](https:\/\/en.wikipedia.org\/wiki\/Category:Bipolar_spectrum 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view](https:\/\/en.wikipedia.org\/w\/index.php?title=Schizoaffective_disorder&mobileaction=toggle_view_mobile)\n\n- [![Wikimedia Foundation](https:\/\/en.wikipedia.org\/static\/images\/footer\/wikimedia.svg)](https:\/\/www.wikimedia.org\/)\n- [![Powered by MediaWiki](https:\/\/en.wikipedia.org\/w\/resources\/assets\/mediawiki_compact.svg)](https:\/\/www.mediawiki.org\/)\n\nSearch\n\nToggle the table of contents\n\nSchizoaffective disorder\n\n31 languages\n\n[Add topic](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder)","attrs_readable_markdown":"| Schizoaffective disorder |   |\n|---|---|\n| [Specialty](https:\/\/en.wikipedia.org\/wiki\/Medical_specialty \"Medical specialty\") | [Psychiatry](https:\/\/en.wikipedia.org\/wiki\/Psychiatry \"Psychiatry\") |\n| [Symptoms](https:\/\/en.wikipedia.org\/wiki\/Signs_and_symptoms \"Signs and symptoms\") | [Hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucinations \"Hallucinations\") [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusions \"Delusions\") [disorganized thought and behavior](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\") [inappropriate affect](https:\/\/en.wikipedia.org\/wiki\/Inappropriate_affect \"Inappropriate affect\") [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") |\n| [Complications](https:\/\/en.wikipedia.org\/wiki\/Complication_\\(medicine\\) \"Complication (medicine)\") | lack of motivation cognitive issues risk of harm to self or others anxiety disorders |\n| Usual onset | 16–30 years of age |\n| Types | bipolar type[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-1) depressive type[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-2) Mixed type (Includes both depressive and bipolar symptoms) |\n| [Causes](https:\/\/en.wikipedia.org\/wiki\/Cause_\\(medicine\\) \"Cause (medicine)\") | Unknown[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-NAMI2017-3) |\n| [Risk factors](https:\/\/en.wikipedia.org\/wiki\/Risk_factor \"Risk factor\") | Genetics brain chemistry and structure stress drug use[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-NAMI2017-3) |\n| [Diagnostic method](https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis \"Medical diagnosis\") | [Psychiatric assessment](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_assessment \"Psychiatric assessment\") |\n| [Differential diagnosis](https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis \"Differential diagnosis\") | Psychotic depression bipolar disorder with psychotic features schizophreniform disorder schizophrenia |\n| [Medication](https:\/\/en.wikipedia.org\/wiki\/Medication \"Medication\") | [Antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Antipsychotics \"Antipsychotics\") [mood stabilizers](https:\/\/en.wikipedia.org\/wiki\/Mood_stabilizers \"Mood stabilizers\") [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressants \"Antidepressants\") |\n| [Prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\") | Depends on the individual, medication response, and therapeutic support available |\n| Frequency | 0\\.3% |\n\n**Schizoaffective disorder** is a [mental disorder](https:\/\/en.wikipedia.org\/wiki\/Mental_disorder \"Mental disorder\") characterized by symptoms of both [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") ([psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\")) and a [mood disorder](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\"), either [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") or [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\").[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Common symptoms include [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucination \"Hallucination\"), [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusion \"Delusion\"), [disorganized speech and thinking](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\"), as well as mood episodes.[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-6) Schizoaffective disorder can often be [misdiagnosed](https:\/\/en.wikipedia.org\/wiki\/Misdiagnosed \"Misdiagnosed\")[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the correct diagnosis may be [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), [bipolar I disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_I_disorder \"Bipolar I disorder\"), [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\"), or schizophrenia. This is a problem as treatment and [prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\") differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including [anxiety disorders](https:\/\/en.wikipedia.org\/wiki\/Anxiety_disorders \"Anxiety disorders\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock.-7)\n\nThere are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8) [Auditory hallucinations](https:\/\/en.wikipedia.org\/wiki\/Auditory_hallucination \"Auditory hallucination\") are most common.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18056246-9)[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-10) The onset of symptoms usually begins in adolescence or young adulthood.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:22-11)\n\n[Genetics](https:\/\/en.wikipedia.org\/wiki\/Genetics \"Genetics\") (researched in the field of [genomics](https:\/\/en.wikipedia.org\/wiki\/Genomics \"Genomics\")); problems with [neural circuits](https:\/\/en.wikipedia.org\/wiki\/Neural_circuits \"Neural circuits\"); chronic early, and chronic or short-term current [environmental stress](https:\/\/en.wikipedia.org\/wiki\/Stress_\\(biology\\) \"Stress (biology)\") appear to be important causal factors.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-12)[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-13)[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-14) No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of [tetrahydrobiopterin](https:\/\/en.wikipedia.org\/wiki\/Tetrahydrobiopterin \"Tetrahydrobiopterin\") (BH4), [dopamine](https:\/\/en.wikipedia.org\/wiki\/Dopamine \"Dopamine\"), and [glutamic acid](https:\/\/en.wikipedia.org\/wiki\/Glutamic_acid \"Glutamic acid\") in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-15)\n\nWhile a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-16) it is considered a common diagnosis among psychiatric disorders.[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-17) Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them.\n\nThe main current treatment is [antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Antipsychotic \"Antipsychotic\") medication combined with either [mood stabilizers](https:\/\/en.wikipedia.org\/wiki\/Mood_stabilizer \"Mood stabilizer\") or [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressant \"Antidepressant\") (or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\] When there is risk to self or others, usually early in treatment, hospitalization may be necessary.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) [Psychiatric rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_rehabilitation \"Psychiatric rehabilitation\"), [psychotherapy](https:\/\/en.wikipedia.org\/wiki\/Psychotherapy \"Psychotherapy\"), and [vocational rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Vocational_rehabilitation \"Vocational rehabilitation\") are very important for [recovery](https:\/\/en.wikipedia.org\/wiki\/Recovery_approach \"Recovery approach\") of higher psychosocial function\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]. As a group, people diagnosed with schizoaffective disorder using [DSM-IV](https:\/\/en.wikipedia.org\/wiki\/DSM-IV \"DSM-IV\") and [ICD-10](https:\/\/en.wikipedia.org\/wiki\/ICD-10 \"ICD-10\") criteria (which have since been updated\\[*[clarification needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify \"Wikipedia:Please clarify\")*\\]) have a better [outcome](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\"),[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\\[*[non-primary source needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:No_original_research#Primary,_secondary_and_tertiary_sources \"Wikipedia:No original research\")*\\] Outcomes for people with [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") diagnosed schizoaffective disorder depend on data from [prospective cohort studies](https:\/\/en.wikipedia.org\/wiki\/Prospective_cohort_studies \"Prospective cohort studies\"), which have not been completed yet.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV [prevalence](https:\/\/en.wikipedia.org\/wiki\/Prevalence \"Prevalence\") estimates were less than one percent of the population, in the range of 0.5–0.8 percent;[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20) newer DSM-5 prevalence estimates are not yet available.\n\nSigns and symptoms\n\nSchizoaffective disorder is defined by *mood disorder-free psychosis* in the context of a long-term psychotic and mood disorder.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) [Psychosis](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") must meet criterion A for [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") which may include [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusions \"Delusions\"), [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucinations \"Hallucinations\"), [disorganized speech and behavior](https:\/\/en.wikipedia.org\/wiki\/Thought_disorder \"Thought disorder\") and [negative symptoms](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia#Negative_symptoms \"Schizophrenia\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Both delusions and hallucinations are classic symptoms of psychosis.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Delusions are false beliefs which are strongly held despite evidence to the contrary.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although [auditory hallucinations](https:\/\/en.wikipedia.org\/wiki\/Auditory_hallucination \"Auditory hallucination\") (or \"hearing voices\") are the most common. Negative symptoms include [alogia](https:\/\/en.wikipedia.org\/wiki\/Alogia \"Alogia\") (lack of speech), [blunted affect](https:\/\/en.wikipedia.org\/wiki\/Blunted_affect \"Blunted affect\") (reduced intensity of outward emotional expression), [avolition](https:\/\/en.wikipedia.org\/wiki\/Avolition \"Avolition\") (lack of motivation), and [anhedonia](https:\/\/en.wikipedia.org\/wiki\/Anhedonia \"Anhedonia\") (inability to experience pleasure).[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.\n\nMood symptoms include [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), [mixed episode](https:\/\/en.wikipedia.org\/wiki\/Mixed_episode \"Mixed episode\"), or [depression](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\"), and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21) Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and [suicidal thinking](https:\/\/en.wikipedia.org\/wiki\/Suicidal_thinking \"Suicidal thinking\").\n\nDSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)\n\nCauses\n\nA combination of genetic and [environmental factors](https:\/\/en.wikipedia.org\/wiki\/Environmental_factor \"Environmental factor\") are believed to play a role in the development of schizoaffective disorder.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Lancet09-22)[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ07-23)\n\n> Genetic studies do not support the view that schizophrenia, psychotic [mood disorders](https:\/\/en.wikipedia.org\/wiki\/Mood_disorders \"Mood disorders\") and schizoaffective disorder are distinct [etiological](https:\/\/en.wikipedia.org\/wiki\/Etiology \"Etiology\") entities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\"), and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective \\[or mood disorder\\] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and [pathogenesis](https:\/\/en.wikipedia.org\/wiki\/Pathogenesis \"Pathogenesis\"). Laboratory studies of putative [endophenotypes](https:\/\/en.wikipedia.org\/wiki\/Endophenotype \"Endophenotype\"), [brain imaging](https:\/\/en.wikipedia.org\/wiki\/Brain_imaging \"Brain imaging\") studies, and [post mortem](https:\/\/en.wikipedia.org\/wiki\/Post_mortem \"Post mortem\") studies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects.\n\nViewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced [paternal age](https:\/\/en.wikipedia.org\/wiki\/Paternal_age \"Paternal age\") at the time of conception, a known cause of genetic mutations.[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-24) The physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human [neurophysiological](https:\/\/en.wikipedia.org\/wiki\/Neurophysiology \"Neurophysiology\") function in normal brain and mental disorder [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndromes \"Syndromes\") is not fully understood.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18056246-9)\n\nWhile there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) In some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\nSubstance use disorder\n\nA clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of [cannabis (marijuana)](https:\/\/en.wikipedia.org\/wiki\/Cannabis_\\(drug\\) \"Cannabis (drug)\"), however, evidence supports a link between earlier onset of psychotic illness and cannabis use.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-26) The more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness,[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-27)[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-28)[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Moore_TH,_Zammit_S,_[[Anne_Lingford-Hughes|Lingford-Hughes_A]],_et_al._2005_187-94-29) with frequent use being correlated with double the risk of psychosis and schizoaffective disorder.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-30) A 2009 Yale review stated that in individuals with an established psychotic disorder, [cannabinoids](https:\/\/en.wikipedia.org\/wiki\/Cannabinoids \"Cannabinoids\") can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-31) While cannabis use is accepted as a contributory cause of schizoaffective disorder by many,[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Henquet2008-32) it remains controversial,[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Genes10-33)[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Amar2007-34) since not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased [odds ratio](https:\/\/en.wikipedia.org\/wiki\/Odds_ratio \"Odds ratio\") of about 3.[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Cannabis&Psychosis-35) Certain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nMechanisms\n\nThough the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36) [White matter](https:\/\/en.wikipedia.org\/wiki\/White_matter \"White matter\") and [grey matter](https:\/\/en.wikipedia.org\/wiki\/Grey_matter \"Grey matter\") reductions in the right [lentiform nucleus](https:\/\/en.wikipedia.org\/wiki\/Lentiform_nucleus \"Lentiform nucleus\"), left [superior temporal gyrus](https:\/\/en.wikipedia.org\/wiki\/Superior_temporal_gyrus \"Superior temporal gyrus\"), and right [precuneus](https:\/\/en.wikipedia.org\/wiki\/Precuneus \"Precuneus\"), and other areas in the brain are also characteristic of schizoaffective disorder.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36)[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:42-37) Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:42-37) Due to its role in emotional regulation, researchers believe that the [hippocampus](https:\/\/en.wikipedia.org\/wiki\/Hippocampus \"Hippocampus\") is also involved in the progression of schizoaffective disorder.[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:52-38) Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:52-38) Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36)\n\nDiagnosis\n\nPsychosis as a [symptom](https:\/\/en.wikipedia.org\/wiki\/Symptom \"Symptom\") of a psychiatric disorder is first and foremost a [diagnosis of exclusion](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\").[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) So a new-onset episode of psychosis *cannot* be considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39)\n\nAn initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to [exclude](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") psychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital.\n\n[Delirium](https:\/\/en.wikipedia.org\/wiki\/Delirium \"Delirium\") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Excluding medical illnesses associated with psychosis is performed by using [blood tests](https:\/\/en.wikipedia.org\/wiki\/Blood_tests \"Blood tests\") to measure:\n\n- [Thyroid-stimulating hormone](https:\/\/en.wikipedia.org\/wiki\/Thyroid-stimulating_hormone \"Thyroid-stimulating hormone\") to exclude [hypo-](https:\/\/en.wikipedia.org\/wiki\/Hypothyroidism \"Hypothyroidism\") or [hyperthyroidism](https:\/\/en.wikipedia.org\/wiki\/Hyperthyroidism \"Hyperthyroidism\"),\n- Basic electrolytes and [serum calcium](https:\/\/en.wikipedia.org\/wiki\/Serum_calcium \"Serum calcium\") to rule out a metabolic disturbance,\n- [Full blood count](https:\/\/en.wikipedia.org\/wiki\/Complete_blood_count \"Complete blood count\") including [ESR](https:\/\/en.wikipedia.org\/wiki\/Erythrocyte_sedimentation_rate \"Erythrocyte sedimentation rate\") to rule out a systemic infection or chronic disease, and\n- [Serology](https:\/\/en.wikipedia.org\/wiki\/Serology \"Serology\") to exclude [syphilis](https:\/\/en.wikipedia.org\/wiki\/Syphilis \"Syphilis\") or [HIV](https:\/\/en.wikipedia.org\/wiki\/HIV \"HIV\") infection.\n\nOther investigations which may be performed include:\n\n- [EEG](https:\/\/en.wikipedia.org\/wiki\/EEG \"EEG\") to exclude [epilepsy](https:\/\/en.wikipedia.org\/wiki\/Epilepsy \"Epilepsy\"), and an\n- [MRI](https:\/\/en.wikipedia.org\/wiki\/MRI \"MRI\") or [CT scan](https:\/\/en.wikipedia.org\/wiki\/CT_scan \"CT scan\") of the head to exclude brain lesions.\n\nBlood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific *medical* indication. These may include serum [BSL](https:\/\/en.wikipedia.org\/wiki\/Blood_sugar \"Blood sugar\") if [olanzapine](https:\/\/en.wikipedia.org\/wiki\/Olanzapine \"Olanzapine\") has previously been prescribed, thyroid function if [lithium](https:\/\/en.wikipedia.org\/wiki\/Lithium_\\(medication\\) \"Lithium (medication)\") has previously been taken to rule out [hypothyroidism](https:\/\/en.wikipedia.org\/wiki\/Hypothyroidism \"Hypothyroidism\"), liver function tests if [chlorpromazine](https:\/\/en.wikipedia.org\/wiki\/Chlorpromazine \"Chlorpromazine\") has been prescribed, [CPK](https:\/\/en.wikipedia.org\/wiki\/Creatine_kinase \"Creatine kinase\") levels to exclude [neuroleptic malignant syndrome](https:\/\/en.wikipedia.org\/wiki\/Neuroleptic_malignant_syndrome \"Neuroleptic malignant syndrome\"), and a [urinalysis](https:\/\/en.wikipedia.org\/wiki\/Urinalysis \"Urinalysis\") and serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.\n\nBecause psychosis may be precipitated or exacerbated by common classes of [psychiatric medications](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_medications \"Psychiatric medications\"), such as [antidepressants](https:\/\/en.wikipedia.org\/wiki\/Antidepressant \"Antidepressant\"),[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis2-44) [ADHD stimulant medications](https:\/\/en.wikipedia.org\/wiki\/ADHD#Medication \"ADHD\"),[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-45)[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-ReferenceB-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47) and [sleep medications](https:\/\/en.wikipedia.org\/wiki\/Hypnotics \"Hypnotics\"),[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) [prescribed medication-induced psychosis](https:\/\/en.wikipedia.org\/wiki\/Substance-induced_psychosis \"Substance-induced psychosis\") should be [ruled out](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\"), particularly for first-episode psychosis.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) This is an essential step to reduce diagnostic error and to evaluate potential medication sources of further [patient harm](https:\/\/en.wikipedia.org\/wiki\/Iatrogenesis \"Iatrogenesis\").[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Regarding prescribed medication sources of patient harm, [Yale School of Medicine](https:\/\/en.wikipedia.org\/wiki\/Yale_School_of_Medicine \"Yale School of Medicine\") Professor of Psychiatry Malcolm B. Bowers Jr, MD wrote:[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Malcolm2004-50)\\[*[self-published source](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Verifiability#Self-published_sources \"Wikipedia:Verifiability\")*\\]\n\n> Illicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field \\[of psychiatry\\] and disastrous for some of our patients.\n> \n> > It is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications, *I am urging caution in their use*. I believe \\[clinicians\\] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by \\[the clinician\\] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for \\[the clinician\\] to take. *I believe that psychiatry as a field has not emphasized this point sufficiently*. As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed.[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-ReferenceB-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47)[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49)\n\nSubstance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be [excluded](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") to a high level of certainty while the person is psychotic, typically in an emergency department, using both a:\n\n- Broad spectrum urine toxicology screening, and a\n- Full serum toxicology screening (of the blood).\n\nSome [dietary supplements](https:\/\/en.wikipedia.org\/wiki\/Dietary_supplements \"Dietary supplements\") may also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-51)\n\nCommon mistakes made when diagnosing psychotic patients include:[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39)\n\n- Not properly excluding delirium,\n- Missing a [toxic psychosis](https:\/\/en.wikipedia.org\/wiki\/Substance-induced_psychosis \"Substance-induced psychosis\") by not screening for substances *and* medications,\n- Not appreciating medical abnormalities (e.g., [vital signs](https:\/\/en.wikipedia.org\/wiki\/Vital_signs \"Vital signs\")),\n- Not obtaining a medical history and family history,\n- Indiscriminate screening without an organizing framework,\n- Not asking family or others about dietary supplements,\n- Premature diagnostic closure, and\n- Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder.\n\nSchizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) such as [hallucinations](https:\/\/en.wikipedia.org\/wiki\/Hallucination \"Hallucination\") or [delusions](https:\/\/en.wikipedia.org\/wiki\/Delusion \"Delusion\"), and [depressive episodes](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\"). There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) Research has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse.[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-53) There are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\nOnly after these relevant and known causes of psychosis have been ruled out can a psychiatric [differential diagnosis](https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis \"Differential diagnosis\") be made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include:\n\n- Not screening for [dissociative disorders](https:\/\/en.wikipedia.org\/wiki\/Dissociative_disorders \"Dissociative disorders\"). [Dissociative identity disorder](https:\/\/en.wikipedia.org\/wiki\/Dissociative_identity_disorder \"Dissociative identity disorder\") and psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach.[\\[54\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-54)\n\nDSM-5 criteria\n\nThe most widely used criteria for diagnosing schizoaffective disorder are from the [American Psychiatric Association](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\")'s *[Diagnostic and Statistical Manual of Mental Disorders-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\")*.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or [unreliably](https:\/\/en.wikipedia.org\/wiki\/Reliability_\\(statistics\\) \"Reliability (statistics)\")) used on patients;[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the diagnosis is made, it does not stay with most patients over time,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) and it has questionable [diagnostic validity](https:\/\/en.wikipedia.org\/wiki\/Validity_\\(statistics\\) \"Validity (statistics)\") (that is, it does not describe a distinct disorder, nor predict any particular outcome).[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These problems have been slightly reduced (or \"modestly improved\") in the [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") according to Carpenter.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nWhen [psychotic](https:\/\/en.wikipedia.org\/wiki\/Psychosis \"Psychosis\") symptoms are confined to an episode of [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\") or [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\") (with or without [mixed features](https:\/\/en.wikipedia.org\/wiki\/Mixed_affective_state \"Mixed affective state\")), the diagnosis is that of a \"psychotic\" [mood disorder](https:\/\/en.wikipedia.org\/wiki\/Mood_disorder \"Mood disorder\"), namely either psychotic [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") or [psychotic major depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"). Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder, [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\") or [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe.\n\nDSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) As such, it is no longer an \"episode diagnosis.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The new schizoaffective framework looks at the time from \"the \\[first episode of\\] psychosis up to the current episode \\[of psychosis\\], rather than only defining a single episode with \\[co-occurring\\] psychotic and mood [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndrome \"Syndrome\").\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The other period of psychosis \"requires the overlap of mood \\[disorder\\] symptoms with psychotic symptoms to be conspicuous\" and last for a greater portion of the disorder.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)\n\nThese two changes are intended by the DSM-5 workgroup to accomplish two goals:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n- Increase the diagnosis' consistency (or reliability) when it is used;\n- Significantly decrease the overall use of the schizoaffective disorder diagnosis.\n\nIf the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of [psychiatric genetics](https:\/\/en.wikipedia.org\/wiki\/Psychiatric_genetics \"Psychiatric genetics\"), [neuroimaging](https:\/\/en.wikipedia.org\/wiki\/Neuroimaging \"Neuroimaging\"), and [cognitive science](https:\/\/en.wikipedia.org\/wiki\/Cognitive_science \"Cognitive science\") that includes the overlapping fields of [cognitive](https:\/\/en.wikipedia.org\/wiki\/Cognitive_neuroscience \"Cognitive neuroscience\"), [affective](https:\/\/en.wikipedia.org\/wiki\/Affective_neuroscience \"Affective neuroscience\"), and [social neuroscience](https:\/\/en.wikipedia.org\/wiki\/Social_neuroscience \"Social neuroscience\"), which may change the way schizoaffective disorder is [conceptualized](https:\/\/en.wikipedia.org\/wiki\/Construct_\\(philosophy_of_science\\) \"Construct (philosophy of science)\") and defined in future versions of the [DSM](https:\/\/en.wikipedia.org\/wiki\/Diagnostic_and_Statistical_Manual_of_Mental_Disorders \"Diagnostic and Statistical Manual of Mental Disorders\") and [ICD](https:\/\/en.wikipedia.org\/wiki\/ICD \"ICD\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-TransformingDiagnosis-56)\n\nComorbidities\n\nSchizoaffective disorder shares a high level of [comorbidity](https:\/\/en.wikipedia.org\/wiki\/Comorbidity \"Comorbidity\") with anxiety disorders, depression, and bipolar disorder.[\\[57\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-57)[\\[58\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-58) Individuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to [tobacco](https:\/\/en.wikipedia.org\/wiki\/Tobacco \"Tobacco\"), [marijuana](https:\/\/en.wikipedia.org\/wiki\/Cannabis_\\(drug\\) \"Cannabis (drug)\"), or [alcohol](https:\/\/en.wikipedia.org\/wiki\/Alcohol_\\(drug\\) \"Alcohol (drug)\").[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-59) Health care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder.\n\nTypes\n\nOne of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder:[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-who.int-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8)\n\n- Bipolar type, when the disturbance includes [manic episodes](https:\/\/en.wikipedia.org\/wiki\/Manic_episodes \"Manic episodes\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), or [mixed episodes](https:\/\/en.wikipedia.org\/wiki\/Mixed_episodes \"Mixed episodes\")—major depressive episodes also typically occur;\n- Depressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes.\n- Mixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder.[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:12-8)\n\nProblems with DSM-IV schizoaffective disorder\n\nThe [American Psychiatric Association's](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\") DSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) largely because the criteria were poorly defined, [ambiguous](https:\/\/en.wikipedia.org\/wiki\/Ambiguity \"Ambiguity\"), and hard to use (or poorly [operationalized](https:\/\/en.wikipedia.org\/wiki\/Operationalization \"Operationalization\")).[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid18199238-60) Poorly trained clinicians used the diagnosis without making necessary [exclusions](https:\/\/en.wikipedia.org\/wiki\/Diagnosis_of_exclusion \"Diagnosis of exclusion\") of common causes of psychosis, including some prescribed psychiatric medications.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis.[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-The_Overlap_of_Schizophrenic_and_Affective_Spectra-61)[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_Disorders:_New_Research-64)\n\nCarpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n> a recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused.\n\nAs stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Even when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records, [reliability](https:\/\/en.wikipedia.org\/wiki\/Interrater_reliability \"Interrater reliability\") was still poor for the DSM-IV schizoaffective diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-IV schizoaffective diagnosis is not stable over time either.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) An initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) By comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Most patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nIn April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were \"developing new criteria for schizoaffective disorder to improve reliability and [face validity](https:\/\/en.wikipedia.org\/wiki\/Face_validity \"Face validity\"),\" and were \"determining whether the dimensional assessment of mood \\[would\\] justify a recommendation to drop schizoaffective disorder as a diagnostic category.\"[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20) Speaking to an audience at the May 2009 annual conference of the [American Psychiatric Association](https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association \"American Psychiatric Association\"), Carpenter said:[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-OnTrack-20)\n\n> We had hoped to get rid of schizoaffective \\[disorder\\] as a diagnostic category \\[in the DSM-5\\] because we don't think it's \\[a\\] valid \\[scientific entity\\] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice.\n\nA major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV \"schizophrenia\" or \"mood disorder with psychotic features\".\n\nBut DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a \"mood disorder with psychotic features\" diagnosis,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) because [long-term data](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_data \"Longitudinal data\") revealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features,[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) even though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\n\nThese problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed;[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) furthermore, [outcome studies](https:\/\/en.wikipedia.org\/wiki\/Cohort_study \"Cohort study\") done 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor [prognosis](https:\/\/en.wikipedia.org\/wiki\/Prognosis \"Prognosis\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also.\n\nDSM-5 research directions\n\nThe new schizoaffective disorder criteria continue to have questionable diagnostic validity.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Questionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5 [categorizes](https:\/\/en.wikipedia.org\/wiki\/Categorization \"Categorization\") and defines schizoaffective disorder.\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/29\/Emil_Kraepelin2.gif)](https:\/\/en.wikipedia.org\/wiki\/File:Emil_Kraepelin2.gif)\n\n[Emil Kraepelin's](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") [dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\") (\n\nc.\n\n1898) continues to influence [classification and diagnosis](https:\/\/en.wikipedia.org\/wiki\/Nosology \"Nosology\") in psychiatry.\n\nA core concept in modern psychiatry since [DSM-III](https:\/\/en.wikipedia.org\/wiki\/DSM_III#DSM-III_\\(1980\\) \"DSM III\") was released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the [Kraepelinian dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\"). [Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") introduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before [genetics](https:\/\/en.wikipedia.org\/wiki\/Genetics \"Genetics\") were known and before any treatments existed for [mental illness](https:\/\/en.wikipedia.org\/wiki\/Mental_illness \"Mental illness\").[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) The Kraepelinian dichotomy was not used for [DSM-I](https:\/\/en.wikipedia.org\/wiki\/DSM-I \"DSM-I\") and [DSM-II](https:\/\/en.wikipedia.org\/wiki\/DSM-II \"DSM-II\") because both manuals were influenced by the dominant [psychodynamic](https:\/\/en.wikipedia.org\/wiki\/Psychodynamic \"Psychodynamic\") psychiatry of the time,[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Revolution-66) but the designers of DSM-III wanted to use more scientific and biological definitions.[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Revolution-66) Consequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system.\n\nThe Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by [data](https:\/\/en.wikipedia.org\/wiki\/Empirical_data \"Empirical data\") from modern psychiatric genetics for over eight years,[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-EndofKraepelinianDichotomy-67) and there is now [evidence](https:\/\/en.wikipedia.org\/wiki\/Empirical_evidence \"Empirical evidence\") of a significant overlap in the genetics of schizophrenia and bipolar disorder.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) According to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken [false dichotomy](https:\/\/en.wikipedia.org\/wiki\/False_dichotomy \"False dichotomy\").[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nThe dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Real life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder.[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) People with [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Thus, they are likely to continue to introduce [either-or](https:\/\/en.wikipedia.org\/wiki\/False_dichotomy \"False dichotomy\") [conceptual](https:\/\/en.wikipedia.org\/wiki\/Conceptualization \"Conceptualization\") and diagnostic error, by way of [confirmation bias](https:\/\/en.wikipedia.org\/wiki\/Confirmation_bias \"Confirmation bias\") into clinicians' [mindsets](https:\/\/en.wikipedia.org\/wiki\/Mindset \"Mindset\"), hindering accurate assessment and treatment.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nThe new definition continues the lack of [parsimony](https:\/\/en.wikipedia.org\/wiki\/Occam%27s_razor \"Occam's razor\") of the old definition.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Simpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more \"research \\[is\\] needed to establish a new [classification system](https:\/\/en.wikipedia.org\/wiki\/Nosology \"Nosology\") of equal or greater validity\"[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) to the existing system.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Because of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful.[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) After enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a [spectrum or dimensional approach](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") to diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nMore [parsimonious](https:\/\/en.wikipedia.org\/wiki\/Occam%27s_razor \"Occam's razor\") definitions than the current one were considered by Carpenter and the DSM-5 workgroup:[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\n> One option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective \\[or mood\\] symptoms \\[that is, [mania](https:\/\/en.wikipedia.org\/wiki\/Mania \"Mania\"), [hypomania](https:\/\/en.wikipedia.org\/wiki\/Hypomania \"Hypomania\"), [mixed episode](https:\/\/en.wikipedia.org\/wiki\/Mixed_state_\\(psychiatry\\) \"Mixed state (psychiatry)\"), or [depression](https:\/\/en.wikipedia.org\/wiki\/Major_depressive_episode \"Major depressive episode\")\\] as a dimension to [schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\") and [schizophreniform disorder](https:\/\/en.wikipedia.org\/wiki\/Schizophreniform_disorder \"Schizophreniform disorder\") *or* to define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect \\[or mood\\] dimensions covering the entire course of illness, that would capture the current [concept](https:\/\/en.wikipedia.org\/wiki\/Conceptualization \"Conceptualization\") of periods of psychosis related and unrelated to mood episodes.\n\n> \\[N\\]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis \\[or psychotic [mood disorders](https:\/\/en.wikipedia.org\/wiki\/Mood_disorders \"Mood disorders\")\\] and schizophrenia. To the contrary, *the idea of a dichotomy between these types of conditions has proven naïve*. \\[T\\]he admixture of \"schizophrenic\" and affective \\[or mood\\] symptoms is a feature of many, or even most, cases with severe mental illness. Most *presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response* in psychosis. \\[U\\]ltimately a more ... [dimensional approach](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") \\[to assessment and treatment\\] will be required.\n\nThe field of [psychiatry](https:\/\/en.wikipedia.org\/wiki\/Psychiatry \"Psychiatry\") has begun to question its assumptions and analyze its data in order to merge closer with [evidence-based medicine](https:\/\/en.wikipedia.org\/wiki\/Evidence-based_medicine \"Evidence-based medicine\").[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The removal of the \"episode diagnosis\", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed *exactingly*.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55) But the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55) Community clinicians used the previous definition \"for about a third of cases with non-affective psychotic disorders.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Non-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)\n\nFrom a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's [neural circuits](https:\/\/en.wikipedia.org\/wiki\/Neural_circuit \"Neural circuit\"), for example, are just beginning to be mapped by modern neuroscience in the [Human Connectome Project](https:\/\/en.wikipedia.org\/wiki\/Human_Connectome_Project \"Human Connectome Project\") and [CLARITY](https:\/\/en.wikipedia.org\/wiki\/CLARITY \"CLARITY\"). Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and [patient harm](https:\/\/en.wikipedia.org\/wiki\/Iatrogenesis \"Iatrogenesis\"); this is crucial both for responsible patient care and to retain public trust. Looking forward, a [paradigm shift](https:\/\/en.wikipedia.org\/wiki\/Paradigm_shift \"Paradigm shift\") is needed in psychiatric research to address unanswered questions about schizoaffective disorder. The [dimensional](https:\/\/en.wikipedia.org\/wiki\/Spectrum_approach \"Spectrum approach\") Research Domain Criteria project currently being developed by the [U.S. National Institute of Mental Health](https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Mental_Health \"National Institute of Mental Health\"), may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders.[\\[70\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-RDoC-70)\n\nTreatment\n\nThe primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Lancet09-22) Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) [involuntarily](https:\/\/en.wikipedia.org\/wiki\/Involuntary_commitment \"Involuntary commitment\"). Long-term hospitalization is uncommon since [deinstitutionalization](https:\/\/en.wikipedia.org\/wiki\/Deinstitutionalization \"Deinstitutionalization\") started in the 1950s, although it still occurs.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) Community support services including drop-in centers, visits by members of a [community mental health team](https:\/\/en.wikipedia.org\/wiki\/Community_mental_health_service \"Community mental health service\"), supported employment and support groups are common.[\\[71\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-71) Evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder.[\\[72\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-72)\n\nBecause of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be [misdiagnosed](https:\/\/en.wikipedia.org\/wiki\/Medical_error \"Medical error\"). Many people are either diagnosed with [depression](https:\/\/en.wikipedia.org\/wiki\/Depression_\\(mood\\) \"Depression (mood)\"), schizophrenia, or [bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\") instead of schizoaffective disorder.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52) Because of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders.[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:02-52)\n\nWhile various medications and treatment options *exist* for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)*Schizoaffective* disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)\n\nTherapy\n\nPsychosocial treatments have been found to improve outcomes related to schizoaffective disorder.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Supportive [psychotherapy](https:\/\/en.wikipedia.org\/wiki\/Psychotherapy \"Psychotherapy\") and [cognitive behavioral therapy](https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy \"Cognitive behavioral therapy\") are both helpful.[\\[74\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-74) Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-75) With ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing.\n\nPsychiatric\/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing [activities of daily living](https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living \"Activities of daily living\"); increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on [vocational rehabilitation](https:\/\/en.wikipedia.org\/wiki\/Vocational_rehabilitation \"Vocational rehabilitation\").[\\[76\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-76) Evidence suggests that cognition-based approaches may be able to improve work and social functioning.[\\[77\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-77)\n\nPsychiatric rehabilitation consists of eight main areas:\n\n- Psychiatric (symptom reduction and management)\n- Health and Medical (maintaining consistency of care)\n- Housing (safe environments)\n- Basic living skills ([hygiene](https:\/\/en.wikipedia.org\/wiki\/Hygiene \"Hygiene\"), meals \\[including increasing healthy food intake and reducing processed food intake\\], safety, planning and chores)\n- Social ([relationships](https:\/\/en.wikipedia.org\/wiki\/Intimate_relationship \"Intimate relationship\"), family boundaries, communication and integration of client into the community)\n- Education and vocation (coping skills, [motivation](https:\/\/en.wikipedia.org\/wiki\/Motivation \"Motivation\") and suitable goals chosen by client)\n- Finance ([personal budget](https:\/\/en.wikipedia.org\/wiki\/Personal_budget \"Personal budget\"))\n- Community and legal (resources)\n\nMedication\n\n[Antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Antipsychotic \"Antipsychotic\") medication is usually required both for acute treatment and the prevention of relapse.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78) There is no single antipsychotic of choice in treating schizoaffective disorder, but [atypical antipsychotics](https:\/\/en.wikipedia.org\/wiki\/Atypical_antipsychotic \"Atypical antipsychotic\") may be considered due to their mood-stabilizing abilities.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APP_textbook-21)[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) To date, [paliperidone](https:\/\/en.wikipedia.org\/wiki\/Paliperidone \"Paliperidone\") (Invega) is the only antipsychotic with [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) approval for the treatment of schizoaffective disorder.[\\[79\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manufacturer's_Official_webpage-79) Other antipsychotics may be prescribed to further alleviate psychotic symptoms.[\\[80\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-80)\n\nThe management of the bipolar type of schizoaffective disorder is similar to the [treatment of bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Treatment_of_bipolar_disorder \"Treatment of bipolar disorder\"), with the goal of preventing mood episodes and cycling.[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Stahl-81) [Lithium](https:\/\/en.wikipedia.org\/wiki\/Lithium_\\(medication\\) \"Lithium (medication)\") or anticonvulsant mood stabilizers such as [valproic acid](https:\/\/en.wikipedia.org\/wiki\/Valproic_acid \"Valproic acid\"), [carbamazepine](https:\/\/en.wikipedia.org\/wiki\/Carbamazepine \"Carbamazepine\"), and [lamotrigine](https:\/\/en.wikipedia.org\/wiki\/Lamotrigine \"Lamotrigine\") are prescribed in combination with an antipsychotic.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-BMJ_best_practice-73)\n\nAntidepressants have also been used to treat schizoaffective disorder.[\\[82\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-82) Though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers.[\\[83\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-83)\n\nSome research has supported the efficacy of [anxiolytics](https:\/\/en.wikipedia.org\/wiki\/Anxiolytic \"Anxiolytic\") in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive.[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:0-84) Due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment.[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:0-84)\n\nClozapine\n\n[Clozapine](https:\/\/en.wikipedia.org\/wiki\/Clozapine \"Clozapine\") is FDA-approved for treatment resistant schizophrenia.[\\[85\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-85) Though not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine is an [atypical antipsychotic](https:\/\/en.wikipedia.org\/wiki\/Atypical_antipsychotic \"Atypical antipsychotic\") that is recognized as being particularly effective when other antipsychotic agents have failed.[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Stahl-81) When combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals.[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality.[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78)[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-87)\n\nDespite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant.[\\[88\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-88) Clozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include [agranulocytosis](https:\/\/en.wikipedia.org\/wiki\/Agranulocytosis \"Agranulocytosis\") and [neutropenia](https:\/\/en.wikipedia.org\/wiki\/Neutropenia \"Neutropenia\").[\\[89\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-89) To mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests.[\\[90\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-90)\n\nElectroconvulsive therapy\n\n[Electroconvulsive therapy](https:\/\/en.wikipedia.org\/wiki\/Electroconvulsive_therapy \"Electroconvulsive therapy\") (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics.[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-APA_guideline-78)\n\nEpidemiology\n\nCompared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.[\\[91\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:3-91) Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.[\\[92\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock._p.501-502-92) 30% of cases occur between the ages of 25 and 35.[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:03-36) It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-93) Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-:22-11)[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx2-94)\n\nHistory\n\nThe term *schizoaffective psychosis* was introduced by the American psychiatrist [Jacob Kasanin](https:\/\/en.wikipedia.org\/wiki\/Jacob_S._Kasanin \"Jacob S. Kasanin\") in 1933[\\[95\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-pmid16857267-95) to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) Kasanin's concept of the illness was influenced by the [psychoanalytic](https:\/\/en.wikipedia.org\/wiki\/Psychoanalysis \"Psychoanalysis\") teachings of [Adolf Meyer](https:\/\/en.wikipedia.org\/wiki\/Adolf_Meyer_\\(psychiatrist\\) \"Adolf Meyer (psychiatrist)\") and Kasanin postulated that *schizoaffective psychosis* was caused by \"emotional conflicts\" of a \"mainly sexual nature\" and that psychoanalysis \"would help prevent the recurrence of such attacks.\"[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) He based his description on a case study of nine individuals.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Karl_Ludwig_Kahlbaum.JPG\/250px-Karl_Ludwig_Kahlbaum.JPG)](https:\/\/en.wikipedia.org\/wiki\/File:Karl_Ludwig_Kahlbaum.JPG)\n\n[Karl Kahlbaum](https:\/\/en.wikipedia.org\/wiki\/Karl_Kahlbaum \"Karl Kahlbaum\") (1828–1899)\n\nOther psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist [Karl Kahlbaum](https:\/\/en.wikipedia.org\/wiki\/Karl_Kahlbaum \"Karl Kahlbaum\") (1828–1899) described schizoaffective disorders as a separate group in his *vesania typica circularis*.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kahlbaum distinguished between [cross-sectional](https:\/\/en.wikipedia.org\/wiki\/Cross-sectional_study \"Cross-sectional study\") and [longitudinal](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_study \"Longitudinal study\") observations. In 1920, psychiatrist [Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") (1856–1926) observed a \"great number\" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, *dementia praecox* (now called schizophrenia) and *manic depressive insanity* (now called bipolar disorders and recurrent depression).[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nKraepelin acknowledged that \"there are many overlaps in this area,\" that is, the area between schizophrenia and mood disorders.[\\[96\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-96) In 1959, psychiatrist [Kurt Schneider](https:\/\/en.wikipedia.org\/wiki\/Kurt_Schneider \"Kurt Schneider\") (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed \"concurrent and sequential types\".[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) (The *concurrent type* of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time \\[now called psychotic mood disorders or affective psychosis\\]; while his *sequential type* refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Schneider described schizoaffective disorders as \"cases in-between\" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nThe historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes *and* polygenic variations.[\\[97\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-97)[\\[98\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-98)[\\[99\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-99)[\\[100\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-100)\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Emil_Kraepelin_1926.jpg\/250px-Emil_Kraepelin_1926.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:Emil_Kraepelin_1926.jpg)\n\n[Emil Kraepelin](https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin \"Emil Kraepelin\") (1856–1926). Embracing the [Kraepelinian dichotomy](https:\/\/en.wikipedia.org\/wiki\/Kraepelinian_dichotomy \"Kraepelinian dichotomy\") in [DSM-III](https:\/\/en.wikipedia.org\/wiki\/DSM-III \"DSM-III\") in 1980, while a step forward from [psychodynamic](https:\/\/en.wikipedia.org\/wiki\/Psychodynamic \"Psychodynamic\") explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the [DSM-5](https:\/\/en.wikipedia.org\/wiki\/DSM-5 \"DSM-5\") workgroup.\n\nSchizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in \"Psychotic Disorders Not Otherwise Specified\" before being formally recognized in DSM-III-R.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) DSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) In DSM-IV, published in 1994, schizoaffective disorders belonged to the category \"Other Psychotic Disorders\" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology.[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)\n\nDSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly [operationalized](https:\/\/en.wikipedia.org\/wiki\/Operationalization \"Operationalization\").[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These [ambiguous](https:\/\/en.wikipedia.org\/wiki\/Ambiguous \"Ambiguous\") and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Patients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were [longitudinally determined](https:\/\/en.wikipedia.org\/wiki\/Longitudinal_study \"Longitudinal study\") to have outcomes indistinguishable from those with mood disorders with or without psychotic features.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was [harmful](https:\/\/en.wikipedia.org\/wiki\/Iatrogenic \"Iatrogenic\") to many patients.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\\[101\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment-101) The poor prognosis for DSM-IV schizoaffective disorder was not based on [patient outcomes](https:\/\/en.wikipedia.org\/wiki\/Cohort_study \"Cohort study\") [research](https:\/\/en.wikipedia.org\/wiki\/Empirical_research \"Empirical research\"), but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician [enculturation](https:\/\/en.wikipedia.org\/wiki\/Enculturation \"Enculturation\") with [unscientific](https:\/\/en.wikipedia.org\/wiki\/Unscientific \"Unscientific\") assumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy;[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) and by clinicians being unfamiliar with the [scientific](https:\/\/en.wikipedia.org\/wiki\/Empirical_science \"Empirical science\") limitations of the diagnostic and classification system.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nThe DSM-5 schizoaffective disorder workgroup analyzed all of the available research [evidence](https:\/\/en.wikipedia.org\/wiki\/Empirical_science#Philosophy_of_science \"Empirical science\") on schizoaffective disorder, and concluded that \"presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response.\"[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Given our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness [syndromes](https:\/\/en.wikipedia.org\/wiki\/Syndrome \"Syndrome\"), the limits of our knowledge are clearer: *Presenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more*.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Schizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)\n\nStigma of schizoaffective disorder include moralist arguments, religious causes, and others during history.[\\[102\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-102)[\\[103\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-103)\n\nResearch\n\nLittle is known of the causes and mechanisms that lead to the development of schizoaffective disorder.[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-SadCreation-55)[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Whether schizoaffective disorder is a variant of schizophrenia (as in DSM-5 and ICD-10 classification systems), a variant of bipolar disorder, or part of a dimensional continuum between [psychotic depression](https:\/\/en.wikipedia.org\/wiki\/Psychotic_depression \"Psychotic depression\"), bipolar disorders and schizophrenia is currently being investigated.[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68)\n\nMore recently, some research suggests the need for a more specialized classification for schizoaffective disorder. In a 2017 examining diagnostic heterogeneity study, researchers found that when compared to a schizophrenia sample, individuals with schizoaffective disorder rate higher in suicidality and anxiety disorder comorbidity.[\\[104\\]](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_note-104)\n\nSee also\n\n- [Schizophrenia](https:\/\/en.wikipedia.org\/wiki\/Schizophrenia \"Schizophrenia\")\n- [Bipolar disorder](https:\/\/en.wikipedia.org\/wiki\/Bipolar_disorder \"Bipolar disorder\")\n\nReferences\n\n1. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-1)**\n   [\"Schizoaffective disorder, bipolar type\"](http:\/\/www.icd10data.com\/ICD10CM\/Codes\/F01-F99\/F20-F29\/F25-\/F25.0). *www.icd10data.com*.\n2. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-2)**\n   [\"Schizoaffective disorder, depressive type\"](http:\/\/www.icd10data.com\/ICD10CM\/Codes\/F01-F99\/F20-F29\/F25-\/F25.1). *www.icd10data.com*.\n3. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-NAMI2017_3-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-NAMI2017_3-1)\n   [\"Schizoaffective Disorder Overview – Causes\"](https:\/\/www.nami.org\/Learn-More\/Mental-Health-Conditions\/Schizoaffective-Disorder). *www.nami.org*.\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-who.int_4-4)\n   [\"F25 Schizoaffective disorders\"](http:\/\/apps.who.int\/classifications\/icd10\/browse\/2010\/en#\/F25). *ICD-10 Version:2010*. World Health Organization.\n5. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-8) [***j***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-9) [***k***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-10) [***l***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-11) [***m***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-12) [***n***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-13) [***o***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-14) [***p***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-15) [***q***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-16) [***r***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-17) [***s***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-18) [***t***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-19) [***u***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-20) [***v***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-21) [***w***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-22) [***x***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-23) [***y***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-24) [***z***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-25) [***aa***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-26) [***ab***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-27) [***ac***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-28) [***ad***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-29) [***ae***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-30) [***af***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-31) [***ag***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-32) [***ah***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-33) [***ai***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-34) [***aj***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-35) [***ak***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-36) [***al***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-37) [***am***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-38) [***an***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-39) [***ao***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-40) [***ap***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-41) [***aq***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-42) [***ar***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-43) [***as***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-44) [***at***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-45) [***au***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-46) [***av***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-47) [***aw***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-48) [***ax***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-49) [***ay***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-50) [***az***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-51) [***ba***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-52) [***bb***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-53) [***bc***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-54) [***bd***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-55) [***be***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-56)\n   Malaspina D, Owen MJ, Heckers S, Tandon R, Trump D, Schultz S, Barch DM, Gaebel W, Gur RE, Tsuang M, Van Os J, Carpenter W (May 2013). \"Schizoaffective disorder in the DSM-5\". *Schizophrenia Research*. **150** (1): 21–5\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.schres.2013.04.026](https:\/\/doi.org\/10.1016%2Fj.schres.2013.04.026). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [23707642](https:\/\/pubmed.ncbi.nlm.nih.gov\/23707642). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [14770729](https:\/\/api.semanticscholar.org\/CorpusID:14770729).\n6. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-6)**\n   Brannon, Guy E; Bienenfeld, David; Talavera, Francisco (9 September 2013). [\"Schizoaffective Disorder\"](http:\/\/emedicine.medscape.com\/article\/294763-overview). *Medscape Drugs & Diseases*. WebMD.\n7. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Kaplan_&_Saddock._7-0)**\n   Kaplan, HI; Saddock, VA (2007). *Synopsis of Psychiatry*. New York: Lippincott, Williams & Wilkins. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-7817-7327-0](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7817-7327-0 \"Special:BookSources\/978-0-7817-7327-0\")\n   \n   .\n8. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:12_8-2)\n   [\"Schizoaffective disorder\"](https:\/\/www.rcpsych.ac.uk\/mental-health\/problems-disorders\/schizoaffective-disorder). *Royal College of Psychiatrists*. Retrieved 30 September 2022.\n9. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18056246_9-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18056246_9-1)\n   Martin LF, Hall MH, Ross RG, Zerbe G, Freedman R, Olincy A (December 2007). \"Physiology of schizophrenia, bipolar disorder, and schizoaffective disorder\". *The American Journal of Psychiatry*. **164** (12): 1900–6\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1176\/appi.ajp.2007.06010017](https:\/\/doi.org\/10.1176%2Fappi.ajp.2007.06010017). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18056246](https:\/\/pubmed.ncbi.nlm.nih.gov\/18056246).\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-10)**\n    Startup H, Freeman D, Garety PA (19 June 2006). \"Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence\". *Behaviour Research and Therapy*. **45** (3): 523–537\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.brat.2006.04.006](https:\/\/doi.org\/10.1016%2Fj.brat.2006.04.006). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16782048](https:\/\/pubmed.ncbi.nlm.nih.gov\/16782048).\n11. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:22_11-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-:22_11-1)\n    [\"Schizoaffective Disorder in Children and Adolescents\"](https:\/\/www.mindyra.com\/solutions\/child\/schizoaffective-disorder). *www.mindyra.com*. Retrieved 30 September 2022.\n12. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-12)**\n    Kempf, L. (11 July 2009). \"Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: Trouble at the borders\". *International Review of Psychiatry*. **17** (1): 9–19\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/09540260500064959](https:\/\/doi.org\/10.1080%2F09540260500064959). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16194767](https:\/\/pubmed.ncbi.nlm.nih.gov\/16194767). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [21422704](https:\/\/api.semanticscholar.org\/CorpusID:21422704) – via Taylor & Francis.\n13. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-13)**\n    American Psychiatric Association (2013). *Diagnostic and Statistical Manual of Mental Disorders* (Fifth ed.). Arlington, VA: American Psychiatric Publishing. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-89042-555-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-89042-555-8 \"Special:BookSources\/978-0-89042-555-8\")\n    \n    .\n14. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-14)**\n    Munk Laursen, Thomas (16 June 2009). [\"Bipolar Disorder, Schizoaffective Disorder, and Schizophrenia Overlap: A New Comorbidity Index\"](https:\/\/www.psychiatrist.com\/jcp\/medical\/comorbidity\/bipolar-disorder-schizoaffective-disorder-schizophrenia\/). *The Journal of Clinical Psychiatry*. **70** (10) – via Psychiatrist.com.\n15. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-15)**\n    Archibald, Luke (20 December 2019). [\"Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). *Alcohol Research: Current Reviews*. **40** (1) 6. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.35946\/arcr.v40.1.06](https:\/\/doi.org\/10.35946%2Farcr.v40.1.06). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6927747](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [31886105](https:\/\/pubmed.ncbi.nlm.nih.gov\/31886105) – via NIH.\n16. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-16)**\n    Marneros, Andreas (30 June 2012). [\"Schizoaffective Disorder\"](https:\/\/doi.org\/10.16946%2Fkjsr.2012.15.1.5). *Korean Journal of Schizophrenia Research*. **15** (1): 5–12\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.16946\/kjsr.2012.15.1.5](https:\/\/doi.org\/10.16946%2Fkjsr.2012.15.1.5) – via KoreaMed Synapse.\n17. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-17)**\n    Joshi, Kruti; Lin, Jay; Lingohr-Smith, Melissa; Fu, Dong-Jing; Muser, Erik (October 2016). [\"Treatment Patterns and Antipsychotic Medication Adherence Among Commercially Insured Patients With Schizoaffective Disorder in the United States\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5017269). *Journal of Clinical Psychopharmacology*. **36** (5): 429–435\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/JCP.0000000000000549](https:\/\/doi.org\/10.1097%2FJCP.0000000000000549). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [0271-0749](https:\/\/search.worldcat.org\/issn\/0271-0749). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5017269](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5017269). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27525965](https:\/\/pubmed.ncbi.nlm.nih.gov\/27525965).\n18. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-BeckerKilian2006_18-2)\n    Becker, T.; Kilian, R. (2006). \"Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?\". *[Acta Psychiatrica Scandinavica. Supplementum](https:\/\/en.wikipedia.org\/wiki\/Acta_Psychiatrica_Scandinavica._Supplementum \"Acta Psychiatrica Scandinavica. Supplementum\")*. **113** (429): 9–16\\. 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[PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [14674956](https:\/\/pubmed.ncbi.nlm.nih.gov\/14674956). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [43303750](https:\/\/api.semanticscholar.org\/CorpusID:43303750).\n20. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-OnTrack_20-2)\n    Jeffrey, Susan (26 May 2009). [\"APA 2009: DSM on Track for 2012, But Difficult Decisions Lie Ahead\"](http:\/\/www.medscape.com\/viewarticle\/703312). *Medscape Medical News*. WebMD. 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(December 2010). \"Acute psychotic disorders related to bupropion: review of the literature\". *Encephale*. **36** (6): 461–71\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.encep.2010.01.005](https:\/\/doi.org\/10.1016%2Fj.encep.2010.01.005). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [21130229](https:\/\/pubmed.ncbi.nlm.nih.gov\/21130229).\n44. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Wellbutrin-Zyban-Psychosis2_44-0)**\n    Kumar, S.; Kodela, S.; Detweiler, J.G.; Kim, K.Y.; Detweiler, M.B. (November–December 2011). \"Bupropion-induced psychosis: folklore or a fact? A systematic review of the literature\". *General Hospital Psychiatry*. **33** (6): 612–7\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.genhosppsych.2011.07.001](https:\/\/doi.org\/10.1016%2Fj.genhosppsych.2011.07.001). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [21872337](https:\/\/pubmed.ncbi.nlm.nih.gov\/21872337).\n45. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-45)**\n    Bramness, Jørgen G; Gundersen, Øystein Hoel; Guterstam, Joar; Rognli, Eline Borger; Konstenius, Maija; Løberg, Else-Marie; Medhus, Sigrid; Tanum, Lars; et al. (5 December 2012). [\"Amphetamine-induced psychosis – a separate diagnostic entity or primary psychosis triggered in the vulnerable?\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3554477). *BMC Medicine*. **12** (1): 221. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1186\/1471-244X-12-221](https:\/\/doi.org\/10.1186%2F1471-244X-12-221). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3554477](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3554477). 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[PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [2670101](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2670101). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18698321](https:\/\/pubmed.ncbi.nlm.nih.gov\/18698321).\n48. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391_48-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391_48-1)\n    Markowitz, J.S.; Brewerton, T.D. (June 1996). \"Zolpidem-induced psychosis\". *Annals of Clinical Psychiatry*. **8** (2): 89–91\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3109\/10401239609148806](https:\/\/doi.org\/10.3109%2F10401239609148806). 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[\"Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk\"](https:\/\/www.federalregister.gov\/a\/04-2912\/p-276). *Federal Register*. **69** (28). HHS Food And Drug Administration: 6787–854\\. 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[\"A Misdiagnosed Case of Schizoaffective Disorder With Bipolar Manifestations\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8394638). *Cureus*. **13** (7) e16686. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.7759\/cureus.16686](https:\/\/doi.org\/10.7759%2Fcureus.16686). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [2168-8184](https:\/\/search.worldcat.org\/issn\/2168-8184). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [8394638](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8394638). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [34466319](https:\/\/pubmed.ncbi.nlm.nih.gov\/34466319).\n53. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-53)**\n    McQueen, Janie. [\"Schizophrenia and Substance Use Disorder: What to Know\"](https:\/\/www.webmd.com\/schizophrenia\/schizophrenia-substance-use-disorder). *WebMD*. Retrieved 10 November 2023.\n54. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-54)**\n    Shibayama, M. (2011). \"Differential diagnosis between dissociative disorders and schizophrenia\". *Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica*. **113** (9): 906–911\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [22117396](https:\/\/pubmed.ncbi.nlm.nih.gov\/22117396).\n55. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-SadCreation_55-4)\n    Malhi, G.S. (October 2013). \"Making up schizoaffective disorder: Cosmetic changes to a sad creation?\". *Australian and New Zealand Journal of Psychiatry*. **47** (10): 891–4\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1177\/0004867413505522](https:\/\/doi.org\/10.1177%2F0004867413505522). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24072567](https:\/\/pubmed.ncbi.nlm.nih.gov\/24072567). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [206399250](https:\/\/api.semanticscholar.org\/CorpusID:206399250).\n56. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-TransformingDiagnosis_56-0)**\n    [\"NIMH Director's Blog: Transforming Diagnosis\"](https:\/\/web.archive.org\/web\/20130529152509\/http:\/\/www.nimh.nih.gov\/about\/director\/2013\/transforming-diagnosis.shtml). *NIMH Director's Blog*. Archived from [the original](http:\/\/www.nimh.nih.gov\/about\/director\/2013\/transforming-diagnosis.shtml) on 29 May 2013. Retrieved 20 October 2013.\n57. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-57)**\n    Laursen, Thomas Munk; Agerbo, Esben; Pedersen, Carsten Bøcker (October 2009). \"Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index\". *The Journal of Clinical Psychiatry*. **70** (10): 1432–1438\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.4088\/JCP.08m04807](https:\/\/doi.org\/10.4088%2FJCP.08m04807). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1555-2101](https:\/\/search.worldcat.org\/issn\/1555-2101). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19538905](https:\/\/pubmed.ncbi.nlm.nih.gov\/19538905). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [34270304](https:\/\/api.semanticscholar.org\/CorpusID:34270304).\n58. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-58)**\n    Young, Sarah; Pfaff, Danielle; Lewandowski, Kathryn Eve; Ravichandran, Caitlin; Cohen, Bruce M.; Öngür, Dost (2013). \"Anxiety disorder comorbidity in bipolar disorder, schizophrenia and schizoaffective disorder\". *Psychopathology*. **46** (3): 176–185\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1159\/000339556](https:\/\/doi.org\/10.1159%2F000339556). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1423-033X](https:\/\/search.worldcat.org\/issn\/1423-033X). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [22906962](https:\/\/pubmed.ncbi.nlm.nih.gov\/22906962). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [20297075](https:\/\/api.semanticscholar.org\/CorpusID:20297075).\n59. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-59)**\n    Archibald, Luke; Brunette, Mary F.; Wallin, Diana J.; Green, Alan I. (20 December 2019). [\"Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). *Alcohol Research: Current Reviews*. **40** (1) arcr.v40.1.06. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.35946\/arcr.v40.1.06](https:\/\/doi.org\/10.35946%2Farcr.v40.1.06). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [2168-3492](https:\/\/search.worldcat.org\/issn\/2168-3492). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [6927747](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6927747). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [31886105](https:\/\/pubmed.ncbi.nlm.nih.gov\/31886105).\n60. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid18199238_60-0)**\n    Malhi, G.S.; Green, M.; Fagiolini, A.; Peselow, E.D.; Kumari, V. (February 2008). \"Schizoaffective disorder: diagnostic issues and future recommendations\". *Bipolar Disorders*. **10** (1 Pt 2): 215–30\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1111\/j.1399-5618.2007.00564.x](https:\/\/doi.org\/10.1111%2Fj.1399-5618.2007.00564.x). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18199238](https:\/\/pubmed.ncbi.nlm.nih.gov\/18199238).\n61. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-The_Overlap_of_Schizophrenic_and_Affective_Spectra_61-0)**\n    Marneros, A; Akiskal, HS (2007). *The Overlap of Schizophrenic and Affective Spectra*. New York: Cambridge University Press. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-521-85858-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-521-85858-8 \"Special:BookSources\/978-0-521-85858-8\")\n    \n    .\n62. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition_62-3)\n    Goodwin, FK; Jamison, KR (2007). *Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition*. 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[ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-19-513579-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-19-513579-4 \"Special:BookSources\/978-0-19-513579-4\")\n    \n    .\n63. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms_63-8)\n    Goodwin, FK; Marneros, A (2005). *Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms*. 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[PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [7195359](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7195359). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [32358572](https:\/\/pubmed.ncbi.nlm.nih.gov\/32358572).\n94. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-PsychosisExclusionaryDx2_94-0)**\n    Freudenreich, Oliver (3 December 2012). [\"Differential Diagnosis of Psychotic Symptoms: Medical \"Mimics\"\"](https:\/\/web.archive.org\/web\/20130604094749\/http:\/\/www.psychiatrictimes.com\/forensic-psychiatry\/differential-diagnosis-psychotic-symptoms-medical-%E2%80%9Cmimics%E2%80%9D). *Psychiatric Times*. UBM Medica. Archived from [the original](http:\/\/www.psychiatrictimes.com\/forensic-psychiatry\/differential-diagnosis-psychotic-symptoms-medical-%E2%80%9Cmimics%E2%80%9D) on 4 June 2013. Retrieved 19 October 2013.\n95. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-pmid16857267_95-0)**\n    Lake, C.R.; Hurwitz, N. (August 2006). \"Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders\". *Psychiatry Research*. **143** (2–3\\): 255–87\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.psychres.2005.08.012](https:\/\/doi.org\/10.1016%2Fj.psychres.2005.08.012). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [16857267](https:\/\/pubmed.ncbi.nlm.nih.gov\/16857267). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [35916818](https:\/\/api.semanticscholar.org\/CorpusID:35916818).\n96. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-96)** [Marneros & Akiskal 2007](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#CITEREFMarnerosAkiskal2007), pp. 3–4.\n97. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-97)**\n    Van Snellenberg, J.X.; de Candia, T. (July 2009). \"Meta-analytic evidence for familial coaggregation of schizophrenia and bipolar disorder\". *Arch. Gen. Psychiatry*. **66** (7): 748–55\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1001\/archgenpsychiatry.2009.64](https:\/\/doi.org\/10.1001%2Farchgenpsychiatry.2009.64). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19581566](https:\/\/pubmed.ncbi.nlm.nih.gov\/19581566). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [20216200](https:\/\/api.semanticscholar.org\/CorpusID:20216200).\n98. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-98)**\n    \"Schizophrenia and bipolar disorder may share genetic origins\". *Harv Ment Health Lett*. **25** (12): 7. June 2009. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19582944](https:\/\/pubmed.ncbi.nlm.nih.gov\/19582944).\n99. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-99)**\n    Purcell, S.M.; Wray, N.R.; Stone, J.L.; Visscher, P.M.; O'Donovan, M.C.; Sullivan, P.F.; Sklar, P. (July 2009). [\"Common polygenic variation contributes to risk of schizophrenia and bipolar disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3912837). *Nature*. **460** (7256): 748–52\\. [Bibcode](https:\/\/en.wikipedia.org\/wiki\/Bibcode_\\(identifier\\) \"Bibcode (identifier)\"):[2009Natur.460..748P](https:\/\/ui.adsabs.harvard.edu\/abs\/2009Natur.460..748P). [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/nature08185](https:\/\/doi.org\/10.1038%2Fnature08185). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3912837](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3912837). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19571811](https:\/\/pubmed.ncbi.nlm.nih.gov\/19571811).\n100. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-100)**\n     Potash, J.B.; Bienvenu, OJ (June 2009). \"Neuropsychiatric disorders: Shared genetics of bipolar disorder and schizophrenia\". *Nature Reviews Neurology*. **5** (6): 299–300\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/nrneurol.2009.71](https:\/\/doi.org\/10.1038%2Fnrneurol.2009.71). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19498428](https:\/\/pubmed.ncbi.nlm.nih.gov\/19498428). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [21986987](https:\/\/api.semanticscholar.org\/CorpusID:21986987).\n101. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment_101-0)**\n     Lake, C.R.; Hurwitz, N. (2007). \"Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease\". *Current Opinion in Psychiatry*. **20** (4): 365–79\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/YCO.0b013e3281a305ab](https:\/\/doi.org\/10.1097%2FYCO.0b013e3281a305ab). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [17551352](https:\/\/pubmed.ncbi.nlm.nih.gov\/17551352). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [37664803](https:\/\/api.semanticscholar.org\/CorpusID:37664803).\n102. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-102)**\n     Assis, Jorge Cândido de; Villares, Cecília Cruz; Bressan, Rodrigo Affonseca (2023). [*Between Reason and Illusion: Demystifying Schizophrenia*](https:\/\/link.springer.com\/10.1007\/978-3-031-24556-5). Copernicus Books. Cham: Springer Nature Switzerland. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/978-3-031-24556-5](https:\/\/doi.org\/10.1007%2F978-3-031-24556-5). [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n     \n     [978-3-031-24555-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-3-031-24555-8 \"Special:BookSources\/978-3-031-24555-8\")\n     \n     .\n103. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-103)**\n     Farrell, Michael (2024). *Controversies in schizophrenia: issues, causes, and treatment*. New York, NY: Routledge, Taylor & Francis Group. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n     \n     [978-1-003-41355-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-003-41355-4 \"Special:BookSources\/978-1-003-41355-4\")\n     \n     .\n104. **[^](https:\/\/en.wikipedia.org\/wiki\/Schizoaffective_disorder#cite_ref-104)**\n     Seldin, Katherine; Armstrong, Kristan; Schiff, Max L.; Heckers, Stephan (2017). [\"Reducing the Diagnostic Heterogeneity of Schizoaffective Disorder\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5300988). *Frontiers in Psychiatry*. **8**: 18. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3389\/fpsyt.2017.00018](https:\/\/doi.org\/10.3389%2Ffpsyt.2017.00018). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1664-0640](https:\/\/search.worldcat.org\/issn\/1664-0640). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5300988](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5300988). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [28239362](https:\/\/pubmed.ncbi.nlm.nih.gov\/28239362).\n\nFurther reading\n\n- Moore, D.P.; Jefferson, J.W. (2004). *Handbook of medical psychiatry* (2nd ed.). Philadelphia: Elsevier\/Mosby. pp. 126–127\\. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n  \n  [978-0-323-02911-7](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-323-02911-7 \"Special:BookSources\/978-0-323-02911-7\")\n  \n  .\n- Goetzt, C.G. (2003). *Textbook of clinical neurology* (2nd ed.). Philadelphia: W.B. Saunders. p. 48. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n  \n  [978-0-7216-3800-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7216-3800-3 \"Special:BookSources\/978-0-7216-3800-3\")\n  \n  .\n\nExternal links","meta_canonical":null}

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URL	https://en.wikipedia.org/wiki/Schizoaffective_disorder
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Boilerpipe Text	Schizoaffective disorder Specialty Psychiatry Symptoms Hallucinations delusions disorganized thought and behavior inappropriate affect depression mania Complications lack of motivation cognitive issues risk of harm to self or others anxiety disorders Usual onset 16–30 years of age Types bipolar type [ 1 ] depressive type [ 2 ] Mixed type (Includes both depressive and bipolar symptoms) Causes Unknown [ 3 ] Risk factors Genetics brain chemistry and structure stress drug use [ 3 ] Diagnostic method Psychiatric assessment Differential diagnosis Psychotic depression bipolar disorder with psychotic features schizophreniform disorder schizophrenia Medication Antipsychotics mood stabilizers antidepressants Prognosis Depends on the individual, medication response, and therapeutic support available Frequency 0.3% Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia ( psychosis ) and a mood disorder , either bipolar disorder or depression . [ 4 ] [ 5 ] The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. [ 5 ] Common symptoms include hallucinations , delusions , disorganized speech and thinking , as well as mood episodes. [ 6 ] Schizoaffective disorder can often be misdiagnosed [ 5 ] when the correct diagnosis may be psychotic depression , bipolar I disorder , schizophreniform disorder , or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders . [ 5 ] [ 7 ] There are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania). [ 4 ] [ 5 ] [ 8 ] Auditory hallucinations are most common. [ 9 ] [ 10 ] The onset of symptoms usually begins in adolescence or young adulthood. [ 11 ] Genetics (researched in the field of genomics ); problems with neural circuits ; chronic early, and chronic or short-term current environmental stress appear to be important causal factors. [ 12 ] [ 13 ] [ 14 ] No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of tetrahydrobiopterin (BH4), dopamine , and glutamic acid in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder. [ 15 ] While a diagnosis of schizoaffective disorder is rare, 0.3% in the general population, [ 16 ] it is considered a common diagnosis among psychiatric disorders. [ 17 ] Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them. The main current treatment is antipsychotic medication combined with either mood stabilizers or antidepressants (or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder. [ citation needed ] When there is risk to self or others, usually early in treatment, hospitalization may be necessary. [ 18 ] Psychiatric rehabilitation , psychotherapy , and vocational rehabilitation are very important for recovery of higher psychosocial function [ citation needed ] . As a group, people diagnosed with schizoaffective disorder using DSM-IV and ICD-10 criteria (which have since been updated [ clarification needed ] ) have a better outcome , [ 4 ] [ 5 ] but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same. [ 5 ] [ 19 ] [ non-primary source needed ] Outcomes for people with DSM-5 diagnosed schizoaffective disorder depend on data from prospective cohort studies , which have not been completed yet. [ 5 ] The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis; [ 18 ] that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV prevalence estimates were less than one percent of the population, in the range of 0.5–0.8 percent; [ 20 ] newer DSM-5 prevalence estimates are not yet available. Signs and symptoms Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder. [ 5 ] Psychosis must meet criterion A for schizophrenia which may include delusions , hallucinations , disorganized speech and behavior and negative symptoms . [ 5 ] Both delusions and hallucinations are classic symptoms of psychosis. [ 21 ] Delusions are false beliefs which are strongly held despite evidence to the contrary. [ 21 ] Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although auditory hallucinations (or "hearing voices") are the most common. Negative symptoms include alogia (lack of speech), blunted affect (reduced intensity of outward emotional expression), avolition (lack of motivation), and anhedonia (inability to experience pleasure). [ 21 ] Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis. Mood symptoms include mania , hypomania , mixed episode , or depression , and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts. [ 21 ] Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and suicidal thinking . DSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder. [ 4 ] Causes A combination of genetic and environmental factors are believed to play a role in the development of schizoaffective disorder. [ 22 ] [ 23 ] Genetic studies do not support the view that schizophrenia, psychotic mood disorders and schizoaffective disorder are distinct etiological entities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for bipolar disorder , and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective [or mood disorder] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and pathogenesis . Laboratory studies of putative endophenotypes , brain imaging studies, and post mortem studies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects. Viewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced paternal age at the time of conception, a known cause of genetic mutations. [ 24 ] The physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human neurophysiological function in normal brain and mental disorder syndromes is not fully understood. [ 9 ] While there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan. [ 25 ] In some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age. [ 25 ] Substance use disorder A clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of cannabis (marijuana) , however, evidence supports a link between earlier onset of psychotic illness and cannabis use. [ 26 ] The more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness, [ 27 ] [ 28 ] [ 29 ] with frequent use being correlated with double the risk of psychosis and schizoaffective disorder. [ 30 ] A 2009 Yale review stated that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. [ 31 ] While cannabis use is accepted as a contributory cause of schizoaffective disorder by many, [ 32 ] it remains controversial, [ 33 ] [ 34 ] since not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased odds ratio of about 3. [ 35 ] Certain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed. [ 5 ] Mechanisms Though the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder. [ 36 ] White matter and grey matter reductions in the right lentiform nucleus , left superior temporal gyrus , and right precuneus , and other areas in the brain are also characteristic of schizoaffective disorder. [ 36 ] [ 37 ] Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder. [ 37 ] Due to its role in emotional regulation, researchers believe that the hippocampus is also involved in the progression of schizoaffective disorder. [ 38 ] Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes. [ 38 ] Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well. [ 36 ] Diagnosis Psychosis as a symptom of a psychiatric disorder is first and foremost a diagnosis of exclusion . [ 39 ] So a new-onset episode of psychosis cannot be considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out. [ 39 ] Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis. [ 39 ] An initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to exclude psychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital. Delirium should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses. [ 39 ] Excluding medical illnesses associated with psychosis is performed by using blood tests to measure: Thyroid-stimulating hormone to exclude hypo- or hyperthyroidism , Basic electrolytes and serum calcium to rule out a metabolic disturbance, Full blood count including ESR to rule out a systemic infection or chronic disease, and Serology to exclude syphilis or HIV infection. Other investigations which may be performed include: EEG to exclude epilepsy , and an MRI or CT scan of the head to exclude brain lesions. Blood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific medical indication. These may include serum BSL if olanzapine has previously been prescribed, thyroid function if lithium has previously been taken to rule out hypothyroidism , liver function tests if chlorpromazine has been prescribed, CPK levels to exclude neuroleptic malignant syndrome , and a urinalysis and serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others. Because psychosis may be precipitated or exacerbated by common classes of psychiatric medications , such as antidepressants , [ 40 ] [ 41 ] [ 42 ] [ 43 ] [ 44 ] ADHD stimulant medications , [ 45 ] [ 46 ] [ 47 ] and sleep medications , [ 48 ] [ 49 ] prescribed medication-induced psychosis should be ruled out , particularly for first-episode psychosis. [ 39 ] This is an essential step to reduce diagnostic error and to evaluate potential medication sources of further patient harm . [ 39 ] Regarding prescribed medication sources of patient harm, Yale School of Medicine Professor of Psychiatry Malcolm B. Bowers Jr, MD wrote: [ 50 ] [ self-published source ] Illicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field [of psychiatry] and disastrous for some of our patients. It is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications, I am urging caution in their use . I believe [clinicians] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by [the clinician] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for [the clinician] to take. I believe that psychiatry as a field has not emphasized this point sufficiently . As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed. [ 40 ] [ 41 ] [ 42 ] [ 43 ] [ 46 ] [ 47 ] [ 48 ] [ 49 ] Substance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be excluded to a high level of certainty while the person is psychotic, typically in an emergency department, using both a: Broad spectrum urine toxicology screening, and a Full serum toxicology screening (of the blood). Some dietary supplements may also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements. [ 51 ] Common mistakes made when diagnosing psychotic patients include: [ 39 ] Not properly excluding delirium, Missing a toxic psychosis by not screening for substances and medications, Not appreciating medical abnormalities (e.g., vital signs ), Not obtaining a medical history and family history, Indiscriminate screening without an organizing framework, Not asking family or others about dietary supplements, Premature diagnostic closure, and Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder. Schizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms [ 52 ] such as hallucinations or delusions , and depressive episodes . There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder. [ 52 ] Research has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse. [ 53 ] There are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress. [ 25 ] Only after these relevant and known causes of psychosis have been ruled out can a psychiatric differential diagnosis be made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include: Not screening for dissociative disorders . Dissociative identity disorder and psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach. [ 54 ] DSM-5 criteria The most widely used criteria for diagnosing schizoaffective disorder are from the American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders-5 . [ 5 ] The DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or unreliably ) used on patients; [ 5 ] when the diagnosis is made, it does not stay with most patients over time, [ 5 ] and it has questionable diagnostic validity (that is, it does not describe a distinct disorder, nor predict any particular outcome). [ 5 ] These problems have been slightly reduced (or "modestly improved") in the DSM-5 according to Carpenter. [ 5 ] When psychotic symptoms are confined to an episode of mania or depression (with or without mixed features ), the diagnosis is that of a "psychotic" mood disorder , namely either psychotic bipolar disorder or psychotic major depression . Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder, schizophreniform disorder or schizophrenia . [ 5 ] The second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe. DSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis. [ 5 ] As such, it is no longer an "episode diagnosis." [ 5 ] The new schizoaffective framework looks at the time from "the [first episode of] psychosis up to the current episode [of psychosis], rather than only defining a single episode with [co-occurring] psychotic and mood syndromes ." [ 5 ] Specifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic. [ 5 ] The other period of psychosis "requires the overlap of mood [disorder] symptoms with psychotic symptoms to be conspicuous" and last for a greater portion of the disorder. [ 55 ] These two changes are intended by the DSM-5 workgroup to accomplish two goals: [ 5 ] Increase the diagnosis' consistency (or reliability) when it is used; Significantly decrease the overall use of the schizoaffective disorder diagnosis. If the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of psychiatric genetics , neuroimaging , and cognitive science that includes the overlapping fields of cognitive , affective , and social neuroscience , which may change the way schizoaffective disorder is conceptualized and defined in future versions of the DSM and ICD . [ 5 ] [ 56 ] Comorbidities Schizoaffective disorder shares a high level of comorbidity with anxiety disorders, depression, and bipolar disorder. [ 57 ] [ 58 ] Individuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to tobacco , marijuana , or alcohol . [ 59 ] Health care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder. Types One of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder: [ 4 ] [ 5 ] [ 8 ] Bipolar type, when the disturbance includes manic episodes , hypomania , or mixed episodes —major depressive episodes also typically occur; Depressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes. Mixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder. [ 8 ] Problems with DSM-IV schizoaffective disorder The American Psychiatric Association's DSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often, [ 5 ] largely because the criteria were poorly defined, ambiguous , and hard to use (or poorly operationalized ). [ 5 ] [ 60 ] Poorly trained clinicians used the diagnosis without making necessary exclusions of common causes of psychosis, including some prescribed psychiatric medications. [ 5 ] Specialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis. [ 61 ] [ 62 ] [ 63 ] [ 64 ] Carpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that: [ 5 ] a recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused. As stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable. [ 5 ] A diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively. [ 5 ] Even when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records, reliability was still poor for the DSM-IV schizoaffective diagnosis. [ 5 ] The DSM-IV schizoaffective diagnosis is not stable over time either. [ 5 ] An initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients. [ 5 ] By comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression. [ 5 ] Most patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis. [ 5 ] In April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were "developing new criteria for schizoaffective disorder to improve reliability and face validity ," and were "determining whether the dimensional assessment of mood [would] justify a recommendation to drop schizoaffective disorder as a diagnostic category." [ 20 ] Speaking to an audience at the May 2009 annual conference of the American Psychiatric Association , Carpenter said: [ 20 ] We had hoped to get rid of schizoaffective [disorder] as a diagnostic category [in the DSM-5] because we don't think it's [a] valid [scientific entity] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice. A major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV "schizophrenia" or "mood disorder with psychotic features". But DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a "mood disorder with psychotic features" diagnosis, [ 5 ] because long-term data revealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features, [ 5 ] [ 19 ] even though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders. [ 5 ] [ 19 ] These problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed; [ 5 ] furthermore, outcome studies done 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor prognosis . [ 5 ] The DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also. DSM-5 research directions The new schizoaffective disorder criteria continue to have questionable diagnostic validity. [ 5 ] Questionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5 categorizes and defines schizoaffective disorder. Emil Kraepelin's dichotomy ( c. 1898 ) continues to influence classification and diagnosis in psychiatry. A core concept in modern psychiatry since DSM-III was released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the Kraepelinian dichotomy . Emil Kraepelin introduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before genetics were known and before any treatments existed for mental illness . [ 65 ] The Kraepelinian dichotomy was not used for DSM-I and DSM-II because both manuals were influenced by the dominant psychodynamic psychiatry of the time, [ 66 ] but the designers of DSM-III wanted to use more scientific and biological definitions. [ 66 ] Consequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system. The Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by data from modern psychiatric genetics for over eight years, [ 67 ] and there is now evidence of a significant overlap in the genetics of schizophrenia and bipolar disorder. [ 65 ] According to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken false dichotomy . [ 65 ] [ 68 ] The dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis. [ 5 ] Real life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder. [ 69 ] People with psychotic depression , bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders. [ 65 ] [ 68 ] The categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients. [ 65 ] [ 68 ] Thus, they are likely to continue to introduce either-or conceptual and diagnostic error, by way of confirmation bias into clinicians' mindsets , hindering accurate assessment and treatment. [ 65 ] [ 68 ] The new definition continues the lack of parsimony of the old definition. [ 5 ] [ 69 ] Simpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more "research [is] needed to establish a new classification system of equal or greater validity" [ 69 ] to the existing system. [ 5 ] [ 69 ] Because of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful. [ 65 ] [ 68 ] After enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a spectrum or dimensional approach to diagnosis. [ 5 ] [ 68 ] More parsimonious definitions than the current one were considered by Carpenter and the DSM-5 workgroup: [ 5 ] One option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective [or mood] symptoms [that is, mania , hypomania , mixed episode , or depression ] as a dimension to schizophrenia and schizophreniform disorder or to define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect [or mood] dimensions covering the entire course of illness, that would capture the current concept of periods of psychosis related and unrelated to mood episodes. [N]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis [or psychotic mood disorders ] and schizophrenia. To the contrary, the idea of a dichotomy between these types of conditions has proven naïve . [T]he admixture of "schizophrenic" and affective [or mood] symptoms is a feature of many, or even most, cases with severe mental illness. Most presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response in psychosis. [U]ltimately a more ... dimensional approach [to assessment and treatment] will be required. The field of psychiatry has begun to question its assumptions and analyze its data in order to merge closer with evidence-based medicine . [ 68 ] The removal of the "episode diagnosis", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed exactingly . [ 55 ] But the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness. [ 5 ] [ 55 ] Community clinicians used the previous definition "for about a third of cases with non-affective psychotic disorders." [ 5 ] Non-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems. [ 55 ] From a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's neural circuits , for example, are just beginning to be mapped by modern neuroscience in the Human Connectome Project and CLARITY . Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and patient harm ; this is crucial both for responsible patient care and to retain public trust. Looking forward, a paradigm shift is needed in psychiatric research to address unanswered questions about schizoaffective disorder. The dimensional Research Domain Criteria project currently being developed by the U.S. National Institute of Mental Health , may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders. [ 70 ] Treatment The primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports. [ 22 ] Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily . Long-term hospitalization is uncommon since deinstitutionalization started in the 1950s, although it still occurs. [ 18 ] Community support services including drop-in centers, visits by members of a community mental health team , supported employment and support groups are common. [ 71 ] Evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder. [ 72 ] Because of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be misdiagnosed . Many people are either diagnosed with depression , schizophrenia, or bipolar disorder instead of schizoaffective disorder. [ 52 ] Because of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders. [ 52 ] While various medications and treatment options exist for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan. [ 25 ] Schizoaffective disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age. [ 25 ] Therapy Psychosocial treatments have been found to improve outcomes related to schizoaffective disorder. [ 73 ] Supportive psychotherapy and cognitive behavioral therapy are both helpful. [ 74 ] Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning. [ 75 ] With ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing. Psychiatric/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing activities of daily living ; increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on vocational rehabilitation . [ 76 ] Evidence suggests that cognition-based approaches may be able to improve work and social functioning. [ 77 ] Psychiatric rehabilitation consists of eight main areas: Psychiatric (symptom reduction and management) Health and Medical (maintaining consistency of care) Housing (safe environments) Basic living skills ( hygiene , meals [including increasing healthy food intake and reducing processed food intake], safety, planning and chores) Social ( relationships , family boundaries, communication and integration of client into the community) Education and vocation (coping skills, motivation and suitable goals chosen by client) Finance ( personal budget ) Community and legal (resources) Medication Antipsychotic medication is usually required both for acute treatment and the prevention of relapse. [ 21 ] [ 78 ] There is no single antipsychotic of choice in treating schizoaffective disorder, but atypical antipsychotics may be considered due to their mood-stabilizing abilities. [ 21 ] [ 73 ] To date, paliperidone (Invega) is the only antipsychotic with Food and Drug Administration (FDA) approval for the treatment of schizoaffective disorder. [ 79 ] Other antipsychotics may be prescribed to further alleviate psychotic symptoms. [ 80 ] The management of the bipolar type of schizoaffective disorder is similar to the treatment of bipolar disorder , with the goal of preventing mood episodes and cycling. [ 81 ] Lithium or anticonvulsant mood stabilizers such as valproic acid , carbamazepine , and lamotrigine are prescribed in combination with an antipsychotic. [ 73 ] Antidepressants have also been used to treat schizoaffective disorder. [ 82 ] Though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers. [ 83 ] Some research has supported the efficacy of anxiolytics in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive. [ 84 ] Due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment. [ 84 ] Clozapine Clozapine is FDA-approved for treatment resistant schizophrenia. [ 85 ] Though not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication. [ 86 ] Clozapine is an atypical antipsychotic that is recognized as being particularly effective when other antipsychotic agents have failed. [ 81 ] When combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals. [ 86 ] Clozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality. [ 78 ] [ 87 ] Despite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant. [ 88 ] Clozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include agranulocytosis and neutropenia . [ 89 ] To mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests. [ 90 ] Electroconvulsive therapy Electroconvulsive therapy (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics. [ 78 ] Epidemiology Compared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed. [ 91 ] Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life. [ 92 ] 30% of cases occur between the ages of 25 and 35. [ 36 ] It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution. [ 93 ] Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood. [ 11 ] [ 94 ] History The term schizoaffective psychosis was introduced by the American psychiatrist Jacob Kasanin in 1933 [ 95 ] to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia. [ 62 ] Kasanin's concept of the illness was influenced by the psychoanalytic teachings of Adolf Meyer and Kasanin postulated that schizoaffective psychosis was caused by "emotional conflicts" of a "mainly sexual nature" and that psychoanalysis "would help prevent the recurrence of such attacks." [ 63 ] He based his description on a case study of nine individuals. [ 63 ] Karl Kahlbaum (1828–1899) Other psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist Karl Kahlbaum (1828–1899) described schizoaffective disorders as a separate group in his vesania typica circularis . [ 63 ] Kahlbaum distinguished between cross-sectional and longitudinal observations. In 1920, psychiatrist Emil Kraepelin (1856–1926) observed a "great number" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, dementia praecox (now called schizophrenia) and manic depressive insanity (now called bipolar disorders and recurrent depression). [ 63 ] Kraepelin acknowledged that "there are many overlaps in this area," that is, the area between schizophrenia and mood disorders. [ 96 ] In 1959, psychiatrist Kurt Schneider (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed "concurrent and sequential types". [ 63 ] (The concurrent type of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time [now called psychotic mood disorders or affective psychosis]; while his sequential type refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.) [ 63 ] Schneider described schizoaffective disorders as "cases in-between" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders. [ 63 ] The historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes and polygenic variations. [ 97 ] [ 98 ] [ 99 ] [ 100 ] Emil Kraepelin (1856–1926). Embracing the Kraepelinian dichotomy in DSM-III in 1980, while a step forward from psychodynamic explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the DSM-5 workgroup. Schizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in "Psychotic Disorders Not Otherwise Specified" before being formally recognized in DSM-III-R. [ 62 ] DSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive. [ 62 ] In DSM-IV, published in 1994, schizoaffective disorders belonged to the category "Other Psychotic Disorders" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology. [ 63 ] DSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly operationalized . [ 5 ] These ambiguous and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis. [ 5 ] Patients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were longitudinally determined to have outcomes indistinguishable from those with mood disorders with or without psychotic features. [ 5 ] A poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was harmful to many patients. [ 5 ] [ 101 ] The poor prognosis for DSM-IV schizoaffective disorder was not based on patient outcomes research , but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician enculturation with unscientific assumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy; [ 65 ] [ 68 ] and by clinicians being unfamiliar with the scientific limitations of the diagnostic and classification system. [ 5 ] The DSM-5 schizoaffective disorder workgroup analyzed all of the available research evidence on schizoaffective disorder, and concluded that "presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response." [ 5 ] Given our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness syndromes , the limits of our knowledge are clearer: Presenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more . [ 5 ] Schizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason. [ 5 ] Stigma of schizoaffective disorder include moralist arguments, religious causes, and others during history. [ 102 ] [ 103 ] Research Little is known of the causes and mechanisms that lead to the development of schizoaffective disorder. 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Bibcode : 2009Natur.460..748P . doi : 10.1038/nature08185 . PMC 3912837 . PMID 19571811 . ^ Potash, J.B.; Bienvenu, OJ (June 2009). "Neuropsychiatric disorders: Shared genetics of bipolar disorder and schizophrenia". Nature Reviews Neurology . 5 (6): 299– 300. doi : 10.1038/nrneurol.2009.71 . PMID 19498428 . S2CID 21986987 . ^ Lake, C.R.; Hurwitz, N. (2007). "Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease". Current Opinion in Psychiatry . 20 (4): 365– 79. doi : 10.1097/YCO.0b013e3281a305ab . PMID 17551352 . S2CID 37664803 . ^ Assis, Jorge Cândido de; Villares, Cecília Cruz; Bressan, Rodrigo Affonseca (2023). Between Reason and Illusion: Demystifying Schizophrenia . Copernicus Books. Cham: Springer Nature Switzerland. doi : 10.1007/978-3-031-24556-5 . ISBN 978-3-031-24555-8 . ^ Farrell, Michael (2024). Controversies in schizophrenia: issues, causes, and treatment . New York, NY: Routledge, Taylor & Francis Group. 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[o]") ## Contents move to sidebar hide - [(Top)](https://en.wikipedia.org/wiki/Schizoaffective_disorder) - [1 Signs and symptoms](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Signs_and_symptoms) - [2 Causes](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Causes) Toggle Causes subsection - [2\.1 Substance use disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Substance_use_disorder) - [3 Mechanisms](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Mechanisms) - [4 Diagnosis](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Diagnosis) Toggle Diagnosis subsection - [4\.1 DSM-5 criteria](https://en.wikipedia.org/wiki/Schizoaffective_disorder#DSM-5_criteria) - [4\.1.1 Comorbidities](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Comorbidities) - [4\.1.2 Types](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Types) - [4\.1.3 Problems with DSM-IV schizoaffective disorder](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Problems_with_DSM-IV_schizoaffective_disorder) - [4\.1.4 DSM-5 research directions](https://en.wikipedia.org/wiki/Schizoaffective_disorder#DSM-5_research_directions) - [5 Treatment](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Treatment) Toggle Treatment subsection - [5\.1 Therapy](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Therapy) - [5\.2 Medication](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Medication) - [5\.2.1 Clozapine](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Clozapine) - [5\.3 Electroconvulsive therapy](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Electroconvulsive_therapy) - [6 Epidemiology](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Epidemiology) - [7 History](https://en.wikipedia.org/wiki/Schizoaffective_disorder#History) - [8 Research](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Research) - [9 See also](https://en.wikipedia.org/wiki/Schizoaffective_disorder#See_also) - [10 References](https://en.wikipedia.org/wiki/Schizoaffective_disorder#References) - [11 Further reading](https://en.wikipedia.org/wiki/Schizoaffective_disorder#Further_reading) - [12 External links](https://en.wikipedia.org/wiki/Schizoaffective_disorder#External_links) Toggle the table of contents # Schizoaffective disorder 31 languages - [العربية](https://ar.wikipedia.org/wiki/%D8%A7%D8%B6%D8%B7%D8%B1%D8%A7%D8%A8_%D9%81%D8%B5%D8%A7%D9%85%D9%8A_%D8%B9%D8%A7%D8%B7%D9%81%D9%8A "اضطراب فصامي عاطفي – Arabic") - [Basa Bali](https://ban.wikipedia.org/wiki/Panglalah_skizoafektif "Panglalah skizoafektif – Balinese") - [Català](https://ca.wikipedia.org/wiki/Trastorn_esquizoafectiu "Trastorn esquizoafectiu – Catalan") - [Čeština](https://cs.wikipedia.org/wiki/Schizoafektivn%C3%AD_porucha "Schizoafektivní porucha – Czech") - [Deutsch](https://de.wikipedia.org/wiki/Schizoaffektive_St%C3%B6rung "Schizoaffektive Störung – German") - [Ελληνικά](https://el.wikipedia.org/wiki/%CE%A3%CF%87%CE%B9%CE%B6%CE%BF%CF%83%CF%85%CE%BD%CE%B1%CE%B9%CF%83%CE%B8%CE%B7%CE%BC%CE%B1%CF%84%CE%B9%CE%BA%CE%AE_%CE%B4%CE%B9%CE%B1%CF%84%CE%B1%CF%81%CE%B1%CF%87%CE%AE "Σχιζοσυναισθηματική διαταραχή – Greek") - [Esperanto](https://eo.wikipedia.org/wiki/Skizoafektiva_perturbo "Skizoafektiva perturbo – Esperanto") - [Español](https://es.wikipedia.org/wiki/Trastorno_esquizoafectivo "Trastorno esquizoafectivo – Spanish") - [Euskara](https://eu.wikipedia.org/wiki/Nahasmendu_eskizoafektibo "Nahasmendu eskizoafektibo – Basque") - [فارسی](https://fa.wikipedia.org/wiki/%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D8%A7%D8%B3%DA%A9%DB%8C%D8%B2%D9%88%D8%A7%D9%81%DA%A9%D8%AA%DB%8C%D9%88 "اختلال اسکیزوافکتیو – Persian") - [Suomi](https://fi.wikipedia.org/wiki/Skitsoaffektiivinen_h%C3%A4iri%C3%B6 "Skitsoaffektiivinen häiriö – Finnish") - [Français](https://fr.wikipedia.org/wiki/Trouble_schizo-affectif "Trouble schizo-affectif – French") - [עברית](https://he.wikipedia.org/wiki/%D7%94%D7%A4%D7%A8%D7%A2%D7%94_%D7%A1%D7%9B%D7%99%D7%96%D7%95%D7%90%D7%A4%D7%A7%D7%98%D7%99%D7%91%D7%99%D7%AA "הפרעה סכיזואפקטיבית – Hebrew") - [Magyar](https://hu.wikipedia.org/wiki/Szkizoaffekt%C3%ADv_zavar "Szkizoaffektív zavar – Hungarian") - [Bahasa Indonesia](https://id.wikipedia.org/wiki/Gangguan_skizoafektif "Gangguan skizoafektif – Indonesian") - [Italiano](https://it.wikipedia.org/wiki/Disturbo_schizoaffettivo "Disturbo schizoaffettivo – Italian") - [日本語](https://ja.wikipedia.org/wiki/%E7%B5%B1%E5%90%88%E5%A4%B1%E8%AA%BF%E6%84%9F%E6%83%85%E9%9A%9C%E5%AE%B3 "統合失調感情障害 – Japanese") - [Nederlands](https://nl.wikipedia.org/wiki/Schizoaffectieve_stoornis "Schizoaffectieve stoornis – Dutch") - [Norsk bokmål](https://no.wikipedia.org/wiki/Schizoaffektiv_lidelse "Schizoaffektiv lidelse – Norwegian Bokmål") - [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AC%BF%E0%AC%9C%E0%AD%8B%E0%AC%86%E0%AC%AB%E0%AD%87%E0%AC%95%E0%AD%8D%E0%AC%9F%E0%AC%BF%E0%AC%AD_%E0%AC%AC%E0%AD%87%E0%AC%AE%E0%AC%BE%E0%AC%B0%E0%AD%80 "ସିଜୋଆଫେକ୍ଟିଭ ବେମାରୀ – Odia") - [Polski](https://pl.wikipedia.org/wiki/Zaburzenia_schizoafektywne "Zaburzenia schizoafektywne – Polish") - [Português](https://pt.wikipedia.org/wiki/Transtorno_esquizoafetivo "Transtorno esquizoafetivo – Portuguese") - [Русский](https://ru.wikipedia.org/wiki/%D0%A8%D0%B8%D0%B7%D0%BE%D0%B0%D1%84%D1%84%D0%B5%D0%BA%D1%82%D0%B8%D0%B2%D0%BD%D0%BE%D0%B5_%D1%80%D0%B0%D1%81%D1%81%D1%82%D1%80%D0%BE%D0%B9%D1%81%D1%82%D0%B2%D0%BE "Шизоаффективное расстройство – Russian") - [Simple English](https://simple.wikipedia.org/wiki/Schizoaffective_disorder "Schizoaffective disorder – Simple English") - [Slovenčina](https://sk.wikipedia.org/wiki/Schizoafekt%C3%ADvna_porucha "Schizoafektívna porucha – Slovak") - [Српски / srpski](https://sr.wikipedia.org/wiki/%C5%A0izoafektivni_poreme%C4%87aj "Šizoafektivni poremećaj – Serbian") - [Svenska](https://sv.wikipedia.org/wiki/Schizoaffektivt_syndrom "Schizoaffektivt syndrom – Swedish") - [Türkçe](https://tr.wikipedia.org/wiki/%C5%9Eizoaffektif_bozukluk "Şizoaffektif bozukluk – Turkish") - [Українська](https://uk.wikipedia.org/wiki/%D0%A8%D0%B8%D0%B7%D0%BE%D0%B0%D1%84%D0%B5%D0%BA%D1%82%D0%B8%D0%B2%D0%BD%D0%B8%D0%B9_%D1%80%D0%BE%D0%B7%D0%BB%D0%B0%D0%B4 "Шизоафективний розлад – Ukrainian") - [اردو](https://ur.wikipedia.org/wiki/%D8%B4%DB%8C%D8%B2%D9%88_%D8%A7%D9%81%DB%8C%DA%A9%D9%B9%DB%8C%D9%88_%D8%B9%D8%A7%D8%B1%D8%B6%DB%81 "شیزو افیکٹیو عارضہ – Urdu") - [中文](https://zh.wikipedia.org/wiki/%E5%88%86%E8%A3%82%E6%83%85%E6%84%9F%E9%9A%9C%E7%A2%8D "分裂情感障碍 – Chinese") [Edit links](https://www.wikidata.org/wiki/Special:EntityPage/Q834047#sitelinks-wikipedia "Edit interlanguage links") - [Article](https://en.wikipedia.org/wiki/Schizoaffective_disorder "View the content page [c]") - [Talk](https://en.wikipedia.org/wiki/Talk:Schizoaffective_disorder "Discuss improvements to the content page [t]") English - [Read](https://en.wikipedia.org/wiki/Schizoaffective_disorder) - [View source](https://en.wikipedia.org/w/index.php?title=Schizoaffective_disorder&action=edit "This page is protected. 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The specific problem is: This article is mostly about ideas about treatment, and does not read like a reference. Please help [improve this article](https://en.wikipedia.org/wiki/Special:EditPage/Schizoaffective_disorder "Special:EditPage/Schizoaffective disorder") if you can. (April 2025) ([Learn how and when to remove this message](https://en.wikipedia.org/wiki/Help:Maintenance_template_removal "Help:Maintenance template removal")) \| Medical condition \| Schizoaffective disorder \| \| \|---\|---\| \| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") \| [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") \| \| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") \| [Hallucinations](https://en.wikipedia.org/wiki/Hallucinations "Hallucinations") [delusions](https://en.wikipedia.org/wiki/Delusions "Delusions") [disorganized thought and behavior](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") [inappropriate affect](https://en.wikipedia.org/wiki/Inappropriate_affect "Inappropriate affect") [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") [mania](https://en.wikipedia.org/wiki/Mania "Mania") \| \| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") \| lack of motivation cognitive issues risk of harm to self or others anxiety disorders \| \| Usual onset \| 16–30 years of age \| \| Types \| bipolar type[\[1\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-1) depressive type[\[2\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-2) Mixed type (Includes both depressive and bipolar symptoms) \| \| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") \| Unknown[\[3\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-NAMI2017-3) \| \| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") \| Genetics brain chemistry and structure stress drug use[\[3\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-NAMI2017-3) \| \| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") \| [Psychiatric assessment](https://en.wikipedia.org/wiki/Psychiatric_assessment "Psychiatric assessment") \| \| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") \| Psychotic depression bipolar disorder with psychotic features schizophreniform disorder schizophrenia \| \| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") \| [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotics "Antipsychotics") [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizers "Mood stabilizers") [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants") \| \| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") \| Depends on the individual, medication response, and therapeutic support available \| \| Frequency \| 0\.3% \| Schizoaffective disorder is a [mental disorder](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder") characterized by symptoms of both [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") ([psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis")) and a [mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), either [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") or [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)").[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Common symptoms include [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [disorganized speech and thinking](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder"), as well as mood episodes.[\[6\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-6) Schizoaffective disorder can often be [misdiagnosed](https://en.wikipedia.org/wiki/Misdiagnosed "Misdiagnosed")[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the correct diagnosis may be [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), [bipolar I disorder](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder"), [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder"), or schizophrenia. This is a problem as treatment and [prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorders "Anxiety disorders").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[7\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock.-7) There are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) [Auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination") are most common.[\[9\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18056246-9)[\[10\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-10) The onset of symptoms usually begins in adolescence or young adulthood.[\[11\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:22-11) [Genetics](https://en.wikipedia.org/wiki/Genetics "Genetics") (researched in the field of [genomics](https://en.wikipedia.org/wiki/Genomics "Genomics")); problems with [neural circuits](https://en.wikipedia.org/wiki/Neural_circuits "Neural circuits"); chronic early, and chronic or short-term current [environmental stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)") appear to be important causal factors.[\[12\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-12)[\[13\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-13)[\[14\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-14) No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of [tetrahydrobiopterin](https://en.wikipedia.org/wiki/Tetrahydrobiopterin "Tetrahydrobiopterin") (BH4), [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), and [glutamic acid](https://en.wikipedia.org/wiki/Glutamic_acid "Glutamic acid") in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.[\[15\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-15) While a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,[\[16\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-16) it is considered a common diagnosis among psychiatric disorders.[\[17\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-17) Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them. The main current treatment is [antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") medication combined with either [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizer "Mood stabilizer") or [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") (or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] When there is risk to self or others, usually early in treatment, hospitalization may be necessary.[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) [Psychiatric rehabilitation](https://en.wikipedia.org/wiki/Psychiatric_rehabilitation "Psychiatric rehabilitation"), [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy"), and [vocational rehabilitation](https://en.wikipedia.org/wiki/Vocational_rehabilitation "Vocational rehabilitation") are very important for [recovery](https://en.wikipedia.org/wiki/Recovery_approach "Recovery approach") of higher psychosocial function\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\]. As a group, people diagnosed with schizoaffective disorder using [DSM-IV](https://en.wikipedia.org/wiki/DSM-IV "DSM-IV") and [ICD-10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10") criteria (which have since been updated\[[clarification needed](https://en.wikipedia.org/wiki/Wikipedia:Please_clarify "Wikipedia:Please clarify")\]) have a better [outcome](https://en.wikipedia.org/wiki/Prognosis "Prognosis"),[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\[[non-primary source needed](https://en.wikipedia.org/wiki/Wikipedia:No_original_research#Primary,_secondary_and_tertiary_sources "Wikipedia:No original research")\] Outcomes for people with [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") diagnosed schizoaffective disorder depend on data from [prospective cohort studies](https://en.wikipedia.org/wiki/Prospective_cohort_studies "Prospective cohort studies"), which have not been completed yet.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV [prevalence](https://en.wikipedia.org/wiki/Prevalence "Prevalence") estimates were less than one percent of the population, in the range of 0.5–0.8 percent;[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) newer DSM-5 prevalence estimates are not yet available. ## Signs and symptoms Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) [Psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis") must meet criterion A for [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") which may include [delusions](https://en.wikipedia.org/wiki/Delusions "Delusions"), [hallucinations](https://en.wikipedia.org/wiki/Hallucinations "Hallucinations"), [disorganized speech and behavior](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") and [negative symptoms](https://en.wikipedia.org/wiki/Schizophrenia#Negative_symptoms "Schizophrenia").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Both delusions and hallucinations are classic symptoms of psychosis.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Delusions are false beliefs which are strongly held despite evidence to the contrary.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although [auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination") (or "hearing voices") are the most common. Negative symptoms include [alogia](https://en.wikipedia.org/wiki/Alogia "Alogia") (lack of speech), [blunted affect](https://en.wikipedia.org/wiki/Blunted_affect "Blunted affect") (reduced intensity of outward emotional expression), [avolition](https://en.wikipedia.org/wiki/Avolition "Avolition") (lack of motivation), and [anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") (inability to experience pleasure).[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis. Mood symptoms include [mania](https://en.wikipedia.org/wiki/Mania "Mania"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), [mixed episode](https://en.wikipedia.org/wiki/Mixed_episode "Mixed episode"), or [depression](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode"), and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and [suicidal thinking](https://en.wikipedia.org/wiki/Suicidal_thinking "Suicidal thinking"). DSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4) ## Causes A combination of genetic and [environmental factors](https://en.wikipedia.org/wiki/Environmental_factor "Environmental factor") are believed to play a role in the development of schizoaffective disorder.[\[22\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Lancet09-22)[\[23\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ07-23) > Genetic studies do not support the view that schizophrenia, psychotic [mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders") and schizoaffective disorder are distinct [etiological](https://en.wikipedia.org/wiki/Etiology "Etiology") entities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective \[or mood disorder\] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and [pathogenesis](https://en.wikipedia.org/wiki/Pathogenesis "Pathogenesis"). Laboratory studies of putative [endophenotypes](https://en.wikipedia.org/wiki/Endophenotype "Endophenotype"), [brain imaging](https://en.wikipedia.org/wiki/Brain_imaging "Brain imaging") studies, and [post mortem](https://en.wikipedia.org/wiki/Post_mortem "Post mortem") studies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects. — According to [William T. Carpenter](https://en.wikipedia.org/wiki/William_T._Carpenter "William T. Carpenter") the head of the [University of Maryland, Baltimore](https://en.wikipedia.org/wiki/University_of_Maryland,_Baltimore "University of Maryland, Baltimore") School of Medicine DSM-5 psychotic disorders workgroup, and others.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Viewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced [paternal age](https://en.wikipedia.org/wiki/Paternal_age "Paternal age") at the time of conception, a known cause of genetic mutations.[\[24\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-24) The physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human [neurophysiological](https://en.wikipedia.org/wiki/Neurophysiology "Neurophysiology") function in normal brain and mental disorder [syndromes](https://en.wikipedia.org/wiki/Syndromes "Syndromes") is not fully understood.[\[9\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18056246-9) While there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) In some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) ### Substance use disorder A clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of [cannabis (marijuana)](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), however, evidence supports a link between earlier onset of psychotic illness and cannabis use.[\[26\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-26) The more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness,[\[27\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-27)[\[28\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-28)[\[29\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Moore_TH,_Zammit_S,_[[Anne_Lingford-Hughes\|Lingford-Hughes_A]],_et_al._2005_187-94-29) with frequent use being correlated with double the risk of psychosis and schizoaffective disorder.[\[30\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-30) A 2009 Yale review stated that in individuals with an established psychotic disorder, [cannabinoids](https://en.wikipedia.org/wiki/Cannabinoids "Cannabinoids") can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness.[\[31\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-31) While cannabis use is accepted as a contributory cause of schizoaffective disorder by many,[\[32\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Henquet2008-32) it remains controversial,[\[33\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Genes10-33)[\[34\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Amar2007-34) since not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased [odds ratio](https://en.wikipedia.org/wiki/Odds_ratio "Odds ratio") of about 3.[\[35\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Cannabis&Psychosis-35) Certain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) ## Mechanisms Though the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) [White matter](https://en.wikipedia.org/wiki/White_matter "White matter") and [grey matter](https://en.wikipedia.org/wiki/Grey_matter "Grey matter") reductions in the right [lentiform nucleus](https://en.wikipedia.org/wiki/Lentiform_nucleus "Lentiform nucleus"), left [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus"), and right [precuneus](https://en.wikipedia.org/wiki/Precuneus "Precuneus"), and other areas in the brain are also characteristic of schizoaffective disorder.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36)[\[37\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:42-37) Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.[\[37\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:42-37) Due to its role in emotional regulation, researchers believe that the [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus") is also involved in the progression of schizoaffective disorder.[\[38\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:52-38) Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.[\[38\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:52-38) Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) ## Diagnosis Psychosis as a [symptom](https://en.wikipedia.org/wiki/Symptom "Symptom") of a psychiatric disorder is first and foremost a [diagnosis of exclusion](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion").[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) So a new-onset episode of psychosis cannot be considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) An initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to [exclude](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") psychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital. [Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Excluding medical illnesses associated with psychosis is performed by using [blood tests](https://en.wikipedia.org/wiki/Blood_tests "Blood tests") to measure: - [Thyroid-stimulating hormone](https://en.wikipedia.org/wiki/Thyroid-stimulating_hormone "Thyroid-stimulating hormone") to exclude [hypo-](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") or [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), - Basic electrolytes and [serum calcium](https://en.wikipedia.org/wiki/Serum_calcium "Serum calcium") to rule out a metabolic disturbance, - [Full blood count](https://en.wikipedia.org/wiki/Complete_blood_count "Complete blood count") including [ESR](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") to rule out a systemic infection or chronic disease, and - [Serology](https://en.wikipedia.org/wiki/Serology "Serology") to exclude [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") or [HIV](https://en.wikipedia.org/wiki/HIV "HIV") infection. Other investigations which may be performed include: - [EEG](https://en.wikipedia.org/wiki/EEG "EEG") to exclude [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy"), and an - [MRI](https://en.wikipedia.org/wiki/MRI "MRI") or [CT scan](https://en.wikipedia.org/wiki/CT_scan "CT scan") of the head to exclude brain lesions. Blood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific medical indication. These may include serum [BSL](https://en.wikipedia.org/wiki/Blood_sugar "Blood sugar") if [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine") has previously been prescribed, thyroid function if [lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") has previously been taken to rule out [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism"), liver function tests if [chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") has been prescribed, [CPK](https://en.wikipedia.org/wiki/Creatine_kinase "Creatine kinase") levels to exclude [neuroleptic malignant syndrome](https://en.wikipedia.org/wiki/Neuroleptic_malignant_syndrome "Neuroleptic malignant syndrome"), and a [urinalysis](https://en.wikipedia.org/wiki/Urinalysis "Urinalysis") and serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others. Because psychosis may be precipitated or exacerbated by common classes of [psychiatric medications](https://en.wikipedia.org/wiki/Psychiatric_medications "Psychiatric medications"), such as [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant"),[\[40\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\[41\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\[42\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\[43\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\[44\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis2-44) [ADHD stimulant medications](https://en.wikipedia.org/wiki/ADHD#Medication "ADHD"),[\[45\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-45)[\[46\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-ReferenceB-46)[\[47\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47) and [sleep medications](https://en.wikipedia.org/wiki/Hypnotics "Hypnotics"),[\[48\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\[49\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) [prescribed medication-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") should be [ruled out](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion"), particularly for first-episode psychosis.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) This is an essential step to reduce diagnostic error and to evaluate potential medication sources of further [patient harm](https://en.wikipedia.org/wiki/Iatrogenesis "Iatrogenesis").[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Regarding prescribed medication sources of patient harm, [Yale School of Medicine](https://en.wikipedia.org/wiki/Yale_School_of_Medicine "Yale School of Medicine") Professor of Psychiatry Malcolm B. Bowers Jr, MD wrote:[\[50\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Malcolm2004-50)\[[self-published source](https://en.wikipedia.org/wiki/Wikipedia:Verifiability#Self-published_sources "Wikipedia:Verifiability")\] > Illicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field \[of psychiatry\] and disastrous for some of our patients. > > > It is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications, I am urging caution in their use. I believe \[clinicians\] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by \[the clinician\] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for \[the clinician\] to take. I believe that psychiatry as a field has not emphasized this point sufficiently. As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed.[\[40\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\[41\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\[42\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\[43\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\[46\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-ReferenceB-46)[\[47\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47)[\[48\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\[49\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) Substance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be [excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") to a high level of certainty while the person is psychotic, typically in an emergency department, using both a: - Broad spectrum urine toxicology screening, and a - Full serum toxicology screening (of the blood). Some [dietary supplements](https://en.wikipedia.org/wiki/Dietary_supplements "Dietary supplements") may also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements.[\[51\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-51) Common mistakes made when diagnosing psychotic patients include:[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) - Not properly excluding delirium, - Missing a [toxic psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") by not screening for substances and medications, - Not appreciating medical abnormalities (e.g., [vital signs](https://en.wikipedia.org/wiki/Vital_signs "Vital signs")), - Not obtaining a medical history and family history, - Indiscriminate screening without an organizing framework, - Not asking family or others about dietary supplements, - Premature diagnostic closure, and - Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder. Schizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) such as [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination") or [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), and [depressive episodes](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode"). There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) Research has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse.[\[53\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-53) There are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) Only after these relevant and known causes of psychosis have been ruled out can a psychiatric [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") be made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include: - Not screening for [dissociative disorders](https://en.wikipedia.org/wiki/Dissociative_disorders "Dissociative disorders"). [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder") and psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach.[\[54\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-54) ### DSM-5 criteria The most widely used criteria for diagnosing schizoaffective disorder are from the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association")'s [Diagnostic and Statistical Manual of Mental Disorders-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or [unreliably](https://en.wikipedia.org/wiki/Reliability_\(statistics\) "Reliability (statistics)")) used on patients;[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the diagnosis is made, it does not stay with most patients over time,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) and it has questionable [diagnostic validity](https://en.wikipedia.org/wiki/Validity_\(statistics\) "Validity (statistics)") (that is, it does not describe a distinct disorder, nor predict any particular outcome).[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These problems have been slightly reduced (or "modestly improved") in the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") according to Carpenter.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) When [psychotic](https://en.wikipedia.org/wiki/Psychosis "Psychosis") symptoms are confined to an episode of [mania](https://en.wikipedia.org/wiki/Mania "Mania") or [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") (with or without [mixed features](https://en.wikipedia.org/wiki/Mixed_affective_state "Mixed affective state")), the diagnosis is that of a "psychotic" [mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), namely either psychotic [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") or [psychotic major depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"). Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder, [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") or [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe. DSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) As such, it is no longer an "episode diagnosis."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The new schizoaffective framework looks at the time from "the \[first episode of\] psychosis up to the current episode \[of psychosis\], rather than only defining a single episode with \[co-occurring\] psychotic and mood [syndromes](https://en.wikipedia.org/wiki/Syndrome "Syndrome")."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The other period of psychosis "requires the overlap of mood \[disorder\] symptoms with psychotic symptoms to be conspicuous" and last for a greater portion of the disorder.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) These two changes are intended by the DSM-5 workgroup to accomplish two goals:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) - Increase the diagnosis' consistency (or reliability) when it is used; - Significantly decrease the overall use of the schizoaffective disorder diagnosis. If the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of [psychiatric genetics](https://en.wikipedia.org/wiki/Psychiatric_genetics "Psychiatric genetics"), [neuroimaging](https://en.wikipedia.org/wiki/Neuroimaging "Neuroimaging"), and [cognitive science](https://en.wikipedia.org/wiki/Cognitive_science "Cognitive science") that includes the overlapping fields of [cognitive](https://en.wikipedia.org/wiki/Cognitive_neuroscience "Cognitive neuroscience"), [affective](https://en.wikipedia.org/wiki/Affective_neuroscience "Affective neuroscience"), and [social neuroscience](https://en.wikipedia.org/wiki/Social_neuroscience "Social neuroscience"), which may change the way schizoaffective disorder is [conceptualized](https://en.wikipedia.org/wiki/Construct_\(philosophy_of_science\) "Construct (philosophy of science)") and defined in future versions of the [DSM](https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders "Diagnostic and Statistical Manual of Mental Disorders") and [ICD](https://en.wikipedia.org/wiki/ICD "ICD").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[56\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-TransformingDiagnosis-56) #### Comorbidities Schizoaffective disorder shares a high level of [comorbidity](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity") with anxiety disorders, depression, and bipolar disorder.[\[57\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-57)[\[58\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-58) Individuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to [tobacco](https://en.wikipedia.org/wiki/Tobacco "Tobacco"), [marijuana](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), or [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)").[\[59\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-59) Health care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder. #### Types One of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder:[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) - Bipolar type, when the disturbance includes [manic episodes](https://en.wikipedia.org/wiki/Manic_episodes "Manic episodes"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), or [mixed episodes](https://en.wikipedia.org/wiki/Mixed_episodes "Mixed episodes")—major depressive episodes also typically occur; - Depressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes. - Mixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder.[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) #### Problems with DSM-IV schizoaffective disorder The [American Psychiatric Association's](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association") DSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) largely because the criteria were poorly defined, [ambiguous](https://en.wikipedia.org/wiki/Ambiguity "Ambiguity"), and hard to use (or poorly [operationalized](https://en.wikipedia.org/wiki/Operationalization "Operationalization")).[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[60\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18199238-60) Poorly trained clinicians used the diagnosis without making necessary [exclusions](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") of common causes of psychosis, including some prescribed psychiatric medications.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis.[\[61\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-The_Overlap_of_Schizophrenic_and_Affective_Spectra-61)[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62)[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)[\[64\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_Disorders:_New_Research-64) Carpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) > a recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused. As stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Even when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records, [reliability](https://en.wikipedia.org/wiki/Interrater_reliability "Interrater reliability") was still poor for the DSM-IV schizoaffective diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV schizoaffective diagnosis is not stable over time either.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) An initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) By comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Most patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) In April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were "developing new criteria for schizoaffective disorder to improve reliability and [face validity](https://en.wikipedia.org/wiki/Face_validity "Face validity")," and were "determining whether the dimensional assessment of mood \[would\] justify a recommendation to drop schizoaffective disorder as a diagnostic category."[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) Speaking to an audience at the May 2009 annual conference of the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association"), Carpenter said:[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) > We had hoped to get rid of schizoaffective \[disorder\] as a diagnostic category \[in the DSM-5\] because we don't think it's \[a\] valid \[scientific entity\] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice. A major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV "schizophrenia" or "mood disorder with psychotic features". But DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a "mood disorder with psychotic features" diagnosis,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) because [long-term data](https://en.wikipedia.org/wiki/Longitudinal_data "Longitudinal data") revealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) even though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) These problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed;[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) furthermore, [outcome studies](https://en.wikipedia.org/wiki/Cohort_study "Cohort study") done 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor [prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also. #### DSM-5 research directions The new schizoaffective disorder criteria continue to have questionable diagnostic validity.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Questionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5 [categorizes](https://en.wikipedia.org/wiki/Categorization "Categorization") and defines schizoaffective disorder. [![](https://upload.wikimedia.org/wikipedia/commons/2/29/Emil_Kraepelin2.gif)](https://en.wikipedia.org/wiki/File:Emil_Kraepelin2.gif) [Emil Kraepelin's](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") [dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") ( c. 1898) continues to influence [classification and diagnosis](https://en.wikipedia.org/wiki/Nosology "Nosology") in psychiatry. A core concept in modern psychiatry since [DSM-III](https://en.wikipedia.org/wiki/DSM_III#DSM-III_\(1980\) "DSM III") was released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy"). [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") introduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before [genetics](https://en.wikipedia.org/wiki/Genetics "Genetics") were known and before any treatments existed for [mental illness](https://en.wikipedia.org/wiki/Mental_illness "Mental illness").[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) The Kraepelinian dichotomy was not used for [DSM-I](https://en.wikipedia.org/wiki/DSM-I "DSM-I") and [DSM-II](https://en.wikipedia.org/wiki/DSM-II "DSM-II") because both manuals were influenced by the dominant [psychodynamic](https://en.wikipedia.org/wiki/Psychodynamic "Psychodynamic") psychiatry of the time,[\[66\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Revolution-66) but the designers of DSM-III wanted to use more scientific and biological definitions.[\[66\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Revolution-66) Consequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system. The Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by [data](https://en.wikipedia.org/wiki/Empirical_data "Empirical data") from modern psychiatric genetics for over eight years,[\[67\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-EndofKraepelinianDichotomy-67) and there is now [evidence](https://en.wikipedia.org/wiki/Empirical_evidence "Empirical evidence") of a significant overlap in the genetics of schizophrenia and bipolar disorder.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) According to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken [false dichotomy](https://en.wikipedia.org/wiki/False_dichotomy "False dichotomy").[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Real life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder.[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) People with [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Thus, they are likely to continue to introduce [either-or](https://en.wikipedia.org/wiki/False_dichotomy "False dichotomy") [conceptual](https://en.wikipedia.org/wiki/Conceptualization "Conceptualization") and diagnostic error, by way of [confirmation bias](https://en.wikipedia.org/wiki/Confirmation_bias "Confirmation bias") into clinicians' [mindsets](https://en.wikipedia.org/wiki/Mindset "Mindset"), hindering accurate assessment and treatment.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The new definition continues the lack of [parsimony](https://en.wikipedia.org/wiki/Occam%27s_razor "Occam's razor") of the old definition.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Simpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more "research \[is\] needed to establish a new [classification system](https://en.wikipedia.org/wiki/Nosology "Nosology") of equal or greater validity"[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) to the existing system.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Because of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) After enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a [spectrum or dimensional approach](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") to diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) More [parsimonious](https://en.wikipedia.org/wiki/Occam%27s_razor "Occam's razor") definitions than the current one were considered by Carpenter and the DSM-5 workgroup:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) > One option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective \[or mood\] symptoms \[that is, [mania](https://en.wikipedia.org/wiki/Mania "Mania"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), [mixed episode](https://en.wikipedia.org/wiki/Mixed_state_\(psychiatry\) "Mixed state (psychiatry)"), or [depression](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode")\] as a dimension to [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") and [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") or to define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect \[or mood\] dimensions covering the entire course of illness, that would capture the current [concept](https://en.wikipedia.org/wiki/Conceptualization "Conceptualization") of periods of psychosis related and unrelated to mood episodes. > \[N\]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis \[or psychotic [mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders")\] and schizophrenia. To the contrary, the idea of a dichotomy between these types of conditions has proven naïve. \[T\]he admixture of "schizophrenic" and affective \[or mood\] symptoms is a feature of many, or even most, cases with severe mental illness. Most presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response in psychosis. \[U\]ltimately a more ... [dimensional approach](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") \[to assessment and treatment\] will be required. The field of [psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") has begun to question its assumptions and analyze its data in order to merge closer with [evidence-based medicine](https://en.wikipedia.org/wiki/Evidence-based_medicine "Evidence-based medicine").[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The removal of the "episode diagnosis", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed exactingly.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) But the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) Community clinicians used the previous definition "for about a third of cases with non-affective psychotic disorders."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Non-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) From a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's [neural circuits](https://en.wikipedia.org/wiki/Neural_circuit "Neural circuit"), for example, are just beginning to be mapped by modern neuroscience in the [Human Connectome Project](https://en.wikipedia.org/wiki/Human_Connectome_Project "Human Connectome Project") and [CLARITY](https://en.wikipedia.org/wiki/CLARITY "CLARITY"). Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and [patient harm](https://en.wikipedia.org/wiki/Iatrogenesis "Iatrogenesis"); this is crucial both for responsible patient care and to retain public trust. Looking forward, a [paradigm shift](https://en.wikipedia.org/wiki/Paradigm_shift "Paradigm shift") is needed in psychiatric research to address unanswered questions about schizoaffective disorder. The [dimensional](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") Research Domain Criteria project currently being developed by the [U.S. National Institute of Mental Health](https://en.wikipedia.org/wiki/National_Institute_of_Mental_Health "National Institute of Mental Health"), may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders.[\[70\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-RDoC-70) ## Treatment The primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports.[\[22\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Lancet09-22) Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) [involuntarily](https://en.wikipedia.org/wiki/Involuntary_commitment "Involuntary commitment"). Long-term hospitalization is uncommon since [deinstitutionalization](https://en.wikipedia.org/wiki/Deinstitutionalization "Deinstitutionalization") started in the 1950s, although it still occurs.[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) Community support services including drop-in centers, visits by members of a [community mental health team](https://en.wikipedia.org/wiki/Community_mental_health_service "Community mental health service"), supported employment and support groups are common.[\[71\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-71) Evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder.[\[72\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-72) Because of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be [misdiagnosed](https://en.wikipedia.org/wiki/Medical_error "Medical error"). Many people are either diagnosed with [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"), schizophrenia, or [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") instead of schizoaffective disorder.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) Because of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) While various medications and treatment options exist for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)Schizoaffective disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) ### Therapy Psychosocial treatments have been found to improve outcomes related to schizoaffective disorder.[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Supportive [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy") and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") are both helpful.[\[74\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-74) Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning.[\[75\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-75) With ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing. Psychiatric/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing [activities of daily living](https://en.wikipedia.org/wiki/Activities_of_daily_living "Activities of daily living"); increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on [vocational rehabilitation](https://en.wikipedia.org/wiki/Vocational_rehabilitation "Vocational rehabilitation").[\[76\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-76) Evidence suggests that cognition-based approaches may be able to improve work and social functioning.[\[77\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-77) Psychiatric rehabilitation consists of eight main areas: - Psychiatric (symptom reduction and management) - Health and Medical (maintaining consistency of care) - Housing (safe environments) - Basic living skills ([hygiene](https://en.wikipedia.org/wiki/Hygiene "Hygiene"), meals \[including increasing healthy food intake and reducing processed food intake\], safety, planning and chores) - Social ([relationships](https://en.wikipedia.org/wiki/Intimate_relationship "Intimate relationship"), family boundaries, communication and integration of client into the community) - Education and vocation (coping skills, [motivation](https://en.wikipedia.org/wiki/Motivation "Motivation") and suitable goals chosen by client) - Finance ([personal budget](https://en.wikipedia.org/wiki/Personal_budget "Personal budget")) - Community and legal (resources) ### Medication [Antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") medication is usually required both for acute treatment and the prevention of relapse.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21)[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78) There is no single antipsychotic of choice in treating schizoaffective disorder, but [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") may be considered due to their mood-stabilizing abilities.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21)[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) To date, [paliperidone](https://en.wikipedia.org/wiki/Paliperidone "Paliperidone") (Invega) is the only antipsychotic with [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approval for the treatment of schizoaffective disorder.[\[79\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manufacturer's_Official_webpage-79) Other antipsychotics may be prescribed to further alleviate psychotic symptoms.[\[80\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-80) The management of the bipolar type of schizoaffective disorder is similar to the [treatment of bipolar disorder](https://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder "Treatment of bipolar disorder"), with the goal of preventing mood episodes and cycling.[\[81\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Stahl-81) [Lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") or anticonvulsant mood stabilizers such as [valproic acid](https://en.wikipedia.org/wiki/Valproic_acid "Valproic acid"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), and [lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") are prescribed in combination with an antipsychotic.[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Antidepressants have also been used to treat schizoaffective disorder.[\[82\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-82) Though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers.[\[83\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-83) Some research has supported the efficacy of [anxiolytics](https://en.wikipedia.org/wiki/Anxiolytic "Anxiolytic") in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive.[\[84\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:0-84) Due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment.[\[84\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:0-84) #### Clozapine Main article: [Clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine") [Clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine") is FDA-approved for treatment resistant schizophrenia.[\[85\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-85) Though not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.[\[86\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine is an [atypical antipsychotic](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") that is recognized as being particularly effective when other antipsychotic agents have failed.[\[81\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Stahl-81) When combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals.[\[86\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality.[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78)[\[87\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-87) Despite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant.[\[88\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-88) Clozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include [agranulocytosis](https://en.wikipedia.org/wiki/Agranulocytosis "Agranulocytosis") and [neutropenia](https://en.wikipedia.org/wiki/Neutropenia "Neutropenia").[\[89\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-89) To mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests.[\[90\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-90) ### Electroconvulsive therapy [Electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy") (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics.[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78) ## Epidemiology Compared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.[\[91\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:3-91) Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.[\[92\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock._p.501-502-92) 30% of cases occur between the ages of 25 and 35.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.[\[93\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-93) Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.[\[11\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:22-11)[\[94\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx2-94) ## History The term schizoaffective psychosis was introduced by the American psychiatrist [Jacob Kasanin](https://en.wikipedia.org/wiki/Jacob_S._Kasanin "Jacob S. Kasanin") in 1933[\[95\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid16857267-95) to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) Kasanin's concept of the illness was influenced by the [psychoanalytic](https://en.wikipedia.org/wiki/Psychoanalysis "Psychoanalysis") teachings of [Adolf Meyer](https://en.wikipedia.org/wiki/Adolf_Meyer_\(psychiatrist\) "Adolf Meyer (psychiatrist)") and Kasanin postulated that schizoaffective psychosis was caused by "emotional conflicts" of a "mainly sexual nature" and that psychoanalysis "would help prevent the recurrence of such attacks."[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) He based his description on a case study of nine individuals.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/c2/Karl_Ludwig_Kahlbaum.JPG/250px-Karl_Ludwig_Kahlbaum.JPG)](https://en.wikipedia.org/wiki/File:Karl_Ludwig_Kahlbaum.JPG) [Karl Kahlbaum](https://en.wikipedia.org/wiki/Karl_Kahlbaum "Karl Kahlbaum") (1828–1899) Other psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist [Karl Kahlbaum](https://en.wikipedia.org/wiki/Karl_Kahlbaum "Karl Kahlbaum") (1828–1899) described schizoaffective disorders as a separate group in his vesania typica circularis.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kahlbaum distinguished between [cross-sectional](https://en.wikipedia.org/wiki/Cross-sectional_study "Cross-sectional study") and [longitudinal](https://en.wikipedia.org/wiki/Longitudinal_study "Longitudinal study") observations. In 1920, psychiatrist [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") (1856–1926) observed a "great number" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, dementia praecox (now called schizophrenia) and manic depressive insanity (now called bipolar disorders and recurrent depression).[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kraepelin acknowledged that "there are many overlaps in this area," that is, the area between schizophrenia and mood disorders.[\[96\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-96) In 1959, psychiatrist [Kurt Schneider](https://en.wikipedia.org/wiki/Kurt_Schneider "Kurt Schneider") (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed "concurrent and sequential types".[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) (The concurrent type of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time \[now called psychotic mood disorders or affective psychosis\]; while his sequential type refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.)[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Schneider described schizoaffective disorders as "cases in-between" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) The historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes and polygenic variations.[\[97\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-97)[\[98\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-98)[\[99\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-99)[\[100\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-100) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Emil_Kraepelin_1926.jpg/250px-Emil_Kraepelin_1926.jpg)](https://en.wikipedia.org/wiki/File:Emil_Kraepelin_1926.jpg) [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") (1856–1926). Embracing the [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") in [DSM-III](https://en.wikipedia.org/wiki/DSM-III "DSM-III") in 1980, while a step forward from [psychodynamic](https://en.wikipedia.org/wiki/Psychodynamic "Psychodynamic") explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") workgroup. Schizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in "Psychotic Disorders Not Otherwise Specified" before being formally recognized in DSM-III-R.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) DSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) In DSM-IV, published in 1994, schizoaffective disorders belonged to the category "Other Psychotic Disorders" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) DSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly [operationalized](https://en.wikipedia.org/wiki/Operationalization "Operationalization").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These [ambiguous](https://en.wikipedia.org/wiki/Ambiguous "Ambiguous") and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Patients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were [longitudinally determined](https://en.wikipedia.org/wiki/Longitudinal_study "Longitudinal study") to have outcomes indistinguishable from those with mood disorders with or without psychotic features.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was [harmful](https://en.wikipedia.org/wiki/Iatrogenic "Iatrogenic") to many patients.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[101\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment-101) The poor prognosis for DSM-IV schizoaffective disorder was not based on [patient outcomes](https://en.wikipedia.org/wiki/Cohort_study "Cohort study") [research](https://en.wikipedia.org/wiki/Empirical_research "Empirical research"), but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician [enculturation](https://en.wikipedia.org/wiki/Enculturation "Enculturation") with [unscientific](https://en.wikipedia.org/wiki/Unscientific "Unscientific") assumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy;[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) and by clinicians being unfamiliar with the [scientific](https://en.wikipedia.org/wiki/Empirical_science "Empirical science") limitations of the diagnostic and classification system.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 schizoaffective disorder workgroup analyzed all of the available research [evidence](https://en.wikipedia.org/wiki/Empirical_science#Philosophy_of_science "Empirical science") on schizoaffective disorder, and concluded that "presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Given our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness [syndromes](https://en.wikipedia.org/wiki/Syndrome "Syndrome"), the limits of our knowledge are clearer: Presenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Schizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Stigma of schizoaffective disorder include moralist arguments, religious causes, and others during history.[\[102\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-102)[\[103\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-103) ## Research Little is known of the causes and mechanisms that lead to the development of schizoaffective disorder.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Whether schizoaffective disorder is a variant of schizophrenia (as in DSM-5 and ICD-10 classification systems), a variant of bipolar disorder, or part of a dimensional continuum between [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), bipolar disorders and schizophrenia is currently being investigated.[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) More recently, some research suggests the need for a more specialized classification for schizoaffective disorder. In a 2017 examining diagnostic heterogeneity study, researchers found that when compared to a schizophrenia sample, individuals with schizoaffective disorder rate higher in suicidality and anxiety disorder comorbidity.[\[104\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-104) ## See also - [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") - [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") ## References 1. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-1) ["Schizoaffective disorder, bipolar type"](http://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F25-/F25.0). www.icd10data.com. 2. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-2) ["Schizoaffective disorder, depressive type"](http://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F25-/F25.1). www.icd10data.com. 3. ^ [*a](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-NAMI2017_3-0) [b](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-NAMI2017_3-1) ["Schizoaffective Disorder Overview – Causes"](https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizoaffective-Disorder). www.nami.org. 4. ^ [a](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-0) [b](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-1) [c](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-2) [d](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-3) [e](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-4) ["F25 Schizoaffective disorders"](http://apps.who.int/classifications/icd10/browse/2010/en#/F25). 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[PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17551352](https://pubmed.ncbi.nlm.nih.gov/17551352). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [37664803](https://api.semanticscholar.org/CorpusID:37664803). 102. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-102) Assis, Jorge Cândido de; Villares, Cecília Cruz; Bressan, Rodrigo Affonseca (2023). [Between Reason and Illusion: Demystifying Schizophrenia](https://link.springer.com/10.1007/978-3-031-24556-5). Copernicus Books. Cham: Springer Nature Switzerland. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/978-3-031-24556-5](https://doi.org/10.1007%2F978-3-031-24556-5). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-031-24555-8](https://en.wikipedia.org/wiki/Special:BookSources/978-3-031-24555-8 "Special:BookSources/978-3-031-24555-8") . 103. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-103) Farrell, Michael (2024). Controversies in schizophrenia: issues, causes, and treatment. New York, NY: Routledge, Taylor & Francis Group. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-003-41355-4](https://en.wikipedia.org/wiki/Special:BookSources/978-1-003-41355-4 "Special:BookSources/978-1-003-41355-4") . 104. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-104) Seldin, Katherine; Armstrong, Kristan; Schiff, Max L.; Heckers, Stephan (2017). ["Reducing the Diagnostic Heterogeneity of Schizoaffective Disorder"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300988). Frontiers in Psychiatry. 8: 18. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3389/fpsyt.2017.00018](https://doi.org/10.3389%2Ffpsyt.2017.00018). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1664-0640](https://search.worldcat.org/issn/1664-0640). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5300988](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300988). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28239362](https://pubmed.ncbi.nlm.nih.gov/28239362). ## Further reading - Moore, D.P.; Jefferson, J.W. (2004). Handbook of medical psychiatry (2nd ed.). Philadelphia: Elsevier/Mosby. pp. 126–127\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-323-02911-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-02911-7 "Special:BookSources/978-0-323-02911-7") . - Goetzt, C.G. (2003). Textbook of clinical neurology (2nd ed.). Philadelphia: W.B. Saunders. p. 48. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7216-3800-3](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7216-3800-3 "Special:BookSources/978-0-7216-3800-3") . ## External links \| \| \| \|---\|---\| \| Classification \| [D](https://www.wikidata.org/wiki/Q834047 "d:Q834047") [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11"): [6A21](https://icd.who.int/browse/latest-release/mms/en#106339515) [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10"): [F25](https://icd.who.int/browse10/2019/en#/F25) [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes"): [295\.70](http://www.icd9data.com/getICD9Code.ashx?icd9=295.70) [OMIM](https://en.wikipedia.org/wiki/Online_Mendelian_Inheritance_in_Man "Online Mendelian Inheritance in Man"): [181500](https://omim.org/entry/181500) [MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings"): [D011618](https://meshb.nlm.nih.gov/record/ui?ui=D011618) [DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database"): [33444](http://www.diseasesdatabase.com/ddb33444.htm) [SNOMED CT](https://en.wikipedia.org/wiki/SNOMED_CT "SNOMED CT"): [68890003](https://browser.ihtsdotools.org/?perspective=full&conceptId1=68890003&languages=en) \| \| External resources \| [MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus"): [000930](https://www.nlm.nih.gov/medlineplus/ency/article/000930.htm) [eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine"): [article/294763](https://emedicine.medscape.com/article/294763-overview) [Patient UK](https://en.wikipedia.org/wiki/Patient_UK "Patient UK"): [Schizoaffective disorder](https://patient.info/doctor/Schizoaffective-Disorder) \| [Portal](https://en.wikipedia.org/wiki/Wikipedia:Contents/Portals "Wikipedia:Contents/Portals"): - ![icon](https://upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/20px-WHO_Rod.svg.png) [Medicine](https://en.wikipedia.org/wiki/Portal:Medicine "Portal:Medicine") \| [v](https://en.wikipedia.org/wiki/Template:Mental_disorders "Template:Mental disorders") [t](https://en.wikipedia.org/wiki/Template_talk:Mental_disorders "Template talk:Mental disorders") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Mental_disorders "Special:EditPage/Template:Mental disorders")[Mental disorders](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder") ([Classification](https://en.wikipedia.org/wiki/Classification_of_mental_disorders "Classification of mental disorders")) \| \| \|---\|---\| \| Adult personality and behavior \| \| \| \| \| \| Sexual \| [Ego-dystonic sexual orientation](https://en.wikipedia.org/wiki/Ego-dystonic_sexual_orientation "Ego-dystonic sexual orientation") [Paraphilia](https://en.wikipedia.org/wiki/Paraphilia "Paraphilia") [Fetishism](https://en.wikipedia.org/wiki/Sexual_fetishism "Sexual fetishism") [Voyeurism](https://en.wikipedia.org/wiki/Voyeurism "Voyeurism") [Sexual anhedonia](https://en.wikipedia.org/wiki/Sexual_anhedonia "Sexual anhedonia") [Sexual anorexia](https://en.wikipedia.org/wiki/Sexual_anorexia "Sexual anorexia") [Sexual maturation disorder](https://en.wikipedia.org/wiki/Sexual_maturation_disorder "Sexual maturation disorder") [Sexual relationship disorder](https://en.wikipedia.org/wiki/Sexual_relationship_disorder "Sexual relationship disorder") [Compulsive sexual behaviour disorder](https://en.wikipedia.org/wiki/Compulsive_sexual_behaviour_disorder "Compulsive sexual behaviour disorder") \| \| Other \| [Factitious disorder](https://en.wikipedia.org/wiki/Factitious_disorder "Factitious disorder") [Munchausen syndrome](https://en.wikipedia.org/wiki/Factitious_disorder_imposed_on_self "Factitious disorder imposed on self") [Fear of intimacy](https://en.wikipedia.org/wiki/Fear_of_intimacy "Fear of intimacy") [Gender dysphoria](https://en.wikipedia.org/wiki/Gender_dysphoria "Gender dysphoria") [Intermittent explosive disorder](https://en.wikipedia.org/wiki/Intermittent_explosive_disorder "Intermittent explosive disorder") [Dermatillomania](https://en.wikipedia.org/wiki/Excoriation_disorder "Excoriation disorder") [Kleptomania](https://en.wikipedia.org/wiki/Kleptomania "Kleptomania") [Pyromania](https://en.wikipedia.org/wiki/Pyromania "Pyromania") [Trichotillomania](https://en.wikipedia.org/wiki/Trichotillomania "Trichotillomania") [Personality disorder](https://en.wikipedia.org/wiki/Personality_disorder "Personality disorder") \| \| [Childhood and learning](https://en.wikipedia.org/wiki/Mental_disorders_diagnosed_in_childhood "Mental disorders diagnosed in childhood") \| \| \| \| \| \| [Emotional and behavioral](https://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders "Emotional and behavioral disorders") \| [ADHD](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder "Attention deficit hyperactivity disorder") [Conduct disorder](https://en.wikipedia.org/wiki/Conduct_disorder "Conduct disorder") [ODD](https://en.wikipedia.org/wiki/Oppositional_defiant_disorder "Oppositional defiant disorder") [Emotional and behavioral disorders](https://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders "Emotional and behavioral disorders") [Separation anxiety disorder](https://en.wikipedia.org/wiki/Separation_anxiety_disorder "Separation anxiety disorder") [Movement disorders](https://en.wikipedia.org/wiki/Movement_disorders "Movement disorders") [Stereotypic](https://en.wikipedia.org/wiki/Stereotypic_movement_disorder "Stereotypic movement disorder") Social functioning [DAD](https://en.wikipedia.org/wiki/Disinhibited_attachment_disorder "Disinhibited attachment disorder") [RAD](https://en.wikipedia.org/wiki/Reactive_attachment_disorder "Reactive attachment disorder") [Selective mutism](https://en.wikipedia.org/wiki/Selective_mutism "Selective mutism") [Speech](https://en.wikipedia.org/wiki/Speech_disorder "Speech disorder") [Cluttering](https://en.wikipedia.org/wiki/Cluttering "Cluttering") [Stuttering](https://en.wikipedia.org/wiki/Stuttering "Stuttering") [Tic disorder](https://en.wikipedia.org/wiki/Tic_disorder "Tic disorder") [Tourette syndrome](https://en.wikipedia.org/wiki/Tourette_syndrome "Tourette syndrome") \| \| [Intellectual disability](https://en.wikipedia.org/wiki/Intellectual_disability "Intellectual disability") \| [X-linked intellectual disability](https://en.wikipedia.org/wiki/X-linked_intellectual_disability "X-linked intellectual disability") [Lujan–Fryns syndrome](https://en.wikipedia.org/wiki/Lujan%E2%80%93Fryns_syndrome "Lujan–Fryns syndrome") \| \| Psychological development ([developmental disabilities](https://en.wikipedia.org/wiki/Developmental_disability "Developmental disability")) \| [Pervasive](https://en.wikipedia.org/wiki/Pervasive_developmental_disorder "Pervasive developmental disorder") [Specific](https://en.wikipedia.org/wiki/Specific_developmental_disorder "Specific developmental disorder") \| \| [Mood](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder") (affective) \| \| \| [Bipolar](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") [Bipolar I](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") [Bipolar II](https://en.wikipedia.org/wiki/Bipolar_II_disorder "Bipolar II disorder") [Bipolar NOS](https://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified "Bipolar disorder not otherwise specified") [Cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia") [Depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") [Atypical depression](https://en.wikipedia.org/wiki/Atypical_depression "Atypical depression") [Dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia") [Major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") [Melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") [Seasonal affective disorder](https://en.wikipedia.org/wiki/Seasonal_affective_disorder "Seasonal affective disorder") [Mania](https://en.wikipedia.org/wiki/Mania "Mania") \| \| \| Neurological and symptomatic \| \| \| \| \| \| [Autism spectrum](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum") \| [Autism](https://en.wikipedia.org/wiki/Autism "Autism") [Asperger syndrome](https://en.wikipedia.org/wiki/Asperger_syndrome "Asperger syndrome") [High-functioning autism](https://en.wikipedia.org/wiki/High-functioning_autism "High-functioning autism") [PDD-NOS](https://en.wikipedia.org/wiki/Pervasive_developmental_disorder_not_otherwise_specified "Pervasive developmental disorder not otherwise specified") [Savant syndrome](https://en.wikipedia.org/wiki/Savant_syndrome "Savant syndrome") \| \| [Dementia](https://en.wikipedia.org/wiki/Dementia "Dementia") \| [AIDS dementia complex](https://en.wikipedia.org/wiki/HIV-associated_neurocognitive_disorder "HIV-associated neurocognitive disorder") [Alzheimer's disease](https://en.wikipedia.org/wiki/Alzheimer%27s_disease "Alzheimer's disease") [Creutzfeldt–Jakob disease](https://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease "Creutzfeldt–Jakob disease") [Frontotemporal dementia](https://en.wikipedia.org/wiki/Frontotemporal_dementia "Frontotemporal dementia") [Huntington's disease](https://en.wikipedia.org/wiki/Huntington%27s_disease "Huntington's disease") [Mild cognitive impairment](https://en.wikipedia.org/wiki/Mild_cognitive_impairment "Mild cognitive impairment") [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease") [Pick's disease](https://en.wikipedia.org/wiki/Pick%27s_disease "Pick's disease") [Sundowning](https://en.wikipedia.org/wiki/Sundowning "Sundowning") [Vascular dementia](https://en.wikipedia.org/wiki/Vascular_dementia "Vascular dementia") [Wandering](https://en.wikipedia.org/wiki/Wandering_\(dementia\) "Wandering (dementia)") \| \| Other \| [Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") [Organic brain syndrome](https://en.wikipedia.org/wiki/Organic_brain_syndrome "Organic brain syndrome") [Post-concussion syndrome](https://en.wikipedia.org/wiki/Post-concussion_syndrome "Post-concussion syndrome") \| \| [Neurotic](https://en.wikipedia.org/wiki/Neurosis "Neurosis"), [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)")\-related and [somatoform](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder") \| \| \| \| \| \| [Adjustment](https://en.wikipedia.org/wiki/Adjustment_disorder "Adjustment disorder") \| [Adjustment disorder](https://en.wikipedia.org/wiki/Adjustment_disorder "Adjustment disorder") with depressed mood \| \| [Anxiety](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder") \| \| \| \| \| \| [Phobia](https://en.wikipedia.org/wiki/Phobia "Phobia") \| [Agoraphobia](https://en.wikipedia.org/wiki/Agoraphobia "Agoraphobia") [Childhood phobia](https://en.wikipedia.org/wiki/Childhood_phobia "Childhood phobia") [Social anxiety](https://en.wikipedia.org/wiki/Social_anxiety "Social anxiety") [Social phobia](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") [Anthropophobia](https://en.wikipedia.org/wiki/Anthropophobia "Anthropophobia") [Specific social phobia](https://en.wikipedia.org/wiki/Specific_social_phobia "Specific social phobia") [Specific phobia](https://en.wikipedia.org/wiki/Specific_phobia "Specific phobia") [Claustrophobia](https://en.wikipedia.org/wiki/Claustrophobia "Claustrophobia") \| \| Other \| [Generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder") [OCD](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") [Panic attack](https://en.wikipedia.org/wiki/Panic_attack "Panic attack") [Panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder") [Paranoia](https://en.wikipedia.org/wiki/Paranoia "Paranoia") [Stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress") [Acute stress reaction](https://en.wikipedia.org/wiki/Acute_stress_reaction "Acute stress reaction") [PTSD](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") \| \| [Dissociative](https://en.wikipedia.org/wiki/Dissociative_disorder "Dissociative disorder") \| [Depersonalization-derealization disorder](https://en.wikipedia.org/wiki/Depersonalization-derealization_disorder "Depersonalization-derealization disorder") [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder") [Dissociative amnesia](https://en.wikipedia.org/wiki/Dissociative_amnesia "Dissociative amnesia") [Dissociative fugue](https://en.wikipedia.org/wiki/Dissociative_fugue "Dissociative fugue") [Dissociative disorder not otherwise specified](https://en.wikipedia.org/wiki/Dissociative_disorder_not_otherwise_specified "Dissociative disorder not otherwise specified") [Other specified dissociative disorder](https://en.wikipedia.org/wiki/Other_specified_dissociative_disorder "Other specified dissociative disorder") \| \| [Somatic symptom](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder") \| [Body dysmorphic disorder](https://en.wikipedia.org/wiki/Body_dysmorphic_disorder "Body dysmorphic disorder") [Conversion disorder](https://en.wikipedia.org/wiki/Conversion_disorder "Conversion disorder") [Ganser syndrome](https://en.wikipedia.org/wiki/Ganser_syndrome "Ganser syndrome") [Globus pharyngeus](https://en.wikipedia.org/wiki/Globus_pharyngeus "Globus pharyngeus") [Psychogenic non-epileptic seizures](https://en.wikipedia.org/wiki/Psychogenic_non-epileptic_seizure "Psychogenic non-epileptic seizure") [False pregnancy](https://en.wikipedia.org/wiki/False_pregnancy "False pregnancy") [Hypochondriasis](https://en.wikipedia.org/wiki/Hypochondriasis "Hypochondriasis") [Mass psychogenic illness](https://en.wikipedia.org/wiki/Mass_psychogenic_illness "Mass psychogenic illness") [Nosophobia](https://en.wikipedia.org/wiki/Nosophobia "Nosophobia") [Psychogenic pain](https://en.wikipedia.org/wiki/Psychogenic_pain "Psychogenic pain") \| \| Physiological and physical behavior \| \| \| \| \| \| [Eating](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder") \| [Anorexia nervosa](https://en.wikipedia.org/wiki/Anorexia_nervosa "Anorexia nervosa") [Bulimia nervosa](https://en.wikipedia.org/wiki/Bulimia_nervosa "Bulimia nervosa") [Binge eating disorder](https://en.wikipedia.org/wiki/Binge_eating_disorder "Binge eating disorder") [Avoidant/restrictive food intake disorder](https://en.wikipedia.org/wiki/Avoidant/restrictive_food_intake_disorder "Avoidant/restrictive food intake disorder") [Pica](https://en.wikipedia.org/wiki/Pica_\(disorder\) "Pica (disorder)") [Rumination syndrome](https://en.wikipedia.org/wiki/Rumination_syndrome "Rumination syndrome") [Other specified feeding or eating disorder](https://en.wikipedia.org/wiki/Other_specified_feeding_or_eating_disorder "Other specified feeding or eating disorder") \| \| Nonorganic [sleep](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") \| [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia") [Parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") [Night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror") [Nightmare](https://en.wikipedia.org/wiki/Nightmare "Nightmare") [REM sleep behavior disorder](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder "Rapid eye movement sleep behavior disorder") \| \| [Postnatal](https://en.wikipedia.org/wiki/Psychiatric_disorders_of_childbirth "Psychiatric disorders of childbirth") \| [Postpartum depression](https://en.wikipedia.org/wiki/Postpartum_depression "Postpartum depression") [Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis") \| \| [Sexual desire](https://en.wikipedia.org/wiki/Sexual_dysfunction#Sexual_desire_disorders "Sexual dysfunction") \| [Hypersexuality](https://en.wikipedia.org/wiki/Hypersexuality "Hypersexuality") [Hypoactive sexual desire disorder](https://en.wikipedia.org/wiki/Hypoactive_sexual_desire_disorder "Hypoactive sexual desire disorder") \| \| [Psychoactive](https://en.wikipedia.org/wiki/Psychoactive_drug "Psychoactive drug") substances, [substance abuse](https://en.wikipedia.org/wiki/Substance_abuse "Substance abuse") and substance-related \| \| \| [Drug overdose](https://en.wikipedia.org/wiki/Drug_overdose "Drug overdose") [Hallucinogen persisting perception disorder](https://en.wikipedia.org/wiki/Hallucinogen_persisting_perception_disorder "Hallucinogen persisting perception disorder") [Intoxication](https://en.wikipedia.org/wiki/Substance_intoxication "Substance intoxication") [Physical dependence](https://en.wikipedia.org/wiki/Physical_dependence "Physical dependence") [Rebound effect](https://en.wikipedia.org/wiki/Rebound_effect "Rebound effect") [Stimulant psychosis](https://en.wikipedia.org/wiki/Stimulant_psychosis "Stimulant psychosis") [Substance dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence") [Substance-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") [Withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal") \| \| \| [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [schizotypal](https://en.wikipedia.org/wiki/Schizotypal_personality_disorder "Schizotypal personality disorder") and [delusional](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder") \| \| \| \| \| \| Delusional \| [Delusional disorder](https://en.wikipedia.org/wiki/Delusional_disorder "Delusional disorder") [Folie à deux](https://en.wikipedia.org/wiki/Folie_%C3%A0_deux "Folie à deux") \| \| [Psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis") and schizophrenia-like \| [Brief reactive psychosis](https://en.wikipedia.org/wiki/Brief_reactive_psychosis "Brief reactive psychosis") [Schizoaffective disorder]() [Schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") \| \| Schizophrenia \| [Childhood schizophrenia](https://en.wikipedia.org/wiki/Childhood_schizophrenia "Childhood schizophrenia") [Disorganized (hebephrenic) schizophrenia](https://en.wikipedia.org/wiki/Disorganized_schizophrenia "Disorganized schizophrenia") [Pseudoneurotic schizophrenia](https://en.wikipedia.org/wiki/Pseudoneurotic_schizophrenia "Pseudoneurotic schizophrenia") [Simple-type schizophrenia](https://en.wikipedia.org/wiki/Simple-type_schizophrenia "Simple-type schizophrenia") \| \| Other \| [Catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") \| \| Symptoms and uncategorized \| \| \| [Impulse-control disorder](https://en.wikipedia.org/wiki/Impulse-control_disorder "Impulse-control disorder") [Klüver–Bucy syndrome](https://en.wikipedia.org/wiki/Kl%C3%BCver%E2%80%93Bucy_syndrome "Klüver–Bucy syndrome") [Psychomotor agitation](https://en.wikipedia.org/wiki/Psychomotor_agitation "Psychomotor agitation") [Stereotypy](https://en.wikipedia.org/wiki/Stereotypy "Stereotypy") [Caregiver burden](https://en.wikipedia.org/wiki/Caregiver_burden "Caregiver burden") \| \| \| ![](https://upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/20px-Symbol_category_class.svg.png) [Category](https://en.wikipedia.org/wiki/Category:Mental_disorders "Category:Mental disorders") \| \| \| [v](https://en.wikipedia.org/wiki/Template:Mood_disorders "Template:Mood disorders") [t](https://en.wikipedia.org/wiki/Template_talk:Mood_disorders "Template talk:Mood disorders") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Mood_disorders "Special:EditPage/Template:Mood disorders")[Mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder") \| \| \|---\|---\| \| [Spectrum](https://en.wikipedia.org/wiki/Affective_spectrum "Affective spectrum") \| \| \| \| \| \| [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") \| [Bipolar I](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder") [Bipolar II](https://en.wikipedia.org/wiki/Bipolar_II_disorder "Bipolar II disorder") [Cyclothymia](https://en.wikipedia.org/wiki/Cyclothymia "Cyclothymia") [Bipolar NOS](https://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified "Bipolar disorder not otherwise specified") [Childhood](https://en.wikipedia.org/wiki/Bipolar_disorder_in_children "Bipolar disorder in children") [Hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania") [Mania](https://en.wikipedia.org/wiki/Mania "Mania") [Mixed affective state](https://en.wikipedia.org/wiki/Mixed_affective_state "Mixed affective state") [Rapid cycling](https://en.wikipedia.org/wiki/Rapid_cycling "Rapid cycling") \| \| [Depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") \| [Major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") [Dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia") [Seasonal affective disorder](https://en.wikipedia.org/wiki/Seasonal_affective_disorder "Seasonal affective disorder") [Atypical depression](https://en.wikipedia.org/wiki/Atypical_depression "Atypical depression") [Melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") [Major depressive episode](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode") [Depression in childhood and adolescence](https://en.wikipedia.org/wiki/Depression_in_childhood_and_adolescence "Depression in childhood and adolescence") \| \| Comorbidities \| [Schizoaffective disorder]() \| \| [Symptoms](https://en.wikipedia.org/wiki/Symptom "Symptom") \| [Delusion](https://en.wikipedia.org/wiki/Delusion "Delusion") [Depression (differential diagnoses)](https://en.wikipedia.org/wiki/Depression_\(differential_diagnoses\) "Depression (differential diagnoses)") [Emotional dysregulation](https://en.wikipedia.org/wiki/Emotional_dysregulation "Emotional dysregulation") [Anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") [Dysphoria](https://en.wikipedia.org/wiki/Dysphoria "Dysphoria") [Suicidal ideation](https://en.wikipedia.org/wiki/Suicidal_ideation "Suicidal ideation") [Episodic memory](https://en.wikipedia.org/wiki/Episodic_memory "Episodic memory") [Hallucination](https://en.wikipedia.org/wiki/Hallucination "Hallucination") [Mood swing](https://en.wikipedia.org/wiki/Mood_swing "Mood swing") [Sleep disorder](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia") [Psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis") [Psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression") [Racing thoughts](https://en.wikipedia.org/wiki/Racing_thoughts "Racing thoughts") [Reduced affect display](https://en.wikipedia.org/wiki/Reduced_affect_display "Reduced affect display") \| \| [Diagnosis](https://en.wikipedia.org/wiki/List_of_diagnostic_classification_and_rating_scales_used_in_psychiatry "List of diagnostic classification and rating scales used in psychiatry") \| [Bipolar Spectrum Diagnostic Scale](https://en.wikipedia.org/wiki/Bipolar_Spectrum_Diagnostic_Scale "Bipolar Spectrum Diagnostic Scale") [Child Mania Rating Scale](https://en.wikipedia.org/wiki/Child_Mania_Rating_Scale "Child Mania Rating Scale") [General Behavior Inventory](https://en.wikipedia.org/wiki/General_Behavior_Inventory "General Behavior Inventory") [Hypomania Checklist](https://en.wikipedia.org/wiki/Hypomania_Checklist "Hypomania Checklist") [Mood Disorder Questionnaire](https://en.wikipedia.org/wiki/Mood_Disorder_Questionnaire "Mood Disorder Questionnaire") [Rating scales for depression](https://en.wikipedia.org/wiki/Rating_scales_for_depression "Rating scales for depression") [Young Mania Rating Scale](https://en.wikipedia.org/wiki/Young_Mania_Rating_Scale "Young Mania Rating Scale") \| \| [Treatment](https://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder "Treatment of bipolar disorder") \| \| \| \| \| \| [Anticonvulsants](https://en.wikipedia.org/wiki/Anticonvulsant "Anticonvulsant") \| [Carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine") [Lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") [Oxcarbazepine](https://en.wikipedia.org/wiki/Oxcarbazepine "Oxcarbazepine") [Valproate](https://en.wikipedia.org/wiki/Valproate "Valproate") [Sodium valproate](https://en.wikipedia.org/wiki/Sodium_valproate "Sodium valproate") [Valproate semisodium](https://en.wikipedia.org/wiki/Valproate_semisodium "Valproate semisodium") \| \| [Sympathomimetics](https://en.wikipedia.org/wiki/Sympathomimetic_drug "Sympathomimetic drug"), [SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") and similar \| [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") [Dextroamphetamine](https://en.wikipedia.org/wiki/Dextroamphetamine "Dextroamphetamine") [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") [Methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate") [Sertraline](https://en.wikipedia.org/wiki/Sertraline "Sertraline") \| \| Other [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizer "Mood stabilizer") \| [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") [Lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") [Lithium carbonate](https://en.wikipedia.org/wiki/Lithium_carbonate "Lithium carbonate") [Lithium citrate](https://en.wikipedia.org/wiki/Lithium_citrate "Lithium citrate") \| \| Non-pharmaceutical \| [Clinical psychology](https://en.wikipedia.org/wiki/Clinical_psychology "Clinical psychology") [Psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy") [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") [Dialectical behavior therapy](https://en.wikipedia.org/wiki/Dialectical_behavior_therapy "Dialectical behavior therapy") [Electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy") [Involuntary commitment](https://en.wikipedia.org/wiki/Involuntary_commitment "Involuntary commitment") [Light therapy](https://en.wikipedia.org/wiki/Light_therapy "Light therapy") [Transcranial magnetic stimulation](https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation "Transcranial magnetic stimulation") \| \| [History](https://en.wikipedia.org/wiki/History_of_bipolar_disorder "History of bipolar disorder") \| [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") [Karl Leonhard](https://en.wikipedia.org/wiki/Karl_Leonhard "Karl Leonhard") [John Cade](https://en.wikipedia.org/wiki/John_Cade "John Cade") [Mogens Schou](https://en.wikipedia.org/wiki/Mogens_Schou "Mogens Schou") [Frederick K. Goodwin](https://en.wikipedia.org/wiki/Frederick_K._Goodwin "Frederick K. Goodwin") [Kay Redfield Jamison](https://en.wikipedia.org/wiki/Kay_Redfield_Jamison "Kay Redfield Jamison") [S. Nassir Ghaemi](https://en.wikipedia.org/wiki/S._Nassir_Ghaemi "S. 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Readable Markdown	\| Schizoaffective disorder \| \| \|---\|---\| \| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") \| [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") \| \| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") \| [Hallucinations](https://en.wikipedia.org/wiki/Hallucinations "Hallucinations") [delusions](https://en.wikipedia.org/wiki/Delusions "Delusions") [disorganized thought and behavior](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") [inappropriate affect](https://en.wikipedia.org/wiki/Inappropriate_affect "Inappropriate affect") [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") [mania](https://en.wikipedia.org/wiki/Mania "Mania") \| \| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") \| lack of motivation cognitive issues risk of harm to self or others anxiety disorders \| \| Usual onset \| 16–30 years of age \| \| Types \| bipolar type[\[1\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-1) depressive type[\[2\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-2) Mixed type (Includes both depressive and bipolar symptoms) \| \| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") \| Unknown[\[3\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-NAMI2017-3) \| \| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") \| Genetics brain chemistry and structure stress drug use[\[3\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-NAMI2017-3) \| \| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") \| [Psychiatric assessment](https://en.wikipedia.org/wiki/Psychiatric_assessment "Psychiatric assessment") \| \| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") \| Psychotic depression bipolar disorder with psychotic features schizophreniform disorder schizophrenia \| \| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") \| [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotics "Antipsychotics") [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizers "Mood stabilizers") [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants") \| \| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") \| Depends on the individual, medication response, and therapeutic support available \| \| Frequency \| 0\.3% \| Schizoaffective disorder is a [mental disorder](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder") characterized by symptoms of both [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") ([psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis")) and a [mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), either [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") or [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)").[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Common symptoms include [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), [disorganized speech and thinking](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder"), as well as mood episodes.[\[6\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-6) Schizoaffective disorder can often be [misdiagnosed](https://en.wikipedia.org/wiki/Misdiagnosed "Misdiagnosed")[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the correct diagnosis may be [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), [bipolar I disorder](https://en.wikipedia.org/wiki/Bipolar_I_disorder "Bipolar I disorder"), [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder"), or schizophrenia. This is a problem as treatment and [prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorders "Anxiety disorders").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[7\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock.-7) There are three forms of schizoaffective disorder: bipolar or manic type (marked by symptoms of schizophrenia and mania), depressive type (marked by symptoms of schizophrenia and depression), and mixed type (marked by symptoms of schizophrenia, depression, and mania).[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) [Auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination") are most common.[\[9\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18056246-9)[\[10\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-10) The onset of symptoms usually begins in adolescence or young adulthood.[\[11\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:22-11) [Genetics](https://en.wikipedia.org/wiki/Genetics "Genetics") (researched in the field of [genomics](https://en.wikipedia.org/wiki/Genomics "Genomics")); problems with [neural circuits](https://en.wikipedia.org/wiki/Neural_circuits "Neural circuits"); chronic early, and chronic or short-term current [environmental stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)") appear to be important causal factors.[\[12\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-12)[\[13\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-13)[\[14\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-14) No single isolated organic cause has been found, but extensive evidence exists for abnormalities in the metabolism of [tetrahydrobiopterin](https://en.wikipedia.org/wiki/Tetrahydrobiopterin "Tetrahydrobiopterin") (BH4), [dopamine](https://en.wikipedia.org/wiki/Dopamine "Dopamine"), and [glutamic acid](https://en.wikipedia.org/wiki/Glutamic_acid "Glutamic acid") in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder.[\[15\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-15) While a diagnosis of schizoaffective disorder is rare, 0.3% in the general population,[\[16\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-16) it is considered a common diagnosis among psychiatric disorders.[\[17\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-17) Diagnosis of schizoaffective disorder is based on DSM-5 criteria, which consist principally of the presence of symptoms of schizophrenia, mania, and depression, and the temporal relationships between them. The main current treatment is [antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") medication combined with either [mood stabilizers](https://en.wikipedia.org/wiki/Mood_stabilizer "Mood stabilizer") or [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") (or both). There is growing concern by some researchers that antidepressants may increase psychosis, mania, and long-term mood episode cycling in the disorder.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] When there is risk to self or others, usually early in treatment, hospitalization may be necessary.[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) [Psychiatric rehabilitation](https://en.wikipedia.org/wiki/Psychiatric_rehabilitation "Psychiatric rehabilitation"), [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy"), and [vocational rehabilitation](https://en.wikipedia.org/wiki/Vocational_rehabilitation "Vocational rehabilitation") are very important for [recovery](https://en.wikipedia.org/wiki/Recovery_approach "Recovery approach") of higher psychosocial function\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\]. As a group, people diagnosed with schizoaffective disorder using [DSM-IV](https://en.wikipedia.org/wiki/DSM-IV "DSM-IV") and [ICD-10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10") criteria (which have since been updated\[[clarification needed](https://en.wikipedia.org/wiki/Wikipedia:Please_clarify "Wikipedia:Please clarify")\]) have a better [outcome](https://en.wikipedia.org/wiki/Prognosis "Prognosis"),[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) but have variable individual psychosocial functional outcomes compared to people with mood disorders, from worse to the same.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19)\[[non-primary source needed](https://en.wikipedia.org/wiki/Wikipedia:No_original_research#Primary,_secondary_and_tertiary_sources "Wikipedia:No original research")\] Outcomes for people with [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") diagnosed schizoaffective disorder depend on data from [prospective cohort studies](https://en.wikipedia.org/wiki/Prospective_cohort_studies "Prospective cohort studies"), which have not been completed yet.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 diagnosis was updated because DSM-IV criteria resulted in overuse of the diagnosis;[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) that is, DSM-IV criteria led to many patients being misdiagnosed with the disorder. DSM-IV [prevalence](https://en.wikipedia.org/wiki/Prevalence "Prevalence") estimates were less than one percent of the population, in the range of 0.5–0.8 percent;[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) newer DSM-5 prevalence estimates are not yet available. Signs and symptoms Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) [Psychosis](https://en.wikipedia.org/wiki/Psychosis "Psychosis") must meet criterion A for [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") which may include [delusions](https://en.wikipedia.org/wiki/Delusions "Delusions"), [hallucinations](https://en.wikipedia.org/wiki/Hallucinations "Hallucinations"), [disorganized speech and behavior](https://en.wikipedia.org/wiki/Thought_disorder "Thought disorder") and [negative symptoms](https://en.wikipedia.org/wiki/Schizophrenia#Negative_symptoms "Schizophrenia").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Both delusions and hallucinations are classic symptoms of psychosis.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Delusions are false beliefs which are strongly held despite evidence to the contrary.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although [auditory hallucinations](https://en.wikipedia.org/wiki/Auditory_hallucination "Auditory hallucination") (or "hearing voices") are the most common. Negative symptoms include [alogia](https://en.wikipedia.org/wiki/Alogia "Alogia") (lack of speech), [blunted affect](https://en.wikipedia.org/wiki/Blunted_affect "Blunted affect") (reduced intensity of outward emotional expression), [avolition](https://en.wikipedia.org/wiki/Avolition "Avolition") (lack of motivation), and [anhedonia](https://en.wikipedia.org/wiki/Anhedonia "Anhedonia") (inability to experience pleasure).[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis. Mood symptoms include [mania](https://en.wikipedia.org/wiki/Mania "Mania"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), [mixed episode](https://en.wikipedia.org/wiki/Mixed_episode "Mixed episode"), or [depression](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode"), and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self-esteem), agitation, risk-taking behavior, decreased need for sleep, poor concentration, rapid speech, and racing thoughts.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21) Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motor activity, fatigue, guilt or feelings of worthlessness, and [suicidal thinking](https://en.wikipedia.org/wiki/Suicidal_thinking "Suicidal thinking"). DSM-5 states that if a patient only experiences psychotic symptoms during a mood episode, their diagnosis is mood disorder with psychotic features and not schizophrenia or schizoaffective disorder. If the patient experiences psychotic symptoms without mood symptoms for longer than a two-week period, their diagnosis is either schizophrenia or schizoaffective disorder. If mood disorder episodes are present for the majority and residual course of the illness and up until the diagnosis, the patient can be diagnosed with schizoaffective disorder.[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4) Causes A combination of genetic and [environmental factors](https://en.wikipedia.org/wiki/Environmental_factor "Environmental factor") are believed to play a role in the development of schizoaffective disorder.[\[22\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Lancet09-22)[\[23\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ07-23) > Genetic studies do not support the view that schizophrenia, psychotic [mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders") and schizoaffective disorder are distinct [etiological](https://en.wikipedia.org/wiki/Etiology "Etiology") entities, but rather the evidence suggests the existence of common inherited vulnerability that increases the risks for all these syndromes. Some susceptibility pathways may be specific for schizophrenia, others for [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), and yet other mechanisms and genes may confer risk for mixed schizophrenic and affective \[or mood disorder\] psychoses, but there is no support from genetics for the view that these are distinct disorders with distinct etiologies and [pathogenesis](https://en.wikipedia.org/wiki/Pathogenesis "Pathogenesis"). Laboratory studies of putative [endophenotypes](https://en.wikipedia.org/wiki/Endophenotype "Endophenotype"), [brain imaging](https://en.wikipedia.org/wiki/Brain_imaging "Brain imaging") studies, and [post mortem](https://en.wikipedia.org/wiki/Post_mortem "Post mortem") studies shed little additional light on the validity of the schizoaffective disorder diagnosis, as most studies combine subjects with different chronic psychoses in comparison to healthy subjects. Viewed broadly then, biological and environmental factors interact with a person's genes in ways which may increase or decrease the risk for developing schizoaffective disorder; exactly how this happens (the biological mechanism) is not yet known. Schizophrenia spectrum disorders, of which schizoaffective disorder is a part, have been increasingly linked to advanced [paternal age](https://en.wikipedia.org/wiki/Paternal_age "Paternal age") at the time of conception, a known cause of genetic mutations.[\[24\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-24) The physiology of people diagnosed with schizoaffective disorder appears to be similar, but not identical, to that of those diagnosed with schizophrenia and bipolar disorder; however, human [neurophysiological](https://en.wikipedia.org/wiki/Neurophysiology "Neurophysiology") function in normal brain and mental disorder [syndromes](https://en.wikipedia.org/wiki/Syndromes "Syndromes") is not fully understood.[\[9\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18056246-9) While there are various medications and treatment options for those with schizoaffective disorder, this disorder can affect a person for their entire lifespan.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) In some cases, this disorder can affect a person's ability to have a fulfilling social life and they may also have trouble forming bonds or relationships with others. Schizoaffective disorder is also more likely to occur in women and begins at a young age.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) Substance use disorder A clear causal connection between substance use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. In the specific case of [cannabis (marijuana)](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), however, evidence supports a link between earlier onset of psychotic illness and cannabis use.[\[26\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-26) The more often cannabis is used, particularly in early adolescence, the more likely a person is to develop a psychotic illness,[\[27\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-27)[\[28\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-28)[\[29\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Moore_TH,_Zammit_S,_[[Anne_Lingford-Hughes\|Lingford-Hughes_A]],_et_al._2005_187-94-29) with frequent use being correlated with double the risk of psychosis and schizoaffective disorder.[\[30\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-30) A 2009 Yale review stated that in individuals with an established psychotic disorder, [cannabinoids](https://en.wikipedia.org/wiki/Cannabinoids "Cannabinoids") can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness.[\[31\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-31) While cannabis use is accepted as a contributory cause of schizoaffective disorder by many,[\[32\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Henquet2008-32) it remains controversial,[\[33\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Genes10-33)[\[34\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Amar2007-34) since not all young people who use cannabis later develop psychosis, but those who do use cannabis have an increased [odds ratio](https://en.wikipedia.org/wiki/Odds_ratio "Odds ratio") of about 3.[\[35\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Cannabis&Psychosis-35) Certain drugs can imitate symptoms of schizophrenia (which is known to have similar symptoms to schizoaffective disorder). This is important to note when including that substance-induced psychosis should be ruled out when diagnosing patients so that patients are not misdiagnosed.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Mechanisms Though the pathophysiology of schizoaffective disorder remains unclear, studies suggest that dopamine, norepinephrine, and serotonin may be factors in the development of the disorder.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) [White matter](https://en.wikipedia.org/wiki/White_matter "White matter") and [grey matter](https://en.wikipedia.org/wiki/Grey_matter "Grey matter") reductions in the right [lentiform nucleus](https://en.wikipedia.org/wiki/Lentiform_nucleus "Lentiform nucleus"), left [superior temporal gyrus](https://en.wikipedia.org/wiki/Superior_temporal_gyrus "Superior temporal gyrus"), and right [precuneus](https://en.wikipedia.org/wiki/Precuneus "Precuneus"), and other areas in the brain are also characteristic of schizoaffective disorder.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36)[\[37\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:42-37) Deformities in white matter have also been found to worsen with time in individuals with schizoaffective disorder.[\[37\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:42-37) Due to its role in emotional regulation, researchers believe that the [hippocampus](https://en.wikipedia.org/wiki/Hippocampus "Hippocampus") is also involved in the progression of schizoaffective disorder.[\[38\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:52-38) Specifically, psychotic disorders (such as schizoaffective disorder) have been associated with lower hippocampal volumes.[\[38\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:52-38) Moreover, deformities in the medial and thalamic regions of the brain have been implicated as contributing factors to the disorder as well.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) Diagnosis Psychosis as a [symptom](https://en.wikipedia.org/wiki/Symptom "Symptom") of a psychiatric disorder is first and foremost a [diagnosis of exclusion](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion").[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) So a new-onset episode of psychosis cannot be considered to be a symptom of a psychiatric disorder until other relevant and known medical causes of psychosis are excluded, or ruled out.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) An initial assessment includes a comprehensive history and physical examination. Although no biological laboratory tests exist which confirm schizoaffective disorder, biological tests should be performed to [exclude](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") psychosis associated with or caused by substance use, medications, toxins or poisons, surgical complications, or other medical illnesses. Since non-medical mental health practitioners are not trained to exclude medical causes of psychosis, people experiencing psychosis should be referred to an emergency department or hospital. [Delirium](https://en.wikipedia.org/wiki/Delirium "Delirium") should be ruled out, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, indicating other underlying factors which includes medical illnesses.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Excluding medical illnesses associated with psychosis is performed by using [blood tests](https://en.wikipedia.org/wiki/Blood_tests "Blood tests") to measure: - [Thyroid-stimulating hormone](https://en.wikipedia.org/wiki/Thyroid-stimulating_hormone "Thyroid-stimulating hormone") to exclude [hypo-](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") or [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), - Basic electrolytes and [serum calcium](https://en.wikipedia.org/wiki/Serum_calcium "Serum calcium") to rule out a metabolic disturbance, - [Full blood count](https://en.wikipedia.org/wiki/Complete_blood_count "Complete blood count") including [ESR](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") to rule out a systemic infection or chronic disease, and - [Serology](https://en.wikipedia.org/wiki/Serology "Serology") to exclude [syphilis](https://en.wikipedia.org/wiki/Syphilis "Syphilis") or [HIV](https://en.wikipedia.org/wiki/HIV "HIV") infection. Other investigations which may be performed include: - [EEG](https://en.wikipedia.org/wiki/EEG "EEG") to exclude [epilepsy](https://en.wikipedia.org/wiki/Epilepsy "Epilepsy"), and an - [MRI](https://en.wikipedia.org/wiki/MRI "MRI") or [CT scan](https://en.wikipedia.org/wiki/CT_scan "CT scan") of the head to exclude brain lesions. Blood tests are not usually repeated for relapse in people with an established diagnosis of schizoaffective disorder, unless there is a specific medical indication. These may include serum [BSL](https://en.wikipedia.org/wiki/Blood_sugar "Blood sugar") if [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine") has previously been prescribed, thyroid function if [lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") has previously been taken to rule out [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism"), liver function tests if [chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") has been prescribed, [CPK](https://en.wikipedia.org/wiki/Creatine_kinase "Creatine kinase") levels to exclude [neuroleptic malignant syndrome](https://en.wikipedia.org/wiki/Neuroleptic_malignant_syndrome "Neuroleptic malignant syndrome"), and a [urinalysis](https://en.wikipedia.org/wiki/Urinalysis "Urinalysis") and serum toxicology screening if substance use is suspected. Assessment and treatment may be done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others. Because psychosis may be precipitated or exacerbated by common classes of [psychiatric medications](https://en.wikipedia.org/wiki/Psychiatric_medications "Psychiatric medications"), such as [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant"),[\[40\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\[41\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\[42\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\[43\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\[44\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis2-44) [ADHD stimulant medications](https://en.wikipedia.org/wiki/ADHD#Medication "ADHD"),[\[45\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-45)[\[46\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-ReferenceB-46)[\[47\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47) and [sleep medications](https://en.wikipedia.org/wiki/Hypnotics "Hypnotics"),[\[48\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\[49\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) [prescribed medication-induced psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") should be [ruled out](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion"), particularly for first-episode psychosis.[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) This is an essential step to reduce diagnostic error and to evaluate potential medication sources of further [patient harm](https://en.wikipedia.org/wiki/Iatrogenesis "Iatrogenesis").[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) Regarding prescribed medication sources of patient harm, [Yale School of Medicine](https://en.wikipedia.org/wiki/Yale_School_of_Medicine "Yale School of Medicine") Professor of Psychiatry Malcolm B. Bowers Jr, MD wrote:[\[50\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Malcolm2004-50)\[[self-published source](https://en.wikipedia.org/wiki/Wikipedia:Verifiability#Self-published_sources "Wikipedia:Verifiability")\] > Illicit drugs aren't the only ones that precipitate psychosis or mania—prescribed drugs can too, and in particular, some psychiatric drugs. We investigated this and found that about 1 in 12 psychotic or manic patients in an inpatient psychiatric facility are there due to antidepressant-induced psychosis or mania. That's unfortunate for the field \[of psychiatry\] and disastrous for some of our patients. > > > It is important to be understood here. I want to call attention to the fact that some persons with a family history of even the subtler forms of bipolar disorder or psychosis are more vulnerable than others to the mania- or psychosis-inducing potential of antidepressants, stimulants and sleeping medications. While I'm not making a blanket statement against these medications, I am urging caution in their use. I believe \[clinicians\] should ask patients and their families whether there is a family history of bipolar disorder or psychosis before prescribing these medications. Most patients and their families don't know the answer when they are first asked, so time should be allowed for the patient to ask family or relatives, between the session when asked by \[the clinician\] and a follow-up session. This may increase the wait for a medication slightly, but because some patients are vulnerable, this is a necessary step for \[the clinician\] to take. I believe that psychiatry as a field has not emphasized this point sufficiently. As a result, some patients have been harmed by the very treatments that were supposed to help them; or to the disgrace of psychiatry, harmed and then misdiagnosed.[\[40\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Preda_A,_MacLean_RW,_Mazure_CM,_Bowers_MB_Jr_2001_30%E2%80%933-40)[\[41\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fortunati_F,_Mazure_C,_Preda_A,_Wahl_R,_Bowers_M_Jr_2002_331%E2%80%93334-41)[\[42\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Effexor-Psychosis-42)[\[43\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Wellbutrin-Zyban-Psychosis-43)[\[46\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-ReferenceB-46)[\[47\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Steven_M._Berman,_Ronald_Kuczenski,_James_T._McCracken,_and_Edythe_D._London_2009_123%E2%80%9342-47)[\[48\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Markowitz_JS,_Brewerton_TD._1996_89%E2%80%9391-48)[\[49\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Chiung-Lei_H,_Ching-Jui_C,_Ching-Feng_H,_Hsi-Len_L._2003_683%E2%80%9386-49) Substance-induced psychosis should also be ruled out. Both substance- and medication-induced psychosis can be [excluded](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") to a high level of certainty while the person is psychotic, typically in an emergency department, using both a: - Broad spectrum urine toxicology screening, and a - Full serum toxicology screening (of the blood). Some [dietary supplements](https://en.wikipedia.org/wiki/Dietary_supplements "Dietary supplements") may also induce psychosis or mania, but cannot be ruled out with laboratory tests. So a psychotic person's family, partner, or friends should be asked whether he or she is currently taking any dietary supplements.[\[51\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-51) Common mistakes made when diagnosing psychotic patients include:[\[39\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx-39) - Not properly excluding delirium, - Missing a [toxic psychosis](https://en.wikipedia.org/wiki/Substance-induced_psychosis "Substance-induced psychosis") by not screening for substances and medications, - Not appreciating medical abnormalities (e.g., [vital signs](https://en.wikipedia.org/wiki/Vital_signs "Vital signs")), - Not obtaining a medical history and family history, - Indiscriminate screening without an organizing framework, - Not asking family or others about dietary supplements, - Premature diagnostic closure, and - Not revisiting or questioning the initial diagnostic impression of primary psychiatric disorder. Schizoaffective disorder can only be diagnosed among those who have undergone a clinical evaluation with a psychiatrist. The criterion includes mental and physical symptoms[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) such as [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination") or [delusions](https://en.wikipedia.org/wiki/Delusion "Delusion"), and [depressive episodes](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode"). There are also links to bad hygiene and a troubled social life for those with schizoaffective disorder.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) Research has failed to conclusively demonstrate a positive relationship between schizoaffective disorder and substance abuse.[\[53\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-53) There are several theorized causations for the onset of Schizoaffective disorder, including, genetics, general brain function, like chemistry, and structure, and stress.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) Only after these relevant and known causes of psychosis have been ruled out can a psychiatric [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") be made. A mental health clinician will incorporate family history, observation of a psychotic person's behavior while the person is experiencing active symptoms, to begin a psychiatric differential diagnosis. Diagnosis also includes self-reported experiences, as well as behavioral abnormalities reported by family members, friends, or significant others. Mistakes in this stage include: - Not screening for [dissociative disorders](https://en.wikipedia.org/wiki/Dissociative_disorders "Dissociative disorders"). [Dissociative identity disorder](https://en.wikipedia.org/wiki/Dissociative_identity_disorder "Dissociative identity disorder") and psychotic symptoms in schizoaffective disorder have considerable overlap, yet a different overall treatment approach.[\[54\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-54) DSM-5 criteria The most widely used criteria for diagnosing schizoaffective disorder are from the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association")'s [Diagnostic and Statistical Manual of Mental Disorders-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV schizoaffective disorder definition was plagued by problems of being inconsistently (or [unreliably](https://en.wikipedia.org/wiki/Reliability_\(statistics\) "Reliability (statistics)")) used on patients;[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) when the diagnosis is made, it does not stay with most patients over time,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) and it has questionable [diagnostic validity](https://en.wikipedia.org/wiki/Validity_\(statistics\) "Validity (statistics)") (that is, it does not describe a distinct disorder, nor predict any particular outcome).[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These problems have been slightly reduced (or "modestly improved") in the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") according to Carpenter.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) When [psychotic](https://en.wikipedia.org/wiki/Psychosis "Psychosis") symptoms are confined to an episode of [mania](https://en.wikipedia.org/wiki/Mania "Mania") or [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") (with or without [mixed features](https://en.wikipedia.org/wiki/Mixed_affective_state "Mixed affective state")), the diagnosis is that of a "psychotic" [mood disorder](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), namely either psychotic [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") or [psychotic major depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"). Only when psychotic states persist in a sustained fashion for two weeks or longer without concurrent affective symptoms is the diagnosis schizoaffective disorder, [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") or [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The second cardinal guideline in the DSM-5 diagnosis of schizoaffective disorder is one of timeframe. DSM-5 requires two episodes of psychosis (whereas DSM-IV needed only one) to qualify for the schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) As such, it is no longer an "episode diagnosis."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The new schizoaffective framework looks at the time from "the \[first episode of\] psychosis up to the current episode \[of psychosis\], rather than only defining a single episode with \[co-occurring\] psychotic and mood [syndromes](https://en.wikipedia.org/wiki/Syndrome "Syndrome")."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specifically, one of the episodes of psychosis must last a minimum of two weeks without mood disorder symptoms, but the person may be mildly to moderately depressed while psychotic.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The other period of psychosis "requires the overlap of mood \[disorder\] symptoms with psychotic symptoms to be conspicuous" and last for a greater portion of the disorder.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) These two changes are intended by the DSM-5 workgroup to accomplish two goals:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) - Increase the diagnosis' consistency (or reliability) when it is used; - Significantly decrease the overall use of the schizoaffective disorder diagnosis. If the schizoaffective diagnosis is used less often, other diagnoses (like psychotic mood disorders and schizophrenia) are likely to be used more often; but this is hypothetical until real-world data arrive. Validity problems with the diagnosis remain and await further work in the fields of [psychiatric genetics](https://en.wikipedia.org/wiki/Psychiatric_genetics "Psychiatric genetics"), [neuroimaging](https://en.wikipedia.org/wiki/Neuroimaging "Neuroimaging"), and [cognitive science](https://en.wikipedia.org/wiki/Cognitive_science "Cognitive science") that includes the overlapping fields of [cognitive](https://en.wikipedia.org/wiki/Cognitive_neuroscience "Cognitive neuroscience"), [affective](https://en.wikipedia.org/wiki/Affective_neuroscience "Affective neuroscience"), and [social neuroscience](https://en.wikipedia.org/wiki/Social_neuroscience "Social neuroscience"), which may change the way schizoaffective disorder is [conceptualized](https://en.wikipedia.org/wiki/Construct_\(philosophy_of_science\) "Construct (philosophy of science)") and defined in future versions of the [DSM](https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders "Diagnostic and Statistical Manual of Mental Disorders") and [ICD](https://en.wikipedia.org/wiki/ICD "ICD").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[56\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-TransformingDiagnosis-56) Comorbidities Schizoaffective disorder shares a high level of [comorbidity](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity") with anxiety disorders, depression, and bipolar disorder.[\[57\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-57)[\[58\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-58) Individuals with schizoaffective disorder are also often diagnosed with substance abuse disorder, usually relating to [tobacco](https://en.wikipedia.org/wiki/Tobacco "Tobacco"), [marijuana](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), or [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)").[\[59\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-59) Health care providers indicate the importance of assessing for co-occurring substance use disorders, as multiple diagnoses not only potentially increase negative symptomology, but may also adversely affect the treatment of schizoaffective disorder. Types One of three types of schizoaffective disorder may be noted in a diagnosis based on the mood component of the disorder:[\[4\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-who.int-4)[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) - Bipolar type, when the disturbance includes [manic episodes](https://en.wikipedia.org/wiki/Manic_episodes "Manic episodes"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), or [mixed episodes](https://en.wikipedia.org/wiki/Mixed_episodes "Mixed episodes")—major depressive episodes also typically occur; - Depressive type, when the disturbance includes major depressive episodes exclusively—that is, without manic, hypomanic, or mixed episodes. - Mixed type, when the disturbance includes both manic and depressive symptoms, but psychotic symptoms exist separately from bipolar disorder.[\[8\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:12-8) Problems with DSM-IV schizoaffective disorder The [American Psychiatric Association's](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association") DSM-IV criteria for schizoaffective disorder persisted for 19 years (1994–2013). Clinicians adequately trained in diagnosis used the schizoaffective diagnosis too often,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) largely because the criteria were poorly defined, [ambiguous](https://en.wikipedia.org/wiki/Ambiguity "Ambiguity"), and hard to use (or poorly [operationalized](https://en.wikipedia.org/wiki/Operationalization "Operationalization")).[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[60\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid18199238-60) Poorly trained clinicians used the diagnosis without making necessary [exclusions](https://en.wikipedia.org/wiki/Diagnosis_of_exclusion "Diagnosis of exclusion") of common causes of psychosis, including some prescribed psychiatric medications.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Specialty books written by experts on schizoaffective disorder have existed for over eight years before DSM-5 describing the overuse of the diagnosis.[\[61\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-The_Overlap_of_Schizophrenic_and_Affective_Spectra-61)[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62)[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63)[\[64\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_Disorders:_New_Research-64) Carpenter and the DSM-5 schizoaffective disorders workgroup analyzed data made available to them in 2009, and reported in May 2013 that:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) > a recent review of psychotic disorders from large private insurance and Medicare databases in the U.S. found that the diagnosis of DSM-IV schizoaffective disorder was used for about a third of cases with non-affective psychotic disorders. Hence, this unreliable and poorly defined diagnosis is clearly overused. As stated above, the DSM-IV schizoaffective disorder diagnosis is very inconsistently used or unreliable.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A diagnosis is unreliable when several different mental health professionals observing the same individual make different diagnoses excessively.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Even when a structured DSM-IV diagnostic interview and best estimate procedures were made by experts in the field that included information from family informants and prior clinical records, [reliability](https://en.wikipedia.org/wiki/Interrater_reliability "Interrater reliability") was still poor for the DSM-IV schizoaffective diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV schizoaffective diagnosis is not stable over time either.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) An initial diagnosis of schizoaffective disorder during time spent at a psychiatric inpatient facility was stable at 6-month and 24-month follow ups for only 36% of patients.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) By comparison, diagnostic stability was 92% for schizophrenia, 83% for bipolar disorder and 74% for major depression.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Most patients diagnosed with DSM-IV schizoaffective disorder are later diagnosed with a different disorder, and that disorder is more stable over time than the DSM-IV schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) In April 2009, Carpenter and the DSM-5 schizoaffective disorder workgroup reported that they were "developing new criteria for schizoaffective disorder to improve reliability and [face validity](https://en.wikipedia.org/wiki/Face_validity "Face validity")," and were "determining whether the dimensional assessment of mood \[would\] justify a recommendation to drop schizoaffective disorder as a diagnostic category."[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) Speaking to an audience at the May 2009 annual conference of the [American Psychiatric Association](https://en.wikipedia.org/wiki/American_Psychiatric_Association "American Psychiatric Association"), Carpenter said:[\[20\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-OnTrack-20) > We had hoped to get rid of schizoaffective \[disorder\] as a diagnostic category \[in the DSM-5\] because we don't think it's \[a\] valid \[scientific entity\] and we don't think it's reliable. On the other hand, we think it's absolutely indispensable to clinical practice. A major reason why DSM-IV schizoaffective disorder was indispensable to clinical practice is because it offered clinicians a diagnosis for patients with psychosis in the context of mood disorder whose clinical picture, at the time diagnosed, appeared different from DSM-IV "schizophrenia" or "mood disorder with psychotic features". But DSM-IV schizoaffective disorder carries an unnecessarily worse prognosis than a "mood disorder with psychotic features" diagnosis,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) because [long-term data](https://en.wikipedia.org/wiki/Longitudinal_data "Longitudinal data") revealed that a significant proportion of DSM-IV schizoaffective disorder patients had 15-year outcomes indistinguishable from patients with mood disorders with or without psychotic features,[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) even though the clinical picture at the time of first diagnosis looked different from both schizophrenia and mood disorders.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[19\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Fifteen_Year_Schizoaffective_Follow_Up-19) These problems with the DSM-IV schizoaffective disorder definition result in most people the diagnosis is used on being misdiagnosed;[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) furthermore, [outcome studies](https://en.wikipedia.org/wiki/Cohort_study "Cohort study") done 10 years after the diagnosis was released showed that the group of patients defined by the DSM-IV and ICD-10 schizoaffective diagnosis had significantly better outcomes than predicted, so the diagnosis carries a misleading and unnecessarily poor [prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-IV criteria for schizoaffective disorder will continue to be used on U.S. board examinations in psychiatry through the end of 2014; established practitioners may continue to use the problematic DSM-IV definition much further into the future also. DSM-5 research directions The new schizoaffective disorder criteria continue to have questionable diagnostic validity.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Questionable diagnostic validity does not doubt that people with symptoms of psychosis and mood disorder need treatment—psychosis and mood disorder must be treated. Instead, questionable diagnostic validity means there are unresolved problems with the way the DSM-5 [categorizes](https://en.wikipedia.org/wiki/Categorization "Categorization") and defines schizoaffective disorder. [![](https://upload.wikimedia.org/wikipedia/commons/2/29/Emil_Kraepelin2.gif)](https://en.wikipedia.org/wiki/File:Emil_Kraepelin2.gif) [Emil Kraepelin's](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") [dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") ( c. 1898) continues to influence [classification and diagnosis](https://en.wikipedia.org/wiki/Nosology "Nosology") in psychiatry. A core concept in modern psychiatry since [DSM-III](https://en.wikipedia.org/wiki/DSM_III#DSM-III_\(1980\) "DSM III") was released in 1980, is the categorical separation of mood disorders from schizophrenia, known as the [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy"). [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") introduced the idea that schizophrenia was separate from mood disorders after observing patients with symptoms of psychosis and mood disorder, over a century ago, in 1898. This was a time before [genetics](https://en.wikipedia.org/wiki/Genetics "Genetics") were known and before any treatments existed for [mental illness](https://en.wikipedia.org/wiki/Mental_illness "Mental illness").[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) The Kraepelinian dichotomy was not used for [DSM-I](https://en.wikipedia.org/wiki/DSM-I "DSM-I") and [DSM-II](https://en.wikipedia.org/wiki/DSM-II "DSM-II") because both manuals were influenced by the dominant [psychodynamic](https://en.wikipedia.org/wiki/Psychodynamic "Psychodynamic") psychiatry of the time,[\[66\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Revolution-66) but the designers of DSM-III wanted to use more scientific and biological definitions.[\[66\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Revolution-66) Consequently, they looked to psychiatry's history and decided to use the Kraepelinian dichotomy as a foundation for the classification system. The Kraepelinian dichotomy continues to be used in DSM-5 despite having been challenged by [data](https://en.wikipedia.org/wiki/Empirical_data "Empirical data") from modern psychiatric genetics for over eight years,[\[67\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-EndofKraepelinianDichotomy-67) and there is now [evidence](https://en.wikipedia.org/wiki/Empirical_evidence "Empirical evidence") of a significant overlap in the genetics of schizophrenia and bipolar disorder.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65) According to this genetic evidence, the Kraepelinian categorical separation of mood disorders from schizophrenia at the foundation of the current classification and diagnostic system is a mistaken [false dichotomy](https://en.wikipedia.org/wiki/False_dichotomy "False dichotomy").[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The dichotomy at the foundation of the current system forms the basis for a convoluted schizoaffective disorder definition in DSM-IV that resulted in excessive misdiagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Real life schizoaffective disorder patients have significant and enduring symptoms that bridge what are incorrectly assumed to be categorically separate disorders, schizophrenia and bipolar disorder.[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) People with [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), bipolar disorder with a history of psychosis, and schizophrenia with mood symptoms also have symptoms that bridge psychosis and mood disorders.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The categorical diagnostic manuals do not reflect reality in their separation of psychosis (via the schizophrenia diagnosis) from mood disorder, nor do they currently emphasize the actual overlap found in real-life patients.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Thus, they are likely to continue to introduce [either-or](https://en.wikipedia.org/wiki/False_dichotomy "False dichotomy") [conceptual](https://en.wikipedia.org/wiki/Conceptualization "Conceptualization") and diagnostic error, by way of [confirmation bias](https://en.wikipedia.org/wiki/Confirmation_bias "Confirmation bias") into clinicians' [mindsets](https://en.wikipedia.org/wiki/Mindset "Mindset"), hindering accurate assessment and treatment.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The new definition continues the lack of [parsimony](https://en.wikipedia.org/wiki/Occam%27s_razor "Occam's razor") of the old definition.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Simpler, clearer, and more usable definitions of the diagnosis were supported by certain members of the DSM-5 workgroup; these were debated but deemed premature, because more "research \[is\] needed to establish a new [classification system](https://en.wikipedia.org/wiki/Nosology "Nosology") of equal or greater validity"[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) to the existing system.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[69\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Structure_of_Psychotic_Disorders_in_DSM_5-69) Because of DSM-5's continuing problematic categorical foundation, schizoaffective disorder's conceptual and diagnostic validity remains doubtful.[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) After enough research is completed and data exists, future diagnostic advances will need to either eliminate and replace, or soften and bridge, the hard categorical separation of mood disorders from schizophrenia; most likely using a [spectrum or dimensional approach](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") to diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) More [parsimonious](https://en.wikipedia.org/wiki/Occam%27s_razor "Occam's razor") definitions than the current one were considered by Carpenter and the DSM-5 workgroup:[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) > One option for the DSM-5 would have been to remove the schizoaffective disorder category and to add affective \[or mood\] symptoms \[that is, [mania](https://en.wikipedia.org/wiki/Mania "Mania"), [hypomania](https://en.wikipedia.org/wiki/Hypomania "Hypomania"), [mixed episode](https://en.wikipedia.org/wiki/Mixed_state_\(psychiatry\) "Mixed state (psychiatry)"), or [depression](https://en.wikipedia.org/wiki/Major_depressive_episode "Major depressive episode")\] as a dimension to [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") and [schizophreniform disorder](https://en.wikipedia.org/wiki/Schizophreniform_disorder "Schizophreniform disorder") or to define a single category for the co-occurrence of psychosis and mood symptoms. This option was extensively debated but ultimately deemed to be premature in the absence of sufficient clinical and theoretical validating data justifying such a … reconceptualization. Additionally, there appeared to be no practical way to introduce affect \[or mood\] dimensions covering the entire course of illness, that would capture the current [concept](https://en.wikipedia.org/wiki/Conceptualization "Conceptualization") of periods of psychosis related and unrelated to mood episodes. > \[N\]o valid biomarkers or laboratory measures have emerged to distinguish between affective psychosis \[or psychotic [mood disorders](https://en.wikipedia.org/wiki/Mood_disorders "Mood disorders")\] and schizophrenia. To the contrary, the idea of a dichotomy between these types of conditions has proven naïve. \[T\]he admixture of "schizophrenic" and affective \[or mood\] symptoms is a feature of many, or even most, cases with severe mental illness. Most presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response in psychosis. \[U\]ltimately a more ... [dimensional approach](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") \[to assessment and treatment\] will be required. The field of [psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") has begun to question its assumptions and analyze its data in order to merge closer with [evidence-based medicine](https://en.wikipedia.org/wiki/Evidence-based_medicine "Evidence-based medicine").[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) The removal of the "episode diagnosis", and the addition of two episodes of psychosis, as qualifications for the DSM-5 schizoaffective diagnosis, may improve the diagnosis' consistency over DSM-IV for research purposes, where diagnostic criteria are by necessity followed exactingly.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) But the new definition remains long, unwieldy, and perhaps still not very useful for community clinicians—with two psychoses, one for two weeks minimum and without mood disorder (but the person can be mildly or moderately depressed) and the other with significant mood disorder and psychosis lasting for most of the time, and with lasting mood symptoms for most of the residual portion of the illness.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) Community clinicians used the previous definition "for about a third of cases with non-affective psychotic disorders."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Non-affective psychotic disorders are, by definition, not schizoaffective disorder. For clinicians to make such sizeable errors of misdiagnosis may imply systemic problems with the schizoaffective disorder diagnosis itself. Already, at least one expert believes the new schizoaffective definition has not gone far enough to solve the previous definition's problems.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55) From a scientific standpoint, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brain's [neural circuits](https://en.wikipedia.org/wiki/Neural_circuit "Neural circuit"), for example, are just beginning to be mapped by modern neuroscience in the [Human Connectome Project](https://en.wikipedia.org/wiki/Human_Connectome_Project "Human Connectome Project") and [CLARITY](https://en.wikipedia.org/wiki/CLARITY "CLARITY"). Clinical psychiatry, furthermore, has begun to understand and acknowledge its current limitations—but further steps by the field are required to significantly reduce misdiagnosis and [patient harm](https://en.wikipedia.org/wiki/Iatrogenesis "Iatrogenesis"); this is crucial both for responsible patient care and to retain public trust. Looking forward, a [paradigm shift](https://en.wikipedia.org/wiki/Paradigm_shift "Paradigm shift") is needed in psychiatric research to address unanswered questions about schizoaffective disorder. The [dimensional](https://en.wikipedia.org/wiki/Spectrum_approach "Spectrum approach") Research Domain Criteria project currently being developed by the [U.S. National Institute of Mental Health](https://en.wikipedia.org/wiki/National_Institute_of_Mental_Health "National Institute of Mental Health"), may be the specific problem solving framework psychiatry needs to develop a more scientifically mature understanding of schizoaffective disorder as well as all other mental disorders.[\[70\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-RDoC-70) Treatment The primary treatment of schizoaffective disorder is medication, with improved outcomes using combined long-term psychological and social supports.[\[22\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Lancet09-22) Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) [involuntarily](https://en.wikipedia.org/wiki/Involuntary_commitment "Involuntary commitment"). Long-term hospitalization is uncommon since [deinstitutionalization](https://en.wikipedia.org/wiki/Deinstitutionalization "Deinstitutionalization") started in the 1950s, although it still occurs.[\[18\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BeckerKilian2006-18) Community support services including drop-in centers, visits by members of a [community mental health team](https://en.wikipedia.org/wiki/Community_mental_health_service "Community mental health service"), supported employment and support groups are common.[\[71\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-71) Evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizoaffective disorder.[\[72\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-72) Because of the heterogeneous symptomology associated with schizoaffective disorder, it is common for patients to be [misdiagnosed](https://en.wikipedia.org/wiki/Medical_error "Medical error"). Many people are either diagnosed with [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"), schizophrenia, or [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") instead of schizoaffective disorder.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) Because of the broad range of symptoms of Schizoaffective disorder, patients are often misdiagnosed in a clinical setting. In fact, almost 39% of people are misdiagnosed when it comes to psychiatric disorders.[\[52\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:02-52) While various medications and treatment options exist for those diagnosed with schizoaffective disorder, symptoms may continue to impact a person for their entire lifespan.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25)Schizoaffective disorder can affect a person's ability to experience a fulfilling social life and they may also exhibit difficulty forming bonds or relationships with others. Schizoaffective disorder is more likely to occur in women and symptoms begin manifesting at a young age.[\[25\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-my.clevelandclinic.org-25) Therapy Psychosocial treatments have been found to improve outcomes related to schizoaffective disorder.[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Supportive [psychotherapy](https://en.wikipedia.org/wiki/Psychotherapy "Psychotherapy") and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") are both helpful.[\[74\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-74) Intensive case management (ICM) has been shown to reduce hospitalizations, improve adherence to treatment, and improve social functioning.[\[75\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-75) With ICM, clients are assigned a case manager responsible for coordination of care and assisting clients to access supports to address needs in multiple areas related to well-being, including housing. Psychiatric/psychosocial rehabilitation is often a component of schizoaffective disorder treatment. This rehabilitation method focuses on solving community integration problems such as obtaining and keeping housing and increasing involvement in positive social groups. It also focuses on improving and increasing [activities of daily living](https://en.wikipedia.org/wiki/Activities_of_daily_living "Activities of daily living"); increasing daily healthy habits and decreasing unhealthy behaviors, thereby significantly improving quality of life. Psychiatric rehabilitation may also focus on [vocational rehabilitation](https://en.wikipedia.org/wiki/Vocational_rehabilitation "Vocational rehabilitation").[\[76\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-76) Evidence suggests that cognition-based approaches may be able to improve work and social functioning.[\[77\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-77) Psychiatric rehabilitation consists of eight main areas: - Psychiatric (symptom reduction and management) - Health and Medical (maintaining consistency of care) - Housing (safe environments) - Basic living skills ([hygiene](https://en.wikipedia.org/wiki/Hygiene "Hygiene"), meals \[including increasing healthy food intake and reducing processed food intake\], safety, planning and chores) - Social ([relationships](https://en.wikipedia.org/wiki/Intimate_relationship "Intimate relationship"), family boundaries, communication and integration of client into the community) - Education and vocation (coping skills, [motivation](https://en.wikipedia.org/wiki/Motivation "Motivation") and suitable goals chosen by client) - Finance ([personal budget](https://en.wikipedia.org/wiki/Personal_budget "Personal budget")) - Community and legal (resources) Medication [Antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") medication is usually required both for acute treatment and the prevention of relapse.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21)[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78) There is no single antipsychotic of choice in treating schizoaffective disorder, but [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") may be considered due to their mood-stabilizing abilities.[\[21\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APP_textbook-21)[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) To date, [paliperidone](https://en.wikipedia.org/wiki/Paliperidone "Paliperidone") (Invega) is the only antipsychotic with [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approval for the treatment of schizoaffective disorder.[\[79\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manufacturer's_Official_webpage-79) Other antipsychotics may be prescribed to further alleviate psychotic symptoms.[\[80\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-80) The management of the bipolar type of schizoaffective disorder is similar to the [treatment of bipolar disorder](https://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder "Treatment of bipolar disorder"), with the goal of preventing mood episodes and cycling.[\[81\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Stahl-81) [Lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") or anticonvulsant mood stabilizers such as [valproic acid](https://en.wikipedia.org/wiki/Valproic_acid "Valproic acid"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), and [lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") are prescribed in combination with an antipsychotic.[\[73\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-BMJ_best_practice-73) Antidepressants have also been used to treat schizoaffective disorder.[\[82\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-82) Though they may be useful in treating the depressive subtype of the disorder, research suggests that antidepressants are far less effective in treatment than antipsychotics and mood stabilizers.[\[83\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-83) Some research has supported the efficacy of [anxiolytics](https://en.wikipedia.org/wiki/Anxiolytic "Anxiolytic") in treating schizoaffective disorder, though general findings on their effectiveness in treating schizoaffective disorder remain inconclusive.[\[84\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:0-84) Due to the severe negative outcomes associated with many anti-anxiety drugs, many researchers have cautioned against their long term use in treatment.[\[84\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:0-84) Clozapine [Clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine") is FDA-approved for treatment resistant schizophrenia.[\[85\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-85) Though not approved specifically for schizoaffective disorder by the FDA, research suggests that clozapine may also be effective in treating schizoaffective disorder, particularly in those resistant to initial medication.[\[86\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine is an [atypical antipsychotic](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") that is recognized as being particularly effective when other antipsychotic agents have failed.[\[81\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Stahl-81) When combined with cognitive therapy, clozapine has been found to decrease positive and negative symptoms of psychosis at a higher rate in schizoaffective individuals.[\[86\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Rey_Souto_148%E2%80%93156-86) Clozapine has also been associated with a decreased risk of suicide attempts in patients with schizoaffective disorder and a history of suicidality.[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78)[\[87\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-87) Despite clozapine being highly effective at treating schizophrenia and schizoaffective disorder, clozapine treatment may be ineffective for some patients, particularly in those that are already drug-resistant.[\[88\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-88) Clozapine has more side effects than other atypical antipsychotics. Serious side effects of clozapine include [agranulocytosis](https://en.wikipedia.org/wiki/Agranulocytosis "Agranulocytosis") and [neutropenia](https://en.wikipedia.org/wiki/Neutropenia "Neutropenia").[\[89\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-89) To mitigate the possibility of agranulocytosis and neutropenia, patients taking clozapine often have regular blood tests.[\[90\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-90) Electroconvulsive therapy [Electroconvulsive therapy](https://en.wikipedia.org/wiki/Electroconvulsive_therapy "Electroconvulsive therapy") (ECT) may be considered for patients with schizoaffective disorder experiencing severe depression or severe psychotic symptoms that have not responded to treatment with antipsychotics.[\[78\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-APA_guideline-78) Epidemiology Compared to depression, schizophrenia, and bipolar disorder, schizoaffective disorder is less commonly diagnosed.[\[91\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:3-91) Schizoaffective disorder is estimated to occur in 0.3 to 0.8 percent of people at some point in their life.[\[92\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Kaplan_&_Saddock._p.501-502-92) 30% of cases occur between the ages of 25 and 35.[\[36\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:03-36) It is more common in women than men; however, this is because of the high concentration of women in the depressive subcategory, whereas the bipolar subtype has a roughly even gender distribution.[\[93\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-93) Children are less likely to be diagnosed with this disorder, as the onset presents itself in adolescence or young adulthood.[\[11\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-:22-11)[\[94\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-PsychosisExclusionaryDx2-94) History The term schizoaffective psychosis was introduced by the American psychiatrist [Jacob Kasanin](https://en.wikipedia.org/wiki/Jacob_S._Kasanin "Jacob S. Kasanin") in 1933[\[95\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-pmid16857267-95) to describe an episodic psychotic illness with predominant affective symptoms, that was thought at the time to be a good-prognosis schizophrenia.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) Kasanin's concept of the illness was influenced by the [psychoanalytic](https://en.wikipedia.org/wiki/Psychoanalysis "Psychoanalysis") teachings of [Adolf Meyer](https://en.wikipedia.org/wiki/Adolf_Meyer_\(psychiatrist\) "Adolf Meyer (psychiatrist)") and Kasanin postulated that schizoaffective psychosis was caused by "emotional conflicts" of a "mainly sexual nature" and that psychoanalysis "would help prevent the recurrence of such attacks."[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) He based his description on a case study of nine individuals.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/c2/Karl_Ludwig_Kahlbaum.JPG/250px-Karl_Ludwig_Kahlbaum.JPG)](https://en.wikipedia.org/wiki/File:Karl_Ludwig_Kahlbaum.JPG) [Karl Kahlbaum](https://en.wikipedia.org/wiki/Karl_Kahlbaum "Karl Kahlbaum") (1828–1899) Other psychiatrists, before and after Kasanin, have made scientific observations of schizoaffective disorder based on assumptions of a biological and genetic cause of the illness. In 1863, German psychiatrist [Karl Kahlbaum](https://en.wikipedia.org/wiki/Karl_Kahlbaum "Karl Kahlbaum") (1828–1899) described schizoaffective disorders as a separate group in his vesania typica circularis.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kahlbaum distinguished between [cross-sectional](https://en.wikipedia.org/wiki/Cross-sectional_study "Cross-sectional study") and [longitudinal](https://en.wikipedia.org/wiki/Longitudinal_study "Longitudinal study") observations. In 1920, psychiatrist [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") (1856–1926) observed a "great number" of cases that had characteristics of both groups of psychoses that he originally posited were two distinct and separate illnesses, dementia praecox (now called schizophrenia) and manic depressive insanity (now called bipolar disorders and recurrent depression).[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Kraepelin acknowledged that "there are many overlaps in this area," that is, the area between schizophrenia and mood disorders.[\[96\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-96) In 1959, psychiatrist [Kurt Schneider](https://en.wikipedia.org/wiki/Kurt_Schneider "Kurt Schneider") (1887–1967) began to further refine conceptualizations of the different forms that schizoaffective disorders can take since he observed "concurrent and sequential types".[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) (The concurrent type of illness he referred to is a longitudinal course of illness with episodes of mood disorder and psychosis occurring predominantly at the same time \[now called psychotic mood disorders or affective psychosis\]; while his sequential type refers to a longitudinal course predominantly marked by alternating mood and psychotic episodes.)[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) Schneider described schizoaffective disorders as "cases in-between" the traditional Kraepelinian dichotomy of schizophrenia and mood disorders.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) The historical clinical observation that schizoaffective disorder is an overlap of schizophrenia and mood disorders is explained by genes for both illnesses being present in individuals with schizoaffective disorder; specifically, recent research shows that schizophrenia and mood disorders share common genes and polygenic variations.[\[97\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-97)[\[98\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-98)[\[99\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-99)[\[100\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-100) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Emil_Kraepelin_1926.jpg/250px-Emil_Kraepelin_1926.jpg)](https://en.wikipedia.org/wiki/File:Emil_Kraepelin_1926.jpg) [Emil Kraepelin](https://en.wikipedia.org/wiki/Emil_Kraepelin "Emil Kraepelin") (1856–1926). Embracing the [Kraepelinian dichotomy](https://en.wikipedia.org/wiki/Kraepelinian_dichotomy "Kraepelinian dichotomy") in [DSM-III](https://en.wikipedia.org/wiki/DSM-III "DSM-III") in 1980, while a step forward from [psychodynamic](https://en.wikipedia.org/wiki/Psychodynamic "Psychodynamic") explanations of the disorder, introduced significant problems in schizoaffective disorder diagnosis, as explained recently by the [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") workgroup. Schizoaffective disorder was included as a subtype of schizophrenia in DSM-I and DSM-II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to bipolar disorder than to schizophrenia. DSM-III placed schizoaffective disorder in "Psychotic Disorders Not Otherwise Specified" before being formally recognized in DSM-III-R.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) DSM-III-R included its own diagnostic criteria as well as the subtypes, bipolar and depressive.[\[62\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Manic-Depressive_Illness:_Bipolar_Disorders_and_Recurrent_Depression,_2nd_Edition-62) In DSM-IV, published in 1994, schizoaffective disorders belonged to the category "Other Psychotic Disorders" and included almost the same criteria and the same subtypes of illness as DSM-III-R, with the addition of mixed bipolar symptomatology.[\[63\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Bipolar_Disorders:_Mixed_States,_Rapid_Cycling_and_Atypical_Forms-63) DSM-IV and DSM-IV-TR (published in 2000) criteria for schizoaffective disorder were poorly defined and poorly [operationalized](https://en.wikipedia.org/wiki/Operationalization "Operationalization").[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) These [ambiguous](https://en.wikipedia.org/wiki/Ambiguous "Ambiguous") and unreliable criteria lasted 19 years and led clinicians to significantly overuse the schizoaffective disorder diagnosis.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Patients commonly diagnosed with DSM-IV schizoaffective disorder showed a clinical picture at time of diagnosis that appeared different from schizophrenia or psychotic mood disorders using DSM-IV criteria, but who as a group, were [longitudinally determined](https://en.wikipedia.org/wiki/Longitudinal_study "Longitudinal study") to have outcomes indistinguishable from those with mood disorders with or without psychotic features.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) A poor prognosis was assumed to apply to these patients by most clinicians, and this poor prognosis was [harmful](https://en.wikipedia.org/wiki/Iatrogenic "Iatrogenic") to many patients.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5)[\[101\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_Disorder_Diagnosis_&_Substandard_Treatment-101) The poor prognosis for DSM-IV schizoaffective disorder was not based on [patient outcomes](https://en.wikipedia.org/wiki/Cohort_study "Cohort study") [research](https://en.wikipedia.org/wiki/Empirical_research "Empirical research"), but was caused by poorly defined criteria interacting with clinical tradition and belief; clinician [enculturation](https://en.wikipedia.org/wiki/Enculturation "Enculturation") with [unscientific](https://en.wikipedia.org/wiki/Unscientific "Unscientific") assumptions from the diagnosis' history (discussed above), including the invalid Kraepelinian dichotomy;[\[65\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Craddock_N_p.109-65)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) and by clinicians being unfamiliar with the [scientific](https://en.wikipedia.org/wiki/Empirical_science "Empirical science") limitations of the diagnostic and classification system.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) The DSM-5 schizoaffective disorder workgroup analyzed all of the available research [evidence](https://en.wikipedia.org/wiki/Empirical_science#Philosophy_of_science "Empirical science") on schizoaffective disorder, and concluded that "presenting symptoms of psychosis have little validity in determining diagnosis, prognosis, or treatment response."[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Given our understanding of overlapping genetics in bipolar disorders, schizoaffective disorder, and schizophrenia, as well as the overlap in treatments for these disorders; but given the lack of specificity of presenting symptoms for determining diagnosis, prognosis or treatment response in these psychotic illness [syndromes](https://en.wikipedia.org/wiki/Syndrome "Syndrome"), the limits of our knowledge are clearer: Presenting symptoms of psychosis describe only presenting symptoms to be treated, and not much more.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Schizoaffective disorder was changed to a longitudinal or life course diagnosis in DSM-5 for this reason.[\[5\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Schizoaffective_in_the_DSM5-5) Stigma of schizoaffective disorder include moralist arguments, religious causes, and others during history.[\[102\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-102)[\[103\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-103) Research Little is known of the causes and mechanisms that lead to the development of schizoaffective disorder.[\[55\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-SadCreation-55)[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) Whether schizoaffective disorder is a variant of schizophrenia (as in DSM-5 and ICD-10 classification systems), a variant of bipolar disorder, or part of a dimensional continuum between [psychotic depression](https://en.wikipedia.org/wiki/Psychotic_depression "Psychotic depression"), bipolar disorders and schizophrenia is currently being investigated.[\[68\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-Mental_Health_on_the_Spectrum-68) More recently, some research suggests the need for a more specialized classification for schizoaffective disorder. In a 2017 examining diagnostic heterogeneity study, researchers found that when compared to a schizophrenia sample, individuals with schizoaffective disorder rate higher in suicidality and anxiety disorder comorbidity.[\[104\]](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_note-104) See also - [Schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia") - [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") References 1. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-1) ["Schizoaffective disorder, bipolar type"](http://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F25-/F25.0). www.icd10data.com. 2. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-2) ["Schizoaffective disorder, depressive type"](http://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F25-/F25.1). www.icd10data.com. 3. ^ [*a](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-NAMI2017_3-0) [b](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-NAMI2017_3-1) ["Schizoaffective Disorder Overview – Causes"](https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizoaffective-Disorder). www.nami.org. 4. ^ [a](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-0) [b](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-1) [c](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-2) [d](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-3) [e](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-who.int_4-4) ["F25 Schizoaffective disorders"](http://apps.who.int/classifications/icd10/browse/2010/en#/F25). ICD-10 Version:2010. World Health Organization. 5. ^ [a](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-0) [b](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-1) [c](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-2) [d](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-3) [e](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-4) [f](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-5) [g](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-6) [h](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-7) [i](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-8) [j](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-9) [k](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-10) [l](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-11) [m](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-12) [n](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-13) [o](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-14) [p](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-15) [q](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-16) [r](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-17) [s](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-18) [t](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-19) [u](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-20) [v](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-21) [w](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-22) [x](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-23) [y](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-24) [z](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-25) [aa](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-Schizoaffective_in_the_DSM5_5-26) 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[^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-103) Farrell, Michael (2024). Controversies in schizophrenia: issues, causes, and treatment. New York, NY: Routledge, Taylor & Francis Group. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-003-41355-4](https://en.wikipedia.org/wiki/Special:BookSources/978-1-003-41355-4 "Special:BookSources/978-1-003-41355-4") . 104. [^](https://en.wikipedia.org/wiki/Schizoaffective_disorder#cite_ref-104) Seldin, Katherine; Armstrong, Kristan; Schiff, Max L.; Heckers, Stephan (2017). ["Reducing the Diagnostic Heterogeneity of Schizoaffective Disorder"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300988). Frontiers in Psychiatry. 8: 18. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3389/fpsyt.2017.00018](https://doi.org/10.3389%2Ffpsyt.2017.00018). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1664-0640](https://search.worldcat.org/issn/1664-0640). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5300988](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300988). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28239362](https://pubmed.ncbi.nlm.nih.gov/28239362). Further reading - Moore, D.P.; Jefferson, J.W. (2004). Handbook of medical psychiatry (2nd ed.). Philadelphia: Elsevier/Mosby. pp. 126–127\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-323-02911-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-02911-7 "Special:BookSources/978-0-323-02911-7") . - Goetzt, C.G. (2003). Textbook of clinical neurology (2nd ed.). Philadelphia: W.B. Saunders. p. 48. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7216-3800-3](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7216-3800-3 "Special:BookSources/978-0-7216-3800-3") . External links
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