This leaflet is designed to help understand schizoaffective
disorder. It may be useful if:
- you have a diagnosis of schizoaffective disorder
- you are worried that you may have this condition
- someone close to you has been diagnosed with schizoaffective
- you would like to know more about the disorder.
- what is it like having schizoaffective disorder
- what causes it
- who and what can help
- important information for people who know or look after someone
with a diagnosis of schizoaffective disorder.
What is schizoaffective disorder?
This is a disorder of the mind that affects your thoughts
and emotions, and may affect your actions. You may
experience episodes that are combinations of both 'psychotic'
symptoms and 'bipolar disorder' symptoms. These symptoms are
clearly present for most of the time over a period of at least
Types of schizoaffective disorder
Schizoaffective disorder manic type
In this type, you have both the psychotic and manic
symptoms, occurring within one episode.
Schizoaffective disorder depressive type
In this type, you have both the psychotic and depressive
symptoms, occurring at the same time during the
Schizoaffective disorder mixed type
In this type, you have psychotic symptoms with both manic and
depressive symptoms. However, The psychotic symptoms are
independent and not necessarily related to the bipolar disorder
What are psychotic symptoms?
- Thought disorder/muddled
You find it hard to concentrate as your thoughts seem fuzzy or
muddled. Your thinking feels bizarre and disconnected. You may
be unable to finish a book that you have been reading or follow a
The muddled thinking may affect your speech, so you may jump
from one topic to another and after a while, you may not be able to
remember what you were trying to say in the first place. This makes
it difficult for people to follow your conversation.
You may believe that your thoughts are being interfered
- someone or something is able to insert thoughts in your mind
(you may feel like a particular thought it not yours);
- someone or something is taking certain thoughts out of your
mind - that your thoughts are disappearing.
Sometimes you may feel that other people can hear your
thoughts or have access to them in some way.
- Beliefs that you are being
You may insist that outside forces like aliens, spirits, God or
the devil are controlling how you feel, think and behave. You may
feel like a robot whose remote control is in someone else's hand.
You might be distressed if you feel that someone else is making you
think certain things, or that you have no control on a particular
behaviour of yours because an outside force controls it.
You may hear sounds or voices, see and smell things that are not
there. Sometimes you can feel that someone is touching you or
hitting you, but you can't see anyone. The most common type of
hallucination is hearing voices.
- What is hearing voices like?
These voices sound real. Unlike thoughts which come from your
own mind, these voices seem to come from outside you and noone else
can hear them. There can be one voice or several different voices
which may be commenting on what you are doing.
- How do people react to these voices?
As these voices sound real, you may start talking back to them.
You may try to do things that these voices tell you to do, or you
may be able to ignore them.
- Where do these voices come from if no-one else can hear
In schizoaffective disorder, there is a chemical imbalance in
the brain. As a result, your brain creates the voices which you can
hear but noone else can.
These are beliefs or ideas which you believe in 100 per cent,
without a single doubt, and which nobody else seems to accept.
These beliefs or ideas cannot be explained as part of your culture,
religion or background. Other people may find your ideas
strange, unrealistic or even bizarre.
How do delusions start?
- They can start suddenly when an idea or belief comes to you out
of the blue.
- They may form after weeks or months of feeling that something
strange is happening but you can't identify what it is. This is
called 'delusional mood'.
- Sometimes they help you to understand your hallucinations, for
example if you hear voices talking amongst themselves about you,
then your mind may explain that your neighbours are plotting
against you or the spirit world has made contact with you. This is
called a 'delusional idea'.
The most common type of delusion is paranoid
- These are ideas which convince you that others might harm you,
are plotting against you or spying on you.
- Feeling persecuted can be very scary and upsetting for those
people who you feel are against you.
- You may want to stay away from people or protect yourself from
What are manic symptoms?
- A sense of extreme physical and mental well-being, excessive
energy and elation of mood which is also called feeling
- You may not sleep much and your concentration is affected.
- You may talk very fast, often jumping from one topic to another
and have very optimistic ideas which can be unrealistic or bizarre,
for example you may believe that you have special abilities and
- In later stages, your speech may become incomprehensible; you
may become irritable and neglect your health and safety.
- This can affect your relationships and make it difficult for
you to carry on working.
What are the symptoms of depression?
- You not only feel sad all the time, but you lose interest in
the things that you previously liked.
- You may also lose your motivation and energy.
- Your sleep and eating patterns may be affected.
- You may not be able to concentrate on a book or TV programme
and can also experience intense feelings of guilt, worthlessness
What are the causes of schizoaffective disorder?
- The exact cause is not known, but we do know that there is a
chemical imbalance in people affected by
- Genes: research has shown that the same genes
may be responsible for schizophrenia, schizoaffective disorder and
bipolar disorder. People with this disorder are more likely to have
family members who have been diagnosed with these conditions.
- Stress: stress can contribute to the start of
an episode of schizoaffective disorder, such as a bereavement,
physical illness, car accident or family/relationship problems. In
particular, traumatic experiences in childhood can increase the
chances of developing this condition in the future.
How common is schizoaffective disorder?
- Less than 1 in 100 people are likely to have schizoaffective
disorder in their lifetime.
- Schizoaffective manic patients make up 3% to 5% of all patients
admitted to a psychiatric hospital.
Who is affected by schizoaffective disorder?
More women than men are affected by schizoaffective disorder.
It tends to develop at a later age in women than men and is
more likely to the depressive type. The depressive type
is also more common in older people, while the bipolar type is
more common in younger people. Symptoms usually begin in early
Is schizoaffective disorder the same as schizophrenia?
Some people feel that schizoaffective disorder sits in the
middle of a spectrum, with schizophrenia at one end and bipolar
disorder at the other. However, schizoaffective disorder is
recognised as a separate condition to schizophrenia, both in
clinical practice and in the research literature.
The treatment of schizoaffective disorder
The treatment of these disorders depends on the type. Treatment
includes medication which is usually started and monitored by a
psychiatrist, along with talking therapies.
How can medication help?
- Taking medication regularly can help to control the most
distressing symptoms of the disorder. They can help you to feel
calmer by weakening the delusions, and gradually reducing the
frequency and intensity of the hallucinations.
- Your thinking becomes clearer and you may feel well enough to
look after yourself, your home and re-start your studies or work,
and concentrate on other aspects of life which are important to
- If these medications are taken regularly, they can prevent you
having another episode. It is important to continue to take these
medications, even if you feel well.
How long will I have to take the
- Usually these medications will need to be taken for the rest of
- In some cases, the medication can be gradually reduced and
stopped. However, this must be done under the supervision of a
What will happen if I stop the medication?
- If a person has diabetes and stops taking their medication,
they may become unwell. Similarly with schizoaffective disorder, if
you stop taking your medication, you too may become unwell. This
may not happen immediately, but may take 3 to 6 months.
Types of medication
- An acute episode of schizoaffective disorder may benefit from
antipsychotics. Atypical antipsychotics include Olanzapine,
Risperidone, Quetiapine and Amisulpride.
- In the treatment of depressive symptoms, medication may include
antidepressants. There are many different types of antidepressants
and you may be started on one of the newer one, a SSRI (Selective
Serotonin Reuptake Inhibitor), such as Sertraline or
- In the treatment of manic symptoms, mood stabilisers such
as lithium, sodium valproate and carbamazapine may be useful.
- The long-term treatment of schizoaffective disorder
involves the use of antipsychotics with psychological (talking)
- For the manic type, often a combination of a mood stabiliser
and an antipsychotic are prescribed.
- For the depressive type, a mood stabiliser and an
antidepressant is preferred.
The effects and side-effects of these medications should be
fully explained to you and your carer(s).
Cognitive Behavioural Therapy (CBT)
People are helped to monitor their thoughts, feelings and
actions. The therapist will help you to find out the unhelpful
thoughts and behaviours which may be contributing to your distress.
These thoughts could be linked to your delusions and
your behaviours to your hallucinatory experiences. The
therapist will help you to work out helpful ways of thinking and
reacting and then to put these positive thoughts and behaviours
into real situation.
CBT is recommended if you are suffering from psychotic symptoms
as it can help you cope with troublesome delusions and
hallucinations. It equips you with various coping strategies so
that you are able to solve your issues and problems.
This is especially helpful if you live with your family or are
in close contact with them. Family therapy will help your family to
understand your problems and how best to support you.
Supportive Psychotherapy and Counselling
People are able to discuss their problems and issues with a
professional in detail and gain support from telling your story to
someone who will listen.
Some people may have difficulty talking about their emotions.
Art therapy can help you to express your emotions through art.
This is an opportunity to meet other people with the same
illness and to discuss alternative coping strategies, recognising
early signs that you may be starting to feel unwell again.
What will happen without treatment?
The symptoms may get worse and you may have more frequent and
longer episodes. There is also a risk of suicide.
Community Mental Health Services
These services are important in keeping you out of hospital
or in managing your gradual return back into the community after
being discharged from hospital. Specialist services may be needed
including community psychiatric nursing, social services and
occupational therapy as well as support in managing
your domestic and financial affairs.
There are different teams that can support you in the
- Early Intervention Team: provides intensive
support to young people who have recently been diagnosed with
schizophrenia or schizoaffective disorder.
- Assertive Outreach Team: provides extensive
help and support for people who have had a diagnosis of
schizophrenia or schizoaffective disorder for quite some time,
especially for people who find it difficult to work with other
services or have not been able to take their medications regularly
for various reasons.
- Crisis Resolution Home Treatment Team: can
help at you at home, prevent a hospital admission and provide
intensive support after a hospital admission.
- Vocational Rehabilitation: includes day
centres, day hospital or community health centres. These facilities
offer different creative activities such as back to work courses,
education, art and cooking.
Care Programme Approach (CPA) (England and Wales
This is a way of making sure that you get the right care and
support. You may be given a care co-ordinator who is responsible
for organising different parts of your treatment. You will have
regular meetings every 6 to 9 months which can include your family
or carer(s). A plan will be made about what to do in an emergency,
including what has helped in the past. Your plan will be amended at
each CPA meeting to take into account what you and your
family/carer(s) would like to happen.
If you think you are becoming unwell or need help:
- Call your local mental health team/care co-ordinator.
- Call the local Crisis Team or Emergency out-of-hours phone
- Go to your local Emergency Department if the situation is such
that it cannot be dealt with at home.
- Learn to recognise the early signs that you may be getting
unwell, such as not being able to sleep, feeling persecuted or
anxious. Some people may start hearing voices or whispers when no
one is around. It is important to get help as soon as possible, for
example by calling your care co-ordinator.
- Exercise regularly and eat a healthy balanced diet.
- Learn to talk to someone you trust in your family or a
- Learn relaxation techniques.
Try not to:
- Use illicit drugs as they can cause another episode.
- Drink too much alcohol - remember the safe alcohol drinking
limits of 21 units per week for a man and 14 units per week for a
- Get stressed.
- Smoke cigarettes - 30 to 40 people out of a 100 with
mental health problems smoke. They may help you to relax
and focus your thoughts in the short-term but interferes with your
medication and is very harmful to your body in the long-term.
Further support and help
provides advice and support to anyone experiencing a mental health
problem and campaigns to improve services, raise awareness and
promote understanding. Infoline: 0300 123 3393.
Illness: National voluntary organisation that helps
people with any severe mental illness, their family and carers.
Helpline: 0300 5000 927.
national mental health helplione offering emotional support and
practical information for people with mental illness, families,
carers and professionals. Helpline: 0845 767 8000.
Support in Mind
Scotland: works to improve the wellbeing and quality
of life of people affected by serious mental illness. This includes
those who are family members, carers and supporters.
Bebbington P et al (2004) Psychosis, victimisation and childhood
disadvantage. Evidence from the second British National Survey of
Psychiatric Morbidity. British Journal of Psychiatry, 185:
Caron J et al (2005) Socio-demographic and clinical predictors
of quality of life in patients with schizophrenia or
schizo-affective disorder. Psychiatry Resource, 137(3): 203-13.
Lake CR et al (2007) Schizoaffective Disorder merges
Schizophrenia and bipolar disorders as one disease - there is no
schizoaffective disorder. Current Opinion Psychiatry,
Laursen TM et al (2007) A comparison of selected risk factors
for unipolar depressive disorder, bipolar affective disorder,
schizoaffective disorder, and schizophrenia from a Danish
population-based cohort. Journal of Clinical Psychiatry,
Malhi GS et al (2008) Schizoaffective disorder: diagnostic
issues and future recommendations. Bipolar Disorder,
Marneros A et al (2003) Schizoaffective disorder: clinical
aspects, differential diagnosis, and treatment. Current
PsychiatryRep, (53): 202-5.
Reid WH et al (1998) Suicide preventon effects associated with
clozapine therapy in schizophrenia disorder. Psychiatric Services,
49/8 (1029-1033), 10752730.
Schizophrenia: core intervention in the treatment and management
of schizophrenia in primary and secondary care. NICE guidelines,
Schizophrenia: atypical antipsychotics: the clinical
effectiveness and cost effectiveness of newer atypical
antipsychotic drugs in schizophrenia. NICE guidelines, 2002.
This leaflet was written by Dr Maryam Siddiqui and Dr
Series editor: Dr Philip Timms
User and Carer input from members of the Royal College of
Psychiatrists Public Education Editorial Board.
This leaflet reflects the best available evidence at the time
© March 2013. Due for review: March 2015.
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