Schizoaffective disorder Health Article

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, produced by the American Psychiatric Association, is used by most mental health professionals in North America and Europe to diagnose mental disorders. The DSM-IV-TR provides these major criteria for schizoaffective disorder:

• • At least two symptoms of psychosis from among the following, present for at least one month: Delusions; hallucinations; disorganized speech (strange, peculiar, difficult to comprehend); disorganized (bizarre or child-like) behavior; catatonic behavior; minimal speech (approaching mutism); lack of drive to act on one's own behalf; a wooden quality to one's emotions, or near-absent emotionality.
• • Delusions or hallucinations have occurred for at least two weeks in the absence of prominent mood symptoms.
• • During a "substantial portion" of the period of active illness, the individual meets criteria for one of the following mood disturbances: Major depressive episode, manic episode, mixed episode.
• • The symptoms are not caused by a biologically active entity such as drugs, alcohol, adverse reaction to a medication, physical injury, or medical illness.

Demographics

Because of the imprecise nature of the diagnosis, the actual rate of brief schizoaffective disorder in adults is unknown. The proportion of schizoaffective disorder identified in persons undergoing treatment for psychiatric disorders has ranged from 2% to almost 30%, depending on the study cited. More females than males (overall) suffer from schizoaffective disorder. However, similar to gender ratios in clinical depression and bipolar disorder, it seems that there is a much higher ratio of women to men in the depressive subtype whereas the bipolar subtype has a more even gender distribution. Thus, the higher ratio of women overall is primarily caused by the concentration of women within the depressive subtype of schizoaffective disorder.

Diagnosis

Even using the DSM-IV-TR criteria, identification of schizoaffective disorder remains difficult and relatively subjective. An unusual condition in this set of diagnostic criteria is the need to weigh the relative prominence of the mood symptoms and to identify a period of psychotic symptoms that occurred without significant mood disturbance. In the various other psychotic disorders, there is frequently a low level of depression accompanying the symptoms. When depressive symptoms are the sole form of mood disturbance, only subjective clinical judgment determines whether there has been sufficient severity or duration of that disturbance to merit the possibility of schizoaffective disorder. An additional complication is the cultural relativity of "psychotic symptoms." If the psychotic-like behaviors shown are expected and valued in the person's culture or religion, and these behaviors occur in a traditionally affirming context such as religious services or meditation, then schizoaffective disorder would not be diagnosed.

As stated, schizoaffective disorder is typically identified by a process of lengthy observation and elimination of another diagnostic alternative over a long course of care. A very thorough history of the client's entire past experiences of psychiatric symptoms, mental health treatments, and response to different kinds of medications that have been taken, helps in determining whether that individual is suffering from schizoaffective disorder. Information about current and past experiences is collected in interviews with the client and possibly in discussion with the client's immediate family. Data also may be gathered from earlier medical records with the client's consent. In order to examine the sufferer's ability to concentrate, to remember, to understand his or her situation realistically, and to think logically, the clinician may use a semi-structured interview called a mental status examination. The mental status examination is designed to uncover psychotic or demented thought processes. Psychological assessment instruments, such as the MMPI-2, The Rorschach Inkblot Test, various mood disorder questionnaires, or structured diagnostic interviews, are sometimes used as well to aid in diagnosis. The criteria used by the clinician to classify this constellation of symptoms as schizoaffective disorder are presented in the DSM-IV-TR.