Schizoaffective Disorder

Question 1

Diagnostic criteria of schizoaffective disorder

Answer 1

• At least 2 weeks of psychotic episodes without mood symptoms
• At least 2 weeks of mood episodes without psychotic symptoms
• Mood symptoms accompanying the psychotic symptoms during part of the illness
• Not caused by another substance or medical condition

Question 2

The main differential diagnoses for schizoaffective disorder

Answer 2

• Substance-induced mood disorder
  
  • Cocaine
  • Methamphetamine / amphetamine
  • K2/Spice (synthetic cannabinoid)
  • Cocaine withdrawal (if mood sx are depressive)
• Bipolar disorder (often with mood sx predating the development of psychosis)
• Depression with psychotic features (mood sx predating the development of psychosis)
• Schizophrenia (may sometimes have mood sx, but not as pronounced as schizoaffective and are transient)

Question 3

If a patient has no episodes of psychosis without mood symptoms, . . .

Answer 3

. . . it is NOT schizoaffective

It is more likely depression with psychotic features or bipolar with psychotic features.

In other words, there has to be some time where the patient is just displaying schizophrenia symptoms uncomplicated by mood symptoms.

Question 4

Treatment of schizoaffective disorder

Answer 4

• Generally respond to antipsychotics and often require long-term therapy.
  
  • Atypical antipsythotics are preferred
• Mood stabilizers are indicated if manic symptoms are present
  
  • Lithium, valproate, carbamazepine
• An antidepressant should be added only if the antipsychotic alone is insufficient to treat depressive symptoms
• If unresponsive to pharmacotherapy, ECT is safe and effective

Question 5

1st generation antipsythotic side effect profile vs 2nd generation

Answer 5

1st generation: Dystonias, akithisia, tardive dyskinesias, NMS

2nd generation: Insulin resistance, weight gain, hyperlipidemia