DSMIV diagnostic criteria

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A. Schizoaffective disorder is an illness which meets the criteria for schizophrenia and concurrently meets the criteria for a major depressive episode, manic episode, or mixed episode.

B. The illness must also be associated with delusions or hallucinations for two weeks, without significant mood symptoms.

C. Mood symptoms must be present for a significant portion of the illness.

D. A general medical condition or substance use is not the cause of symptoms.

II. Clinical Features of Schizoaffective Disorder

A. Symptoms of schizophrenia are present, but also associated with recurrent or chronic mood disturbances.

B. Psychotic symptoms and mood symptoms occur independently or together.

C. If manic or mixed symptoms occur, they must be present for one week and major depressive symptoms must be present for two weeks.

III. Epidemiology of Schizoaffective Disorder

A. The lifetime prevalence is under one percent.

B. First-degree biological relatives of schizoaffective disorder patients have an increased risk of schizophrenia as well as mood disorders.

IV.Classification of Schizoaffective Disorder

A. Bipolar Type. Diagnosed when a manic or mixed episode occurs. Major depression may also occur.

B. Depressive Type. Diagnosed if only major depressive episodes occur.

V. Differential Diagnosis of Schizoaffective Disorder

A. Schizophrenia. In schizophrenia mood symptoms are relatively brief in relation to psychotic symptoms. Mood symptoms usually do not meet the full criteria for major depressive or manic episodes.

B. Mood Disorder with Psychotic Features. In mood disorder with psychotic features, the psychotic features occur only in the presence of a major mood disturbance.

C. Delusional Disorder. Depressive symptoms can occur in delusional disorders, but psychotic symptoms of a delusional disorder are non-bizarre compared to schizoaffective disorder.

D. Substance-Induced Psychotic Disorder. Psychotic and mood symptoms of schizoaffective disorder can also be caused by street drugs, medications or toxins.

E. Psychotic disorder due to a general medical condition, delirium, or dementia should be ruled out by medical history, physical exam and labs.

VI.Treatment of Schizoaffective Disorder

A. Psychotic symptoms are treated with antipsychotic agents (see Antipsychotic Therapy, page 101).

B. The depressed phase of schizoaffective disorder is treated with antidepressant medications (see Antidepressant Therapy, page 109).

C. For bipolar type, mood stabilizers, such as lithium, valproate or carbamazepine, are used alone or in combination with antipsychotics (see Mood Stabilizers, page 112).

D. Electroconvulsive therapy may be necessary for severe depression or mania.

E. Hospitalization and supportive psychotherapy may be required.

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