Schizoaffective DisorderSymptoms, Causes, and Treatment

What is schizoaffective disorder?

Schizoaffective disorder is a mental health condition that involves a mix of both schizophrenia symptoms, such as hallucinations and delusions, along with bipolar disorder or depression symptoms. The disorder can take on one of two forms:

• Schizoaffective disorder bipolar type, which involves schizophrenia symptoms along with manic episodes, and possibly depressive episodes.
• Schizoaffective disorder depressive type, which involves schizophrenia symptoms and only depressive episodes.

Regardless of the type you have, living with schizoaffective disorder can be incredibly challenging. Some of the symptoms make it difficult for you to regulate your emotions and moods, while others affect your ability to stay grounded in reality. A combination of hallucinations, delusions, and intense emotional highs and lows can interfere with everything from your normal daily activities to your relationships. In some cases, the symptoms may be so severe that you have difficulty functioning without first spending time in a residential psychiatric ward.

The symptoms themselves aren’t the only issue. How you react to them can cause you to withdraw from your loved ones out of shame, or turn to dangerous self-medication strategies, such as drug abuse, to cope.

Despite this, schizoaffective disorder isn’t fated to worsen over time. With a combination of professional treatment and self-help strategies, you can manage your symptoms and live a rich, fulfilling life. It all starts with identifying the symptoms and getting the right diagnosis.

Schizoaffective disorder symptoms

Misdiagnoses can make it difficult to determine the prevalence of schizoaffective disorder, but researchers estimate it affects about 0.3 percent of the population. This makes it less common than cases of depression, bipolar disorder, or schizophrenia.

The symptoms, which involve psychosis and some mix of mania or depression symptoms, usually show up during teenage years or early adulthood.

Psychosis symptoms

Delusions. Delusions are false but strongly held beliefs. You may believe that a delivery person is plotting against you, for example, or a celebrity is sending you secret messages through their social media posts.

Hallucinations. Hallucinating involves seeing or hearing things that aren’t there. You might hear voices or see things that aren’t real. Hallucinations can also affect your sense of smell or touch.

Disorganized thoughts and behaviors. You may have difficulty concentrating, or your thoughts can feel scrambled as they rapidly shift from one subject to another. This can manifest in your speaking patterns as you give illogical responses, use made-up words, or repeat phrases. Your other behaviors might also appear disorganized and appear to other people as bizarre or unpredictable. Your behavior may even impair your daily functioning.

Mania symptoms

You may experience episodes of mania, with feelings of elation or euphoria. You might suddenly believe you can accomplish anything, and be filled with excessive energy. However, mania comes with other symptoms that can affect your relationships and overall well-being, such as:

• Increased risk-taking.
• Irritability.
• Racing thoughts and rapid speech.
• Difficulty concentrating.
• Reduced sleep.

Depression symptoms

Episodes of depression involve a deep sense of sadness and hopelessness. When it comes to energy and motivation, you might experience the opposite of mania. Maybe you struggle to find the motivation to get out of bed, leave the house, or interact with other people.

Other symptoms can include:

• Bouts of insomnia or oversleeping.
• Changes in appetite, such as overeating or decrease in hunger.
• Difficulty concentrating.
• Decreased interest in hobbies and passions.
• Memory issues, such as forgetfulness.

Similar conditions

In addition to schizophrenia, a medical professional will need to rule out other conditions that can be mistaken for schizoaffective disorder.

Major depression with psychotic features. This is when the psychotic symptoms only show up during depressive episodes.

Bipolar disorder with psychotic features. This is when psychotic symptoms only show up during manic episodes.

Schizoaffective disorder treatment

Managing schizoaffective disorder symptoms typically involves professional treatments, including medication and therapy. In severe cases, a mental health expert might advise an inpatient hospitalization program. No matter the case, a treatment plan needs to be customized to meet your specific needs.

Medication

• Antipsychotic medication, such as paliperidone, is the most commonly prescribed type of drug for this condition. They can help reduce the severity of schizophrenia symptoms.
• Mood stabilizers, such as lithium and oxcarbazepine, might be used primarily to manage manic episodes.
• Antidepressants, including selective-serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline, may be recommended in treating the depression subtype.

Therapy

You might work one-on-one with a therapist to build skills that improve your cognitive functioning. If needed, a professional can also help you strengthen your social skills. Psychoeducational programs can help educate you on the disorder, its causes, symptoms, and different ways to cope.

Therapy might not be limited to individual sessions. You can also participate in family or group therapy with your loved ones. This can be particularly helpful if you rely heavily on your social circle for a sense of structure and daily support.

Electroconvulsive therapy (ECT)

Despite the social stigma around the treatment, research has shown electroconvulsive therapy (ECT) to be a useful approach, especially in cases in which medication seems ineffective. For example, one 2019 study found ECT to be a safe and effective way to reduce symptoms of schizophrenia and schizoaffective disorder, although the study was very small.

ECT might be considered after all other approaches have been exhausted. It can come with undesirable side effects, such as short-term memory loss, and may require ongoing treatment to avoid relapse.

Living with schizoaffective disorder

Schizoaffective disorder is a complex condition. It combines the often misunderstood symptoms of schizophrenia with the volatility of mood disorders. The diagnosis can sound daunting, but the more you know, the better equipped you’ll be to manage your symptoms.

Take time to learn as much as you can about schizoaffective disorder. This could involve reading books or watching videos that cover topics like mania, depression, and schizophrenia. Listening to stories of other people with the condition will give you an idea of how it can vary in severity and ways in which it can be managed.

Tip 1: Track symptoms and triggers

Keep track of your symptoms. The disorder can present in different ways. So, even if you talk with people who have the same condition, their experiences may seem very different from your own. You may struggle more with manic episodes, for example, while someone else feels weighed down by depression. Or your hallucinations could be more auditory than visual.

Consider keeping a journal of how your symptoms manifest and any early warning signs. For example, common early signs of psychosis symptoms may include growing increasingly suspicious of others, intensified sensations, or a decrease in focus.

Identify your triggers. Sometimes, psychosis and bipolar episodes occur for seemingly no reason. However, if you notice any situations that commonly seem to precede those episodes, record them in your journal. For example, some common triggers for mania include using recreational stimulants, starting a creative project, or falling in love. Common triggers of depressive episodes can include fatigue, sleep deprivation, or lack of physical activity.

Having this record can also be handy when you need to communicate your symptoms with a mental health professional.

Tip 2: Try “Catch, Check, and Change”

As you build insight into your most common and troubling symptoms, you can begin forming concrete steps to address them.

One aspect of your mood disorder might involve unhelpful thinking patterns (or “cognitive distortions“) that come with depressive episodes. You may make negative assumptions and become fixated on these thoughts, sometimes mistaking them for reality. You can use a three-step cognitive behavioral approach called Catch, Check, and Change to deal with this.

Catch the thought. This involves writing down or simply saying the specific troubling thought aloud to yourself. “I think my brother isn’t returning my phone call because dealing with me is an inconvenience.”

Check the thought. Consider whether there’s factual evidence to support the thought or evidence to the contrary. Are there other reasons why your brother may not be returning your call right now?

Change. Adopt either a more positive thought or a more neutral thought that has more evidence behind it. For example, if it’s a Monday afternoon, your brother might not be replying because he’s busy at work. This step might also involve changing to a new behavior that’s more helpful than ruminating on the unknown.

Tip 3: Practice grounding techniques

Grounding techniques can be helpful when you’re experiencing schizophrenic symptoms like auditory hallucinations. Grounding involves using your senses to anchor yourself in the present, pulling you away from internal experiences. To try this, ask yourself:

• What is something in your line of sight? How would you describe its color, shape, size, or texture? Is it in motion? Allow it to take up your full attention.
• What can you hear right now? What do you notice about the quality of the sound? Perhaps it’s rhythmic ticking or the muffled sound of traffic outside.
• What can you reach out and touch right now? It could be something as simple as your own clothing. What does it feel like? Smooth? Rough?
• What can you smell? Focus on strong or subtle scents in your environment. How would you describe them with words?
• What can you taste? This last one might be easiest to do if you have a drink, piece of gum, or some sort of food handy.

You can take this a step further by having go-to coping mechanisms that involve sensory grounding. This might involve anything from playing with putty to cuddling an emotional support dog or other animal.

Tip 4: Add structure to your days

Losing touch with reality during an episode of psychosis can be an incredibly disruptive experience that leaves you feeling adrift in your day. There are also likely to be days when depressive episodes make it hard for you to maintain your normal routine. Even manic episodes, although energizing, can keep you from focusing on what’s important in life.

Adding more structure to your days can help you cope with what might feel like a chaotic life. Structure and consistency can give you a sense of direction and purpose. For example, if part of your day is disrupted by a mental health issue, you’ll have an easier time picking up where you left off when you have a strong daily structure or “roadmap”.

You can’t control every aspect of the world around you. However, maintaining a predictable rhythm to your days may also reduce the risk of unexpected stressors that can affect your mood or trigger symptoms.

Use tools like a planner, calendar, or a simple to-do list. Experiment to determine whether using a physical notebook or a smartphone app works best for you.

Follow a regular routine. Aim to perform basic activities like eating, bathing, and sleeping at the same time each day, whenever works best for you. Also, try to be consistent with exercise routines or relaxation practices that you adopt.

Use medication reminders. Medication is often an essential part of managing this disorder. With that in mind, use tools like pill organizers, post-it notes, or phone reminders to ensure you don’t lose track of when to take meds.

Have regularly scheduled social events on your calendar, even if you can’t show up every time. Even something as simple as meeting with a friend for a coffee every week can give you something to routinely look forward to. You might even decide to run errands, meal prep, or workout together.

Tip 5: Prioritize self-care

Research suggests that people with long-running psychiatric issues are less likely to engage in self-care routines. Depression can sap your appetite and manic episodes can make it hard to sleep. However, prioritizing self-care may help you better manage your symptoms.

Find a physical activity you like and stick with it. Aerobic exercise, such as jogging, biking, or swimming, may be particularly helpful in managing schizophrenia symptoms. Exercise can help reduce depressive symptoms as well.

Work on sleep hygiene. Schizophrenic symptoms, mania, and depression can all contribute to sleep issues like insomnia. On the other hand, sleep deprivation can worsen psychosis symptoms, increase negative moods, and make it harder to manage emotions. Some ways to improve your quality of sleep include:

• Adjust your sleep environment to be dark, cool, and quiet.
• Develop a relaxing routine before bed.
• Establish a consistent sleep-wake cycle by going to bed and waking up at the same time each day.

Reduce or avoid the use of drugs and alcohol. Alcohol-use disorder is common among people with schizoaffective disorder, and it can complicate the condition or get in the way of recovery. Substances like nicotine may seem to offer you a mood boost, but withdrawal symptoms from trying to quit can come with emotional swings and interfere with concentration and sleep. Smoking may also reduce the effectiveness of certain antipsychotic medications.

Eat a healthy diet. Certain dietary changes may help rein in mood issues as well as schizophrenia symptoms. Foods high in omega-3 fatty acids, such as certain fish, nuts, and seeds, seem to help with the management of both bipolar disorder and schizophrenia.

Foods high in folate, such as leafy, green veggies, and foods high in zinc, such as seafood, may also be useful. In general, a well-balanced diet that’s high in essential vitamins and minerals will help your physical and mental well-being.

Tip 6: Manage stress

Managing your condition while juggling the ups and downs of life can take a toll on you mentally. When stress from work, family, and relationships builds, you may be more at risk of experiencing episodes of psychosis and mood instability.

Identify and reduce your environmental stressors. Perhaps watching the TV news spikes your anxiety or sours your mood. Or maybe being in noisy places like crowded bars or restaurants stresses you out. Identify your stress triggers and try to avoid or reduce them where possible.

Know when to give yourself a break. Practice saying “no” to invitations and extra work tasks when you’re tired or stressed out. If you’re already feeling overwhelmed, consider ways to delegate tasks to other people. Maybe you ask a spouse to cook or a coworker to finish up a task for you.

Create a list of go-to relaxation techniques. Regularly practicing relaxation techniques, such as deep breathing, yoga, or meditation, can help to relieve stress. Consider adding one or more of these practices into your daily schedule.

Make stress management an ongoing priority. Don’t wait until life feels overwhelming to address stress. Even when you seem to have mental health issues under control, continue to follow established relaxation practices and cut down on unnecessary stressors.

Tip 7: Build and maintain support

Maintaining a social network ensures you have plenty of support—whether you need emotional comfort or help with your day-to-day activities. Long-term support can improve your self-esteem and self-confidence, boosting your resilience in the process.

On top of that, social interactions can ease your nervous system and have a soothing effect. This is due to a phenomenon called social buffering.

[Read: Social Support for Stress Relief]

Regularly connect face-to-face with loved ones. Whether it’s a friend or family member, spend time with someone who makes you feel safe and comfortable. As well as enjoying each other’s company and engaging in hobbies and shared interests, a good friend can lend a nonjudgemental ear when you need to express your emotions.

Make new connections. If you feel like you need more social interaction, take steps to expand your support network.

• Join support groups for people living with schizophrenia or mood disorders. Whether you join an in-person or online group, you can talk to people who really understand what you’re going through.
• Volunteer at a local church or other organization. This might help give you a sense of connection and purpose.
• Enroll in classes at a community college or join a hobby group. You can meet new people while you engage in long-held passions or develop new skills.

Involve loved ones in your treatment plans. You may want to include them in psychoeducational sessions with a professional, or keep them updated on your medication needs. The more they know, the more they’ll be able to support you in your time of need.

Look for supportive environments. Depending on the severity of your condition, it might be beneficial to search for residential facilities where you can have access to quick professional support. Residential facilities can also help introduce stability, structure, and community that you’re lacking. Talk to your therapist or physician for some local options or visit a nearby mental health clinic.

Tip 8: Develop a crisis plan

Conditions like schizoaffective disorder may put you at a higher risk of suicide and substance abuse. With that in mind, it’s important to have a safety plan for times when you start to feel overwhelmed.

The plan can involve a set of steps you are able to follow on your own. For example, you might remove dangerous objects from your home, or use coping methods like exercise or breathing techniques to avoid using.

The plan should also draw upon your social support network. Create a list of emergency contacts, including close friends and family members who might be able to quickly come to your aid if you are in crisis. Also include local mental health clinics and trusted professionals like therapists or physicians. As you make the list, consider questions like:

• Who will likely be physically close enough to help?
• Who is likeliest to answer a late-night phone call?
• What helpline can I call or text if no one I know is available?

[Read: Are You Feeling Suicidal?]

As you manage your symptoms and seek treatment, don’t allow the stigma of mental illness to rule your life. Many people have fears and misconceptions about mental health issues, especially rare ones like schizoaffective disorder and schizophrenia. The more you understand about your condition, the better you’ll be able to push back against those judgments and ensure you’re able to live a full, rewarding life.

Last updated or reviewed on July 16, 2024