Schizophrenia and schizoaffective disorder are serious mental health conditions and psychotic disorders. Both disorders are characterized by hallucinations, delusions, and cognitive disturbances. Although schizoaffective disorder does fall along the schizophrenia spectrum, it is now considered a distinct condition.
Schizophrenia and schizoaffective disorder are potentially debilitating to those who live with them. Knowing the difference between schizophrenia and schizoaffective disorder and how they relate to depression can help you understand the diagnosis and treatment options.
Schizophrenia is a serious mental health condition and psychotic disorder. According to a 2016 study across 195 countries and territories, this condition affects approximately 0.28 percent of the population across the world.
There are several risk factors for developing schizophrenia. Some of these risk factors are environmental while others are genetic. The environmental risk factors for schizophrenia include infections, substance use, stress, and complications during pregnancy and birth.
Research suggests that infections while in utero and during childhood and adolescence may lead to the later development of schizophrenia. This link may be related to inflammation in the brain caused by infections during these critical periods of development.
Besides infections, other complications of pregnancy have also been linked to schizophrenia. For instance, a child has a greater risk of later developing schizophrenia if they had a low birth weight or experienced malnutrition in utero. Some cardiovascular congenital anomalies are also associated with the development of schizophrenia.
Cannabis (marijuana) use has been linked to schizophrenia. In one study, when people self-reported the frequency of their cannabis use, as the number of times cannabis was used over a lifetime increased so did the odds of being diagnosed with schizophrenia. It is thought that cannabis use alone doesn’t cause schizophrenia, but it could reduce the time to disease onset in those predisposed to schizophrenia. This effect is likely due to the actions of tetrahydrocannabinol (THC), which is the component of the cannabis plant that causes a “high,” and not cannabidiol (CBD).
Research also suggests that stress during developmentally critical periods, such as adolescence, increases vulnerability to schizophrenia.
Studies have linked being born during winter and early spring (between January and May for those in the Northern Hemisphere) to the development of schizophrenia later in life. This may, in part, be due to factors such as temperature, humidity, daylight duration, infections, changes of maternal hormones, and other things a baby faces while in the womb.
Schizophrenia is also strongly driven by genetics, as studies of families and twins have shown. Not only does schizophrenia run in families, but twin studies provide particularly compelling information about genetics by comparing the schizophrenia rates in twins who are identical (monozygotic) against twins who are not identical (dizygotic). Research shows that the likelihood of both monozygotic twins developing schizophrenia is 33 percent, while in dizygotic twins this rate is only 7 percent. From this data, researchers can conclude that genes are a strong (but not total) influence in the development of schizophrenia. Several genes have now been linked in scientific research to schizophrenia.
People tend to most closely associate schizophrenia with hallucinations, but the symptoms can be much more complicated than that. The symptoms of schizophrenia can be classified into three broad categories:
Positive symptoms, which are also called psychotic symptoms, usually involve an altered sense of reality or the addition of something that is not actually there. Examples of positive symptoms of schizophrenia include hallucinations (visual or auditory), delusions (typically in relation to feeling important or persecuted), and thought disorder (which includes disorganized thinking or speaking).
Negative symptoms happen when something that is normally present is lacking. For instance, a person with schizophrenia might have a lack of motivation, feel less pleasure in everyday life, be unable to express emotions as vividly (also called “flat affect”), and simply talk less than usual.
Cognitive symptoms might affect a person’s ability to remember, process information, or focus on something. The degree to which cognitive symptoms affect someone with schizophrenia can vary greatly from person to person.
Schizophrenia is usually diagnosed by a psychiatrist or clinical psychologist after a thorough review of an individual's personal history, including an analysis of the symptoms the individual is currently experiencing. Physical tests may also be done to rule out other diseases.
Schizophrenia is typically diagnosed during early adulthood (most commonly in the late teens to early 20s for men and the late 20s to early 30s for women). This is when symptoms, such as psychosis, begin to manifest.
It can be hard to diagnose schizophrenia because psychosis can also occur in the context of depression and bipolar disorder. The use of amphetamines and hallucinogenic drugs can also cause symptoms similar to those seen in schizophrenia.
Treatment for schizophrenia is lifelong, and there currently is no cure for this disorder. However, symptoms can be managed through the use of medications and different forms of therapy.
The main drugs used to treat schizophrenia are a class of pharmaceuticals called antipsychotics. Antipsychotics are typically an oral medication, although sometimes long-lasting antipsychotic injections can be administered. Common antipsychotics used today include:
While medications are usually the first-line treatment against symptoms of schizophrenia, psychotherapy or talk therapy can also help. Research has shown that a form of psychotherapy known as cognitive behavioral therapy (CBT) can help individuals with schizophrenia better manage their symptoms. CBT is a form of psychotherapy that focuses on being aware of, and changing, thought and behavior patterns. Often, CBT teaches specific skills and techniques, such as acceptance or problem-solving.
Schizoaffective disorder is a condition on the schizophrenia spectrum. This disorder is partially a psychotic disorder and partially a mood disorder. That is, schizoaffective disorder has components of schizophrenia along with components of a mood disorder (either depression or bipolar disorder). There are two types of schizoaffective disorder: the bipolar type and the depressive type. Schizoaffective disorder can present itself uniquely in each person though.
In one epidemiological study conducted in Finland, schizoaffective disorder was found to affect approximately 0.32 percent of the general population. (It is worth noting that this study also found schizophrenia rates of 0.87 percent.) This data suggests that schizoaffective disorder may be even more rare than schizophrenia.
One risk factor for schizoaffective disorder is having a family member with either schizoaffective disorder, schizophrenia, or bipolar disorder. Thus, genetics likely play a role. Other risk factors include stress and substance use. For instance, some studies have shown that cannabis use can negatively impact remission rates in those with the bipolar type of schizoaffective disorder. Schizoaffective disorder is not unlike schizophrenia in that way. However, schizophrenia has been studied somewhat more than schizoaffective disorder.
People with schizoaffective disorder can display all of the symptoms associated with schizophrenia. This includes psychotic or positive symptoms (hallucinations or delusions), negative symptoms such as lack of motivation or flat affect, and cognitive symptoms like confusion.
There are two types of schizoaffective disorder, each with slightly different symptoms: the bipolar type and the depressive type.
In the bipolar type of schizoaffective disorder, symptoms are a mix of schizophrenia symptoms and bipolar disorder symptoms. Bipolar disorder is a mood disorder characterized by alternating periods of the “highs” of mania and the “lows” of depression. The bipolar-like symptoms associated with schizoaffective disorder fall under two categories:
In the depressive type of schizoaffective disorder, symptoms lean toward depression. The most common symptoms of a depressive episode associated with schizoaffective disorder are feeling sad or inadequate, experiencing decreased energy, having changes in appetite, and finding little joy in activities once held dear. Symptoms may also include feeling suicidal or engaging in self-harm behaviors.
Due to the similarities that schizoaffective disorder shares with both schizophrenia and mood disorders, many people with schizoaffective disorder are incorrectly diagnosed initially. Some scientists believe schizoaffective disorder is not a unique disorder, but rather represents a comorbid (or concurrent) mood disorder and schizophrenia. Like other psychiatric conditions, schizoaffective disorder is best diagnosed by a psychiatrist or psychologist through an extensive clinical interview.
Like schizophrenia, schizoaffective disorder is not yet curable, but it is manageable. It is a lifelong condition that requires medication — and typically psychotherapy, such as CBT. Because of the extensive mood symptoms that occur as a part of schizoaffective disorder, treatment can be complicated. Medications used (in some combination) to treat schizoaffective disorder include antipsychotics, antidepressants, and mood stabilizers.
Antipsychotics are primarily used to treat the schizophrenia-like symptoms of schizoaffective disorder. These drugs can include Risperdal (risperidone), Abilify (aripiprazole), and Latuda (lurasidone).
Antidepressants help some people manage their depressive symptoms. Examples of antidepressants include selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine).
Mood stabilizers are drugs that are also used to treat seizures. At the right doses, they can also be used for bipolar-type schizoaffective disorder to stabilize mood swings. Some of these drugs include Lamictal (lamotrigine), Depakote (divalproex sodium), and lithium.
The connection between schizophrenia, schizoaffective disorder, and depression can be complicated. Depression is often a symptom of schizoaffective disorder. However, people with schizophrenia can also experience symptoms of depression. In one study of 90 individuals with stable schizophrenia or schizoaffective disorder, 31 percent were found to have clinically relevant symptoms of depression.
Having multiple conditions can complicate treatment. Research shows that having comorbid schizophrenia spectrum disorders and depression decreases the quality of life of individuals living with these conditions.
If you have been diagnosed with depression, schizophrenia, or schizoaffective disorder, it is important to stay aware of your thoughts, feelings, and mood. Be open and honest with your doctor and therapists about your experience, so they can help you manage your symptoms.
Be particularly vigilant about the increased risk for suicidal behaviors among people with schizophrenia. Reach out to your doctor or health care team immediately if you have any thoughts of self-harm.
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