What is the Difference Between Schizoaffective Disorder and Schizophrenia?

Schizophrenia and schizoaffective disorder are related conditions, and because the names are so similar many believe the latter is a subtype of the former. Schizoaffective disorder sufferers often receive a schizophrenia diagnosis when the condition is in its early stages, which helps reinforce this conception.

But the relationship between the two disorders is not so simple. There are similarities between schizophrenia and schizoaffective disorder, but there are also significant differences that make it impossible to categorize one by referring to the other. In fact, despite schizophrenia’s notoriety, schizoaffective disorder is the more complicated condition to diagnose and treat.

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The schizoaffective disorder vs. schizophrenia comparison reveals pronounced overlap but clear differences. In fact, schizoaffective disorder is a hybrid condition that combines the characteristics of schizophrenia with those of mood disorders, such as depression and bipolar disorder. It is this blending of different mental health conditions that sets schizoaffective disorder apart from its more well-known cousin, since the standard schizophrenia definition classifies it as a disorder that affects thought, feelings, and behavior but not mood, at least not directly.

Some mental health experts prefer a spectrum model to explain the two conditions, with schizophrenia and bipolar disorder occupying the two extreme ends and schizoaffective disorder found somewhere in the middle. This idea makes some sense, since people with schizoaffective disorder do generally exhibit the same mood swings that are experienced by individuals with bipolar disorder, either the lows of depression or the highs of mania.

However, schizoaffective disorder, bipolar type (sometimes referred to as bipolar schizoaffective disorder) is only one variety of the condition. Schizoaffective disorder, depressive type includes the symptoms of major depression without the mania, and is just as likely to be diagnosed as bipolar schizoaffective disorder.

Three other types of schizoaffective disorder (mixed, unspecified, and other) are also recognized under the International Statistical Classification of Diseases and Related Health Problems (ICD), a categorization system (currently in its 10th revision) used for mental health disorders by the World Health Organization (WHO).

Schizoaffective disorder ICD 10 classifications are recognized as authoritative everywhere, including in the United States, even though the American Psychiatric Association’s DSM-5 classification system (which uses similar categories for schizoaffective disorder types) is more well-known.

Living with schizoaffective disorder is difficult in any circumstance, but the trials and tribulations are sometimes made worse by a false schizophrenia diagnosis. In other instances, the disorder is incorrectly classified as major depression or bipolar disorder, which can lead to treatment choices that don’t address all of the disruptive and debilitating symptoms of this complicated medical condition.

In its schizophrenic aspects, schizoaffective disorder often mimics either paranoid schizophrenia or disorganized schizophrenia. Schizoaffective disorder vs. schizophrenia comparisons reveal that each demonstrates the so-called positive symptoms of conventional schizophrenia, which are common to the paranoid and disorganized varieties of the disorder schizophrenia. Those positive symptoms tend to involve psychotic breaks with reality that can make normal functioning difficult, if not impossible.

The positive symptoms of schizophrenia (and schizoaffective disorder) include:

• Hallucinations. Auditory hallucinations in the form of voices are the most common type. These voices are often hostile, accusatory, threatening, or insulting, and may tell the sufferer to hurt themselves or others.
• Delusions. False, irrational beliefs about reality that provoke fear, anxiety, paranoia, and mistrust of others. Reason and logic are not enough to disable these powerful mind traps.
• Disorganized thinking. Thought and speech patterns that lack coherence or connection to real events. Sufferers having episodes of disorganized thinking may experience thought blocking, where the mind suddenly goes blank.
• Movement disorders. Excessive, repetitive, agitated body movements that have no obvious purpose or context.

When these psychotic symptoms are frightful or disabling enough, a period of complete or partial hospitalization might be necessary.

If the positive symptoms of schizophrenia occur without any previous or remembered history of mood disorder, it is very easy for psychiatrists to misdiagnose schizoaffective disorder as schizophrenia. Likewise, if the patient is suffering from depression or mania without any noticeable signs of schizophrenia a mood disorder might be diagnosed, again leaving the sufferer without an accurate idea about what is actually going on.

In schizoaffective disorder, bipolar type, periods of mania can be identified by the following symptoms:

• Talking too much or too fast
• Racing thoughts
• A constant need to be busy or moving
• Difficulty sleeping
• Erratic focus and concentration
• Delusions of grandeur, high self-esteem bordering on egomania
• Self-destructive or dangerous behavior

Schizoaffective disorder, bipolar type also features low periods that are nearly identical to those experienced by people with schizoaffective disorder, depressive type. The symptoms of these depressive episodes include:

• Low energy and motivation
• Loss of appetite, or excessive hunger
• Rapid weight changes
• Too much or too little speech
• Inconsistent effort, loss of ability to complete projects
• Apathy about work, school, or relationships
• An inability to enjoy formerly pleasurable activities
• Feelings of guilt, helplessness, or unworthiness

Given the complexity of the symptoms of schizoaffective disorder, it is not hard to see why it is frequently misdiagnosed. It takes time for the full range of schizoaffective disorder effects to manifest, yet sufferers will understandably seek a diagnosis plus treatment when the initial symptoms of either schizophrenia or a mood disorder are experienced.

An accurate schizoaffective disorder diagnosis requires extensive exploration of a patient’s medical background. Psychiatrists can only make an official diagnosis of the disorder if:

1. Psychotic episodes involving two or more of the following symptoms have been experienced for a period of at least one month:

• • Delusions
  • Hallucinations
  • Disorganized thinking
  • Disorganized (problematic) behavior
  • Catatonia (common to catatonic schizophrenia)
  • Negative symptoms of schizophrenia (lack of emotion, lack of speech, less ability to experience pleasure, can’t start or sustain activities, etc.)

One symptom may be enough to make a diagnosis, if it is: a). delusions that are especially bizarre or out of touch with reality, or b). auditory hallucinations that are continuous and/or involve multiple voices having conversations or issuing instructions.

2. During the total duration of the illness, the mood disorder is dominant more than half the time. Schizoaffective disorder criteria can be satisfied if either major depression or bipolar-style mania have been present for an extended period, although both can be expected to manifest at some point if schizoaffective disorder, bipolar type is present.

Generally, the schizophrenia symptoms and the mood disorder will not be present simultaneously, at least not at equal strength, and that is another reason why a schizoaffective disorder diagnosis cannot be given when the disorder is in the initial stage.

While paranoid schizophrenia sufferers tend to experience psychosis regularly and chronically, with schizoaffective disorder psychotic symptoms are more episodic and short-lived—they come and go quickly, in other words. This is an important distinction that helps psychiatrists and other mental health professionals make a correct diagnosis of schizoaffective disorder.

Despite their differences, treatment programs for schizoaffective disorder and schizophrenia are usually quite similar. They almost invariably include:

1. Medication. Antipsychotics are the drugs of choice for schizophrenia symptoms, while antidepressants and/or mood stabilizers like lithium are administered to combat the effects of mania and depression. With schizoaffective disorder, medication protocols allow for the simultaneous prescribing of drugs that treat mania/depression and any psychotic symptoms that might be present. At present, the only antipsychotic drug specifically approved by the FDA for the treatment of schizoaffective disorder is paliperidone (sold under the brand name Invega), but other drugs with a track record of success are still administered.
2. Individual and group psychotherapy. As they explore the sources of their troubles, patients will be encouraged to set goals for sustainable improvement. Specific therapies like CBT (cognitive behavioral therapy) will be administered to help disorder sufferers recognize and alter unproductive behaviors and thought patterns, as they empower themselves against their conditions.
3. Family therapy. Family members can help disorder sufferers by offering moral, practical, and medical support, during therapy and afterward, when schizophrenia and schizoaffective disorder sufferers need networks of caregivers to assist them with multiple tasks.
4. Life skills training. Individuals with schizophrenia or schizoaffective disorder often have difficulty managing their lives, making specialized instruction on topics involving personal care and life maintenance valuable and important.
5. Assistance with employment and housing (as needed). People with these disorders frequently end up homeless and unemployed, which is a worst-case outcome that can be avoided with practical assistance and intervention.
6. Hospitalization (if necessary). Psychotic episodes or periods of deep depression require emergency healthcare in a clinical/hospital setting. Once the crisis has passed, the disorder sufferer may be returned to their homes and re-enrolled in their outpatient/aftercare programs.

As separate but related conditions, schizoaffective disorder and schizophrenia have some diversity in their treatment regimens, especially with respect to medication. But regardless of which condition is diagnosed, mental health professionals will rely on evidence-based medical procedures to help restore each individual’s good health and personal autonomy.

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