Schizoaffective Disorder: More Than Just Schizophrenia

In April of 2007, a Virginia Tech student killed 37 and wounded 12 other students in a shooting rampage.

In January of 2011, Americans were horrified to learn of the shooting of House of Representatives member Gabrielle Giffords, and the deaths of six of her constituents, including a nine-year-old child. 

In April of 2012, the news came that a former neuropsychiatry student had shot 70 people, killing 12 of them, at a screening of Batman film The Dark Knight Rises in a movie theater in Aurora, Colorado.

In December of 2012, the news was that a distraught young man had murdered his mother and then 26 children and teachers at Sandy Hook Elementary School in Connecticut, before killing himself.

Before and after these horrific events, there have been dozens of other reports of train station shovings, knifings, decapitations, and cannibalism in the United States and in other countries around the world. A common denominator of most of these events has been that the perpetrators of these horrific crimes have been mentally ill, usually with a schizoaffective disorder. Not all mass murders are committed by people who have schizoaffective disorders, however, and not everyone who suffers this psychiatric condition falls into the darkness of insanity.

What Is A Schizoaffective Disorder?

Schizoaffective disorder is a perplexing mental illness that takes on some of the characteristics of schizophrenia and some of the characteristics of a mood disorder, such as bipolar disorder. Like schizophrenics, people who have schizoaffective disorder may have distorted thinking, harbor delusions, or experience hallucinations. Like people who have bipolar disorder, they may become extremely depressed, or hyperactive in a manic state.

The DSM-5 sets specific criteria for a diagnosis of schizoaffective disorder:

• The individual must experience delusions (irrational ideas not abandoned when challenged with facts) or hallucinations (sensations of things that are not objectively there) for at least 2 weeks at some point in the course of the illness, when not experiencing depression or mania.
• The individual must experience delusions or hallucinations, that is, meet the definitions of schizophrenia, during depression or mania.
• The individual must experience depression or mania through the majority of the course of the illness.

The mood disorder may be bipolar (both depressive and manic episodes) or unipolar (depression without manic episodes). Younger people who have the disease tend to be bipolar; older people who have the disease tend only to have episodes of depression. People whose disturbances can be traced to medication or another medical condition do not have schizoaffective disorder.

See Also: Schizophrenia Symptoms: Beyond Hearing Voices In Your Head

What Is the Prognosis for Schizoaffective Disorder?

About 10% of people who have schizoaffective disorder commit suicide or homicide. People with the condition have a brighter future than those who have schizophrenia, but are less likely to lead independent lives than people who have bipolar disorder. Early onset of the disease (age 25 or younger), lack of remissions, and the lack of an identifiable traumatic event triggering symptoms are indicators of a bleaker outlook for the disease.

Does Anyone Ever Lead a Successful Life with Schizoaffective Disorder?

Although about 10 percent who have schizoaffective disorder commit homicide or suicide, 90 percent do not. The disease may make it very difficult to maintain family relationships or friendships, to finish school, or to get and hold down a job. A few people who have the condition, however, lead highly successful lives.

Here are some examples:

• While still a teenager, musician, singer, songwriter, and producer Brian Wilson founded one of the most successful bands of his era, the Beach Boys. Under his leadership, the Beach Boys had over two-dozen top-40 hits. After his father died, when Wilson was 31, he became a recluse, drinking, overeating, abusing drugs, and experiencing hallucinations in the form of disembodied voices, with a mild bipolar disorder. Eventually Wilson was diagnosed with schizoaffective disorder, and with therapy and medication was able to return to being a successful music producer. Wilson even eventually finished the album Smile, which the Beach Boys had not been able to complete after the symptoms of his illness began. What Wilson had going for him was that he had chosen a profession in which hearing disembodied voices was actually a useful skill, and he had the resources for the best medical treatment and minimal danger of financial distress.
• For many years Keris Myrick, CEO of Project Return, which manages over 100 self-help groups in the Los Angeles area, and author of Mad in America, suffered from voices in her head that gave her suicidal thoughts and several times forced her into mental institutions. Myrick says that she realized the severity of her illness when she was shopping in a supermarket and cereal boxes started warning her that they contained poison. Even now at the age of 54, she still hears voices and still consults a psychiatrist, sometimes retreating to a closet to try down out the chaos in her head. The primary voice she hears now, however, is her own, and she serves as an adviser to the American Psychiatric Association and speaks on the need for better access to mental health services around the United States. Myrick has a psychiatric service dog, a terrier named Steinbeck, who knows to lean up against her when she is suffering hallucinations. Myrick has benefited from family support and the courage to "air her dirty laundry" in her efforts to help others who have the disease.

Schizoaffective disorder is not a condition that can be managed without medical help. Nearly all people who have the condition need medication to stabilize their moods, and antidepressants use has to be monitored by a doctor to ensure that it does not accelerate the onset of mania. The medications used to treat schizoaffective disorder can have severe side effects and must be monitored regularly to prevent anemia and other serious complications.

See Also: Is Obsessive Compulsive Disorder A Risk Factor For Schizophrenia?

The most important contribution of professional intervention for schizoaffective disorder, however, is hope. Trained therapists can help people who have this extraordinarily difficult condition maintain or reclaim basic life skills, choose attainable career goals, and access social support networks. They can teach their patients and clients the basic skills of wellness planning, and provide them with the opportunities to earn the self-respect they need to function independently.