Changes in Definition of Schizoaffective Disorder Will Exclude More People
Schizoaffective Disorder Basics
People with schizoaffective disorder have symptoms that meet the established criteria for a diagnosis of schizophrenia. While these schizophrenia symptoms are present, affected individuals also experience symptoms that would qualify them for a diagnosis of at least one episode of major depression, one episode of bipolar mania, or one mixed bipolar episode that features symptoms of both mania and depression. Specific symptoms that factor into a schizophrenia diagnosis include delusional thought processes, some form of hallucination, highly disorganized thinking, a lack of normal emotional responsiveness, a lack of verbal communication, and declines in reason, memory and a range of other higher-level mental abilities. Symptoms of major depression include intensely negative or “down” emotional states, appetite and sleep disturbances, concentration problems and suicidal thoughts or behaviors. Symptoms of bipolar mania include unusually high energy levels, easy distractibility, impulsive behavior, unusually rapid speech and decreased participation in sleep.
While the presence of depressive or bipolar symptoms is required for a schizoaffective disorder diagnosis, a person affected by the disorder must also experience schizophrenia-related symptoms for a minimum of two weeks without experiencing either bipolar- or depression-based problems. The DSM lists additional criteria for diagnosing schizoaffective disorder that include a stipulation that the affected individual must experience depressive or bipolar symptoms for a “substantial portion” of the disorder’s duration, and a stipulation that the schizoaffective symptoms cannot stem from sources such as physical ailments, medication side effects, or substance abuse.
Roughly 1 percent of the US population has schizoaffective disorder, the National Alliance on Mental Illness reports. No one knows exactly what causes the condition, but it appears to stem at least partially from inherited imbalances in certain key brain chemicals. Specific pregnancy-related events may also contribute to schizoaffective disorder’s onset, including such things as fetal exposure to viruses or poisonous substances and problems during childbirth. People with unusually high risks for the condition include anyone with a family history of schizoaffective disorder, depression, bipolar disorder or schizophrenia.
Since it involves symptoms from three other forms of mental illness, schizoaffective disorder is potentially fairly easy to misdiagnose. This is especially true because some of these symptoms, namely those related to depression or bipolar disorder, by definition do not appear in affected individuals all of the time. Even when they do appear, these symptoms may sometimes produce effects that don’t seem obvious at first glance. In the latest edition of the Diagnostic and Statistical Manual, released in May 2013 and commonly abbreviated as DSM 5, the American Psychiatric Association modified the definition for schizoaffective disorder in order to clarify some of these issues.
The first criterion in the previous definition for the disorder—contained in the revised fourth edition of the DSM—stipulates that all affected individuals must simultaneously experience the symptoms of schizophrenia and major depression, or the symptoms of schizophrenia and bipolar disorder, for an “uninterrupted period of time.” The updated definition in DSM 5 keeps this criterion. However, it also adds a secondary stipulation that once depressive or bipolar symptoms emerge alongside schizophrenia, they must remain present for “a majority of the disorder’s total duration.”
In addition to helping to clarify the situations that call for a schizoaffective disorder diagnosis, this change underlies a conceptual shift that asks doctors to stop viewing the condition as being “active” only in small windows of time when the combined symptoms of two disorders are present, and start viewing the condition as an ongoing problem that has continuing effects over time. In practical terms, the new definition for schizoaffective disorder will likely exclude some of the people who would have received a diagnosis under the condition’s previous definition.