Signs and symptoms of schizoaffective bipolar disorder and how to treat it

• Schizoaffective bipolar disorder is when an individual experiences episodes of mania, depression, and symptoms of schizophrenia.
• Symptoms of schizoaffective bipolar disorder include increased energy levels, hallucinations, and trouble concentrating.
• Schizoaffective bipolar disorder can be treated with medications and therapy.
• This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist, and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.

Schizoaffective bipolar disorder is a complex mental health disorder characterized by episodes of mania and depression, alongside symptoms of schizophrenia. There are two types of schizoaffective disorder: bipolar and depression.

Here is what you need to know about schizoaffective bipolar disorder from its symptoms to how it is treated:

What is schizoaffective disorder?

The term schizoaffective comes from the word "schizo" which refers to psychotic symptoms and "affective" which refers to extreme shifts in mood and behavior. About 0.3% of the population is estimated to have schizoaffective disorder.

There are two types of schizoaffective disorders:

• Schizoaffective bipolar is when an individual experiences episodes of mania, depression, and symptoms of schizophrenia.
• Schizoaffective depression is when an individual experiences episodes of depression and symptoms of schizophrenia.

The average age of onset for schizoaffective disorder is between the ages of 16 and 30. It affects men and women equally, but men tend to develop the disorder earlier in life.

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Symptoms of schizoaffective bipolar disorder

Schizoaffective disorder may come with similar symptoms to schizophrenia and bipolar disorder, but it is distinct from both. Because with schizophrenia, there are no major mood episodes needing treatment, and in bipolar disorder there are no chronic psychotic symptoms as seen in schizophrenia.

"The emphasis on mood or schizophrenic symptoms varies between individuals," says Dost Ögnür, MD, PhD, the director of the Schizophrenia and Bipolar Disorder Research Program at McLean Hospital and a professor of psychiatry at Harvard Medical School. This means that some people diagnosed with the disorder may experience more schizophrenic symptoms while others may have more severe mood episodes. People may also experience mixed episodes where they have symptoms of mania, depression, and psychosis simultaneously. "People may have high energy and racing thoughts but they are also miserable so the two can co-exist," says Ögnür.

Manic, depressive, and psychotic symptoms are often confused with one another. Here is a breakdown of common symptoms of each.

Additional symptoms of schizoaffective bipolar disorder are trouble functioning in social or occupational settings and problems with physical care including cleanliness and physical appearance.

People with schizoaffective bipolar disorder are also at a higher risk for substance abuse, Ögnür says.

How is schizoaffective bipolar disorder diagnosed?

Schizoaffective bipolar disorder is diagnosed by a mental health professional such as a psychiatrist.

According to the DSM-5 — the manual used to assess mental health conditions — to diagnose someone with schizoaffective bipolar disorder a person must experience all of the following symptoms:

1. During a manic, depressive, or mixed episode, two of the following psychotic symptoms also occur:
• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior including fast or strange movements
• Loss of emotion, speech, or motivation
2. Delusions or hallucinations continue in the absence of manic or depressive episodes
3. Mood symptoms occur consistently throughout the patient's life
4. Symptoms are not related to the effects of substance use or other medical issues

People with this disorder are often misdiagnosed as bipolar or schizophrenic. That's because each case of schizoaffective disorder is unique and can present a wide range of symptoms that overlap these mental health conditions. So usually a person is misdiagnosed, "depending on the nature of the symptoms at the time of the diagnosis," says Diana Samuel, MD, assistant professor of psychiatry at Columbia University Irving Medical Center. Ögnür says the best way to make an accurate diagnosis is through long-term follow up. "You want long-term information over the course of months to years to evaluate how someone is doing and see what their symptoms are before clinging to a diagnosis," he says.

Causes and risk factors

The exact cause of schizoaffective disorder isn't clear, but it may be a mix of genetics and environmental factors.

People are more likely to develop schizoaffective bipolar disorder if they have immediate family members, such as parents or siblings, with depression, bipolar disorder, schizophrenia, or other mental health conditions.

Previous trauma or post traumatic stress disorder is also common among people with severe mental illnesses, such as schizoaffective bipolar disorder.

One 2011 study published in The Journal of Mental and Nervous disease found that in a group of 102 people with schizophrenia, bipolar disorder, or schizoaffective disorder, almost half — 47.5% — had experienced some type childhood trauma. While both genetics and trauma may contribute to developing schizoaffective bipolar disorder, "these in themselves are not indicators that someone will develop this diagnosis," says Samuel.

Treatments for schizoaffective bipolar disorder

Schizoaffective bipolar disorder is generally treated with medications, psychotherapy, or a combination of both.

Because people diagnosed with schizoaffective disorder often vary in terms of symptoms, the treatments for this disorder also vary for each individual.

Psychotherapy can be done in group settings or one-on-one with a therapist. Samuel says that psychotherapy can help people with schizoaffective bipolar disorder "better understand their illness and learn how to manage issues that might arise or interfere with the ability to manage their symptoms."

There is only one medication approved by the Food and Drug Administration specifically for the treatment of both types of schizoaffective disorder. It is an antipsychotic called Ignevea.

However, other medications are often also prescribed to treat symptoms of schizoaffective bipolar disorder says Ögnür. These include:

• Antidepressants: Used to manage depressive symptoms.
• Mood stabilizers: Reduce the number of extreme highs and lows experienced with bipolar symptoms.
• Anxiety medication: Helps with social functioning and may alleviate some stress caused by paranoia.
• Other types of antipsychotic medications: Used to treat schizophrenic symptoms including delusions, hallucinations, and paranoia.

Samuel says, "at times people with this disorder may be on a combination of medications, or they might just be taking one medication to treat all of their symptoms." Treatment can help people with this disorder resolve their symptoms, but it's important to continue taking medication even if your symptoms appear to be under control says Ögnür. That's because stopping medication can result in a relapse.

Taking your medication regularly, having a strong support system, and learning how to manage potential triggers can help you reduce the rate of relapse.

Ögnür says it is also important for doctors and patients to work together to reduce any side effects associated with medication like trouble sleeping, weight gain, and muscle tremors.

Takeaway

Schizoaffective bipolar disorder is a rare mental health condition that causes someone to experience symptoms of both bipolar disorder and schizophrenia. If you are diagnosed with schizoaffective bipolar disorder, there are treatment options that can help you manage your symptoms and live a fulfilling life.

Related articles from Health Reference:

• Am I bipolar? The major signs of bipolar disorder
• Is bipolar disorder genetic? Yes, but that doesn't guarantee you'll develop it
• The difference between bipolar 1 and 2