Psychological Disorders: Schizoaffective Disorder
American
Description
A. An uninterrupted period of illness during which, at some time,
there is either (1) a Major Depressive Episode, (2) a Manic Episode,
or (3) a Mixed Episode concurrent with symptoms that meet (4) Criterion
A for Schizophrenia.
Note: The Major Depressive Episode must include depressed mood.
(1)
Criteria for Major Depressive Episode
Five (or more) of the following symptoms have been present during
the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss
of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
depressed
mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: In children and adolescents, can be irritable
mood.
markedly
diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated by either subjective
account or observation made by others)
significant
weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite
nearly every day. Note: In children, consider failure to make expected
weight gains.
insomnia
or hypersomnia nearly every day
psychomotor
agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
fatigue
or loss of energy nearly every day
feelings
of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about
being sick)
diminished
ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others)
recurrent
thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for
committing suicide
The symptoms do not meet criteria for a Mixed Episode
The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hypothyroidism).
The symptoms are not better accounted for by Bereavement, i.e., after
the loss of a loved one, the symptoms persist for longer than 2 months
or are characterized by marked functional impairment, morbid preoccupation
with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor
retardation.
(2)
Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive,
or irritable mood, lasting at least 1 week (or any duration if hospitalization
is necessary).
During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have
been present to a significant degree:
inflated self-esteem or grandiosity
decreased
need for sleep (e.g., feels rested after only 3 hours of sleep)
more
talkative than usual or pressure to keep talking
flight
of ideas or subjective experience that thoughts are racing
distractibility
(i.e., attention too easily drawn to unimportant or irrelevant external
stimuli)
increase
in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
excessive
involvement in pleasurable activities that have a high potential for
painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)
The
symptoms do not meet criteria for a Mixed Episode
The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
(3)
Criteria for Mixed Episode
The criteria are met both for a Manic Episode and for a Major Depressive
Episode (except for duration) nearly every day during at least a 1-week
period.
The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
(4)
Criterion A of Schizophrenia
Two (or more) of the following, each present for a significant portion
of time during a 1-month period (or less if successfully treated):
delusions
hallucinations
disorganized speech (e.g., frequent derailment or incoherence)
grossly disorganized or catatonic behavior
negative symptoms, i.e., affective flattening, alogia, or avolition
Only one symptom is required if delusions are bizarre or hallucinations
consist of a voice keeping up a running commentary on the person's
behavior or thoughts, or two or more voices conversing with each other.
B. During the same period of illness, there have been delusions or
hallucinations for at least 2 weeks in the absence of prominent mood
symptoms.
C. Symptoms that meet criteria for a mood episode are present for
a substantial portion of the total duration of the active and residual
periods of the illness.
D. The disturbance is not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a medication) or a general
medical condition.
Specify
type:
Bipolar Type: if the disturbance includes a Manic or a Mixed Episode
(or a Manic or a Mixed Episode and Major Depressive Episodes)
Depressive
Type: if the disturbance only includes Major Depressive Episodes
European
Description
These are episodic disorders in which both affective and schizophrenic
symptoms are prominent within the same episode of illness, preferably
simultaneously, but at least within a few days of each other. Their
relationship to typical mood (affective) disorders and to schizophrenic
disorders is uncertain. They are given a separate category because
they are too common to be ignored. Other conditions in which affective
symptoms are superimposed upon or form part of a pre-existing schizophrenic
illness, or in which they coexist or alternate with other types of
persistent delusional disorders, are classified under the appropriate
category. Mood-incongruent delusions or hallucinations in affective
disorders do not by themselves justify a diagnosis of schizoaffective
disorder.
Patients
who suffer from recurrent schizoaffective episodes, particularly those
whose symptoms are of the manic rather than the depressive type, usually
make a full recovery and only rarely develop a defect state.
Diagnostic
Guidelines
A diagnosis of schizoaffective disorder should be made only when both
definite schizophrenic and definite affective symptoms are prominent
simultaneously, or within a few days of each other, within the same
episode of illness, and when, as a consequence of this, the episode
of illness does not meet criteria for either schizophrenia or a depressive
or manic episode. The term should not be applied to patients who exhibit
schizophrenic symptoms and affective symptoms only in different episodes
of illness. It is common, for example, for a schizophrenic patient
to present with depressive symptoms in the aftermath of a psychotic
episode (see post-schizophrenic depression). Some patients have recurrent
schizoaffective episodes, which may be of the manic or depressive
type or a mixture of the two. Others have one or two schizoaffective
episodes interspersed between typical episodes of mania or depression.
In the former case, schizoaffective disorder is the appropriate diagnosis.
In the latter, the occurrence of an occasional schizoaffective episode
does not invalidate a diagnosis of bipolar affective disorder or recurrent
depressive disorder if the clinical picture is typical in other respects.
F25.0
Schizoaffective Disorder, Manic Type
A disorder in which schizophrenic and manic symptoms are both prominent
in the same episode of illness. The abnormality of mood usually takes
the form of elation, accompanied by increased self-esteem and grandiose
ideas, but sometimes excitement or irritability are more obvious and
accompanied by aggressive behaviour and persecutory ideas. In both
cases there is increased energy, overactivity, impaired concentration,
and a loss of normal social inhibition. Delusions of reference, grandeur,
or persecution may be present, but other more typically schizophrenic
symptoms are required to establish the diagnosis. People may insist,
for example, that their thoughts are being broadcast or interfered
with, or that alien forces are trying to control them, or they may
report hearing voices of varied kinds or express bizarre delusional
ideas that are not merely grandiose or persecutory. Careful questioning
is often required to establish that an individual really is experiencing
these morbid phenomena, and not merely joking or talking in metaphors.
Schizoaffective disorders, manic type, are usually florid psychoses
with an acute onset; although behaviour is often grossly disturbed,
full recovery generally occurs within a few weeks.
Diagnostic
Guidelines
There must be a prominent elevation of mood, or a less obvious elevation
of mood combined with increased irritability or excitement. Within
the same episode, at least one and preferably two typically schizophrenic
symptoms (as specified for schizophrenia [F20], diagnostic guidelines
(a) - (d)) should be clearly present.
This
category should be used both for a single schizoaffective episode
of the manic type and for a recurrent disorder in which the majority
of episodes are schizoaffective, manic type.
Includes:
* schizoaffective psychosis, manic type
* schizophreniform psychosis, manic type
F25.1
Schizoaffective Disorder, Depressive Type
A disorder in which schizophrenic and depressive symptoms are both
prominent in the same episode of illness. Depression of mood is usually
accompanied by several characteristic depressive symptoms or behavioural
abnormalities such as retardation, insomnia, loss of energy, appetite
or weight, reduction of normal interests, impairment of concentration,
guilt, feelings of hopelessness, and suicidal thoughts. At the same
time, or within the same episode, other more typically schizophrenic
symptoms are present; patients may insist, for example, that their
thoughts are being broadcast or interfered with, or that alien forces
are trying to control them. They may be convinced that they are being
spied upon or plotted against and this is not justified by their own
behaviour. Voices may be heard that are not merely disparaging or
condemnatory but that talk of killing the patient or discuss this
behaviour between themselves. Schizoaffective episodes of the depressive
type are usually less florid and alarming than schizoaffective episodes
of the manic type, but they tend to last longer and the prognosis
is less favourable. Although the majority of patients recover completely,
some eventually develop a schizophrenic defect.
Diagnostic Guidelines
There must be prominent depression, accompanied by at least two characteristic
depressive symptoms or associated behavioural abnormalities as listed
for depressive episode; within the same episode, at least one and
preferably two typically schizophrenic symptoms (as specified for
schizophrenia), diagnostic guidelines (a)-(d) should be clearly present.
This
category should be used both for a single schizoaffective episode,
depressive type, and for a recurrent disorder in which the majority
of episodes are schizoaffective, depressive type.
Includes:
* schizoaffective psychosis, depressive type
* schizophreniform psychosis, depressive type