Schizoaffective disorder - Research Paper Example

?Schizoaffective Disorder Table of contents 0 Definition ....................................3 2.0 Demographics of schizoaffective disorder ................3 3.0 Signs and symptoms ..........3 4.0 Differences with schizophrenia and affective mood disorder .......4 5.0 Diagnosis ........................4 6.0 Causes/etiology ....................5 7.0 Pathophysiology ...........................7 8.0 Types ................................8 9.0 Epidemiology /prevalence .........8 10.0 Treatment/management......... 9 10.1 Medications ...........9 10.2 Psychotherapy...........10 10.3 Psychosocial rehabilitation.....10 11.0 Complications and side effects of medications.................11 12.0 History …………….11 13.0 Conclusion .................12 Bibliography Schizoaffective Disorder Abstract The understanding of schizoaffective disorder is very important given the increasing prevalence of the disease among adults and its significant effects on the cognitive, emotional and behavioral patterns of the people affected. Physicians therefore need to perfect their ability to diagnose and distinguish schizoaffective disorder from affective/mood disorder and schizophrenia so as to timely identify the best possible type of intervention for a particular patient. Each of the treatment types aims all focusing on recovery of the patient and symptom management. This paper gives the definition of schizoaffective disorder, explains its signs and symptoms, diagnosis, causes/etiology, pathophysiology, epidemiology/prevalence, treatment/management, complications and side effects of treatments especially medications, its demographics and a brief history. To make the explanation of the disease more clear, the paper differentiates schizoaffective disorder with schizophrenia and affective mood disorder. 1.0 Definition Schizoaffective disorder refers to a mental disorder that causes mood problems and loss of contact with reality (psychosis). This mental condition affects emotion and cognition and is characterised by recurring episodes of depressed or elevated mood or a simultaneous occurrence of both, occurring together or alternating with distortions in perception. This is one of the common, disabling and chronic mental disorders and as the name implies, this disorder is characterised by both the symptoms of an affective (mood) disorder and schizophrenia. 2.0 Demographics of schizoaffective disorder Schizoaffective disorder is mainly diagnosed among adults. The peak years for its onset are early adulthood and late teenage years. This range is often 16-30 years and even among this bracket, occurrence in women is slightly higher than occurrence in men. Generally, adults form a greater percentage of those diagnosed with the disease whereas children are rarely diagnosed with the disorder. 3.0 Signs and symptoms Typical symptoms of schizoaffective disorder include bizarre delusions, hallucinations, disorganized speech or paranoia and thinking patters marked by significant occupational and social dysfunction. The patient experiences recurring episodes of psychosis and mood disorder. Mood disorders are marked by discrete periods of mixed episodes, clinical depression and manic episodes. Signs related to mania include hyperactivity, including social, work and sexual activity, rapid/increased talking, racing/rapid thoughts, insomnia, agitation, distractibility, inflated self-esteem and dangerous/self-destructive behaviour like driving recklessly, going on spending sprees or having a careless sexual life. Symptoms related to schizophrenia include hallucinations (the perception of unreal sensations like hearing voices), delusions (strange unrealistic beliefs such as belief of being followed or monitored and which the person does not give up when factual information is presented to them). Other signs of schizophrenia are odd or unusual behavior, disorganized thinking, poor motivation, total immobility or slow movements, lack of emotion in speech and facial expression and, problems with communication and speech. 4.0 Differences with schizophrenia and affective mood disorder The difference between schizoaffective disorder and schizophrenia is that the mood symptoms associated with schizoaffective disorder are more prominent and manifest for longer periods compared to those associated with schizophrenia. The distinction between schizoaffective disorder and mood disorder is that the hallucinations or delusions associated with schizoaffective disorder must be present in persons having the disorder for at least two weeks and without the presentation of prominent mood symptoms. However, the diagnosis of a person suffering from with mood disorder or schizophrenia may later change to that of schizoaffective disorder or either way. 5.0 Diagnosis Although there are no laboratory tests that particularly diagnose schizoaffective disorder, the physician could use various laboratory tests such as blood tests or X-rays to rule out the possibility that the symptoms were caused by a physical illness. Referral to a psychiatrist or psychologists is then made if no physical reason is identified as the cause of the symptoms. On seeing a psychiatrist or psychologist, the diagnosis of schizoaffective disorder is made when the patient presents features of both affective/mood disorder and schizophrenia but does not strictly meet the diagnostic criteria of affective disorder or schizophrenia alone. Marneros 2003) states that the combination of symptoms from the two divergent spectrums of schizophrenia and affective disorder makes the diagnosing and treating schizoaffective patients difficult. Generally, it is difficult to determine if a patient has the two separate disorders, a combination of both or even a different mental disorder apart from the two. An accurate diagnosis of schizoaffective disorder is therefore made when the patient meets the diagnostic criteria for schizophrenia and mania or major depressive disorder (Malhi et al 2008). Specifically, the person must show the primary symptoms of schizophrenia like as disorganized behaviour, disorganized speech, delusions and hallucinations, and alongside this, they must have had symptoms of manic or major depression episode, for a period of time. These should have occurred in uninterrupted periods of time. In addition, the patient must have had psychosis for a period of at least two weeks without showing any signs of mood disorder. To complete this diagnosis, one must completely review the patient’s history, psychiatric and medical records, and, if possible, get information from family members (Kane 2010). 6.0 Causes/etiology There is no specific know cause of schizoaffective disorder and neither is the disorder a distinct type of psychotic disorder. Instead, it appears as a co-occurring mood disorder and schizophrenia, existing on a continuum in-between and severe recurrent unipolar depression and bipolar disorder and schizophrenia. Basing on this explanation of the nature of schizoaffective disorder , it is more likely that in some cases, its etiology is more similar to that of severe mood disorders and in some cases, more similar to that of schizophrenia. Generally, researchers believe that environmental, genetic and biochemical factors are involved in causing schizoaffective disorder. An analysis of the link between schizoaffective disorder and genetics/hereditary reveals that there is a tendency for schizoaffective disorder being passed on from parents to their children and thus offspring of schizoaffective disorder ’ve people are more likely to develop schizoaffective disorder . However, no specific genetic markers have been pointed out as the specific cause of schizoaffective disorder. Brown et al (2002) explains that schizophrenia spectrum disorders have been marginally associated with paternal age during conception. This condition is a known cause of genetic mutations and is also associated with schizoaffective disorder since schizoaffective disorder is a part of the schizophrenia spectrum disorders. Another evidence linking genetic predisposition to schizoaffective disorder relates to the physiology of persons diagnosed with schizoaffective disorder is similar but not identical to the physiology of persons diagnosed with severe bipolar disorder and schizophrenia (Martin et al 2007). Biochemical factors are mainly explained as brain chemistry. It has been found that people with mood disorders and schizophrenia may have an imbalance of some chemicals in the brain or neurotransmitters. Neurotransmitters are chemical substances that enable brain nerve cells to send messages to and receive messages from each other. An imbalance in these chemicals can therefore interfere with the transmission of important messages, resulting to schizoaffective disorder symptoms. In regard to the environment, evidence from research suggest that some environmental factors like highly stressful situations, poor social interactions or viral infection may trigger the development of schizoaffective disorder in people who genetically predisposed to schizoaffective disorder /who have inherited a tendency to develop schizoaffective disorder . Substance abuse is another suspected cause of schizoaffective disorder. According to Ferdinand et al (2005), the existence of a defined causal connection between the use of drugs and psychotic spectrum disorders like schizoaffective disorder has been difficult to prove. The common explanations for this are substance use is result of schizoaffective disorder and schizoaffective disorder is caused by substance use. The two claims may be correct. For example, cocaine-induced or alcohol induced persist but occur at lower rates after abstinence (Larson, 2006, Mahoney et al, 2008, Soyka 1990). At the same time, people use alcohol and drugs to cope with unpleasant emotional states like anxiety, depression, boredom and loneliness (Gregg 2007). As for marijuana however, evidence is increasing evidence that it can play a role in the development of schizoaffective disorder and morbidity of psychotic disorders, schizoaffective disorder included (Moore et al 2005 and Semple 2005). In support of this, still another study confirmed that "that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness, D'Souza et al 2009). Exposure to prenatal complications, malnutrition and viruses have also been found to contribute to the development of schizoaffective disorder. Overall, various environmental and biological factors are believed to interact with the genes of a person in ways which can increase or reduce the risk for the person developing schizoaffective disorder. 7.0 Pathophysiology The particular pathophysiology of schizoaffective disorder is still unknown. Kaplan and Sadock (2003) suggest that schizoaffective disorder could involve imbalance of brain neurotransmitters. Abnormalities of the neurotransmitters norepinephrine, dopamine and serotonin could also play a role in this disorder. Reduced hippocampal volumes, white matter and thalamus abnormalities have been noted among patients with schizoaffective disorder (Antonius et al 2011, Radonic et al 2011 and Smith et al 2011). 8.0 Types There is a criterion to be met for a person to be diagnosed with schizoaffective disorder. As explained in the earlier parts of the essay, the person must portray primary symptoms of schizophrenia and for a period of time, they must have had symptoms of manic episode or major depression. Basing on this description of the schizoaffective disorder there are only two subtypes of disorder. These are depressive sub-type and the bipolar subtype. The depressive subtype is exclusively marked by major depressive episodes. There are no mixed or manic episodes. The bipolar subtype is marked manic episodes with or without depressive episodes or depressive symptoms (mixed episode). On rare occasions, major depressive episodes occur. 9.0 Epidemiology /prevalence Estimates for the prevalence of schizoaffective disorder suggest at some time during their life, approximately one in every 200 people develop the disorder. This gives a proportion of 0.5%. Others give a proportion of 0.32% and many of them agree to the range of 0.5-0.8% (Perala, 2007). Majority of young people diagnosed with schizoaffective disorder have been found to have the bipolar subtype of schizoaffective disorder disorder whereas older diagnosed with the disorder tend to have the depressive subtype. An evaluation of the disorder indicates that it affects more women than men. However, there is likelihood that this ratio is influenced by the fact that majority of women suffering from the disorder have the depressive subtype and just a few have the bipolar subtype. The situation is converse for men patients. It has also been found out that men diagnosed with schizoaffective disorder tend to portray antisocial behaviour and traits compared to other personality traits. Additional observations are that in women, the age of onset is later for than for men and that there exist no race-based difference in the diagnosis of the disorder (Azorin at al 2005). However, there is no adequate research explaining the etiology and epidemiology relating to gender differences in the onset of the disease. 10.0 Treatment/management There is no cure for schizoaffective disorder but the treatment existing comprises of a combination of psychosocial rehabilitation, psychotherapy and medicine (pharmacotherapy), all focused on recovery of the patient and symptom management. 10.1 Medications Upon examination and diagnosis, a psychiatrist can prescribe a number of medications aimed at reducing the symptoms of the disease through the treatment of psychotic conditions and stabilisation of moods. These medications are normally given as combinations and they include antipsychotic medications, antidepressants and mood stabilisers. Antipsychotics are used in the treatment of psychotic conditions. The newer atypical antipsychotics like risperidone, clozapine, ziprasidone, aripiprazole olanzapine, and quetiapine are safer than the older conventional or typical antipsychotics like fluphenazine and haloperidol in terms of tardive, dyskinesia, and parkinsonism. The atypical drugs may also result to better mood symptoms. However, medications are normally prescribed depending on the side effects they pose and their effectiveness in reducing the symptoms of schizoaffective disorder in a given patient under treatment. Different people interact differently to the medication and thus psychiatrists give a period of trial and error for these medical interventions. Basing on the patient feedback on symptom reduction and side effects, and their clinical experience, the psychiatrist is able to identify the medications that will work best for each patient. They also prescribe drugs basing on the type of schizoaffective disorder presented by a patient. If a patient portrays manic symptoms, an antipsychotic will be prescribed to them in combination with a mood stabiliser. Examples of mood stabilisers are Lithium, Carbamazepine (Tegretol) and Valproate semisodium (Depakote ER)( Baethge, 2003). If the patient manifests the depression or the depressive subtype of schizoaffective disorder the psychiatrist will prescribe an antipsychotic in combination with an antidepressant. Examples of anti-depressants include Zoloft, Prozac, Ativan, Klonopin among others. Lamotrigine is used both as a mood stabilizer an antidepressant due to its antidepressant properties. In addition to these specialised medications, patients who have acute mania are given sleeping pills to help them rest from their delusions, hallucinations and anxiety. 10.2 Psychotherapy The aim of psychotherapy is to assist the patient to learn about schizoaffective disorder , establish their personal goals in relation to the disorder and manage everyday problems that come along with the disorder. These therapies can be conducted to individual patient and group of patient. Family therapy could also be done to assist families cope and effectively help their loved one suffering from schizoaffective disorder. It reduces criticisms, hostility and overprotection of the patient and consequently, they result to a reduction in the relapse rate. The most effective treatment intervention for this disorder is a combination of psychosocial interventions and appropriate drug treatment. Hospitalization can be done for patients who hurt themselves. 10.3 Psychosocial rehabilitation Psychosocial rehabilitation is helpful in helping the patient re-establish the correct social associations and behavior patterns. This form of treatment focuses on social and work skills, reducing expressed emotions, personal grooming and hygiene, home management among others. No matter the subtype, there is no method of preventing schizoaffective disorder just like there is no specific cure. 11.0 Complications and side effects of medications Complications associated with schizoaffective disorder are similar to those for major mood disorders and schizophrenia. Some of these complications are direct for example suicidal behavior resulting from psychotic and/or depressive symptoms, problems emerging from manic behavior like sexual indiscretion, spending sprees, and criminal activity and the use of unsanctioned drugs in an effort to self-medicate. Others are somehow indirectly caused by the disorder for example problems following medical therapy and treatment and, short-term problems and side effects arising from prolonged use of prescribed medications. A drug interaction is also one of these complications. An example of this is confusion or severe extrapyramidal reactions resulting from anti-psychotic-Lithium combinations. Prolonged use of some of the drugs like Benzodiazepines and sleeping pills can lead to dependency thereby exacerbating the psychotic conditions. Others lead to weight gain, excessive sleepiness and even diabetes. 12.0 History In 1863, Karl Kahlbaum, a German psychiatrist, explained schizoaffective disorders as a distinct group of disorders in his vesania typica circularis (Goodwin and Marneros, 2005). He differentiated between longitudinal and cross-sectional observations. In 1920, Emil Kraepelin, a psychiatrist observed that there were many cases of psychological disorders that had features of both groups of psychoses which he claimed were two separate and distinct illnesses namely manic depressive insanity, presently called recurrent depression and bipolar disorder and dementia praecox, currently called schizophrenia. Despite this identification, Kraepelin also acknowledged that there were several overlaps between severe mood disorders and schizophrenia. However, the term schizoaffective psychosis was first used in 1933 Jacob Kasanin, an American psychiatrist. He used the term to explain an episodic psychotic illness that was mainly characterised by affective symptoms. Marneros and Akiskal, (2007) reveal that the different forms of schizoaffective disorder were conceptualised in 1959 by Kurt Schneider, a psychiatrist who first observed concurrent and sequential types of schizoaffective disorder . He described schizoaffective disorders as psychological between mood disorders and the Kraepeliniantraditional dichotomy of schizophrenia. Recent developments in its definitions and differentiation from mood disorders and schizophrenia is the use of genetic composition of individuals who show the signs of schizoaffective disorder. DSM-I and DSM-II included schizoaffective disorder as a subtype of schizophrenia, DSM-III-R placed it in a group of psychological conditions known as “Psychotic Disorders Not Otherwise Specified". This version of DSM had its own diagnostic criteria as well as the bipolar, depressive and subtypes. Come 1994, the publication of DSM-IV placed schizoaffective disorders in the category of "Other Psychotic Disorders." The only difference with DSM-III was the inclusion of mixed bipolar symptomatology. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria defines it as a perplexing mental disorder that has both the features of a mood disorder, such as mania or depression, and features of schizophrenia, including delusions, hallucinations and distorted thinking. 13.0 Conclusion Schizoaffective disorder a mental disorder that causes mood problems and schizoaffective disorder . It is a mental condition affects emotion and cognition and is characterised by recurring episodes. Basically, the disorder is a characterised by both the symptoms of an affective/mood disorder and schizophrenia. Majority of those diagnosed with the disease are adults. Rarely are children diagnosed. Since it was first coined, schizoaffective disorder the definition of schizoaffective disorder has always been improved to include the more specific aspects of its like bizarre delusions, hallucinations, disorganized speech or paranoia and thinking patters marked by significant occupational and social dysfunction. The typical signs are the primary symptoms of schizophrenia and affective (mood) disorder. Accurate diagnosis of schizoaffective disorder is made when the patient meets the diagnostic criteria for schizophrenia and mania or major depressive disorder. Basing on the patient feedback on symptom reduction and side effects, and their clinical experience, the psychiatrist is able to identify the medications that will work best for each patient, either as antipsychotic-antidepressant combination or antipsychotic anti-depressant combination. The treatment choices for the condition are psychosocial rehabilitation, psychotherapy and pharmacotherapy and among these, most effective treatment intervention for this disorder is a combination of psychosocial interventions and appropriate drug treatment. References Antonius, D. Prudent, V. Rebani Y, et al.(2011). White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophr Res, 128(1-3), 76-82. Azorin, J. Kaladjian, A. and Fakra, E. (2005). [Current issues on schizoaffective disorder]. Encephale, 31(3), 359-365. Baethge, C. (2003). Long-term treatment of schizoaffective disorder: review and recommendations. Pharmacopsychiatry, 36(2), 45-56 Brown, A. Schaefer, C. Wyatt, R. et al. (2002). Paternal age and risk of schizophrenia in adult offspring. The American Journal of Psychiatry, 159(9), 1528–1533. D'Souza, D. Sewell, R. Ranganathan, M. (2009). Cannabis and psychosis/schizophrenia: human studies. 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