SCHIZOAFFECTIVE
DISORDER
Of all the categories of psychiatric
illness, schizoaffective disorder has the distinction of being the most complex
and controversial. . This mental illness
seems to be neither fish nor fowl, but a mixture of mood disorder and
schizophrenic symptoms. At
Mentalwellness.com the experts say, "People suffering from schizoaffective
disorder experience a chronic roller-coaster
ride of symptoms and problems that may be more difficult to cope with than either
of its parent diseases, schizophrenia or affective disorders (formerly known as
mood disorders.) .
THE HUMAN FACE OF THE ILLNESS
A lady from Moncton, New Brunswick,
has schizoaffective disorder. She
suffers a lot of mental anguish and has to live in a special care home. Her first episode of the illness started when
she was 23 year old when she was working at a
restaurant. She had to be hospitalized. Joanne says, "I felt scared,
paranoid." Her
second breakdown occurred in her thirties.
She remembers, "I was really sick.
What happened was I was working doing some housework for my aunt. I looked at the wall and there was this big
hole. I saw Jesus and His hair was
moving. I hallucinated. I saw snow inside the house. In the sky I saw a horse with wings ... I was
scared to go out in the public. I had
anxiety attacks. I had a prayer in my hand
and I told my parents that I was going to heaven and they said, 'That's it
we're taking you to the hospital.' "(The doctor) told me that I was
schizoaffective with a chemical imbalance." She complains of insomnia and nightmares
along with the hallucinations, anxiety attacks, depressions, suicidal episodes,
and feeling of fear.
The voices in her head tell her
to kill people, but she strongly fights the urge. She spends her days going to two activity
centers for the mentally ill and at night the staff at the special care home
supervise her.
SCHIZOAFFECTIVE
DISORDER DEFINED
The basic definition of schizoaffective
disorder that guides the professionals is the DMS-IV description of the
illness. The DSM-IV diagnostic criteria lists
three basic requirements for schizoaffective disorder. These are "A. An uninterrupted period of illness which, at
some time, there is either a major depressive episode, a manic episode, or a
mixed episode concurrent with symptoms that meet Criterion A for schizophrenia
(delusions, hallucinations, disorganized speech, grossly disorganized behavior
or actinia, and negative symptoms such as affect flattening ) 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." A schizophrenic may
experience depression in the aftermath of a psychotic episode, but the thought
and moods disorder are not concurrent. "Jacques Gallant, a psychiatric
nurse who works in Moncton at the Mental Health Clinic comments, "When you
see a schizophrenic person you see a person with delusions and hallucinations
mostly. Not saying that schizoaffective
disorder does not have that, but that this is not the main feature of the
illness. "Gallant also mentions that the depression or mania would be of
longer duration in a person with schizoaffective disorder.
AN
OVERVIEW OF TREATMENT OPTIONS
Untreated
schizoaffective disorder can leave the victim homeless, alone, and without
money, so that along with the medications the patient also needs housing,
psychotherapy, community support, and recreational opportunities. Since schizoaffective disorder appears to be
a combination of thought disorder, mood disorder, and anxiety disorder the
medication regime given is usually a combination of antipsychotic,
antidepressant, and ant anxiety drugs.
Psychiatric nurse, Jacques Gallant comments: "If the person is in a
manic state then you would give mood stabilizers. If the person is in a psychotic state, then
you would give antipsychotic. Usually
most of the time you would combine the two treatments together if it's clearly
known that the person suffers from schizoaffective disorder. " Gallant
goes on to mention that mood stabilizers like Epival, lithium, and Tegretol are
often used along with minor tranquilizers like Clonazepam, and atypical
antipsychotics like Olanzapine. Joanne
is on Tranxene (a seditive), Lamictal (a mood stabilizer), Effexor (an
antidepresant), and Risperdol (an antipsychotic). Some patients who are noncompliant with the
drug therapy end up being given long acting inject able d
drugs such as Haldol, Pipotiazine,
or Fluphenazine. Dr. Pillip W. Long
(www.mentalhealth.com) cautions against using the older
antidepressants, as he feels they worsen schizoaffective disorder.
In acute phases of the illness the patient
may need 24 hour care in a hospital or a residential setting. However, the goal is to integrate the person
back into the community as soon as possible and to encourage independent
living. Some
individuals with this illness
manage to work.
CONCLUSION
The National Alliance for the Mentally Ill
(NAMI) states that, "Because schizoaffective disorder is so complicated,
misdiagnosis is common. Some people may
be misdiagnosed as having schizophrenia.
Others may be misdiagnosed as having bipolar disorder. As a practical matter, differentiating
between schizophrenia, bipolar disorder, and schizoaffective disorder is not
absolutely critical, since antipsychotic medication is recommended for all
three ... The prognosis for individuals
diagnosed with schizoaffective disorder is generally better than for those
diagnosed with schizophrenia, but not
quite as good for those diagnosed with a mood disorder." Although schizoaffective disorder is challenging
for the therapist and agonizing for the patient the advent of newer, atypical
antipsychotics seem to be more comfortable for the patient and provide a
brighter outlook for the future.
SELF
HELP
What can the patient do to make the best
possible recovery? Information from --
the New York Presbyterian Hospital states that the person should do the following:
-- Accept that you have a
prolonged illness
--Identify your strengths and
limitations
--Make clear realistic goals
--After a relapse, go slowly and
gradually back to your responsibilities.
--Plan a regular, consistent,
predictable daily routine.
--Make your home as quiet, calm
and relaxed as you can.
--Identify and reduce
stress. Make only one change in you life
at a time.
--Work toward an active and
trusting relationship with the staff involved in you care.
--Take your medicines regularly,
as prescribed.
--Identify early signs of
relapse. Make your own early warning
list.
--Get involved with a group of
people you feel comfortable with.
--Avoid street drugs.
--With or not you drink alcohol
is a very personal decision you should make with
your doctor.
--Eat a well balanced diet.
--Get enough rest.
--Get regular exercise.
--If you're not sure whether your
feelings or fears are based in reality, ask someone
you trust or compare your behavior with others.
--Accept that there may be
setbacks from time to time.
On the Internet many links that provide
information on schizoaffective disorder can be found at:
