Schizoaffective disorder

Overview

• Schizoaffective disorder has symptoms of schizophrenia and bipolar disorder.
• You can experience psychosis with mania and depression.
• No one knows what causes schizoaffective disorder. Research shows that genetic and environmental factors can increase your risk of getting a mental illness.
• There are different types of schizoaffective disorder.
• Your mental health team should offer you medication and talking therapies.
• Your mental health team should help you to learn how to manage your symptoms, and you can find your own way too.

About

What is schizoaffective disorder?

Schizoaffective disorder is a mental illness that can affect your thoughts, mood and behaviour. You may have symptoms of bipolar disorder and schizophrenia. These symptoms may be mania, depression and psychosis.

About 1 in 200 people develop schizoaffective disorder at some time during their life. It tends to develop during early adulthood and is more common in women than men.

You can find out more information about:

• Psychosis by clicking here.
• Bipolar disorder by clicking here.
• Schizophrenia by clicking here.
• Depression by clicking here.

Diagnosis & symptoms

How is schizoaffective disorder diagnosed?

A psychiatrist will diagnose schizoaffective disorder after a mental health assessment. It might take more than one assessment for the psychiatrist to reach a diagnosis. You may get a diagnosis of schizoaffective disorder if you have depressive or manic symptoms with symptoms of schizophrenia.

Psychiatrists will use the following manuals to help to diagnose you:

• International Classification of Diseases (ICD-10) produced by the World Health Organisation (WHO)
• Diagnostic and Statistical Manual (DSM-5) produced by the American Psychiatric Association.

The manuals are guides which explain different mental health conditions and their symptoms. They also explain how long certain symptoms should last for before a diagnosis should be made.

To get a diagnosis of schizoaffective disorder you should have had a combination of symptoms of both psychosis and bi-polar disorder. Your symptoms should be clearly there for at least 2 weeks.

What are the symptoms of schizoaffective disorder?

Schizophrenia is a mental illness which affects the way you think. Symptoms can effect how you cope with day to day life. Symptoms include.

• Hallucinations. You may hear, see, or feel things that aren’t there.
• Delusions. You may believe things that aren’t true.
• Disorganised speech. You may begin to talk quickly or slowly, and the things you say might not make sense to other people. You may switch topics without any obvious link.
• Disorganised behaviour. You might struggle to organise your life, or stick to appointments, for example.
• Catatonic behaviour. You may feel unable to move or appear to be in daze.
• Negative symptoms. These are symptoms that involve loss of ability and enjoyment in life. They can include the following things.
  • Lack of motivation
  • Slow movement
  • Change in sleep patterns
  • Poor grooming or hygiene
  • Difficulty in planning and setting goals
  • Not saying much
  • Changes in body language
  • Lack of eye contact
  • Reduced range of emotions
  • Less interest in socialising or hobbies and activities
  • Low sex drive

You can find more information about ‘Schizophrenia’ by clicking here.

What are the symptoms of mania?

You may experience the following if you have mania.

• Feeling overly active, energetic or restless.
• Feeling more irritable than usual.
• Feeling overconfident
• Talking very quickly, jumping from one idea to another or having racing thoughts.
• Feeling elated, even if things are not going well for you.
• Being easily distracted and struggling to focus on 1 topic.
• Not needing much sleep.
• Thinking you can do much more than you can, which could lead to risky situations and behaviour.
• Doing things you normally wouldn’t which can cause problems. Such as spending lots of money, having casual sex with different partners, using drugs or alcohol, gambling or making unwise business decisions.
• Being much more social than usual.
• Being argumentative, pushy or aggressive.

Mania is associated with bipolar disorder.

You can find more information about ‘Bipolar disorder’ by clicking here.

What are the symptoms of depression?

You may feel the following if you have depressive symptoms.

• Low mood,
• Less energy, tired or ‘slowed down’,
• Hopeless or negative,
• Guilty, worthless or helpless,
• Less interested in things you normally like to do,
• Difficulty concentrating, remembering or making decisions,
• Restless or irritable,
• Sleep too much, not being able to sleep or have disturbed sleep,
• More or less hungry than usual or have a weight change, or
• Thoughts of death or suicide or attempt suicide.

You can find more information about ‘Depression’ by clicking here.

Types & causes

Are there different types of schizoaffective disorder?

There are 3 main types of schizoaffective disorder:

What is manic type?

This means you have symptoms of schizophrenia and mania at the same time through a period of illness.

What is depressive type?

This means you have symptoms of schizophrenia and depression at the same time through a period of illness.

What is mixed type?

This means you have symptoms of schizophrenia, depression and mania through a period of illness.

What causes schizoaffective disorder?

Psychiatrists don’t know precisely what causes schizoaffective disorder.

Research shows that genetic and environmental factors can increase your risk of developing the illness.

What are genetic factors?

Schizoaffective disorder is slightly more common if other members of your family have schizophrenia, schizoaffective disorder or bipolar disorder. This suggests that genetics may have a role to play in the development of schizoaffective disorder.

What are environmental factors?

Environmental factors are your personal experiences. It is thought that stress can contribute towards a schizoaffective episode. Stress can be caused by many different things such as bereavement, debt or employment problems.

It is thought that childhood trauma can be a factor in the condition developing in later life. Research shows that bad treatment in your childhood can make psychosis more likely.

There is information on self-help techniques further down this page. Self help can help you to manage your symptoms and stress.

You can find out more information 'Does Mental Illness Run in Families?' by clicking here.

Treatment

Who will manage my treatment?

There are different NHS mental health teams that can support and treat you. Health professionals from different backgrounds work in the teams shown below. They work together to help you get better.

What is an NHS Early intervention in psychosis team (EIT)?

An NHS Early intervention in psychosis team (EIT) can support you if you experience psychosis for the first time.

The National Institute for Health and Care Excellence (NICE) recommends that early intervention services should be open to people of all ages.

You should be referred to the EIT without delay. Your local EIT will aim to first see you within 14 days.

You can sometimes self-refer to your local EIT. This means that you can contact them and ask for help, without first seeing your GP or another medical professional. Sometimes your family or friends can refer you too.

You should be able to find your local EIT on the internet. You can use a use a search term like ‘NHS early intervention psychosis team Leicestershire’. Or you can call NHS 111 and ask for contact details for your local team,or ask your GP to refer you.

What is an NHS community mental health team (CMHT)?

A community mental health team (CMHT) can support you to recover from mental health issues. They can give you short or long-term care and treatment in the community. You might move from an Early intervention in psychosis team to a CMHT if you need longer term care.

You usually need to be referred to CMHT by your GP or another medical or social care professional.

What is an NHS crisis team?

A crisis team can support you if you are having a mental health crisis in the community. They offer short term support to help prevent hospital admission. They can arrange for you to go to hospital if you are very unwell.

A crisis team can also support you when you are discharged from a short stay in hospital.

You can get crisis support by:

• looking on your local NHS trust’s website for information,
• calling your local NHS urgent mental health helpline. Follow this link: www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline
• calling NHS 111, or
• talking to your GP.

Your local NHS urgent mental health helpline will tell you what you need to do to access your local crisis team.

What is an NHS assertive outreach team?

An assertive outreach team (AOT) may work with you if you are 18 or over and you need intensive support because of complex mental health needs. The team aim to give you support, so that you are able to get the treatment or care that you need from other services.

There isn’t AOTs in every area. You usually need your CMHT team to refer you to your local AOT team.

What is the Care Programme Approach (CPA)?

The Care Programme Approach (CPA) is a package of care that is used by mental health services. CPA should be available if you have a wide range of needs from different services or you are thought to be a high risk of harm. This is known as having complex care needs.

You will have a care plan and a professional to coordinate your care if you are under CPA. All care plans must include a crisis plan.

Not everyone who is supported by a mental health team will be under CPA.

You can find more information about ‘Care Programme Approach (CPA)’ by clicking here.

How can my GP support me?

If your symptoms respond well to treatment you can be referred back to your GP. You should be asked if you are happy for this to happen.

Your GP will monitor your symptoms and will do physical health checks with you. They can prescribe repeat medication that you need for your condition. But they should consult with a psychiatrist if your medication needs to be changed.

Your GP can refer you back to the mental health teams shown above if necessary.

You can find more information about ‘NHS mental health teams’ by clicking here.

What if I am not happy with my treatment?

If you aren’t happy with your treatment you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• ask a relative, friend or advocate to help you speak your doctor,
• contact Patient Advice and Liaison Service (PALS), or
• make a complaint.

There is more information about these options below.

What can I say to my doctor?

You should first speak to your doctor about your treatment. Explain why you aren’t happy with it, giving specific reasons. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you’re not given this treatment, ask your doctor to explain why they think it’s not suitable for you.

Can I get a second opinion?

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

You can find more information about ‘Second opinions’ by clicking here.

What is advocacy?

Advocates help you to deal with and overcome issues that you have. They are independent from the NHS and free to use.

They can be useful if you find it difficult to get your views heard. There are 3 types of advocates that might be able to help if you are unhappy about your treatment.

• NHS complaints advocates can help if you want to make a complaint to the NHS. These are available in all areas.
• Community or mental health advocates can support you to get a health professional to listen to your concerns. These are available in some areas only.
• Independent Mental Health Advocates can help and advise you if you’re detained under the Mental Health Act.

You can find more information about ‘Advocacy’, including how to find advocates, by clicking here.

What is the Patient Advice and Liaison Service (PALS)?

PALS is part of the NHS. They give information and support to patients and can help you to resolve issues.

You can find your local PALS through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

How can I complain?

If you are still unhappy with the issues you have with your treatment after speaking to your doctor, you can complain.

You can complain verbally or in writing. Make sure that you say that you are making a complaint.

You can find more information about ‘Complaints: NHS and social services’ by clicking here.

Selfcare

What are self-care and management skills?

You can learn to help manage your symptoms by looking after yourself. Self-care is how you take care of your diet, exercise, daily routine, relationships and how you are feeling.

What are peer support and self-management programmes?

Peer support means that you get support from people who live with mental illness too.

• You can get peer support by joining a support group, or
• You may be able to get peer support and self management programmes through your mental health team.

You can search for local support groups below:

• Rethink Mental Illness: www.rethink.org/about-us/our-support-groups
• Local Minds: www.mind.org.uk/about-us/local-minds/

Peer support through the community mental health team should be given by a person who has recovered from psychosis and is well.

Peer support and self-management programmes might be able to give you information and advice about:

• how medication can be helpful,
• help you to notice and manage your symptoms,
• how to access mental health support,
• how to access other support services,
• how to cope with stress and other problems,
• what to do in a crisis,
• help you to build a social support network,
• help you to notice when you are becoming unwell, and
• help you to set personal recovery goals.

What are recovery colleges?

Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college.

Recovery colleges aren’t available in all areas. To see if there is a recovery college in your area you can search in the internet. You can use a use a search term like ‘NHS recovery college Leicestershire’.

What is a Wellness Recovery Action Plan (WRAP)?

A Wellness Recovery Action Plan (WRAP) is a plan that you make to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them.

There is more information about the WRAP in the Further Reading section below.

Risks

What risks can schizoaffective disorder cause?

The risk of suicide is higher for the first few years after your symptoms start. You can seek treatment early and make a crisis plan. The right treatment can help control your symptoms and help to lower the risk of suicide.

You can make a crisis plan yourself or you can ask someone to help you. A crisis plan is a plan of action that you will follow to help with suicidal feelings. Usually a plan will include people, services and activities that can help you.

You can find out more about ‘Suicidal thoughts: How to cope’ by clicking here.

Carers

What if I am a carer, friend or relative?

What support can I get?

You can get support if you care for someone with schizoaffective disorder. These are some options for you:

• Family Intervention through the NHS
• Join a carers service
• Join a carers support group
• Ask your local authority for a carer’s assessment
• Read about the condition
• Apply for welfare benefits for carers

Rethink Mental Illness run carers’ support groups in some areas. You can also search for groups on the Carers Trust website:

• Rethink Mental Illness: www.rethink.org/about-us/our-support-groups
• Carers Trust – www.carers.org/search/network-partners;

How can I support the person I care for?

You might find it easier to support someone with schizoaffective disorder if you understand their symptoms, treatment and self-management skills.

You should be aware of what you can do if you are worried about their mental state or risk of self-harm. It can be helpful to know contact information for their mental health team or GP.

You could find out from your relative if they have a crisis plan. You could help your relative to make a crisis plan if they don’t have one.

You can find out more information about:

• Supporting someone with a mental illness by clicking here.
• Carers assessment – Under the Care Act 2014 by clicking here.
• Benefits for carers by clicking here.
• Getting help in a crisis by clicking here.
• Suicidal thoughts - How to support someone by clicking here.
• Responding to unusual behaviour by clicking here.
• Confidentiality and information sharing - For carers, friends and family by clicking here.

Further reading

Wellness Recovery Action Plan (WRAP) Plus. Formerly living without Depression and Manic Depression - Mary Ellen Copeland, PhD.

The Wellness Recovery Action Plan® or WRAP® is a self-designed wellness process. You can use a WRAP to get well, stay well and make your life your own. It was developed in 1997 by a group of people who were searching for ways to overcome their own mental health issues and move on to fulfilling their life dreams and goals.

Website: www.mentalhealthrecovery.com

Useful contacts

The Hearing Voices Network
This service gives support and understanding for those who hear voices or experience other types of hallucination.

Address: 86-90 Paul Street London EC2A 4NE
Email: info@hearing-voices.org
Website: www.hearing-voices.org