Posted by med_empowered on October 10, 2005, at 9:31:16
In reply to Re: schizoaffective - huh?!, posted by xjs7 on October 10, 2005, at 0:11:50
hey! Schizoaffective disorder has been used now and then as a diagnosis since the 30s, I think. What happened in psychiatry is that at some point, psychosis was split up: there was manic-depressive psychosis, and there was schizophrenic psychosis. Obviously, diagnoses like these are good and well in the abstract, but real people are much, much more complicated. Certain people just don't fit the mold--people with psychotic depression, schizophrenia with lots of mood symptoms, etc. So..schizoaffective disorder kind of arose as a "half-way" diagnoses between bipolar and schizophrenia (there's a lot of overlap between the two). I don't know how diagnosis works in the UK, but here in the US schizoaffective basically means there's pronounced depression (depressive-type) or bipolar-ish symptoms (bipolar-type)...in addition, there needs to be a period of at least 2 weeks when there are prominent psychotic symptoms without the presence of any major mood symptoms. So...basically, the diagnosis is supposed to bridge the gap between "affective" (mood) disorders (which can have psychotic symptoms secondary to the mood problems) and "psychotic" disorders, which are primarily based upon psychotic symptoms with mood problems at most being secondary. In the US, schizoaffective is a relatively rare diagnosis--about 1/200 people get the DX at some time, so its about 1/2 as frequent as Bipolar I or schizophrenia--but it seems to be becoming more popular. I think this is because psychiatry is finally revisiting something patients have known for a long time: when psychosis is part of the picture, there can also be very real mood disorders that are just as problematic and severe as the psychosis. Hence you'll hear cases of "classic schizophrenia" (lots of psychosis, no apparent mood disturbances) and "moody schizophrenia" (baffling mix of mood and psychotic issues)...there's also "bipolar I with psychotic features," which is just a psychosis-heavy form of Bipolar I. Its a tricky diagnosis; some shrinks don't use it at all, and there's disagreement over what exactly it means--some consider it primarily a form of schizophrenia, some a disorder all its own, and some place it more on the bipolar spectrum of things. To complicate matters, patients with bipolar disorder (and I think severe, psychotic depression) sometimes have "schizoaffective episodes" in which psychosis pops up w/o really prononced mood problems; sometimes this results in a change of diagnosis, and sometimes it doesn't. In terms of treatment...schizoaffective disorder is usually treated with an antipsychotic, with other stuff added as deemed necessary (lithium, depakote, benzos, antidepressants, etc.). However...some patients, particularly those who lean more towards the bipolar end of the spectrum, can be maintained pretty well on conventional mood-stabilizers such as depakote (its worth noting that mood-stabilizers can be used to control psychosis in bipolar disorders, and some people diagnosed as schizophrenic can do fine with a mood-stabilizer and no long-term neuroleptic treatment...others require a neuroleptic along with a mood-stabilizer). You seem confused as to why exactly you've been labelled "schizoaffective". Both schizophrenia and schizoaffective are kind of mushy diagnoses--when you look at the patients given those diagnoses, there's a whole lot of variation among them in terms of symptoms and outcome. Plus, the criteria by which schizophrenia and schizoaffective are diagnosed have changed with pretty much every edition of the DSM (the psychiatric "bible")...lots of patients diagnosed with "schizophrenia" by one doc will be diagnosed as bipolar by another or given a label of some other sort of mood-disorder. I wholeheartedly agree with the poster who suggested getting a very thorough checkup to make sure there's nothing wrong physically. Also, if mood symptoms are a big part of the picture and you have any doubts about your need for neuroleptics and/or neuroleptics dont work well for you, or they cause lots of problems, you might want to try a more bipolar-type medication schedule based on a mood-stabilizer instead of a neuroleptic. I myself was mis-diagnosed with schizophrenia by an incompetent shrink; turns out, I just have an "unusually complicated" mood-disorder. Some articles I've read have quoted docs recommending that patients initially diangosed with schizophrenia or schizoaffective go through thorough trials with different mood-stabilizers before resorting to long-term neuroleptic treatment. I think that's a reasonable recommendation. Good luck!
poster:med_empowered
thread:564018
URL: http://www.dr-bob.org/babble/20051010/msgs/565201.html