Formalized diagnosis of bipolar affective disorder in patients with paroxysmal schizophrenia and schizoaffective disorder

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Schizoaffective disorder is an endogenous mental disorder, the symptoms of which simultaneously resemble the symptoms of both schizophrenia and affective psychoses. It is characterized by impaired thinking and unregulated emotions. May include disorganization of speech, hallucinations, and paranoid delusions. The diagnosis of the disease is made based on observation if a person has simultaneously signs of bipolar disorder, depression and schizophrenia, but there are no clear criteria for each of these deviations. The pathology usually manifests itself at a young age and is treated by a psychiatrist.

Causes of schizoaffective disorder

The exact causes of the pathology are unknown, like many other mental disorders, but there are several individual characteristics of the body that increase the likelihood of developing schizoaffective disorder. Most often it is observed in individuals with a hereditary predisposition.

Researchers have identified a risk gene that causes the development of schizophrenia. But under certain conditions, it is in a “dormant state” and begins to manifest itself after exposure to severe stress, severe somatic illness, etc. In addition, the appearance of this gene in the fetus may be due to mutational processes. There is also an assumption of the etiological and pathogenetic similarity of this disease and epilepsy, since in both cases there is a periodicity of manifestations and characteristic changes in the electrical activity of the brain on the EEG.

Provoking factors for the development of schizoaffective disorder can be:

• low social status;
• hunger and poverty;
• hostilities;
• forced migration;
• complete loneliness and lack of help from other people;
• alcohol and drug use.

In the case of the use of psychoactive drugs and alcohol, the possibility of developing this mental disorder increases. At the same time, people with this pathology also often have chemical dependencies, with the help of which they try to get away from their painful sensations, but this only aggravates the process of degradation. To determine what is primary – a mental illness or an addiction to alcohol or drugs, an experienced specialist and monitoring of the patient’s condition in a psychiatric hospital are required.

Dr. Isaev’s clinic has all the conditions for conducting differential diagnosis and providing professional assistance for schizoaffective disorder. For more detailed information, you just need to call the number listed on the website.

Treatment

Unfortunately, it is impossible to give an absolute guarantee that anyone close to you will not have to face such a life difficulty as the treatment of sluggish schizophrenia or any other type of schizophrenia. Unfortunately, modern society is quite cruel to a person suffering from such an illness, and patients are very often left behind in life. The social environment of such people is afraid and abstracts from them, relatives become desperate in unsuccessful attempts to cure the patient, and schizophrenics still cannot understand what is really happening to them. It would be wrong to think that society is divided into mentally ill and mentally healthy. After all, no one has the right to set absolute boundaries of normality.

Types of Schizoaffective Disorder

Depending on the predominance of a particular clinical picture, the following types of shazoaffective disorder are distinguished:

• manic;
• depressive;
• mixed;
• unknown etiology;
• other types of deviation.

The manic type is difficult, and the prognosis is often unfavorable. Such a person poses a danger during an exacerbation period and requires placement in a psychiatric ward. The depressive form of the disorder resembles prolonged or moderate clinical depression. In the mixed type, signs of schizophrenia and a picture of affective disorders are noted. Symptoms of schizoaffective disorder begin with the pre-manifest stage, then the attack itself is observed, and after that a remission of varying duration occurs. On average, the acute period lasts for 6-8 months.

Any form of schizoaffective disorder requires timely help. If such a problem has arisen in your family, call us and an experienced specialist will tell you what can be done in this case.

Types of BAR

In the modern classification of the disease, the following types are distinguished:

• unipolar – pronounced phases of depression or the manifestation of only manic episodes;
• correctly intermittent - alternating episodes of mania and depression, separated by an intermission phase (restoration of normal mental activity);
• incorrectly alternating – depressive and manic episodes alternate through interphase without observing the order;
• double type – a change of episodes without intermission followed by a period of restoration of normalcy;
• circular – absence of a stable mental state with successive changes in episodes of mania and depression.

Schizoaffective disorder: symptoms

The first symptoms of this mental disorder are usually observed in adults; children, as a rule, do not suffer from it; the pathology is more often described in women. The first attacks, reminiscent of schizophrenia, alternate with affective manifestations and delusions, while relatively preserved social adaptation and ability to work are observed. Sometimes, at first, emotional disturbances come first, which are replaced by delusions and hallucinations. In some cases, deviations occur simultaneously, and then diagnosis does not cause difficulties.

Schizoaffective disorder refers to transient conditions of an endogenous nature. In this case, disturbances of the emotional type prevail over productive symptoms. The attack is characterized by significant polymorphism of manifestations; its structure includes depressive-paranoid and manic-paranoid types of attack.

The main symptom accompanying schizoaffective disorder is frequent changes in the patient's mood. This happens suddenly, unpredictably and cannot be controlled. After that, attention deficit disorder, hallucinations, and a person’s ability to control their behavior are added to the overall picture. He ceases to understand the difference between reality and his own far-fetched illusions; imagination begins to play the leading role. The disease can manifest itself as pronounced deviations that become noticeable to everyone around, or it can occur in an erased form, when the changes are visible only to those close to you. Typically, schizoaffective disorder is accompanied by the following symptoms:

• depression;
• depression;
• loss of appetite;
• change in body weight;
• addiction to drinking alcohol;
• disturbance of the alternation of sleep and wakefulness;
• lack of interest in what is happening around;
• weakness, loss of strength;
• self-flagellation, decreased self-esteem;
• decreased concentration;
• lack of control over thoughts and actions;
• inadequate emotional reaction;
• suicidal tendencies, thoughts of death;
• strange behavior.

A person with schizoaffective disorder suffers from hallucinations, stops performing simple hygiene procedures, and develops obsessive ideas. The acceleration of thought processes leads to the fact that speech becomes fast, words seem to be layered on top of each other, endings are swallowed.

When the first signs of schizoaffective disorder appear in a loved one, you should not expect the problem to solve itself. The sooner you seek help, the more effective the therapy will be.

In depressive-paranoid types of attacks, the pathology manifests itself in the form of decreased mood and delusions of self-deprecation, ideas of poisoning, destruction, the presence of a fatal incurable disease, and sinfulness. A person suffers from apathy, depression, insomnia. A severe form of the seizure is manifested by depressive oneiroid or stupor. Depressive attacks, if left untreated, can result in the development of addiction or attempted suicide.

The manic form of the attack is accompanied by a decreased need for sleep, unbridled joy, agitation that does not correspond to the situation, and ideas of one’s own importance and greatness. With severe psychosis, delusions of fantastic content and other productive schizophrenia-like symptoms appear. There is a decrease in concentration, increased energy, and inappropriate social behavior due to disinhibition of the nervous system. Clinical manifestations do not appear immediately, but gradually increase in intensity. Sometimes there are ideas of persecution and pronounced aggressiveness, in which a person begins to pose a danger to those around him.

Mixed states represent frequent fluctuations from hypomania and mania to depression. These affects are accompanied by delusions, which contain the theme of the struggle between good and evil with auditory hallucinations of a positive and negative type. They are contradictory and often mutually exclusive in meaning. The mixed type of schizoaffective disorder manifests itself in the form of alternating depressive-paranoid and manic-paranoid disorders (happiness-fear psychosis).

During the period of remission, a person does not have an emotional-volitional defect; after an acute attack, residual symptoms of schizophrenia or affective deviations persist for some time.

Main symptoms of schizophrenia

Schizophrenia is a complex and multifaceted disease with many symptoms. They are divided into two groups - positive and negative. The first indicate mental activity. This includes delusions and hallucinations. The latter are characterized by declines in mental tone. In this case, signs are observed that are also included in the symptoms of bipolar disorder:

• apathy and indifference;
• increased anxiety;
• outbursts of anger;
• motor or speech agitation;
• insomnia, nightmares;
• sudden mood swings.

The intensity of symptoms is determined by the type and form of schizophrenia. Thus, a sluggish one can develop for years, practically without manifesting itself, while a paranoid one usually has an acute and rapid development.

Signs of affective disorders

Clinical symptoms of schizoaffective disorder include mood disturbances and schizophrenic features. The degree of their expression is approximately the same, while they alternate or are observed simultaneously. Deviations of an emotional nature are:

• manic;
• depressed;
• agitated.

During mania, a person feels a surge of energy and strength, is always in a great mood, even to the point of euphoria, and is constantly busy doing something. His thinking speeds up greatly and he has difficulty trying to concentrate on a specific job, and problems with concentration arise. His speech becomes fast and incomprehensible due to constant jumping from one topic to another. The patient feels able to “move mountains.”

One of the variants of mania is increased irritability and anger. The person becomes aggressive, behaves rudely with other people, is rude, interrupts, and counteracts. Often this state accompanies the delirium of saving humanity from an alien invasion or another fictitious global problem of the world level.

When depressed, the patient loses his appetite, and sometimes he does not even have the strength to get out of bed. The pace of thinking processes slows down, a person feels melancholy and engages in self-flagellation, and does not find any sources of joy in life. If help is not provided in time, then during this period the likelihood of suicide greatly increases. A subtype of depression is considered to be agitation, when the patient’s sharply depressed mood is masked by active and unproductive activity, which is chaotic in nature.

Signs of schizophrenia

Typical signs of schizophrenia in schizoaffective disorder include:

• delusional ideas;
• hallucinations.

The patient's delirium usually corresponds to his mood. With depression, ideas of one's own worthlessness and uselessness arise. Sometimes hatred appears towards family and friends, as well as towards humanity as a whole. If mania develops, the patient insists on his greatness, considers himself perfect, is confident in his own superpowers, and points to the mission entrusted to him to save the world.

Hallucinations in schizoaffective disorder are usually auditory, but can also be visual or tactile. During an exacerbation, a person sees something that is not really there or hears non-existent voices and sounds. The situation is greatly complicated by concomitant catatonia, usually in the form of stupor.

Which is more dangerous?

Many people are interested in what is worse - bipolar disorder or schizophrenic psychopathology. The question is not very correct, however, in simple terms, bipolar disorder is not that dangerous. It does not lead to personality disintegration. Schizophrenia can completely destroy it, as a result of which a person will forever remain in his inner world.

Differential diagnosis of schizoaffective disorder

Since schizoaffective disorder includes symptoms of schizophrenia and manic-depressive psychosis, it is important to distinguish between these diseases. Schizophrenia is a severe chronic mental illness in which remission is difficult to achieve and complete recovery is impossible. It differs from schizoaffective disorder in the absence of a residual defect in the period after an exacerbation. In this case, we mean passivity, apathy, desocialization, flattening of emotions.

The bipolar state is accompanied by mood swings, but does not lead to a decrease in socialization. Its similarities with schizoaffective disorder include the following symptoms:

• episodic manifestation;
• being in a depressed or highly excited state;
• severe anxiety.

The difference is that with schizoaffective disorder, productive symptoms are present simultaneously with affective deviations. Therefore, it is impossible to immediately diagnose this pathology even with knowledge and experience. This is especially difficult if the disease does not immediately develop with signs of schizophrenia and affect during the next exacerbation. It is possible to verify the presence of the disease only after some time, and this requires constant medical supervision.

Risk factors

The differences between bipolar disorder and schizophrenia can be found through differential diagnosis and long-term observation of symptoms. If we talk about risk factors and causes of these psychopathologies, they are largely similar. The fact is that the etiology of both disorders is unknown.

In most cases, we are talking about genetic predisposition. First of all, doctors find out whether there are people in the patient’s family with mental disorders. The closer the degree of relationship, the higher the risk of disease.

Schizoaffective disorder: drug treatment

Therapy for schizoaffective disorder at Dr. Isaev’s clinic includes the use of medications to relieve symptoms and psychotherapy. If the patient shows severe aggression during an attack, he is hospitalized until a stable condition is achieved. Taking medications is the main form of assistance for this disease, while working with a psychologist is considered no less important, but auxiliary.

To treat and eliminate negative symptoms, the following are usually prescribed:

• antipsychotics, they eliminate delusions, hallucinations and other symptoms of psychosis;
• anxiolytics for sleep disturbances and severe anxiety;
• antidepressants, which stop low mood, apathy, a feeling of uselessness, the desire for one’s own death, encourage action;
• mood stabilizers to normalize mood in case of low mood or manic disorder;
• sleeping pills that help normalize a good night's rest.

Acute psychosis with this deviation is usually treated with a combination of two or more medications. But it is best for the doctor to select a dose with constant observation, and therefore the person needs to stay in the hospital for some time. After achieving remission, the patient begins outpatient treatment with periodic visits to a psychiatrist. He comes to see him or a specialist is called to his home for a routine inspection.

In our clinic, only proven, certified drugs are used to treat schizoaffective disorder. They give the desired result and at the same time have minimal side effects.

If a person has schizoaffective disorder and dependence on alcohol and psychotropic drugs, then in this case a narcologist is involved in the therapy process, since chemical addictions greatly aggravate the condition and reduce the effectiveness of treatment.

Application of psychotherapy

Psychotherapy for patients with such a diagnosis is an auxiliary method of providing assistance; it accelerates the effect that can be achieved by precise selection of medications, consolidates the result, prolongs remission, and adapts the person to a society of healthy people. Talk therapy is often used for schizoaffective disorder. It allows you to better understand your condition, understand your own feelings and reduce their influence, identify negative attitudes that provoke destructive behavior, and replace them with constructive thoughts and actions. For this purpose, cognitive-behavioral techniques are used for individual lessons and work in groups. If the cause of the disease is psychotrauma at a young age, psychodynamic therapy is used.

If the patient is unable to express all his problems, art therapy is of great help. Taking part in art, music, or dance can help you express yourself and cope with current triggers for your attacks. Family therapy plays a leading role in the treatment of schizoaffective disorder, which allows one to influence the home environment. Thanks to the participation of loved ones in the treatment process, they can understand:

• the feelings that the patient experiences;
• what actions on their part help or hinder recovery;
• what needs to be done to make positive changes.

Many relatives behave incorrectly towards a mentally ill person. With their hypertrophied care, they cause or strengthen his feeling of inferiority. Understanding his problem, but at the same time constantly recognizing himself as weak and incompetent, the patient only aggravates his difficult situation. Thanks to family psychotherapy, a person understands how his condition and signs of the disease can affect those who live nearby. After treatment, all family members begin to act together, directing their efforts to eliminate existing difficulties and problems, and work on a strategy to prevent the next exacerbation of the pathology.

A person who has been diagnosed with schizoaffective disorder, if he contacts Dr. Isaev’s clinic in a timely manner, has the opportunity to completely get rid of the manifestations of the disease. Qualified specialists help a person with this diagnosis reduce the number of attacks and increase the time of remission for a long time.

Psychotherapeutic techniques aim to remove not only causative factors, but also reduce the likelihood of stressful effects. Work with a specialist begins after the acute attack has stopped, otherwise the doctor will not be able to achieve full contact and awareness of the problem. In general, the prognosis for this disease is favorable, but the outcome depends on the timeliness of the start of treatment and the characteristics of affective and schizophrenic manifestations.

The use of psychotherapy significantly increases the effectiveness of drug treatment. The specialist’s job is to detect hidden factors that provoke attacks, eliminate them or reduce their impact. A person is aware of the reasons for the development of deviations and understands their destructiveness. Family psychotherapy also plays a significant role, thanks to which mutual understanding between the patient and close relatives improves.

Manic-depressive psychosis (bipolar disorder) - symptoms and treatment

Treatment for bipolar affective disorder should be carried out by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.

According to clinical recommendations adopted by the Russian Society of Psychiatrists, treatment of bipolar disorder is divided into three main stages:

• relief therapy - aimed at eliminating existing symptoms and minimizing side effects;
• maintenance therapy - maintains the effect obtained at the stage of stopping the disease;
• anti-relapse therapy - prevents relapses (the occurrence of affective phases).

Drug treatment of bipolar disorder

For the treatment of bipolar disorder, drugs from different groups are used: lithium drugs, antiepileptic drugs (valproate, carbamazepine, lamotrigine), antipsychotics (quetiapine, olanzapine), antidepressants and tranquilizers.

Psychotherapy for bipolar disorder

Psychosocial support and psychotherapeutic measures can significantly help in the treatment of bipolar disorder. However, they cannot replace drug therapy. Today, there are specially developed techniques for the treatment of ARB, which can reduce interpersonal conflicts, as well as somewhat “smooth out” cyclical changes in various environmental factors (for example, daylight hours, etc.).

Various psychoeducational programs are carried out with the aim of increasing the patient’s level of awareness about the disease, its nature, course, prognosis, as well as modern methods of therapy. This contributes to the establishment of a better relationship between the doctor and the patient, adherence to the treatment regimen, etc. Some institutions conduct various psychoeducational seminars, which cover the issues outlined above in detail.

There are studies and observations showing the effectiveness of using cognitive behavioral psychotherapy in conjunction with drug treatment. Individual, group or family forms of psychotherapy are used to help reduce the risk of relapse.

Today there are cards for self-registration of mood swings, as well as a self-monitoring sheet. These forms help to quickly monitor changes in mood and promptly adjust therapy and consult a doctor.

Phototherapy for bipolar disorder

Phototherapy is widely used for seasonal affective disorder (SAD). There is no scientifically based evidence that the method helps with bipolar disorder, but it is assumed that SAD and bipolar disorder can be combined with each other. Phototherapy is often used because it is relatively safe, but it must be remembered that the method will not help with affects.

How to prevent rapid cycling

The rapid change of phases can be prevented only by medicinal methods. First of all, mood stabilizers are used (one or two drugs). Patients with bipolar disorder should not take antidepressants, which lead to rapid phase changes, so it is very important that the drugs are selected by a doctor.

Is it possible to completely recover from bipolar disorder?

Maintenance therapy is recommended for life, because symptoms of the disease may return over time. However, if the patient insists and stable remission is observed, then the medications can be discontinued. You should stop taking medications gradually and only under the supervision of a psychiatrist.

Bipolar disorder in pregnancy

Separately, it should be said about the development of bipolar disorder during pregnancy. This disorder is not an absolute contraindication for pregnancy and childbirth. The most dangerous period is the postpartum period, during which various symptoms can develop.

The issue of using drug therapy during pregnancy is decided individually in each specific case. It is necessary to assess the risk/benefit of using medications and carefully weigh the pros and cons. Psychotherapeutic support for pregnant women can also help in the treatment of ARB. If possible, medications should be avoided during the first trimester of pregnancy.[5][7]

Questions and answers

Can schizoaffective disorder be completely cured?

With a mild form of the pathology, stable remission can be achieved for many years. Properly selected therapy can stop their manifestations even with severe attacks and preserve the person’s ability to work. In general, the prognosis in each specific case is individual and depends on many factors.

Is it possible to identify schizoaffective disorder in a loved one?

The symptoms of this disease are very similar to other mental disorders, so only an experienced doctor can make a diagnosis. To do this, it is best to hospitalize the patient and observe him over time.

Symptoms

With such an illness as sluggish schizophrenia, symptoms quite often begin to appear in adolescence, but specific manifestations are revealed somewhat later. The long-term, gradual progression of the disease goes along with gradual personal deformations, but many patients with sluggish schizophrenia still manage to, in some sense, curb their illness and maintain the necessary level of social behavior and adaptation throughout their lives. The line between ordinary and low-progressive schizophrenia is very small. Slightly progressive schizophrenia is characterized by a high frequency of nervous and mental disorders. And in the first option, deviations in associative thinking predominate: a decrease in affective perception, a deficit of social interaction, deformation of associations and an ambivalent attitude towards many things. Considering ambivalence to be the main symptom of schizophrenia, it is divided into three types: emotional, volitional, and intellectual areas.

If you begin to notice any of the above symptoms in a loved one, you should immediately contact the Rehab Family clinic for highly qualified help.