Running Head: Schizophrenia and Schizoaffective Disorders
Schizophrenia and Schizoaffective Disorders
Rachel Krogstie
Dr. Atwater
NUR
4/24/2015
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Schizophrenia and Schizoaffective Disorders
Schizophrenia and Schizoaffective Disorders
In the newest version of the Diagnostic Statistical Manual of Mental Disorders, the 5th
edition (DSM-5), made some notable changes to the diagnoses of schizophrenia and
schizoaffective disorder (Malaspina, et al., 2013). For example, for schizophrenia, there is no
longer a specific subtypes (Malaspina, et al., 2013). Also, in schizoaffective disorder, the
diagnosis goes from an episodic diagnosis to a lifetime diagnosis. This writer will briefly
describe the etiology, signs and symptoms, and treatment of both schizophrenia and
schizoaffective disorders.
Schizophrenia
Schizophrenia is a mental disease that affects a person’s thought processes, emotional
and social health, and decision making (National Alliance on Mental Illness, 2015). This illness
affects about 1% of the population of the United States (National Alliance on Mental Illness,
2015).
Etiology
Researchers have found no exact cause of schizophrenia. However, there are several
different theories on the etiology. Some of these theories include: genetics, environment, brain
chemistry, and drug use (National Alliance on Mental Illness, 2015).
Signs and symptoms
People who have mental illnesses experience signs and symptoms in different ways.
Clients with schizophrenia could experience symptoms like: hallucinations, delusions,
disorganized thinking, anosognosia, and various negative symptoms (National Alliance on
Mental Illness, 2015). Hallucinations can include auditory, visual, and olfactory disturbances
(National Alliance on Mental Illness, 2015). Delusions are false beliefs that do not change even
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when presented with new (or truthful) ideas (National Alliance on Mental Illness, 2015). This
can even manifest in anosognosia, or an unawareness of their illness (National Alliance on
Mental Illness, 2015). Schizophrenic clients also display negative symptoms such as flat affect or
dull speech (National Alliance on Mental Illness, 2015).
Treatment and Nursing Care
There are several different routes to treat schizophrenia, but the most common is the
pharmacological route. Anti-psychotic medications can relieve the symptoms of psychosis.
However, non-pharmacological routes can be just as effective, if not more effective. Nonpharmacological interventions can include psychosocial treatment, psychotherapy, and family
support (National Alliance on Mental Illness, 2015).
Schizoaffective Disorder
Schizoaffective disorder is a chronic mental health condition that is comprised of the
symptoms of schizophrenia and a mood disorder (National Alliance on Mental Illness, 2015).
Many people are misdiagnosed because this illness shares symptoms from many different
conditions (National Alliance on Mental Illness, 2015).
Etiology
Much like schizophrenia, researchers have not pinpointed an exact cause of
schizoaffective disorder. Some of the causes that may contribute to the development of this
illness are: genetics, brain chemistry and structure, stress, or drug use (National Alliance on
Mental Illness, 2015).
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Signs and symptoms
The signs and symptoms of schizoaffective disorder are a lot like schizophrenia except
with the added signs and symptoms of a mood disorder, like bipolar disorder with mania or
depression. The specific symptoms associated with schizoaffective disorder could be depressed
mood or manic behavior along with the common symptoms of hallucinations and delusions of
schizophrenia (National Alliance on Mental Illness, 2015).
Treatment and Nursing Care
There are two main therapies for schizoaffective disorder, medication and psychotherapy.
There is only one medication approved by the FDA to treat schizoaffective disorder, paliperidone
(Invega) (National Alliance on Mental Illness, 2015). However, there are several classes of
medication that can treat the symptoms, such as antipsychotics, antidepressants, and mood
stabilizers (National Alliance on Mental Illness, 2015).
Conclusion
In conclusion, while these two illnesses may look a lot alike, they are completely
different diagnoses. They have different treatments and managements, and now the DSM-5
reflects those changes. Some of the treatments have severe interactions or contraindications with
other treatments and should be monitored closely. It would behoove healthcare professionals, no
matter in which field they serve, to be aware of the clinical manifestations and treatments of
these illnesses.
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References
Malaspina, D., Owen, M. J., Heckers, S., Tandon, R., Bustillo, J., Schultz, S., . . . Carpenter, W.
(2013). Schizoaffective Disorder in the DSM-5. Schizophrenia Research. Retrieved from
http://dx.doi.org/10.1016/j.schres.2013.04.026
National Alliance on Mental Illness. (2015, March). Schizoaffective Disorder. Retrieved from
NAMI: National Alliance on Mental Illness: https://www.nami.org/Learn-More/MentalHealth-Conditions/Schizoaffective-Disorder
National Alliance on Mental Illness. (2015, March). Schizophrenia. Retrieved from NAMI:
National Alliance on Mental Illness: https://www.nami.org/getattachment/LearnMore/Mental-Health-Fact-Sheet-Library/Schizophrenia-Fact-Sheet.pdf
Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., . . . Carpenter, W.
(2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia
Research. Retrieved from http://dx.doi.org/10.1016/j.schres.2013.05.028
Townsend, M. C. (2014). Essentials of Psychiatric Mental Health Nursing. Philadelphia: F.A.
Davis Company.
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Appendix A: DSM-5 Criteria
Table 1
DSM-5 criteria for Schizoaffective Disorder
A. An uninterrupted period of illness during which there is a Major Mood Episode
(Major Depressive or Manic) concurrent with Criterion A of Schizophrenia. Note: The
Major Depressive Episode must include Criterion A1.
B. Depressed mood. Delusions or hallucinations for 2 or more weeks in the absence of a
Major Mood Episode (Depressive or Manic) during the lifetime duration of the illness.
C. Symptoms that meet criteria for a Major Mood Episode are present for the majority of
the total duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance or another medical
condition.
Specify whether:
Bipolar Type: This subtype applies if a Manic Episode is part of the presentation. Major
Depressive Episodes may also occur.
Depressive Type: This subtype applies if only Major Depressive Episodes are part of the
presentation.
With catatonia: This specifier, which applies to both 295.70 (F25.1) Schizoaffective
Disorder, with prominent depressive symptoms, and 295.70 (F25.0) Schizoaffective
Disorder, with prominent Manic Symptoms, may be used to specify a current episode
with at least three of the following: catalepsy, waxy flexibility, stupor, agitation, mutism,
negativism, posturing, mannerisms, stereotypies, grimacing, echolalia, and echopraxia.
(Tandon, et al., 2013)
Table 2
DSM-5 criteria for Schizophenia
A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). (1) Delusions At least one of these
should include 1–3
a. Delusions
b. Hallucinations
c. Disorganized speech
d. Grossly disorganized or catatonic behavior
e. Negative symptoms (Diminished emotional expression, etc.)
B. Social/occupational dysfunction: For a significant portion of the time since the onset
of the disturbance, one or more major areas of functioning, such as work,
interpersonal relations, or self-care, are markedly below the level achieved prior to
the onset (or when the onset is in childhood or adolescence, failure to achieve
expected level of interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6month period must include at least 1 month of symptoms (or less if successfully
treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods
of prodromal or residual symptoms. During these prodromal or residual periods, the
signs of the disturbance may be manifested by only negative symptoms or by two or
more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs,
unusual perceptual experiences).
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D. Schizoaffective and major mood disorder exclusion Schizoaffective disorder and
depressive or bipolar disorder with psychotic features have been ruled out because
either (1) no major depressive or manic episodes have occurred concurrently with the
active phase symptoms; or (2) if mood episodes have occurred during active-phase
symptoms, their total duration has been brief relative to the duration of the active and
residual periods
E. Substance/general mood condition exclusion Substance/general medical condition
exclusion: The disturbance is not attributed to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition.
F. Relationship to Global Developmental Delay or Autism Spectrum Disorder — If
there is a history of autism spectrum disorder or other communication disorder of
childhood onset, the additional diagnosis of schizophrenia is made only if prominent
delusions or hallucinations are also present for at least 1 month (or less if successfully
treated).
(Malaspina, et al., 2013)