Definition

Schizoaffective disorder is a mental disorder in the form of a combination of symptoms of schizophrenia and mood disorders. Schizophrenia is characterized by symptoms of psychosis, such as hallucinations and delusions; while mood disorders are characterized by drastic changes in mood, including depression and mania. Around 30% of schizophrenia cases occur at the age of 20-35 years and are experienced by women. In Indonesia, psychosis disorders have a prevalence of 1.8 per 1000 population. There are two types of schizoaffective disorder, namely:

• Bipolar type, including episodes of mania and major depression.
• Depressive type, includes only major depressive episodes.

Untreated schizoaffective disorder can disrupt work, school, and social situations, causing feelings of loneliness, and difficulty holding down a job, or attending school. Treatment can help reduce symptoms and improve quality of life.

Causes

The cause of schizoaffective disorder is still not known with certainty. However, there are several hypotheses regarding the causes of schizoaffective disorder, including:

• Genetic factors. Experts suspect that schizoaffective disorder can be inherited and is influenced by genetic structure. Parents can pass on schizoaffective traits to their children. Schizoaffective disorder can also affect other extended families.
• Neurotransmitters. A person with schizoaffective disorder has an imbalance of brain neurotransmitters, which are compounds that help communication between nerve cells. An imbalance of dopamine, norepinephrine, and serotonin can cause symptoms of schizoaffective disorder
• Brain structure. The composition and size of brain regions can influence the development of schizoaffective disorder.
• Environmental factor. Several environmental factors can trigger schizoaffective symptoms in someone who is at higher risk. This includes traumatic events, emotional trauma, or certain viral infections.
• Use of drugs. The use of psychoactive substances, such as marijuana, may contribute to the development of schizoaffective disorder.

Risk Factor

Several factors increase a person's risk of experiencing schizoaffective disorder, including:

• Having close relatives (such as parents or siblings) who have schizoaffective disorder, schizophrenia, or bipolar disorder.
• Experiencing a traumatic event that can trigger symptoms.
• Using drugs that affect the mind can make symptoms worse if you have other risk factors.

Symptoms

Symptoms of schizoaffective can vary from person to person. A person with schizoaffective will experience symptoms of psychosis, such as hallucinations or delusions, and mood disorders, such as depression or mania. These two symptoms occur together. Typical signs of schizoaffective disorder are an episode of major mood disturbance, in the form of depression or mania) and at least two weeks of persistent symptoms of psychosis after the episode of mood disturbance has disappeared.

Other signs and symptoms of schizoaffective include:

• Delusion, namely believing something to be a fact, even though there is clear evidence that it is false
• Hallucinations, namely hearing voices or seeing things that are not there
• Communication disorders
• Strange and unnatural behavior
• Symptoms of depression, such as feelings of emptiness, sadness, and uselessness
• Manic episodes, namely episodes of increased energy and a feeling of not needing sleep for several days. This episode is also followed by a change in behavior to become more enthusiastic and aggressive.
• Impaired academic, social and occupational functioning
• Unable to care for yourself

Diagnosis

To make a diagnosis of schizoaffective disorder, your doctor will ask about the symptoms you are experiencing, complaints, onset of symptoms, risk factors, and medications you are currently taking and have ever taken. There are no laboratory tests that can diagnose schizoaffective disorder. Follow-up examinations carried out serve to exclude the possibility of other medical conditions that can cause the same symptoms. If the doctor can rule out the possibility of a physical cause for the symptoms you are experiencing, your doctor will match the symptoms based on the Indonesian Guidelines for Classification and Diagnosis of Mental Disorders III (PPDGJ III) or Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Based on PPDGJ III, the diagnostic criteria for schizoaffective disorder include:

• Episodic disorders in which affective and schizophrenic symptoms are prominent simultaneously in the same episode or at least several days after the other. Associated with mood/affective disorders (F30-39) and schizophrenic disorders (F20-24)
• Episodes can occur in depressive, manic, or both forms

The classification of skizoafluctive disorders based on PPDGJ III includes:

• Manic Type Schizoaffective Disorder (F25.0)
  
  • Mood must be increased/increased irritability or restlessness and at least one or better two typical schizophrenic symptoms (F20.-)
• Schizoaffective Disorder Depressive Type (F25.1)
  
  • There must be prominent depression, accompanied by at least two typical depressive symptoms (F32.-) or behavioral abnormalities associated with a depressive episode (F32.-) and at least one or preferably two of the typical schizophrenic symptoms (F20.-) 
• Mixed Type Schizoaffective Disorder (F25.2)
  
  • Schizophrenic symptoms (F20.-) and mixed bipolar affective symptoms (F31.6)
• Other Schizoaffective Disorders (F25.8)
• YTT Schizoaffective Disorder (F25.9)

Management

Treatment of schizoaffective disorder requires a combination of medication, psychotherapy, and skills training. The drugs used function to stabilize mood and reduce psychotic symptoms. Therapy and skills training function to improve the quality of relationships and coping skills.

Medicines

The medicines used include:

• Antipsychotic. This drug is the main drug to reduce symptoms of psychosis such as delusions, hallucinations and false thinking.
• Antidepressants. Antidepressants or mood stabilizers can treat mood symptoms. In some cases, patients need antipsychotics and antidepressants simultaneously.

These medicines have side effects, including:

• Lithium can cause dizziness, loss of appetite, mild diarrhea, nausea
• Antidepressants can cause constipation, stomach pain, dry mouth, headaches, sexual problems, weight gain
• Antipsychotics can cause fatigue, increased lipid profile, increased body weight, motor disorders

Psychotherapy

During psychotherapy, a psychiatrist will conduct interviews and help someone with schizoaffective disorder to recognize their current condition, determine therapy goals, and help overcome daily problems related to their condition. Therapy sessions with the family can help the family recognize the condition they are experiencing and contribute to therapy.

Skills Practice

Schizoaffective disorder can affect a person's cognitive abilities, so skills training can help a person function more socially and productively. The exercises focus on daily activities such as money and home management, personal hygiene, and work.

Complications

Complications of schizoaffective disorder include:

• Suicidal ideation or attempt
• Isolation from social relationships
• Family or interpersonal conflict
• Don't have a job
• Experiencing anxiety disorders
• Higher risk of abusing alcohol and psychotropic substances
• Have significant health problems
• Experiencing financial difficulties

Prevention

Schizoaffective disorder cannot be prevented. However, early detection of these symptoms can help someone get a diagnosis and treatment more quickly. Quick treatment can help people with schizoaffective disorder experience relapse and hospitalization. This can also help reduce conflict in relationships and obstacles to carrying out daily functions.

Apart from experiencing schizoaffective disorder, people with schizoaffective disorder can also experience other conditions, such as anxiety disorders, substance abuse, attention deficit disorder, and Post-Traumatic Stress Disorder (PTSD).

When to See a Doctor?

If you notice symptoms of schizoaffective disorder in people around you or yourself, consult your doctor. Getting a diagnosis and treatment sooner can help control symptoms and improve quality of life. If someone around you commits self-harm and even ideas or attempts suicide, immediately visit the nearest health facility.

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