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Schizoaffective Disorder

Reviewed by Psychology Today Staff

Schizoaffective disorder is a thought disorder that includes both psychotic features, as seen in schizophrenia, and mood symptoms that may be either depressive or manic in presentation. There are two types of the disorder, one is the bipolar type and the other is the depressive type.

The psychotic and mood symptoms may occur together or at different times. Schizoaffective disorder is diagnosed in fewer people than schizophrenia: Approximately 1 percent of the population worldwide will be diagnosed with schizophrenia; .3 percent with schizoaffective disorder. Because the prevalence of the disorder is low and because it includes both mood and psychotic features, the disorder can be difficult to diagnose.

While at least two primary criteria for schizophrenia must be present, an important distinction is that people with schizoaffective disorder are more functional in terms of self-care and in their ability to interact with others. The onset of the disorder may be seen in the late teenage years to early adulthood, and even sometimes until age 30.


To be diagnosed with schizoaffective disorder, the DSM-5 states that at least two psychotic symptoms must be present, as well as mood symptoms of a specific duration.

The symptoms of psychosis, which are identical to the primary criteria for schizophrenia, include:

  • Hallucinations: seeing things or hearing voices, for example.
  • Delusions: having false beliefs even when they are refuted with evidence
  • Disorganized thinking or behavior
  • Impaired or incoherent speech, which may include catatonia
  • Flat affect or anhedonia, so-called "negative" symptoms of schizophrenia

The mood symptoms that must be present include:

  • Mania: does not need sleep, high energy
  • Racing thoughts
  • Rapid speech
  • Bizarre or risk-taking behavior
  • Depression: feeling sad and defective

Note: A lack of personal hygiene applies to both psychosis and mood.

Because the symptoms of schizoaffective disorder overlap with those of bipolar or depressive disorder and schizophrenia, the condition can be difficult to diagnose. Schizoaffective disorder is diagnosed when there is a period of time with a major depressive or manic mood and, at the same time, at least two psychotic symptoms appear, or when there is no sign of a major mood disorder but clear symptoms of schizophrenia-psychosis persist for at least two weeks. Although there may be periods of time when there are no symptoms of a mood disorder, they are present most of the time.

Is schizoaffective disorder a schizophrenia spectrum disorder?

Yes. And there are various disorders that fall under the schizophrenia spectrum such as schizoaffective disorder, schizophreniform disorder, and schizotypal personality disorder. Schizophreniform disorder is identical to schizophrenia but has a shorter symptom duration at more than a month to less than six months. Schizotypal personality disorder is also similar to schizophrenia, but the bouts are not as intense, lengthy, or frequent, and patients are generally more aware of their distorted thinking.

Is schizoaffective disorder different from bipolar?

Schizoaffective disorder is a combination of schizophrenia and bipolar disorder symptoms; for schizoaffective disorder, take the delusions of schizophrenia and add the mood swings of bipolar.

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Although the cause is unclear, heredity is thought to play a role in schizoaffective disorder. People with a parent or sibling who has schizoaffective disorder, schizophrenia, or bipolar disorder may be at higher than average risk for developing this condition. The use of psychoactive drugs and extreme or chronic stress may contribute to onset for those who have an underlying predisposition to develop schizoaffective disorder. People with schizophrenia and mood disorders have lower than normal levels of dopamine, a brain chemical that also helps manage these tasks.


Because schizoaffective disorder can masquerade as a mood disorder or schizophrenia, it is difficult for health professionals to diagnose. There are no tests or exams that will reveal this disorder. Treatments for schizoaffective disorder are similar to treatments for schizophrenia. Antipsychotics are the mainstay of treatment. Mood stabilizing drugs and antidepressants are often prescribed as well. The disorder can go into remission when proper medication is taken. If the disorder is left untreated, day-to-day functioning can be affected. Unaddressed schizoaffective disorder can lead to difficulties with employment, school, relationships. It can also lead to substance abuse, isolation, homelessness, and even suicidal thoughts.

Treatment may also include psychotherapy, such as cognitive-behavioral therapy to improve the person’s understanding of the condition and help him or her manage day-to-day life, as well as family-focused therapy for the person’s family members. If a patient does not respond to medication or therapy, they may try electroconvulsive therapy that involves sending an electric current to the brain.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
National Alliance on Mental Illness website. Schizoaffective Disorder. 
Tiihonen J, Walhbeck K, Lonnqvist J, et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ.    
Last updated: 07/13/2021