Schizoaffective Disorder (cont.)
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
What is the treatment for schizoaffective disorder?
Treatment for people living with schizoaffective disorder tends to be symptom based rather than distinctly different based on the illness itself. In terms of medication treatment, individuals with the bipolar type of the illness seem to respond best to treatment with an antipsychotic drug combined with a mood-stabilizer drug or treatment with an antipsychotic alone. For people with the depressive type of schizoaffective disorder, combining an antipsychotic medication with an antidepressant tends to work best. Since consistent treatment is important to best outcome, psycho-education of the person with the illness and their loved ones, as well as using long acting medications can be important parts of their care.
For people who don't respond to multiple trials of treatment, electroconvulsive therapy may be an option. Treatment for people who suffer from both schizoaffective disorder and a substance abuse disorder tends to be most effective when both conditions are specifically addressed.
Antipsychotic medications have been shown to be effective in treating acute psychosis and reducing the risk of future psychotic episodes. The treatment of schizoaffective disorder thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to treat psychotic and severe mood symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.
Even with continued treatment, some patients experience relapses. By far, though, the highest relapse rates are seen when medication is discontinued. The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them. Since it is difficult to predict which patients will fall into what groups, it is essential to have long-term follow-up, so that the treatment can be adjusted and any problems addressed promptly.
Antipsychotic medications are the cornerstone in the management of schizoaffective disorder. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.
The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorder, loose associations, ambivalence, or emotional lability), they cause side effects, many of which affect the neurologic (nervous) system.
Since 1989, a new class of antipsychotics (atypical antipsychotics) has been introduced. At clinically effective doses, none (or very few) of these neurological side effects, which often affect the extrapyramidal nerve tracts (which control such things as muscular rigidity, painful spasms, restlessness, or tremors) are observed.
The first of the new class, clozapine (Clozaril), is not associated with extrapyramidal side effects, but it does produce other side effects, including a possible decrease in the number of white blood cells, so the blood needs to be monitored every week during the first six months of treatment and then every two weeks to catch this side effect early if it occurs.
Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), and lurasidone (Latuda). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizoaffective disorder.
Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of mania as well as preventing return of such symptoms in schizoaffective disorder. These medications may take a bit longer to work compared to the neuroleptic medications, and some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, while some can be associated with birth defects when taken by pregnant women.
Since people with schizoaffective disorder often have depression as part of the illness, medications that address that symptom may be of great benefit as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for treatment of schizoaffective disorder include venlafaxine (Effexor), duloxetine (Cymbalta), and buproprion (Wellbutrin).
Most of these medications take from several days to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, and another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).
In spite of successful antipsychotic treatment, many patients with schizoaffective disorder have difficulty with motivation, activities of daily living, relationships, and communication skills. Therefore, psychosocial treatments are also important, and many useful treatment approaches have been developed to complement the medications in assisting people suffering from schizoaffective disorder:
Reviewed by Melissa Conrad Stöppler, MD on 10/23/2013
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