Schizoaffective Disorder - Treatment

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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.

Medication treatment

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).

Non-medication treatments

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:

  • Individual psychotherapy: This involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with schizoaffective disorder become able to understand more about the illness, to learn about themselves, and to better handle the problems of their daily lives. They become better able to differentiate between what is real and, by contrast, what is not and can acquire beneficial problem-solving skills.
  • Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social-skills training, and education in money management. Thus, patients learn skills required to live with the illness through successful reintegration into their community following discharge from the hospital and to minimize or eliminate the need for psychiatric hospitalizations.
  • Family education: Research has consistently shown that people with schizoaffective disorder who have involved families have a better prognosis than those who battle the condition alone.
  • Self-help groups: Outside support for family members of those with schizoaffective disorder is necessary and desirable.
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See what others are saying

Comment from: Bobby, 35-44 Male (Patient) Published: February 14

Hi, I was diagnosed with schizoaffective disorder about three years ago. Before that it was being treated as depression for 8 years which did a lot of damage because of being misdiagnosed. My daily life came to a standstill. I used to get severe episodes of mixed depression and maniac symptoms daily for many years. I even had suicidal thoughts sometimes. Now I am on Quetiapine 900mg and Paliperidone 150mg injection (once a month). I am also on Mirtazapine for depression. My symptoms are well controlled although I still get periodic episodes of acute anxiety attacks. In the past other medicines such as Lithium, Divalproate, Fluoxetine and Sertraline were tried, but to no avail. I wish all the patients of schizoaffective disorder all the very best.

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Comment from: Mom From Mars, 45-54 Female (Patient) Published: October 08

I've been on many different medicines in the last 15 years for my schizoaffective disorder. Depakote worked well for a while till my hair started falling out. Lithium made me crazy. I'm currently on Seroquel, Topamax, and Cymbalta. I have schizoaffective disorder, and bipolar disorder, and many medical problems. I still see the invisible mice that don't run up and down my hall, I still hear people in my head, usually it's only one or two. I've just had to get used to it and accept it.

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