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Dr. Paul LatimerWhen psychiatric symptoms overlap, making the right diagnosis and determining the best course of care can be difficult. But careful observation of the patient over time can help bring clarity to medical professionals.

In medicine, many names for different conditions sound very similar and this can be confusing. One of the more confusing and even controversial disorders in the field of psychiatry is schizoaffective disorder.

Although it sounds similar and even shares some symptoms, this is not the same thing as schizophrenia.

Schizoaffective disorder is characterized by mood symptoms and psychotic symptoms. Individuals with this condition experience psychotic hallmarks such as hallucinations and delusions, but they also experience mood symptoms like depression or mania.

What distinguishes this disorder from conditions like bipolar disorder (which can also have both psychotic and mood symptoms) is that, in schizoaffective disorder, the psychotic symptoms persist even after the mood has stabilized. These individuals need to continue taking an anti-psychotic medication as well as mood stabilizing treatment.

Many individuals with schizoaffective disorder are first diagnosed with bipolar disorder or schizophrenia because of the similarities between the conditions. However, bipolar disorder is only the correct diagnosis if the person’s delusions or hallucinations go away once the mood has returned to normal. The diagnosis, therefore, requires assessment of the course of the illness and not just the symptoms at a point in time.

This means that at the time of the first episode, it would be impossible to make the correct diagnosis. The diagnosis requires observation over time. If psychotic symptoms continue, a diagnosis of schizoaffective disorder may be appropriate.

Misdiagnosis is common with this complicated and controversial disorder, and some psychiatrists even question its existence as a separate disorder. The debate is not helped by the fact that there is relatively little research on this specific disorder. What we know comes mainly from clinical experience, and from the application of research findings from schizophrenia and bipolar disorder.

In practical terms, however, there are patients who appear very much like bipolar patients but in whom psychotic symptoms recur in the absence of either mania or depression, and who therefore require ongoing antipsychotic medication, which is not usual in typical bipolar patients. If only antipsychotic medication is used, they will get recurrent depression that requires an antidepressant and they may respond to antidepressants with mania.

The prognosis of individuals being treated for schizoaffective disorder is generally a little more positive than for schizophrenia, but not quite as positive as for bipolar disorder.

It is important to be aware of these distinctions because they have practical consequences in terms of what to expect with respect to prognosis and required treatment.

A better understanding of why some people have this combination of symptoms will likely not be possible until the genetics of all three disorders have been elucidated. We already know that there is some overlap in the genes responsible for schizophrenia and bipolar disorder.

In the meantime, we will continue to rely on careful observation and history taking, which have always been the cornerstones of diagnosis in psychiatry.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.

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