Schizophrenia and schizoaffective disorders have commonalities as well as differences that need to be understood and distinguished. The short answer to the schizoaffective disorder vs schizophrenia narrative is that schizoaffective disorder is effectively one type of schizophrenia. However, there are distinct changes that differentiate the two. To begin with, schizophrenia is prevalent among 1% of the population, while schizoaffective disorder is known to affect 0.3% of the population. This can also help interpret the fact that the latter condition is a subset or a type of the first condition. Let’s dwell deeper in the subject to understand each condition in detail, the similarities in symptoms and the differences. We will also look at the best methods for managing the respective conditions.
Commonalities that make Schizoaffective Disorder vs Schizophrenia comparison challenging
Both the conditions have certain commonalities and this is responsible for the possible confusion in considering both as same. While it is partly true that the conditions as highlighted in the schizoaffective disorder vs schizophrenia comparison, belong to the same broad category, there are distinct underlying changes that make the disorders at variance with each other. For instance, in both the conditions, patients are known to have experience delusions and hallucinations. As a result of this individuals either of the conditions are known to hear voices, or see images that are actually non-existent. Certain sensations and manifestations that are reported by the individuals are effectively a product of the condition and not an actual circumstance.
Similarly, individuals with either of the conditions are also known to experience delusions. This could be in the form of outrageous thoughts or suggestions which may pertain to a particular individual or an incident. In many cases, individuals are also known to make incredible claims.
While both the conditions appear similar on the surface, there are differences that need to be understood. This is because treatments differ for both the conditions. While the approach is the same, there are changes in the actual treatment. It is therefore essential to clearly distinguish between the two and make a proper assessment of the condition and its severity. Here is a look at each of the conditions in detail. This will give complete information about the schizoaffective disorder vs schizophrenia comparison.
Diagnosis for schizophrenia
The schizoaffective disorder vs schizophrenia comparison begins with the diagnosis. By virtue of the nature of the condition and the symptoms, the diagnosis of schizophrenia involves confirmation of the reasons for the condition. In other words, diagnosis is essentially first focused on determining if the condition is not due to substance abuse, side effects of medications or other underlying mental health disorders. Typically, diagnosis includes :
#1 Assessment by a competent psychiatrist – An evaluation by a psychiatrist helps assess the mental health status of the individual. This helps in the observance of behavior, possible mood swings and visible symptoms that indicate schizophrenia. The history of the patient behavior is also recorded during these evaluations which help to map a pattern of behavior. During assessments, the individual is also probed to ascertain thoughts and possible mood swings. Suicidal tendencies of the patient, alongwith history of hallucinations or possible abnormal behavior is also ascertained during evaluation. Psychiatric evaluation is used alongwith other diagnoses to determine the patient’s condition.
#2 Indepth physical examination – The reason behind physical examinations for a condition that is generally related to mental health, is the need to rule out other causes for the behavior. It is possible that traumatic injuries are the reason behind behavior that is considered as schizophrenic. Additionally, a thorough physical examination helps to determine if individuals have hurt themselves as a result of the condition. This will determine the gravity of the condition.
#3 Imaging – Tests include MRI and CT scan to determine morphological brain abnormalities. Imaging is primarily used to determine between subject variations and this is achieved through the study of a large number of scans to assess the abnormalities. Various methods are popularly used, this includes the CT Rating Scale for Schizophrenia. Higher levels of imaging include MRI scans which are known to offer a better assessment of the condition through different parameters.
#4 Tests for substance use/abuse – Another important dimension in diagnoses includes tests for substance use and abuse. The patient is screened for abuse of alcohol and drugs, which could be the reason for erratic behavior. Due to the overlap of some of the visible conditions and behavior in schizophrenic patients and individuals who abuse substances, it is essential to rule out these reasons. The combination of assessment, imaging, physical evaluation and substance abuse tests, helps to confirm the condition in patients.
Treatment for schizophrenia
It is necessary to highlight various treatment methods in the schizoaffective disorder vs schizophrenia comparison. The treatment for schizophrenia is co-terminus with life. In other words, patients who are diagnosed with the condition are to be on medication and treatment regimens forever. In fact this is necessary even when the symptoms have stopped. Patients who do not exhibit any of the symptoms after a period of treatment will still have to continue the medication for therapy for maintenance. Treatment is invariably a combination of medications and therapy, and in a limited number of cases, it includes hospitalization. The treatment regimen involves multiple specialists – for instance this could involve a counsellor for therapy, a psychologist, a trained nurse, and a co-ordinator to help manage the different requirements.
This is the possible scenario and is not necessarily the only scenario as individuals with mild to moderate symptoms may not require all treatment modalities.
Medications in the forefront – Treatment for schizophrenia involves the use of antipsychotic drugs. The mechanism of action of these drugs is primarily focused on controlling the symptoms that affect dopamine in the brain. Control of the neurotransmitter helps to handle the commonly experienced symptoms and behavior of individuals. The effort is always to achieve control through low dosages, with incrementally higher doses used only when lower dosages are proved to be ineffective. Medication used for treating schizophrenia is often a combination of various drugs, which are carefully considered for achieving positive outcomes in patients. Some of the commonly used cocktail of medications include drugs to handle anxiety and various antidepressants. Outcomes from medications are gradual in nature and in most cases, results are witnessed only after weeks.
A common issue faced by professionals involved in treating schizophrenic patients is the difficulty in administering medications. While a significant percentage of patients take medications, a percentage of patients end up as unwilling to take pills. Consequently, the only option is to administer the medications through injections. This poses practical problems among health care professionals, as this involves changes in the medication chart, choice of drugs, and dosage. This also causes a burden financially, as administering injections in schizophrenic typically requires the presence of medical professionals. In addition to this, the medications are also known to have undesirable side effects, and consequently, some patients are known to show more reluctance in taking the medications.
Advances in antipsychotic medications
Antipsychotic medications that belong to the first generation have side effects that are frequent in nature in addition to exercising strong adverse effects. Some of the commonly reported side effects include movement disorders that have the dubious distinction of being either reversible or irreversible in nature. Commonly known as tardive dyskinesia, this is one of the reasons for reluctance among patient families in using the medication.
Recent advances in antipsychotic medications are increasingly popular, by virtue of the lesser side effects. The marked improvement in the mechanism of action of the drugs, the properties and side effects make them more suitable for use in treating schizophrenics. Some of the most popular medications include arpiprazole, brexpiprazole, cariprazine, asenapine, clozapine, olanzapine, paliperidone, risperidone, ziprasidone, quetiapine etc.
Injections (both intramuscular and subcutaneous) are also a part of the medications in use for treating the condition. The advantage of injections over other medications are the long acting nature. Some of the injections are known to be administered once a fortnight and in some instances once a month. This makes the injections a better choice as it avoids the practical problems involved in getting patients to take medications or injections frequently. This is also a good option when the patients show a dislike for oral medications. Some of the long acting injections include flyphenazine decanoate, risperidone, aripiprazole, and risperidone among others.
Supporting interventions that are part of the treatment regimen
The treatment regimen includes therapy as a supporting intervention. The schizoaffective disorder vs schizophrenia comparison clearly highlights the fact that some treatment options are similar. In addition to medications, it is essential to ensure that patients receive the psychological assistance and psychotherapy. This helps the patients to adapt and make necessary changes in behavior and thought processes. For instance, the ability to identify patterns long before a relapse occurs can help the patient avoid a relapse. This is possible through regular interactions and therapy sessions. Individuals regarded as schizophrenic require regular counselling and assessment in the right atmosphere and settings that will help to bring the individual out of the condition and thought patterns. The goal of all therapy and interventions is to get the individual to take an active part in social life without any deviant behavior. The need to participate in social activities needs mentoring and therapy is the best method to achieve the same. Other efforts include rehabilitation and assistance to find suitable employment opportunities for sustenance. This helps take individuals into the mainstream of society easily.
For patients who do not display any kind of results from medications or other interventions, the last resort is electroconvulsive therapy. This is only used in adults and is not used for treating young patients. Commonly known as ECT, this therapy is also used when patients are undergoing depression. The purpose of ECT is to induce seizures electrically, which provide relief to patients from mental disorders. This involves the transmission of 70 to 120 volts of electric current to the head for a duration that could be anywhere between 100 milliseconds to 6 seconds. This is only used for patients who are classified as treatment resistant and is often repeated for a couple of times till the symptoms associated with the mental disorder subsides.
Diagnosis for schizoaffective disorder
As mentioned above, diagnosis is an important dimension in the schizoaffective disorder vs schizophrenia comparison. The diagnosis for schizoaffective disorders are the same as that for schizophrenia. This is because the disorder is one of the four types of schizophrenia and hence the evaluation is the same. For instance, patients who are suspected of having schizoaffective disorders undergo psychiatric evaluation, tests to rule out drug/alcohol abuse, physical examination, imaging and screenings. The criteria for assessment of schizophrenia patients and individuals with schizoaffective disorder are the same.
Treatment for schizoaffective disorder
The treatment for schizoaffective disorder differs from that of schizophrenia. This reinforces the changes that are highlighted in schizoaffective disorder vs schizophrenia comparison. While the overall combination or approach is more or less similar, the actual method of completing the treatment differs. For instance, treatment is often a combination of medications, therapy and preparation for integration into normal routines. The balance of one or more of these components is determined by the gravity of the condition. Moderate cases may not require all the components in full measure, while serious cases may require different handling.
Use of medications – The purpose of medications is to offer relief from the symptoms of the condition. For instance, the mood swings and depression experienced by individuals with the disorder require treatment for the purpose of bringing normalcy to thoughts, moods and response to various inputs. The cocktail of medications include either one or a combination of three different types of medication. This includes antipsychotic medications, antidepressants and medications for restoring mood.
Among antipsychotic medications, presently only one drug is approved for use among patients. Paliperidone is the only antipsychotic drug that has been approved for use in the US for treating patients with schizoaffective disorder. However, patients with the condition are also known to experience symptoms such as delusions, apart from hallucinations. These conditions are common to patients with the disorder and schizophrenic patients. Specialists treating patients with the disorder typically rely on other drugs belonging to the antipsychotic category to treat these specific symptoms. Here, it is important to note that the use of other medications are only for the purpose of specifically treating particular symptoms and not for managing the condition as a whole.
The combination of medications used to treat the condition include mood stabilizing medications. This is used whenever patients with the condition exhibit bipolar disorder. The use of mood stabilizers helps to restore the right balance in moods and prevents mood swings that are often experienced by patients with the condition. This is typically a part of a combination of medications and it is useful in combatting separate symptoms that are exhibited by patients.
Patients with the condition are also known to experience bouts of depression and as a result, doctors treat patients with antidepressants. Individuals with the condition are known to experience difficulty in falling asleep, or concentrate on tasks, or experience hopelessness/lonely or dejected feelings. Medications prescribed for handling this condition help to mitigate the experiences of the patient and bring in a sense of normalcy.
Therapy sessions – An important dimension in treatment is therapy which could either be in the form of one on one sessions or group sessions. One on one sessions are intended to help create self-awareness in the individual with the disorder. This helps individuals to evaluate their conditions and work towards managing the symptoms. The focus of the efforts is to help individuals gain a better understanding of possible issues that could be encountered on a daily basis. This helps the patient to handle relationship issues better and to manage social interactions effectively without any difficulties.
Another form of therapy is group sessions that may or may not include family members. This is more supportive and collaborative in nature which helps the patient to feel free to express himself or herself. This gives a voice to the patient, informs others of the situation and helps the patient to listen to the points raised by others. This is effective in helping patients come out of isolation and creates a conducive atmosphere for patients, which helps in faster results from the combination of medications and therapy.
Training for rehabilitation – Patients are also introduced to training sessions that are designed to rehabilitate the individual with vocational skills. This essential as patients need to get back to routines like others after the conclusion of the treatment. Development of new skills and modification of present skills are the goals of training to ensure that patients are independent with gainful employment.
In a limited number of cases, hospitalization is required to manage symptoms that are difficult to manage in home environments. Certain symptoms may manifest to severe conditions and may warrant increased care. For instance, it is essential to give patients desired nutrition and proper rest, apart from maintaining personal hygiene. This may require the professional services and care in a healthcare setting.
Similar to schizophrenia, a limited number of patients who are resistant to treatment are recommended to undergo ECT. This is only used in cases where patients do not respond favorably to the treatment regimen. ECT for patients with schizoaffective disorder is the same as ECT for schizophrenics.