Schizophrenia and schizoaffective disorder are both psychotic disorders that cause abnormal thought and behavior patterns.1, 2 The main difference between the two is that people with schizoaffective disorder have symptoms of schizophrenia plus symptoms of a mood disorder.3, 4 Both conditions can be treated with medication and therapy, but schizophrenia may involve more severe symptoms that are harder to treat.5, 6, 7
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What is Schizoaffective Disorder?
Schizoaffective disorder is a mental illness that includes symptoms of both a mood disorder and a psychotic disorder. Because the symptoms of this condition can mimic and overlap with many other mental illnesses, schizoaffective disorder is commonly misdiagnosed.4 Like schizophrenia, schizoaffective disorder is classified as a psychotic disorder. However, it is unique in the fact that it also includes symptoms of a mood disorder.1, 3 The symptoms of schizoaffective tend to be less severe than those seen in schizophrenia, leading some experts to classify it as a milder type of schizophrenia.7
There are two types of schizoaffective disorder: bipolar type and depressive type.3, 5 People with depressive schizoaffective experience psychosis in addition to having symptoms of depression. People with the bipolar type experience psychosis in addition to both depressive and manic episodes. While these symptoms may overlap, there needs to be evidence that a person experiences hallucinations, delusions ,or other psychotic symptoms during times when they don’t have manic or depressive symptoms.3, 5
What Is Schizophrenia?
Schizophrenia spectrum disorder is a psychotic disorder that causes abnormal patterns of thinking and behavior. People with schizophrenia experience auditory or visual hallucinations, and delusional or paranoid thoughts. People with schizophrenia also display negative symptoms including flattened or blunted affect. In extreme cases, they may become catatonic or unresponsive.3, 6
The symptoms of schizophrenia can pass through different phases, becoming more or less severe. Acute phases of schizophrenia involve periods in which the person’s symptoms are more active and severe than in the ‘residual phases’, when symptoms lessen and become less intense.3, 5 Treatments like medication and therapy can help to manage the symptoms of schizophrenia, reducing the acute phases of the disorder.6, 8
What’s the Difference Between Schizoaffective Disorder & Schizophrenia?
The differences between schizoaffective disorder and schizophrenia can be difficult to determine, even for experts. In fact, some researchers and experts believe that schizoaffective disorder is either a form of schizophrenia or a subtype of bipolar or depression.1, 2, 7 A person with schizoaffective disorder has symptoms of schizophrenia, but they also have symptoms of either bipolar disorder or major depressive disorder.3, 4
Some of the differences between schizophrenia and schizoaffective disorder may include:
- Schizoaffective disorder is believed to be three times less common than schizophrenia4
- Schizoaffective disorder is harder to detect than schizophrenia, and is one of the most commonly misdiagnosed mental illnesses4
- Schizoaffective disorder involves symptoms of two different mental illnesses: depression and schizophrenia, or bipolar and schizophrenia3
- Psychotic symptoms are more severe, frequent, and last longer in people diagnosed schizophrenia than those with schizoaffective disorder7
- Schizoaffective disorder is associated with better outcomes and better treatment responses than schizophrenia7
- Schizophrenia involves more psychosis symptoms(i.e. hallucinations, delusions, bizarre thoughts), while schizoaffective involves more mood disturbances (i.e. depression or mania)3
- People with schizophrenia tend to have more cognitive impairment than people diagnosed with schizoaffective disorder1
- People with schizophrenia tend to have less awareness and insight about their symptoms than people with schizoaffective disorder9
Resources For Schizophrenia
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Symptoms of Schizoaffective Disorder vs Schizophrenia
A person with schizoaffective disorder has symptoms of both a psychotic disorder (schizophrenia) as well as symptoms of a mood disorder. These symptoms may overlap, but also need to appear separately in order to rule out other diagnoses including depression or bipolar with psychotic features.2, 3, 4, 5
Mood-related symptoms (i.e. depression or mania) are more pronounced in schizoaffective disorder, while psychotic symptoms (i.e. delusions of grandeur, visual hallucinations, etc.) are more pronounced in schizophrenia. Someone with schizoaffective disorder may experience psychotic episodes similar to those in schizophrenia. However, these psychotic episodes tend to be shorter and less frequent in schizoaffective than in schizophrenia.7
Symptoms of Schizophrenia Spectrum Disorder
The current DSM 5 criteria for diagnosing schizophrenia spectrum disorder includes the display of two or more certain symptoms for a period of six months or longer, which are severe enough to impact their ability to function.
Symptoms of schizophrenia:3
- Delusions: abnormal, false, irrational and strongly held beliefs
- Hallucinations: seeing, hearing or perceiving things that aren’t real
- Disorganized speech: saying things that make no sense, repeating words, etc.
- Disorganized or catatonic behavior: becoming unresponsive or unable to speak or move or uncontrolled speech and movement
- Negative symptoms like a flat or blunted affect, lack of emotions, loss of motivation or interest in things
Symptoms of Schizoaffective Disorder
Someone with schizoaffective disorder will exhibit two or more symptoms of schizophrenia in addition to having either symptoms of major depressive disorder or bipolar disorder that occur separately at least some of the time.3, 4 The specific symptoms of schizoaffective disorder depend on whether the person has bipolar or depressive type.3
Symptoms of Depressive Type Schizoaffective Disorder
Someone with depressive schizoaffective will experience periods of depression..
Someone with depressive schizoaffective will experience five or more of the following symptoms for two or more weeks:3
- Depressed mood
- Loss of interest or pleasure in activities
- Decreased or increased appetite or weight gain or weight loss
- Changes in sleep (sleeping more or less than normal)
- Moving more quickly or slowly than normal
- Feeling tired, fatigued, or lacking in energy
- Feelings of worthlessness or guilt
- Impaired ability to focus, think, or make decisions
- Recurrent thoughts of death or suicide or attempts to commit suicide
Symptoms of Bipolar Type Schizoaffective Disorder
Someone with bipolar schizoaffective will experience periods of depression in addition to mania or hypomania.
A person with bipolar schizoaffective disorder will exhibit three or more of the following symptoms over a period of several days:3
- Inflated sense of self-esteem or grandiose delusions
- Decreased need for sleep and feeling more energized
- Being more talkative or having pressured speech
- Flight of ideas or racing thoughts
- Being more easily distracted
- Increased movement or goal-directed activity
- Impulsive or reckless behavior (i.e. overspending, promiscuity, gambling, drug use, etc)
Causes of Schizophrenia & Schizoaffective Disorder
The causes of schizophrenia and schizoaffective disorder aren’t fully understood, but most experts believe a combination of genetic and environmental factors are involved. The research suggests that the causes and risk factors for both conditions are the same.6, 7, 8
Potential causes and risk factors for both schizoaffective and schizophrenia include:
- Genetics & family history: The risk of developing both conditions is higher for people with a family history of bipolar, schizophrenia, or another mental illness.1, 4, 6
- Brain structure abnormalities: There are studies that document similar abnormalities and cognitive impairments in the brains of people with both disorders, including the frontal lobes of the brain.6, 9
- Chemical imbalances in the brain: Chemical imbalances in the brain have been documented in people with both conditions, including in mood-regulating chemicals like serotonin and dopamine.5, 6, 10
- Brain injuries or disorders: It’s possible that a traumatic brain injury or neurological disorder can increase the likelihood of developing schizophrenia or schizoaffective disorder.5, 6
- Environmental factors: Childhood trauma, personal hardships, high levels of stress, and early use of marijuana and other drugs can increase the risk of developing a psychotic disorder or even trigger the onset of symptoms in predisposed people.5, 6, 10
How are Schizoaffective Disorder & Schizophrenia Diagnosed?
Like all mental health conditions, schizoaffective disorder is diagnosed by licensed medical or mental health providers using symptoms listed in the DSM 5. Usually, this happens during a first appointment with a licensed therapist or doctor who conducts a clinical assessment. In addition to asking a person questions about their symptoms, clinicians observe the client’s affect, speech, and behavior to determine a diagnosis.5, 6
Some clinicians also use formal assessments or questionnaires to determine a person’s diagnosis, and may also gather data from prior medical and psychiatric records. In some cases, medical tests like MRI’s or lab work may be required to rule out other potential causes of a person’s symptoms including brain injuries or drug-induced psychosis.5, 7 Misdiagnosis can also occur, and is more common in people suffering from schizoaffective disorder than in schizophrenia.4
How Are Schizoaffective Disorder & Schizophrenia Treated?
The treatment for all psychotic disorders is very similar, with only slight differences in the medication that may be recommended for someone with schizoaffective disorder or schizophrenia.5, 6, 8, 11 For example, someone with schizoaffective disorder may need medications that can treat both their psychosis and their mania or depression.4, 5, 8
Currently, there aren’t any ways to cure schizophrenia or schizoaffective disorder, but medication and therapy can help people manage their symptoms.6 Getting an accurate diagnosis is important, and helps to ensure that a person gets the right kind of treatment. In most cases, someone with schizophrenia or schizoaffective disorder will require long-term treatment that involves a combination of medication and therapy.5, 6, 11
Finding a therapist who is skilled in treating psychosis, mood disorders, and severe forms of mental illness is recommended. Consider finding a provider that also offers on-site psychiatric medication for more integrated treatment. Other community supports and resources may also be recommended for both schizophrenia and schizoaffective disorder, especially when a person’s symptoms are severe.6, 8, 11
The most commonly recommended treatments for schizoaffective disorder and schizophrenia include:
- Psychiatric medication: People with schizoaffective disorder often are placed on an antipsychotic medication alongside a SSRI antidepressant or mood stabilizer. Those with schizophrenia may only need antipsychotic medications to manage their symptoms. 5, 6, 11. Psychosis is believed to have a strong neurochemical link, which is why medication is almost always a part of the recommended treatment.11
- Family therapy: Family therapy can sometimes help people with both conditions get help and support from their families and loved ones, as well as address family conflicts or issues that are caused or worsened by the person’s symptoms 5, 6
- Electroconvulsive Therapy (ECT): ECT involves administering low-grade electric currents to the brain while a person is under anesthesia in order to induce electric and chemical changes in the brain. It has been found to help relieve symptoms of psychosis and mood disorders.5
- Life skills & social skills training: People with both schizophrenia and schizoaffective disorder often have trouble functioning and interacting normally with others. They may benefit from education, support, and resources that focus on helping them learn life skills and social skills that improve their ability to be independent.6, 8
- Individual therapy: Seeing a therapist for regular sessions may also benefit people suffering from symptoms of schizoaffective disorder or schizophrenia. A variety of therapy approaches can be effective in treating people with both conditions including Cognitive Behavioral Therapy, Assertive Community Treatment, and Acceptance and Commitment Therapy. 6, 8
- Group therapy or support groups: Many people with severe mental health conditions benefit from regular support groups where they can interact with others who struggle with similar issues as them. 6, 8
Final Thoughts
The main difference between schizophrenia and schizoaffective disorder is that schizophrenia is characterized by psychotic symptoms, while schizoaffective disorder is characterized by mood and psychotic symptoms.3, 4 Both disorders can’t be cured, but the symptoms of both can be managed with a combination of medication, therapy, and community or family support.6, 7, 8, 11
Additional Resources
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For Further Reading
People who want more information, resources, or support for schizophrenia or schizoaffective disorder can find more information at the links below.
- NAMI’s website with information, resources, and support groups for schizophrenia: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
- Schizophrenia & Psychosis Action Alliance for advocacy of improved care and support for people living with psychosis: https://sczaction.org/
- Wellness Recovery Action Plan with information, coping skills, and support for people with psychosis or other severe mental illnesses https://www.psychosisnet.com/help-and-recovery/wrap/
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