Schizoaffective personality disorder

A complex condition close to schizophrenia, when a person has similar symptoms in the form of delusions, hallucinations combined with mood disorders, mania or depression, is called schizoaffective disorder. Unlike some other pathologies in which cognitive abilities are impaired, schizoaffective personality disorder is insufficiently studied. The fact is that such a disease state combines the signs of several psychopathologies at once, including all known schizophrenic and affective disorders. As a result of this mixture, a peculiar clinical picture is created that is unique in each case. [1]

Schizoaffective disorder is not recognized immediately. The patient is monitored over a long period of time, with gradual exclusion of all the most likely pathological conditions. Prolonged treatment and endless diagnostic measures without a definite diagnosis can last for years: in many cases, the patient is attributed to a similar illness, in particular to one of the affective disorders (e.g. Bipolar disorder). [2]

Epidemiology

Statistical information regarding the incidence of schizoaffective personality disorder is currently insufficient. This is primarily due to the fact that the pathology is quite difficult to diagnose: it takes months and even years to make a definitive diagnosis. However, according to preliminary estimates of specialists, this disorder may affect slightly less than 1% of the population - approximately 0.5% to 0.8%.

Practitioners note that the diagnosis of schizoaffective disorder is often made as a preliminary conclusion, because there is not always confidence in its accuracy and correct interpretation. It is known that both men and women are ill with approximately the same frequency. In pediatrics, the disorder is much less common than in adult therapy.

Causes of the schizoaffective personality disorder

Schizoaffective personality disorder refers to serious mental disorders and includes signs of schizophrenia, affective disorder, depressive state, bipolar psychosis. Patients with schizophrenia have altered thinking and manifestation of emotions, a different sense of reality and attitude to society. Affective disorder patients have serious problems with emotional status. An overwhelming number of patients suffering from schizoaffective disorder, from time to time face relapses of pathology. Completely get rid of the disease, unfortunately, it is impossible. But with proper comprehensive treatment, it is possible to regain control over the disease picture.

Despite the fact that the disorder has been known for more than a hundred years, the clear causes of its emergence still remain unclear. Presumably, the development of schizoaffective disorder is associated with certain biochemical and genetic factors, as well as with unfavorable environmental influences. In patients with this pathology, the balance of certain chemical components in the brain is disturbed, including neurotransmitters - agents that provide transportation of signals between brain structures.

In individuals with a genetic predisposition to the disease, viral infections, severe and profound stressful situations, social withdrawal, and cognitive problems become starting factors. [3]

So, the following series of basic causes of schizoaffective disorder can be distinguished:

• Hereditary predisposition - meaning the presence in ancestors and direct relatives of both schizoaffective disorder itself and schizophrenia or endogenous affective disorders.
• Metabolic diseases affecting brain structures - also characteristic of patients with schizophrenia and psychosis. Patients have an imbalance of neurotransmitters and their property of transporting signals between brain cells.
• Severe stress, communication disorders, withdrawn nature, cognitive problems, neurotic activity.

Risk factors

Numerous psychological and hereditary factors play a role in the development of schizoaffective personality disorder, including the peculiarities of upbringing and the impact of the environment. Doctors identify a list of individual circumstances that can increase the likelihood of psychopathology:

• Biological factor includes hereditary predisposition, influence of infectious and toxic load, allergies or disturbed metabolic processes. It is proved that schizoaffective disorder is often diagnosed in close relatives. As for toxic load, both alcohol abuse and the use of Ketamine or marijuana can provoke the disorder. According to recent studies, a large number of genes have been identified that are associated with the development of both schizophrenia and schizophrenia-like conditions. The influence of various harmful influences during intrauterine development or immediately after the child's birth also has a negative impact. The involvement of neurotransmitters - in particular, dopamine, serotonin, glutamate - is not excluded.
• Addiction, a medical factor often involves taking steroidal medications. In women, the development of psychopathology can be associated with a difficult pregnancy or childbirth. A special role is played by malnutrition, infectious diseases, hypertension, placental disorders in the process of carrying the fetus. Such factors as alcohol consumption, heavy smoking, and drug use also contribute.
• Psychological factors include a history of depressive and anxiety disorders, bipolar disorder, impaired social or other adaptation. Pathology is more often found in people prone to suspiciousness, mistrust, paranoia, suffering from psychosomatic diseases. Schizoaffective disorder can develop in people who have previously been victims of violence or abuse, who have experienced difficulties, harassment and deprivation in life, regardless of age.

Pathogenesis

Although the exact mechanism of schizoaffective disorder has not yet been elucidated, there are several theories of the origin of the disorder:

• pathology can act as a type or subtype of schizophrenia;
• could be a form of mood disorder;
• patients with schizoaffective disorder may have both schizophrenia and mood disorders at the same time;
• schizoaffective personality disorder may be a variant of independent mental illnesses that are far removed from both schizophrenia and mood disorders;
• patients with schizoaffective pathology may represent a heterogeneous group of similar disorders.

Some scientists adhere to the idea that schizoaffective personality disorder is a single clinical group. Meanwhile, many specialists divide the pathology into depressive and bipolar forms.

Based on the above information, we can conclude that patients with schizoaffective disorder should be included in a heterogeneous series, one part of which includes mood disorder patients with overt manifestations of schizophrenia, and the other part includes schizophrenia patients with predominantly affective manifestations.

The assumption that schizoaffective disorder is a type of schizophrenia has no research support. Many research studies have demonstrated that schizoaffective patients do not have the deficits in smooth tracking eye movements that are characteristic of schizophrenics and are due to neurological deficits or attention deficits.

The theory that schizoaffective disorder belongs to a number of mood disorders also has no scientific confirmation. Quite a few cases of the disease combine affective problems of the depressive type and schizophrenic manifestations. At the same time, there are similarities between patients with schizoaffective disorder and mood disorders.

It is also impossible to speak about the complete independence of the disease. For example, only some relatives of schizoaffective patients have exactly the same manifestations of pathology.

As experts note, the simultaneous existence of both schizophrenia and mood disorders in people is extremely rare, but schizoaffective disorder in its current sense is much more common. [4]

Is schizoaffective disorder hereditary?

Genetic features can really affect the development of many diseases in a person. There are many hereditary pathologies that arise under the influence of a single factor - the presence of the same disease in the family line. In the situation with schizoaffective disorder, we cannot talk about direct inheritance, but there is a genetic predisposition - that is, a person has a greater chance of getting sick than other people. At the same time, the effect of other external and internal factors cannot be ruled out.

Scientists do not yet fully understand the entire mechanism by which genes interact with each other and with the environment. Genetic studies of such disorders as schizoaffective personality disorder, schizophrenia, autism, and bipolar affective disorder are being actively conducted. And this process of study is long and painstaking, as such pathologies have complex genetics.

The risks of the disease increase many times if, in addition to hereditary predisposition, there are other provoking moments - for example, head injuries, emotional shocks, use of psychoactive drugs and medications.

Thus, a certain combination of environmental factors and epigenetic status is required for the development of psychopathology.

Symptoms of the schizoaffective personality disorder

An attack of schizoaffective personality disorder is characterized by an acute onset, before which there is a short prodromal period, manifested by mood swings, general discomfort, sleep disturbance.

The initial symptomatology of the exacerbation is accompanied by obvious affective manifestations, mainly in the form of depression. After a few days, fears appear, ordinary family and professional situations cause anxiety and are perceived as a danger. Closure, suspicion, wariness come to the fore: patients begin to see a threat in almost everything.

Over time, delusions, delusions of dramatization, Kandinsky-Clerambault psychic automatism syndrome are added. A prolonged attack can cause the development of oneiroid and catatonic syndrome. [5]

Baseline clinical symptoms may include:

• Manic manifestations:
  • Mood changes for no apparent reason;
  • excessive excitability;
  • irritability;
  • racing thoughts, rapid, often incomprehensible speech;
  • inability to concentrate on anything;
  • insomnia;
  • pathological obsessiveness.
• Depressive manifestations:
  • Depressed mood;
  • constant feelings of fatigue;
  • feelings of helplessness and hopelessness, self-deprecation;
  • apathy;
  • increased anxiety;
  • suicidal tendencies;
  • drowsiness.
• Schizophrenic manifestations:
  • Thought disorders, hallucinations and delusions;
  • bizarre behavior;
  • catatonic syndrome;
  • emotional stinginess (mimicry, speech);
  • volitional stiffness (abulia).

First signs

The main and first sign of an impending schizoaffective disorder attack is frequent and unreasonable mood changes. The succession of such changes is characterized by suddenness, unpredictability, inability to control. Then the picture expands: concentration of attention is disturbed, hallucinations appear, the person loses the ability to control his actions and make decisions.

Schizoaffective personality disorder entails a "flattening" of the boundary between reality and the imaginary world. The patient loses touch with reality, trusting more in his or her own imagination.

Clinical symptomatology can be both moderate (mild) and vivid (intense). In a mild disorder, the problem can be noticed only by close people, family members. But an intensely ongoing pathology "catches the eye" of everyone around.

Possible first manifestations of psychopathology:

• frequent depression, depressed states;
• frequent worsening of appetite (or complete reluctance to eat);
• weight fluctuations;
• sudden addiction to alcohol;
• loss of domestic interests;
• bouts of weakness, apathy;
• Self-abuse, episodes of recognizing one's own inferiority, inferiority;
• scattered attention spans;
• uncontrollable thoughts, expressions, emotions;
• unreasonable anxieties, worries, fears;
• increased fatigue;
• intellectual retardation;
• odd behavior;
• The cult of hopelessness (pathological pessimism).

The patient often talks about hallucinations, sounds and voices, may not monitor his own appearance and health. Obsessive thoughts are often noted. Speech is accompanied by confused phrases, inability to express their thoughts.

Periods of attacks can last from a few weeks to several months. The average duration is 3-6 months, with a frequency of 1-2 times a year. At the end of the next seizure, mental activity returns to normal.

Schizoaffective disorder in children

Schizoaffective disorder is virtually uncommon in puberty: the presence of symptomatology in children requires extremely careful assessment and is often the result of other disorders.

If such pathology does occur, it happens slowly, gradually, with initial impairment of cognitive functions. There may be transient auditory hallucinations, emotional manifestations, anxiety due to distress.

The initial physical examination usually reveals signs of depression, stress disorder, but not psychotic pathology. Some children have a history of emotional or behavioral problems.

Auditory hallucinations arising against the background of depression, anxiety, dissociative pathology, inattention, hyperactivity are considered a frequent childhood symptom.

Diagnosis of schizoaffective disorder in childhood is particularly difficult. In most cases, when a correct diagnosis cannot be made, the term "diagnostic hypothesis" is used.

In children with isolated psychotic symptoms, seizures are usually rare. However, there is a risk of worsening as they grow older, with a worsening pattern after 20-30 years of age.

Schizoaffective disorder in adolescents

Adolescence is a period of increased prevalence of psychopathologies of any type (according to statistics - 2 cases per thousand patients at the age of eighteen years). Every third adult with such a disorder indicates the start of his or her illness before the age of 20.

In adolescents, the disorder usually manifests itself in a veiled and gradual manner, with an initial prodromal period accompanied by a nonspecific picture, including depressed mood, anxiety, and functional and cognitive impairment.

Major risk factors for the development of the problem in adolescents:

• schizotypal, schizoid, paranoid personality;
• functional decline;
• a family history of psychopathology;
• Subthreshold psychotic picture (brief, implicit auditory hallucinations).

By the way, if the child gets to a specialist in time, the risk of further aggravation of the disorder is significantly reduced.

Schizoaffective disorder: symptoms in women and men

Schizoaffective disorder is usually spoken of as a fairly serious mental disorder, although it has a relatively milder course than schizophrenia. In most cases, hearing hallucinations, sleep and appetite disturbances, anxiety, suicidal thoughts, and depression or manic states predominate among the many symptoms. It is not uncommon for the problem to occur in individuals who use alcohol or drugs.

Schizoaffective disorder is a chronic psychopathology that differs in some clinical features from other similar disorders. These include the presence or absence of mood disorders (manic or depressive) and the presence of a proven psychotic episode without intense mood disturbance.

Thus, the underlying clinical picture usually includes:

• rapid speech, poorly understood due to the overlapping of some words with others, loss of vocabulary endings;
• Behavioral illogic (sudden laughter or crying that does not fit the situation);
• bullshit;
• pessimistic, suicidal thoughts;
• hallucinations of hearing, the appearance of inner voices, conducting "dialogs" with them;
• inattention, inability to concentrate;
• apathy, unwillingness to do anything;
• sleep and appetite disturbances.

The alternation of relapses and remissions confirms schizoaffective personality disorder: symptoms in men and women may differ slightly, with aggravation in persons who abuse alcohol or use psychoactive substances. In female patients, the pathology is more acute, which can be explained by frequent hormonal fluctuations, greater female emotionality and increased reaction to stressful or psychotraumatic situations.

Women

Respond better and sooner to drug therapy. Manifestation of the disease is more often oriented to the period of 25-35 years of age. Vivid affective states (manic, depressive) are more often present. Social adaptation is more successful. A slight loss of function. More successful control of the volitional domain. Preserving the ability to build personal relationships.

Men

Worse with drug therapy. Manifestation of the disease occurs earlier than in women (more often in adolescence). The ability to work is severely affected. Pathology often provokes the appearance of addictions (drug or alcohol). The volitional sphere is severely affected.

In many women, the pathology is more benign than in male patients: patients remain able to work, and remission periods are longer.

Stages

Stages of schizoaffective disorder are defined, depending on the course of the pathology.

• Stage 1 is a period of general somatic disturbances. There are strange, intense, incomprehensible for the patient sensations that do not have a clear localization, diffuse, vivid, variable. Often this stage is called prodromal, blurred. Another name is the stage of somato-psychic depersonalization. With the deepening of symptomatology, the transition to the next stage is noted.
• Stage 2 - affective delusional, accompanied by the appearance of sensual ideas of attitude. Affective sphere is affected. Over time, sensual ideas are transformed into super-valuable ideas of attitude and accusation. With the aggravation of the situation, a hypochondriacal idea of pathology is formed. Many patients talk about casting spoil on them, about witchcraft. Often at this stage start illusions, hallucinations.
• Stage 3 is accompanied by rapid generalization of senestopathies. There is acute delirium, expansive and euphoric states, ideas about their own greatness and power. Delusions of dramatization, automatisms are possible.
• Stage 4 represents total somato-psychic depersonalization. Another name is paraphenia stage, which can occur in melancholic or manic form. With melancholic paraphenia there are generalized pathological sensations, hallucinations. The patient complains that he had a rearrangement of organs, that his insides were burned or removed, etc. In manic paraphrenia there is nihilism, the patient sometimes does not recognize ordinary things and objects, the degree of awareness is disturbed.
• Stage 5 is a period of initial signs of impaired consciousness, often "stunned" is present.
• Stage 6 is amenitic. "Stunting" is transformed into soporus. There is incoherence of thoughts, the risk of febrile or hypertoxic schizophrenia increases.

All six stages are not always noted: the pathological process can stop at any of the stages presented. Most often, stopping occurs at stage 2 or 3. During the following years of life, the attacks become deeper, heavier, longer, aggravated by the component of delusional disorders, but their acuteness decreases, affective fluctuations are noted.

The patient's sense of pathology is initially clearer, with further nihilization. Personality changes are formed - and more intense than in patients with cyclotymic psychosis. First of all, we are talking about mental weakness, lack of initiative, loss of interests. However, there is no pretentiousness and paradoxicality, there is no stamping and bizarre worldview characteristic of schizophrenia. In some cases, the moments of transition from one stage to another are "erased," which does not indicate a loss of schizoaffective structure. [6]

Syndromes in schizoaffective disorder

Schizoaffective disorder is a combined psychotic pathology, structurally comprising both schizophrenic and affective manifestations. These symptoms can occur in different sequences or all together for at least 4-5 days.

The term schizoaffective disorder is not used for patients with schizophrenic symptoms in some seizures and affective symptoms in other seizures. Occasionally, 1-2 schizoaffective attacks alternating with manic or depressive attacks are noted. In the presence of mania, schizoaffective disorder can be diagnosed, and in the case of depression, a differential diagnosis with bipolar affective disorder or recurrent depression is additionally performed.

According to the ICD-10 list, schizoaffective disorder is categorized into three basic types:

• Schizoaffective disorder, manic type (aka schizophrenic type) is characterized by the same severity of both the manic and schizophrenic picture, with no clear diagnosis of either a manic episode or schizophrenia. This type of disorder is assigned to patients who exhibit single or recurrent states, the vast majority of which are schizoaffective-maniacal. Such patients can pose a danger to others, so they are mainly placed for treatment in a closed hospital. Pathology is characterized by a period of maximum progression of the severity of clinical manifestations: specialists talk about the period of manic frenzy. At this time, patients talk with a "layering" of phrases on each other, their speech is confused. There is a strong internal agitation, which explains the discrepancy between the capabilities of the speech apparatus and the desired volume of conversation. Mood disorders are manifested by attempts at personal overestimation, ideas of greatness. Often agitation is combined with ideas of persecution and aggressive behavior. Also draws attention to excessive egocentricity, impaired concentration, loss of normal social inhibition. The patient may demonstrate unrestrained gaiety, he is active, although the period of sleep is significantly reduced. Speech, thoughts, actions are accelerated. Delusions are traced.
• Schizoaffective disorder, depressive type is a disorder that is accompanied by equally pronounced depressive-schizophrenic manifestations, when neither a depressive episode nor schizophrenia can be accurately diagnosed. This formulation is also used in relation to a single episode, relapse of an attack, which occur predominantly with schizoaffective-depressive disorders. The symptomatology is similar to protracted or moderately protracted depressive states. Apathy, depressed mood, sleep disturbance, auditory hallucinations, delusions, general (thinking and motor) retardation come to the forefront in the patient. Against the background of deterioration of appetite, body weight decreases, the patient demonstrates hopelessness, cognitive functions suffer. In severe cases, all kinds of addictions are formed, there is a tendency to suicide.
• Schizoaffective disorder, mixed type is the so-called cyclic schizophrenia, or combined affective and schizophrenic psychosis. The patient has alternating phobias and apathetic moods with bouts of gaiety.

In addition, other variations of schizoaffective disorder with unclear origins are often spoken of.

According to the intensity of progression of the clinical picture, the pre-monifest form of the disease, the immediate pathologic attack and the period of remission are distinguished.

In most cases, the duration of the schizoaffective disorder period is a few months.

Complications and consequences

The absence of adverse effects is understood as the disappearance of acute symptoms (hallucinations, delusions), the patient's return to normal life, professional activity, and the former social circle. Relative recovery can be said if treatment was carried out in the early stages of the disease, or if the disorder manifested itself with minor painful signs.

About the possible unfavorable outcome and increased likelihood of undesirable consequences, if the pathology starts in childhood (up to 18 years of age). The situation is aggravated by:

• the use of psychoactive drugs;
• generalized mental retardation;
• various functional deficiencies.

Early therapeutic and psychotherapeutic interventions improve the patient's well-being and prevent a recurrent attack.

Lack of treatment or its late start leads to problems in personal life, professional activity, education. To a significant extent, the ability to work is reduced, socialization suffers. The patient breaks off all contacts with the environment, often cannot control his condition and situation, irritated, conflicts or withdraws into himself. Severe disorders are accompanied by the emergence of suicidal thoughts with further attempts to realize them.

In addition, in order to relieve themselves and eliminate symptoms, a sick person may resort to the use of alcoholic beverages, drugs, which further exacerbates the existing problem.

Diagnostics of the schizoaffective personality disorder

It can take weeks or even months to diagnose schizoaffective personality disorder. Nevertheless, it is important to diagnose the disorder correctly, as management strategies, therapeutic interventions, prognosis and outlook depend on this.

The key diagnostic points are:

• clinical method, which includes talking to the patient and his/her environment, observation;
• psychometric method, which consists of conducting pathopsychological tests;
• laboratory methods (immunologic, genetic tests);
• instrumental methods (tomography, electroencephalography, neurophysiologic test system).

Clinical diagnosis can be called one of the main diagnostics. To determine schizoaffective disorder, the specialist evaluates the information about the symptomatology voiced by the patient and his or her close environment. Additionally, observation of the patient is established: special attention is paid to his motor activity, features of facial expressions, speech, emotional reactions, as well as the nature of thought processes. If you correctly assess the presence, development and transformation of pathological signs, you can form an idea of the existing disease and its course.

However, we should not forget that the clinical method is not always accurate, as its clarity depends on the frankness and truthfulness of the patient and his environment, and on the qualifications and experience of the specialist. In order to avoid errors, it is important to conduct a comprehensive diagnosis, if possible with the involvement of several doctors of the same profile.

Additional investigations - including tests and instrumental methods - can confirm or refute the suspected diagnosis and determine the best treatment option.

Important: in functional disorders, such as schizoaffective disorder, no pathologic abnormalities are seen on radiographs or tomographic images.

Early diagnosis is essential because starting treatment as early as possible allows the pathology to go into remission sooner, which will significantly improve the patient's prognosis.

A sufficiently large amount of information about the problem can be obtained with the help of psychometric methods, which involve the use of standardized scales and help to assess the existing mental disorders: depression, mania, anxiety and so on. Thanks to psychometrics, it is possible to determine the severity of the disorder, to find out the effectiveness of the current therapy.

Laboratory methods become an effective complement to general diagnostic measures: specialists examine the genetic, neurophysiological, immunological picture. First of all, the genetic factor is considered. Many patients with schizoaffective disorder have relatives suffering from one or another mental disorder. The most dangerous is a close blood relationship, especially if both parents are affected at the same time.

Immunologic techniques are based on the relationship between the immune system and the nervous system. Many immune factors circulating in the bloodstream are able to react in response to psychiatric abnormalities, reflecting pathologic processes occurring in brain structures. Protein antibodies, leukocyte elastase, α-1 proteinase inhibitor, and C-reactive protein are considered the major factors. The numbers of protein antibodies (to brain proteins) are increased in patients with autism, schizophrenia, and developmental inhibition.

To determine mental abnormalities, instrumental diagnostics is used - in particular, tomography, electroencephalography, which are prescribed according to indications. These methods are often used for the purpose of differential diagnosis. For example, MRI is relevant when it is necessary to exclude neuroinfection or damage to brain tissue and vascular network.

The study of bioelectrical brain activity - electroencephalography - in schizoaffective disorders does not demonstrate any abnormalities. However, the use of EEG under conditions of stimuli (light, sound) in this case is more informative. Thus, the values of individual evoked potentials may differ greatly from the norm.

The described methods are prescribed as an addition to standard general clinical procedures (ultrasound, X-ray, laboratory tests). All diagnostic measures taken together allow to obtain comprehensive information about the patient's condition, increase the accuracy of diagnosis and minimize the probability of errors.

Differential diagnosis

At the initial diagnostic stage, the physician must be sure: is it really a psychotic manifestation or is there a possibility of another disorder? For example, depressed patients may talk about hearing voices that convince them of their own inadequacy and weakness, although in fact they are not voices, but their own thoughts. And people with high anxiety may perceive shadows from furniture and objects as thieves entering the apartment.

The clinical picture may resemble psychotic phenomena but poorly fit existing diagnostic criteria. Many cases of schizophrenia start with an initial prodromal stage, emotional and thought-behavioral disturbances, and a certain loss of functional capacity. However, this symptomatology is nonspecific and may be caused by depression or adaptive disorders.

Even when a patient meets the diagnostic criteria for psychopathology, a definitive diagnosis is not easy to make. Premature "attribution" of schizophrenia or bipolar disorder may be recognized as incorrect after some time. To avoid misunderstandings, many professionals use the term psychosis to emphasize uncertainty and to be more flexible in the choice of therapeutic tactics. It is important to recognize the need to start treatment as early as possible. If the same psychosis is left untreated for a long period of time, further therapeutic effects may be hampered and the risk of prolonged disability increases. The risks of missing depression or misdiagnosis of schizophrenia should not be forgotten.

Schizoaffective disorder is also differentiated:

• with impaired general psychological development;
• with post-traumatic stress disorder;
• with delirium;
• with psychosis following the use of psychoactive drugs;
• with drug intoxication.

Examination and physical examination of the patient can exclude organic pathologies closely associated with the development of psychotic-like conditions, as well as somatic diseases - in particular, cyanocobalamin deficiency or thyrotoxicosis.

Schizoaffective disorder is a borderline condition between affective disorder and schizophrenia, and therefore always requires differentiation from these pathologies. In many cases, the doctor will confidently diagnose schizoaffective disorder: the difference with schizophrenia is that schizophrenic and affective symptoms occur simultaneously and are equally manifested. Schizophrenia is diagnosed if the patient has intense manic or depressive symptoms and the schizophrenic symptoms precede the affective disorder.

The features of such pathologies as schizotypal and schizoaffective disorder are presented in the table:

Schizotypal disorder	Schizoaffective disorder
Oddities, attention-grabbing behavior or appearance, posturing, pretentiousness. Belief in mysticism, superstition, confidence in one's own extraordinary abilities. Illusory, unusual perceptual sensations. Practically no friends. Unassociated, incoherent speech, poor, overly distracted, incomprehensible. Excessive anxiety, social discomfort, paranoid ideas, extreme suspiciousness.	Productive manifestations such as psychotic automatisms, paranoid symptomatology, and mania and depression are characteristic. Negativism and cognitive impairment are mild and the prognosis is more favorable.

Among the many mood disorders, cyclothymia in particular can be emphasized. To understand whether a person has cyclothymia or schizoaffective disorder, it is enough to observe him or her for some time. In the first case, mood swings will be lighter, without a clear state of depression and mania. Cyclothymia is most often described as a chronic mood instability, with numerous alternations of mild depression and slight elevation of mood.

Treatment of the schizoaffective personality disorder

Standard treatment consists of prescribing medications that normalize mood and eliminate pathological signs. In addition, psychotherapy is actively used to improve interpersonal and social skills and optimize psychological adaptation.

Selection of medications is carried out depending on the existing symptoms. Antipsychotic drugs are prescribed to get rid of psychotic manifestations (hallucinations, delusions, delusions, mania, absent-mindedness). In mood changes, antidepressants are successfully used, or stabilizing drugs - in particular, lithium salts. These therapies can be used in combination.

The main direction of psychotherapy is to help the patient to realize the fact that he or she has a disease, to create motivation for cure, and to fight the problems created by schizoaffective disorder on a daily basis. The use of family psychotherapy allows to overcome the pathology more effectively.

Practical exercises with the patient help to "tighten" social skills, motivate to maintain personal hygiene and daily activities, and plan their actions.

Most patients suffering from schizoaffective disorder are treated on an outpatient basis. Only in case of severe symptoms, the existence of a threat to others, the patient's desire to commit suicide requires mandatory hospitalization.

Drug treatment

New-generation antipsychotics are often the drugs of first choice. They are effective against a wide range of pathological manifestations, both depressive and cognitive. In addition, they provoke less pronounced extrapyramidal symptomatology compared to classical drugs. Patients with psychomotor agitation are more recommended drugs with pronounced sedative abilities. Often benzodiazepine derivatives are used as additional treatment. If a patient with obesity requires treatment, the choice of medication should take into account that the side effects should not include possible weight gain.

Trial antipsychotic treatment with the selected agent is accompanied by the selection of the optimal dose and duration of the therapeutic course. There is evidence that long-term low-dose therapy is more effective than high-dose therapy. Trial treatment should last at least 1-1.5 months.

In case the drug initially used has not shown the required efficacy or if it is poorly tolerated, the doctor will adjust the treatment. There is evidence that Clozapine can be used particularly successfully even in the absence of a positive response to conventional antipsychotic therapy. Newer drugs are also characterized by better tolerability.

The specifics of additional therapy are discussed separately for each specific case. For example, adjunctive administration of benzodiazepine derivatives is justified if the patient has sleep disorders and anxiety. As an addition to antipsychotic treatment in the presence of psychomotor agitation or aggression, lithium preparations and anticonvulsants (Valproate, Carbamazepine) are prescribed. In case of depression, treatment with antidepressants is indicated, in individually indicated dosages.

When planning a long-term treatment course, it is important to take into account the interaction of some drugs with each other. For example, taking fluvoxamine in combination with Clozapine can increase the serum levels of Clozapine, since both the first and second drugs have a similar metabolism. Concomitant use of antidepressants with antipsychotics may stimulate hallucinations and thought disorders.

In some cases, additional treatment with Buspirone, an azaspirone tranquilizer, is effective. Other possible prescriptions (at the discretion of the doctor): Zuclopenthixol, Fluphenazine decanoate, Haloperidol decanoate, etc., in individual dosages. Treatment is carried out only under constant medical supervision.

Physiotherapeutic treatment

The main goals of physiotherapeutic treatment are to strengthen the body's defensive reactions, detoxification and sedation, tranquilization and analgesia, normalization of disturbed functionality of organs and systems, optimization of cerebral circulation, improvement of metabolic and oxidative processes. Physiotherapy "works" only in conjunction with medication. In addition, LFK may be prescribed.

Doctors recommend the following treatments:

• Daily wet wraps, 45 minutes each. The course consists of 20 procedures. Contraindications: excessive excitement, agitation, confusion.
• Water procedures, circular shower at about 34°C for 1-2 minutes daily.
• Electrosleep for 20-30-40 minutes daily (from 2 to 10 Hz) for a course of 15-20 sessions. Patients with neurotic symptoms and excessive excitability of the nervous system use low frequency current. Patients with lethargy, depression of neurohumoral regulation are shown a higher frequency - from 40 to 100 Hz.
• Aminazine electrophoresis on the collar zone in sessions of 15-20 minutes, every day for 3-4 weeks. It is practiced after the patient comes out of the exacerbation period.
• Galvanic collar is performed every other day, alternating with water procedures.
• Ultraviolet body irradiation, localized, 3-5 biodoses each.
• Inductothermia of the head area for 15-20 minutes every other day for four weeks (for headaches).
• Light-heat baths for 25 minutes, every other day.

Current treatment regimens for schizoaffective disorders do not always include physical therapy, although hyperbaric oxygenation, electroconvulsive therapy, acupuncture, laser therapy, electrophoresis of neuroleptics, and transcerebral electrical stimulation are recommended procedures in many cases.

Lateral magnetotherapy is indicated for sedation, improvement of sleep and relief of emotional tension. A magnetic pulse field with a frequency of 50 Hz is used. The duration of the session is 20 minutes. The course includes 10 daily sessions.

Herbal treatment

Any psychopathology is a condition that requires long-term treatment and monitoring. It can take months to establish control over the disease and eliminate the main symptoms with the help of medication and psychotherapeutic measures. At the same time, many experts note that some plants are able to potentiate the effect of drugs and accelerate the recovery of the patient. Let's consider the most effective herbal remedies.

• Ginkgo Biloba leaves - improves cerebral circulation, eliminates headaches, improves the effect of drugs. Possible side effects: dyspepsia.
• St. John's Wort - calms, improves mood, stabilizes brain activity.
• Milk thistle - has a positive effect not only on the liver, but also on the human psyche, as it has a moderate antidepressant effect. The plant contains a large amount of antioxidants, demonstrates neutralizing and protective effect.
• Flaxseed, as well as other sources of omega-3 fatty acids, help boost brain activity, promote memory recovery, and improve the function of remembering information.
• Ginseng rhizome - helps the body cope with stress, prevents hormone depletion, improves sleep quality, and prevents the development of depressive states.

In addition to using herbal infusions and decoctions, doctors recommend taking herbal baths. Just 15-20 minutes spent in a warm, relaxing bath can increase energy levels and eliminate unfavorable manifestations of schizoaffective disorder. As a rule, for the procedure use 1 liter of strong herbal infusion or 10-15 drops of essential oil. Among the many plants for baths you can choose sage, lavender, thyme, melissa, mint, juniper, pine or spruce needles. After the bath, it is recommended to rinse with cool water.

Surgical treatment

The assistance of a surgeon for patients with schizoaffective disorder is rarely required: it is resorted to only in complex neglected cases in the absence of the effectiveness of other methods of intervention. However, most patients manage to significantly improve their condition with the help of medication and psychotherapy.

Surgery for mental disorders is a very controversial option to correct the problem. Most specialists speak out against such intervention, the consequences of which remain irreversible. Psychosurgical manipulations are accompanied by a large number of complications, often do not have satisfactory results. In addition, to date there are many other ways to treat psychopathological conditions.

All psychosurgical operations practiced by modern surgeons are performed on the visceral brain - in particular, on such structures as the orbitofrontal and prefrontal cortex, cingulate gyrus, hippocampus, thalamic and hypothalamic nuclei, and amygdala.

Among the possible interventions:

• Cingulotomy - involves severing the connection between the posterior frontal and thalamic regions, and excluding the anterior cingulate area.
• Capsulotomy - allows dissociation of the thalamic nuclei and orbitofrontal cortex.
• Subcaudal tractotomy - cuts the connection between the limbic system and the supraorbital portion of the frontal lobe.
• Limbic leukotomy - combines an anterior cingulotomy and subcaudal tractotomy.
• Amygdalotomy - involves targeting the amygdaloid body.
• Endoscopic sympathetic blockade (one variant of thoracic sympathectomy) - affects the susceptibility of organs dependent on the emotional state of the patient.

The main contraindication for neurosurgical treatment of psychopathology is the inability of the patient to consciously confirm his or her consent to surgery. In addition, intervention is not prescribed if affective symptomatology is provoked by existing degenerative or organic pathology of the brain. Among other contraindications: blood coagulation disorders, infectious processes, decompensated conditions.

Prevention

The main preventive aspect is the timely recognition of the problem, its diagnosis and treatment, which should be started as early as possible. Special attention to mental health should be paid to those people who have a hereditary predisposition to schizophrenia and affective disorders.

It is necessary to realize that schizoaffective disorder itself is an incurable problem, but it can be transferred to the stage of stable remission. To do this, it is necessary, without delay, at the first suspicious signs to contact specialists.

To prevent exacerbations, the patient becomes registered in a psychoneurological dispensary and visits it at certain intervals (set by the doctor). If necessary, the doctor will periodically prescribe courses of drug therapy. Some drugs may have to be taken continuously, which depends on the complexity of the course of the pathological process.

In general, it is possible to prevent the development of schizoaffective disorder if you lead a healthy lifestyle, eat properly, observe the work and rest regime, avoid stress and conflict situations, periodically change the environment (for example, for vacation), avoid the use of psychoactive drugs, alcoholic beverages and narcotic drugs. In case of excessive nervous excitability, it is recommended to practice relaxing massages, aromatherapy, yoga, breathing exercises.

Hereditary disorders are often difficult to avoid, and it is also problematic to influence their development. For people with a hereditary predisposition to schizophrenia and affective disorders, it is advisable to consult with specialized specialists in advance: it may be necessary to undergo periodic courses of therapy and observation by a psychiatrist. It is equally important to build trusting contacts with close people, to maintain and develop social activity.

If timely measures are not taken, then even with a mild course of pathology, the patient may have problems in study and work, in personal life. With the onset of depression, the risk of developing anxiety and manic states increases: the patient loses the ability to contact other people, is often irritated, loses control over himself.

To prevent the development of the disease and its consequences, a person at risk may seek help from a psychiatrist or psychotherapist.

There is no specific prevention of schizoaffective personality disorder and other similar diseases, which is primarily due to the lack of understanding of the causes of their emergence.

Forecast

It is impossible to voice an unambiguous prognosis of schizoaffective disorder, since its course can be very variable. In some cases, the long-term consequences are unfavorable: patients against the background of a gradual onset of symptomatology increases, psychotic picture develops. Such a development is more characteristic of persons with hereditary aggravation for schizophrenia.

At the same time, in the absence of aggravating factors, with timely diagnosis and correct treatment, stable personality changes are more often avoided. The pathological state is controlled, a long period of remission is achieved, which helps a person to actually "forget" about the disease and conduct adequate professional and social activities.

If the disease is detected and treated at an early stage - its prognosis is considered the most optimistic. Severe course and delayed diagnosis, initially incorrect treatment, or its absence - these are factors that significantly worsen the outcome of the pathology. Even the most modern drugs, coping with hallucinations and delusions, stabilizing mood, eliminating manic symptoms, in neglected cases may be powerless. Timely medical intervention, quality psychotherapy, in turn, allow the patient to improve his or her well-being, eliminate existing problems and adapt to life. Many patients who were successfully treated for the disorder, subsequently have families, lead a normal lifestyle, engage in professional activities. However, it is important to realize that schizoaffective disorder is a chronic pathology, which is important to control throughout the entire life period. Therefore, even after achieving a stable remission, one should regularly visit doctors and be examined, and periodically undergo a course of preventive therapy (as prescribed by the doctor).

Disability

It is quite difficult for patients with schizoaffective disorder to receive disability. Firstly, the disease is difficult to diagnose, and secondly, it goes through periods of remission and exacerbation, so it is difficult to trace the real picture of the problem. Some experts believe that the diagnosis is not always accurate because of the similar symptoms of several mental disorders at once.

If we consider in general the possibilities of assigning disability to a patient, the doctors of the advisory committee pay attention to the following criteria:

• duration of the disease (at least 3 years, which must be documented);
• frequent relapses requiring hospitalization;
• presence of individual pathological symptoms, including problems with self-criticism during the remission phase;
• impaired ability to work, mood instability;
• obvious cognitive impairment, withdrawal, loneliness;
• The urge to harm both others and yourself;
• aggression, incapacity for self-care.

The main criteria for assigning a disability are the inability to find employment and serve oneself, as well as presenting a danger to others.

To formalize the status of a disabled person, it is necessary to have the opinion of the attending and family doctor, medical records with the results of diagnostics and treatment, as well as extracts from the medical history. The package of documents is supplemented with passport data, information on labor activity and other certificates at the discretion of the commission.

Most often, patients with schizoaffective disorder can only expect a third disability group. In this case, the symptomatology should be expressed by at least 40% (in case of recurrent attacks) with relative preservation of the ability to work. The group is assigned for a year, after which the patient must be re-examined.

The second group of disability is assigned if the symptomatology is expressed by at least 60-70%, and the patient is incapacitated.

The first group in this situation is very rarely assigned: a thorough examination is carried out, which can last for quite a long time. In some cases, the patient spends many months in a special clinic, where he or she is recognized as incompetent. It should be noted that this happens very rarely, since in the vast majority of cases the mental status of a person remains without deviations. Schizoaffective personality disorder can be corrected, and the patient can continue to live a familiar life practically without violating its quality.