What do you get when you cross schizophrenia with bipolar disorder? Schizoaffective disorder. It's actually not quite that simple, but that's a good way to think of this disorder. The boundaries between mental disorders often blur. Diagnosing mental disorders is usually not quite the same as diagnosing other disorders. Psychiatry is firmly grounded in the biomedical model despite the fact that the "biopsychosocial model" has been shown to be superior in accounting for much pathology. Research continues to demonstrate that the mind and the body are the same thing. The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) is an attempt to classify mental disorders based on the medical model.What happens when the symptoms don't quite fit a category? Sometimes the answer is to create a new diagnosis. Schizoaffective disorder is just such a diagnosis. The DSM-IV defines Schizoaffective disorder this way:
An uninterrupted period of illness during which, at some time, there is either (1) a Major Depressive Episode, (2) a Manic Episode, or (3) a Mixed Episode concurrent with symptoms that meet (4) Criterion A for Schizophrenia.
(1) Criteria for Major Depressive Episode
- Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
(2) Criteria for Manic Episode
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
- During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g., feels rested after only 3 hours of sleep) more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
(3) Criterion for Mixed Episode
- The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
(4) Criterion A for Schizophrenia
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
- disorganized speech (e.g., frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms, i.e., affective flattening, alogia, or avolition
(excerpted from the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, American Psychiatric Association 1994)
The ICD-10 - an international diagnostic system developed by the World Health Organization takes a different approach. They actually consider it to be two different disorders. I like their approach better than the DSM-IV because it includes descriptions of behavior without sounding like a Chinese restaurant menu (one from column A and two from column B). Excerpts from their descriptions follow...