Schizoaffective Disorder and Schizophrenia: What Are the Differences?

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Knowing the differences between schizoaffective disorder vs. schizophrenia can be difficult, especially since both include the core psychotic symptoms of hallucinations, delusions, and disorganized thinking. But they are two different disorders, each with its own diagnostic criteria and treatment.

For instance, prominent mood features are required for the diagnosis of schizoaffective disorder, but not for the diagnosis of schizophrenia. Learn more about key differences in schizoaffective disorder vs. schizophrenia, including those related to their symptoms, causes, diagnosis, and treatment.

If you are concerned that you may have one of these psychological disorders, consult a healthcare provider for appropriate diagnosis and treatment.

Symptoms

In both schizoaffective disorder and schizophrenia, hallucinations and delusions tend to occur. Hallucinations are false sensory perceptions and include hearing voices, seeing images, or feeling sensations that are not there.

Delusions are false beliefs, such as thinking that people are visiting through time travel or that a person is secretly disguised as someone else.

With each of these disorders, the person also lacks insight into these perceptual problems and false beliefs.

For both conditions, the symptoms also usually begin when a person is in their early 20s and, oftentimes, there is a family history of the disease.

While the differences in symptoms are subtle, they can help differentiate between the two disorders. For example:

  • A person who has schizophrenia can become depressed or manic, but these mood disorder symptoms are not generally a prominent or persistent part of their condition. Conversely, a person with schizoaffective disorder will experience chronic and persistent mood symptoms.
  • Psychotic symptoms in schizophrenia tend to be persistent, while a person with schizoaffective disorder will generally have briefer episodes of psychotic symptoms that come and go.
Schizophrenia
  • Hallucinations

  • Delusions

  • Flat affect

  • Disorganized thinking

  • Symptom persistence

Schizoaffective Disorder
  • Hallucinations

  • Delusions

  • Flat affect

  • Disorganized thinking

  • Symptoms come and go

  • Mood symptoms (depression or mania)

Causes

Researchers do not know exactly what causes schizophrenia or schizoaffective disorder. They believe that there are a number of different factors that are involved.

Genetics are believed to play a role in increasing a person's risk for developing schizophrenia. Other factors that appear to play a part in causing schizophrenia include differences in brain chemistry and abnormalities in the brain. 

Like schizophrenia, schizoaffective disorder is believed to have a genetic component. Having a family member with the condition increases the likelihood that a person will develop schizoaffective disorder. Abnormalities in brain structure and chemistry are also potential causes. 

For both conditions, environmental factors including trauma, stress, or substance use may trigger the onset of symptoms in people who have a genetic predisposition to the condition.

Schizoaffective Disorder vs. Schizophrenia Diagnosis

Both schizophrenia and schizoaffective disorder are defined as psychotic disorders in the latest version of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). In order to diagnose either condition, healthcare providers assess the individual's symptoms to see if they meet DSM-5 diagnostic criteria.

Schizophrenia Diagnostic Criteria

A diagnosis of schizophrenia is more likely if the individual experiences at least two of the following symptoms:

  • Confused thinking or speech
  • Delusions
  • Hallucinations
  • Negative symptoms, such as lack of expression
  • Unusual body movements

A person who has schizophrenia may experience mood episodes, but the total duration of the mood symptoms is brief compared to the duration of the psychotic symptoms. In schizophrenia, mood symptoms are not expected to occur without psychotic symptoms.

Schizoaffective Disorder Diagnostic Criteria

Schizoaffective disorder may be distinguished from schizophrenia based on the presence of mood symptoms. A person who has schizoaffective disorder is likely to experience severe mood symptoms accounting for more than half of the total duration of illness.

There are two types of schizoaffective disorder:

  • Bipolar type: Characterized by episodes of mania and major depression
  • Depressive type: Characterized by episodes of major depression without mania

A diagnosis of schizoaffective disorder is more likely if the individual experiences longer-lasting mood-related symptoms along with briefer periods of psychotic symptoms. That said, the diagnosis of schizoaffective disorder requires that the psychotic symptoms be present for some time (at least a couple of weeks) when a person is not experiencing any serious mood symptoms.

Recap

In schizophrenia, the psychotic symptoms are almost always present but the mood symptoms come and go. In schizoaffective disorder, the psychotic symptoms may or may not be present during the times when a person is experiencing depression or mania.

Treatment

It is important to distinguish between these two conditions because treatments for each differ. For example, treatment for mood disorder symptoms is necessary for schizoaffective disorder but might not be necessary for schizophrenia.

Most people who are diagnosed with schizophrenia have a chronic and persistent course of illness. The treatment of schizophrenia relies mostly on a special group of prescription medications called antipsychotics.

These include older antipsychotic medications like Haldol (haloperidol) and Thorazine (chlorpromazine). There are also newer medications including Risperdal (risperidone), Zyprexa (olanzapine), Geodon (ziprasidone), Seroquel (quetiapine), Saphris (asenapine), and Latuda (lurasidone).

Maintenance treatment for schizophrenia almost always includes an antipsychotic medication.

The treatment for the psychotic symptoms of schizoaffective disorder also includes antipsychotics. Paliperidone (invega), an atypical second-generation antipsychotic, is the only FDA-approved medication indicated to treat schizoaffective disorder, although all the other antipsychotic medications are commonly used.

For mood symptoms, people who have schizoaffective disorder are prescribed antidepressants if they have the depressive type and mood stabilizers, such as valproate or lithium, if they have the bipolar type.

Recap

Both schizophrenia and schizoaffective disorder are typically treated with antipsychotic medications. Schizoaffective disorder is also treated with antidepressants or mood stabilizers. People who have schizophrenia usually do not need to take mood stabilizers or antidepressants, but sometimes these medications are needed in addition to antipsychotics.

Prevention

There is no way to prevent either schizophrenia or schizoaffective disorder. However, it is possible to improve treatment outcomes and prognosis by getting help as early as possible.

If a person notices symptoms of psychosis or mood problems, it is important to talk to a healthcare provider to receive an appropriate diagnosis. Prompt treatment can help reduce symptom severity and frequency. It can also minimize the detrimental effects that symptoms may have on a person's life and relationships.

Psychotherapy and skills training can also be beneficial when used alongside medication. It may help people better understand their symptoms, establish goals, and cope with the daily challenges related to the condition.

A Word From Verywell

Living with schizoaffective disorder can be similar to living with schizophrenia, except that there is a prominent mood component with schizoaffective disorder.

These two conditions are not the same as schizoid personality disorder or schizotypal disorder, which are personality disorders that also impact thinking and the ability to relate to others. People who have these personality disorders do not have the same degree of psychosis and lack of insight that is characteristic of schizophrenia and schizoaffective disorder.

If you are worried that you are experiencing symptoms of schizophrenia or schizoaffective disorder, or a loved one is having symptoms, seek help from a healthcare professional. While these disorders are serious and can interfere substantially with daily life, they can also be managed with proper treatment.

If you or a loved one are struggling with schizophrenia or schizoaffective disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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