The Difference Between Schizophrenia and Schizoaffective Disorder

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Schizoaffective disorder and schizophrenia are two different disorders, each with its own diagnostic criteria and treatment. They are both defined as psychotic disorders in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM V).

There are many similarities between schizophrenia and schizoaffective disorder, including the core psychotic symptoms of hallucinations, delusions, and disorganized thinking. There are also important differences, including the prominence of mood features, which is required for the diagnosis of schizoaffective disorder, but not for the diagnosis of schizophrenia. It is important to distinguish between the two because the prognosis is different, and treatment for the mood disorder symptoms is necessary for schizoaffective disorder, but might not be necessary for schizophrenia.  

Defining Schizophrenia and Schizoaffective Disorder

With both of these psychotic disorders, hallucinations and delusions tend to occur. Hallucinations are false sensory perceptions, such as hearing voices, seeing images, or feeling sensations that are not there. Delusions are false beliefs, such as the belief that people are visiting through time travel, or that someone is secretly disguised as someone else. 

With both schizophrenia and schizoaffective disorder, the person who has the illness lacks insight into perceptual problems and false beliefs. For both conditions, the symptoms usually begin when a person is in his or her early 20's, and there may be a family history of the disease. 

Schizophrenia

Schizophrenia is a mental illness that causes severe psychotic symptoms that interfere with the ability to relate to others, to think clearly, to take care of one's self, to hold down a job, or even to be in touch with reality. It is usually difficult to interact with others due to the psychotic symptoms.

Besides psychotic symptoms, such as hallucinations and delusions, people with schizophrenia often have incoherent speech and disorganized behavior. They generally exhibit a flat affect (not showing much emotion) and tend to speak much less than average. Often, a person with schizophrenia has deficits in attention, memory, ability to process new information, and trouble with problem-solving. 

Schizoaffective Disorder

Schizoaffective disorder is a mental health condition in which a person experiences psychotic symptoms of schizophrenia, such as delusions, hallucinations, disorganized thinking, or flat affect, along with symptoms of a mood disorder, such as depression and/or mania.

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

Differences Between Schizophrenia and Schizoaffective Disorder

Subtle differences in symptoms can help differentiate between the two disorders. For example, a person who has schizophrenia can become depressed or manic, but these mood disordered symptoms are not generally a prominent or persistent part of the condition. The time course, prognosis, and treatment also differ in small ways. 

Important differences between schizophrenia and schizoaffective disorder include:

Duration of Mood Episodes

A person who has schizoaffective disorder is likely to experience severe mood symptoms accounting for more than half of the total duration of illness.

On the other hand, a person who has schizophrenia may also experience mood episodes, but the total duration of the mood symptoms is brief compared to the duration of the psychotic symptoms.

Duration of the Psychotic Symptoms and the Disease

The psychotic symptoms of schizophrenia tend to be persistent, while in schizoaffective disorder, they tend to come and go.

In terms of the course of the disease, most people who are diagnosed with schizophrenia have a chronic and persistent course of illness. On the other hand, most people diagnosed with schizoaffective disorder experience episodes of symptoms, and are more likely to have symptom-free intervals than people who have schizophrenia. However, this is not a hard and fast rule; in some people, the opposite is true.

Relationship Between Mood Symptoms and Psychotic Symptoms

In schizophrenia, mood symptoms are not expected to occur without psychotic symptoms. 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. That said, the diagnosis of schizoaffective disorder requires that the psychotic symptoms be present for a long enough time (at least a couple of weeks) when a person is not experiencing any serious mood symptoms.

Differences in Treatments

The treatment of schizophrenia relies mostly on a special group of prescription medications called antipsychotics. These include older the older antipsychotic medications haloperidol and chlorpromazine, as well as newer medications, risperidone, olanzapine, ziprasidone, quetiapine, asenapine, or lurasidone. Maintenance treatment for schizophrenia is almost always an antipsychotic medication.

The treatment for the mood-related symptoms of schizoaffective disorder also includes antipsychotics, primarily during the times when a person is experiencing severe psychotic symptoms. Paliperidone (invega), an antipsychotic, is the only medication that has the FDA approved indication to treat schizoaffective disorder.

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. People who have schizophrenia usually do not need to take mood stabilizers or antidepressants, but sometimes, these medications are needed in addition to antipsychotics. 

A Word From Verywell

Living with schizoaffective disorder is very much like like 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 characterized by a strong tendency to have false beliefs. People who have these personality disorders do not have the psychosis and lack of insight that is characteristic of schizophrenia and schizoaffective disorder. 

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

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