Schizophrenia spectrum and other psychotic disorders
Schizoaffective Disorder
Schizoaffective disorder involves both psychotic symptoms and full manic or major depressive episodes, with diagnosis determined by their timing across the entire course of illness.
The timeline is central
Psychosis and mood symptoms appearing at some point is not enough. Full mood episodes occupy most active and residual phases, and there has also been at least two weeks of delusions or hallucinations without a full mood episode.
The bipolar type includes a manic episode; the depressive type includes major depressive episodes only. Longitudinal assessment may take time and the diagnosis can be revised as the course becomes clearer.
Assessment
- Psychotic symptoms may include delusions, hallucinations, disorganised speech or behaviour and negative symptoms.
- Mood episodes meet full criteria rather than brief mood reactions, with suicide and functional risk assessed throughout.
- Clinicians consider substances, medicines, medical conditions, schizophrenia, bipolar disorder and depression with psychotic features.
Coordinated treatment
Antipsychotic medication is usually central, with monitoring for metabolic, movement and other effects. Bipolar presentations may also require mood stabilisation, while depression treatment is planned carefully around mania and psychosis risk.
CBT for psychosis, family intervention, psychoeducation, sleep and early-warning plans, supported work or education and integrated substance-use care can strengthen recovery.
When urgent help is needed
Rapidly increasing psychosis, minimal sleep with rising energy, dangerous decisions, severe depression or loss of self-care needs prompt contact with the treatment team. Suicidal intent, mania or psychosis with immediate danger, catatonia or inability to meet basic needs is an emergency.