They sound alike and look alike.
They're not the same thing. Here's how to tell the difference
between schizophrenia and schizoaffective disorder.
The DSM devotes a chapter to Schizophrenia Spectrum and Other
Psychotic Disorders. Included there: delusional disorder (delusions
without other schizophrenia symptoms), brief psychotic disorder
(psychotic symptoms present less than one month), schizophreniform
disorder (symptoms lasting for less than six months), catatonia,
and substance/medication-induced and
due-to-another-medical-condition psychotic disorder (describe
themselves).
What's left: schizophrenia and schizoaffective disorder. Here
are the criteria for schizophrenia:
A. Two or more present for bulk of a one-month period:
delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, and/or negative symptoms.
B. Symptoms disturb level of functioning.
C. Signs of disturbance last for at least 6 months.
D. Schizoaffective and bipolar disorder ruled out.
E. Symptoms not due to the effects of a substance or medical
condition.
Schizoaffective disorder is diagnosed when these criteria are
met. Watch for the difference. It'll come up right away:
A. A major mood episode concurrent with criterion A of
schizophrenia.
B. Delusions of hallucinations for two or more weeks without a
major mood episode during the lifetime duration of the
disorder.
C. A major mood episode is present for the majority of the
illness.
D. Symptoms not due to the effects of a substance or medical
condition.
Specifiers for schizoaffective disorder include bipolar type,
depressive type, and with catatonia.
TL;DR? They're very similar. Both include some combination of
delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, and/or negative symptoms. But
in schizoaffective disorder, a major mood episode is present most
of the time (though not 100% of the time). Why not 100%? Because
then you'd be looking at MDD or bipolar I with psychotic features.
A topic for another blog post
So how do you boil this down into something simple and
memorable? How about this: Schizoaffective disorder is like
schizophrenia, but includes a big mood component generally
occurring alongside psychotic symptoms.
ASWB exam preppers, see if the above helps you answer this
question correctly:
A social worker sees a client who reports a lifetime of
"seeing things all the time, shadows." He also reports hearing
voices, "probably the NSA," which tell him he's "useless and
stupid." The voices leave him feeling "pretty sad and really
annoyed." Given the symptoms the client describes, what is the MOST
likely of the following DSM diagnoses?
A. Major depression with psychotic features
B. Schizophrenia
C. Schizophreniform disorder
D. Schizoaffective disorder
What do you think?
The client appears to meet criteria for some psychotic disorder,
given that he reports a lifetime of psychotic symptoms
(hallucinations and delusions). The lifetime duration means
schizophreniform disorder isn't the correct answer. Narrowing down
between the three left standing depends upon your reading of
"pretty sad and really annoyed." Sounds like the client gets in a
bad mood due to his symptoms. Does that bad mood rise to the level
of MDD? It does not. So scratch A. And while you're at it, since
schizoaffective disorder requires MDD or bipolar disorder symptoms
alongside schizophrenia symptoms, scratch that one as well. Now
you're left with one answer, the correct answer as it happens: B,
schizophrenia.
For more practice questions from the DSM, about psychotic
disorder diagnosis, and other close-call social work situations,
sign up with SWTP!
[Post by Will Baum,
LCSW]