From the Guidelines
Schizoaffective disorder should be treated with a combination of antipsychotic medications, mood stabilizers, and psychotherapy to reduce morbidity, mortality, and improve quality of life. The treatment plan should be comprehensive, person-centered, and include evidence-based nonpharmacological and pharmacological treatments 1.
Key Treatment Components
- Antipsychotic medications such as risperidone, olanzapine, or aripiprazole to address psychotic symptoms like hallucinations and delusions
- Mood stabilizers like lithium, valproate, or lamotrigine for mood symptoms
- Antidepressants such as sertraline or fluoxetine if depressive symptoms are present
- Regular therapy sessions to develop coping strategies and improve functioning
Treatment Approach
- Treatment is typically long-term, often lifelong, with medication adjustments as needed 1
- Patients should maintain consistent sleep patterns, avoid substance use, and develop strong support networks to help manage this chronic condition effectively
- A comprehensive treatment plan should include social support, therapy, psychoeducation, and overall case management 1
Special Considerations
- Electroconvulsive therapy (ECT) may be considered for adolescents with severe, treatment-resistant schizoaffective disorder, particularly when there are prominent affective symptoms or catatonia 1
- Antipsychotic polypharmacy may be considered for patients who do not respond to monotherapy, but it should be used with caution due to the increased risk of side effects 1
From the Research
Definition and Diagnosis
- Schizoaffective disorder is defined differently in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and in the International Classification of Diseases, Tenth Revision (ICD-10) 2
- The disorder falls on a spectrum between bipolar disorder and schizophrenia and can be divided into bipolar and depressive types 2
Treatment Options
- Antipsychotics, such as atypical antipsychotics, are effective in treating schizoaffective disorder, particularly in the acute phase 3, 4
- For bipolar type schizoaffective disorder, evidence supports the use of an atypical antipsychotic and a mood stabilizer or atypical antipsychotic monotherapy 2
- For the depressive type of the disorder, the combination of an atypical antipsychotic and an antidepressant is probably the best choice, but an atypical antipsychotic and a mood stabilizer could also be used 2
- Paliperidone extended release (ER), paliperidone long-acting injection (LAI), and risperidone have been shown to be effective and safe in reducing psychotic as well as affective components in acutely ill patients with schizoaffective disorder 4
Psychoeducation and Adherence
- Patient psychoeducation can be beneficial in the maintenance phase of treatment 2
- Adherence to treatment is essential for optimal outcome, and long-acting injectable antipsychotics and psychoeducation for caregivers may also improve adherence 2